NHS Jobs • Harrow HA1 3UJ
About this role
1. Liaise internally with multidisciplinary team, senior members of staff, ward staff and Allied Health Professionals. Liaise externally with Social Services, Primary Care Services, General Practitioners, Housing, Homeless Persons Unit, Department of Health, Borders Agency and Office of the Public Guardian. 2. Promote a smooth discharge process by concentrating on tasks which directly support and assist the multidisciplinary team with regards to safe and timely discharge of patients. This will include completing discharge planning documentation, communicating with external agencies such as Social Services, patients families and carers, arranging appropriate transport and liaising with all members of the Multidisciplinary Team including occupational therapy, physiotherapy, Speech and Language Therapist, Dietitian, Clinical Psychologist and Doctor. 3. Where appropriate provide access to patient homes to outside agencies, accompany patients to their own homes, or accompany patients to appointments with outside agencies. 4. Monitor and chase multidisciplinary team members and external agencies to promote timely and safe discharge to provide optimum and appropriate bed usage and reduce length of stay, and in addition manage more complex discharge issues. 5. Answer queries in relation to discharge arrangements or issues from patients, relatives or carers, referring to qualified staff as required. 6. Prepare weekly SitReps (Situation Reports) to enable accurate reporting of DTOC to the Department of Health. 7. Provide excellent administration to include data collection into an Excel database and participate in daily London North West Sector Conference call. 8. Take responsibility for the issue of Discharge Notifications to Social Services to ensure reimbursement guidelines are observed. 9. Identify and implement Eviction Policy in conjunction with Senior Management. 10. Arrange family meetings and where appropriate participate and minute in regard to discharge planning. KEY RESPONSIBILITIES 11. Liaise with agencies such as Housing, Borders & Immigration Agency and Social Services ensuring confidentiality is maintained and information is shared in a sensitive, empathic and responsible manner. 12. Deal with enquiries from Trust staff, patient, relatives and the general public concerning discharge and transfer of patients. 13. Identify priorities and raise any areas of concern to appropriate staff or agency. Level of clinical responsibility Ensure that patients and their relatives with complex transfer/discharge needs and their carers understand and agree to the proposed clinical, social and environmental care package. To seek guidance from multidisciplinary team and liaise with colleagues and relevant agencies ensuring the patient with complex care needs is transferred to an appropriate safe environment and the agreed package of care is implemented. Ascertain entitlement to ambulance service and where appropriate book transport taking patient transfer, mobility and any bariatric needs into account. Assist patient/family to arrange out of area private transport as required ensuring the transfer is appropriate and safe for the patient. Leadership and staff management responsibility To be responsible for supporting with the discharge process and implementing effective safe discharge plans with multi-disciplinary teams and outside agencies. Ensure multidisciplinary team and outside agencies work collaboratively to provide safe and effective discharge planning. Take the lead in coordinating the multidisciplinary team to complete Continuing Care Assessments as appropriate ensuring all areas are completed fully in a timely manner and consistent throughout. Ensure submission to relevant CCG. To work on own initiative as part of the wider team to ensure progress of work throughout the discharge process. Financial responsibility Understand and ensure effective bed utilization to reduce delayed transfers of care. Service Development and Improvement Support change for patient benefit and support staff during the process of change within the team and Trust such as government objectives and recommendations. Identify and inform the manager of any unmet needs and service shortfall and work in a practical way to maintain and improve the standards of the discharge process. Responsibility for dealing with difficult situations Support and enhance the day-to-day smooth functioning of the team and be able to prioritize workload. Act promptly and effectively to meet the regular unpredictable situations that may occur within this role. Know when to seek assistance from managers. Any other aspect of the role Provide advocacy for patients and carers during the discharge planning process. Build and maintain a working partnership with Social Services, and ensure implementation of the governments Reimbursement Policies and other services. Work in an integrated manner with other agencies such as CCG and Social Services