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Job overview

The post holder will work to support and co-ordinate discharges for the service. The post holder will work as part of a multidisciplinary and multi-agency team and in collaboration with other services including the onsite flow management team, hospital staff and community teams to facilitate the timely referrals and support appropriate discharge from hospital. When required, to undertake assessments, care planning and integrated working responsive to patient and carers’ needs.

The post holder will have knowledge of current processes and discharge pathways to support discharges for medically optimized patients awaiting transfer (MOAT) and DTOC reporting .

Main duties of the job

The Post holder will:

• Undertake comprehensive health care needs assessment of patients working flexibly between the acute hospital and community beds, reassessing as appropriate.
• Assess, plan, prioritise, implement and evaluate nursing interventions to meet patients’ needs.
• Be responsible for case managing patients on pathway 3 discharge to assess, including all relevant capacity and nursing assessments.Ensure patient information is communicated to the appropriate professional(s) of the multidisciplinary team and daily sit rep for patients whom are deemed to be medically fit.
• Undertake practice sensitive to the needs of patients, carers and relatives from multi-cultural backgrounds.
• Plan and manage own workload
• Communicate collaboratively with the wider MDT (Multi-Disciplinary team) to explore complex issues and decision
• Be highly visible in the clinical areas
• Agree the arrangements for communication with the patient/family/carer, and to document these in accordance with Trust policy and the patients’ right to confidentiality
• Ensure that essential information on the patients’ condition and progress is recorded by self and team members appropriately according to NMC guidelines
• Providing specialist information for complex discharge manager regarding continuing health care and end of life care

Working for our organisation

MFT is one of the largest NHS Trust In England with a turnover of £2.6bn & is on a different scale than most other NHS Trusts. We’re creating an exceptional integrated health & social care system for the 1 million patients who rely on our services every year.

Bringing together 10 hospitals & community services from across Manchester, Trafford & beyond, we champion collaborative working & transformation, encouraging our 28,000 workforce to pursue their most ambitious goals. We set standards that other Trusts seek to emulate so you’ll benefit from a scale of opportunity that is nothing short of extraordinary.

We’ve also created a digitally enabled organisation to improve clinical quality, patient & staff experience, operational effectiveness & driving research, and innovation through the introduction of Hive; our Electronic Patient Record system which launched in September 2022.

We’re proud to be a major academic Research Centre & Education provider, providing you with a robust infrastructure to encourage and facilitate high-quality research programmes. What’s more, we’re excited to be embarking on our Green Plan which sets out how MFT continues to play its part in making healthcare more sustainable.

At MFT, we create and foster a culture of inclusion and belonging, provide equal opportunities for career development that are fair, open, and transparent, protecting your health and wellbeing and shaping the future of our organisation together.