Job summary
- Main area
- Aging and Health
- Grade
- Band 7
- Contract
- Permanent
- Hours
- Full time - 37.5 hours per week
- Job ref
- 384-SB-EMF16374
- Employer
- Royal Surrey NHS Foundation Trust
- Employer type
- NHS
- Site
- Royal Surrey County Hospital
- Town
- Guildford
- Salary
- £45,753 - £52,067 Per annum (pro rata) including HCAS
- Salary period
- Yearly
- Closing
- 05/08/2024 23:59
- Interview date
- 14/08/2024
Employer heading
Case Manager Team Lead - Band 7
Band 7
Job overview
JOB PURPOSE
The focus of the Complex Discharge Service is to support the timely identification, assessment and support for discharge to the most vulnerable patients in the Royal Surrey. The Complex Discharge Service supports the identification and planning of complex discharge in addition to ensuring patients are transferred to the most appropriate care setting in a timely manner whilst providing a safe, effective and positive patient experience. The principle responsibilities of this team are:
Ø To provide clinical expertise and decision-making for timely effective discharge and the management of patients admitted from care homes.
Ø To provide clinical expertise and decision-making for timely effective discharge and the management of patients referred to the Complex Discharge Service
Ø Lead and support a team of Case Manager and Complex Discharge Coordinators, providing guidance and oversight to ensure high standards of care and service delivery.
Ø Conduct and oversee mental capacity assessments to determine patients' ability to make informed decisions about their care.
Ø Make and support best interest decisions for patients who lack capacity, ensuring their needs and preferences are prioritised.
Ø Act as the primary point of contact between the hospital, care providers, and community services to ensure coordinated and continuous care
Main duties of the job
JOB SUMMARY
Ø To lead the Complex Discharge Service and ensure the case management service delivers a reduction in unnecessary bed days. This will require excellent and highly developed communication, negotiation and problem solving skills.
Ø To provide strong leadership and management for the team utilising clinical expertise and highly developed communication skills.
Ø To utilise highly specialist knowledge and expertise through comprehensive assessment, complex planning, implementation and overall evaluation of individual patients resulting in the transfer of the patient to the most appropriate level of care for their needs.
Ø To liaise with RSCH managers and external partners to plan complex discharges and resolve organisational or external issues impacting on a timely transfer of care.
Ø To be accountable and responsible for ensuring appropriate care provision is actioned for patients requiring discharge and care providers who are sourced have adequate quality controls and meet appropriate registration.
Ø To chair the twice weekly care home meetings with partners and weekly LLOS review.
Ø To provide leadership for the care home transformation plan and ensure admission and discharge workflow is progressing.
Ø To be accountable for escalating internal and external issues and delays that cannot be resolved in a timely manner and providing assurance a resolution is achieved.
Working for our organisation
Royal Surrey is a compassionate and collaborative acute and community Trust. Recognising that our 5000 colleagues are our greatest strength, we offer a comprehensive health and wellbeing program along with a commitment to developing and advancing your career. Our diverse and welcoming Royal Surrey family will ensure you that you feel valued from your initial interview through your entire tenure.
We are clinically led and provide joined up care by bridging the gap between hospital and community services alongside regional specialist cancer care. Our main acute hospital site is in Guildford with community hospital sites at Milford, Haslemere and Cranleigh. We provide adult community health services in homes across Guildford and Waverley.
The Care Quality Commission (CQC) have given us an overall rating of Outstanding.
Royal Surrey has a strong reputation and history to build on. We are proud of our achievements and we are investing in our colleagues through our commitment to supporting professional development as well as investing more than £45 million in our physical environment and new equipment in the next few years. There has never been a better time to join us.
Although it isn't the Trusts normal practice, adverts may close early, so you are encouraged to submit an application as soon as possible.
A video about the Royal Surrey - https://www.youtube.com/watch?v=R96pMboIYdo
Detailed job description and main responsibilities
Band 7 Complex Case Manager Team Lead. Permanent FT 37.5 hours per week
Due to redesign within our service we are developing a team to support the most vulnerable patients in their transition from the acute hospital to home or other care settings. The complex discharge team will complement the work of the established case management team and the discharge hub within the Royal Surrey working across all acute inpatient areas including Milford and Haslemere Hospitals.
This service demands a blend of clinical expertise, coordination prowess, and compassion to facilitate safe and effective discharges for complex cases, including CHC complex and fast track in addition to self-funders. The service will also include development of a care home liaison service, providing support to those admitted from care homes, liaising directly with medical teams and care homes to reduce length of stay and provide seamless care.
Key Responsibilities
- Coordinate complex discharge planning processes, collaborating closely with multidisciplinary teams, patients, and their families.
- Conduct comprehensive assessments to identify patient needs, including social, psychological, and physical aspects impacting discharge plans.
- Develop individualised discharge plans that prioritise patient safety, continuity of care, and adherence to clinical protocols.
- Early identification for patients from care homes, liaise with medical team and care home to ensure adequate information is gathered at the point of entry to the hospital.
- Liaise with services involved in the patients admitted from care homes, adult social services, CHC, care home matrons.
- Facilitate timely and smooth transitions by arranging necessary services and resources post-discharge.
- Maintain accurate documentation of discharge plans, assessments, and communications with stakeholders.
- Monitor and evaluate the effectiveness of discharge plans, making adjustments as needed to optimise patient outcomes.
For the Band 7 and 6 roles you will be an experienced nurse or allied healthcare professional who has an understanding of the complexities of discharge planning and communication across the MDT and with patients, families and other agencies. You will work within a trusted assessor model and therefore in-depth understanding of complex needs assessment including MCA and best interest decision making is paramount. Support and training to develop knowledge and skills will be provided as part of the role.
For the Band 4 Complex Discharge Coordinator role you will play a crucial role in facilitating the discharge process for patients with complex needs. Your responsibilities will include liaising with patients, families, and care providers, as well as maintaining accurate records to ensure continuity of care. The role requires an understanding of the challenges within healthcare and you will possess excellent communication skills you will also be contributing to the assessment of patients.
There will be capacity for hybrid flexible working Monday-Friday 08:00-18:00 and Saturday 08:00-16:00 on a rota basis once every 4 weeks.
If you think this could be you and you would like to understand more or would like to have an informal discussion please contact Sarah Holbrook, Lead Nurse for Patient Flow on ext 6527/4519 [email protected]
Full details of the role, responsibilities and person specification can be found in the Job Description.
Please note interviews for this post will be held on Wednesday 14th August 2024, details to be confirmed if you are successful.
Person specification
Qualifications
Essential criteria
- Educated to degree level as a qualified Health or Social Care Practitioner
- Current professional registration with relevant professional body (e.g NMC/HCPC)
- Postgraduate qualification in relevant clinical specialism or equivalent of equivalent Continuing Professional Development undertaken since qualification
Knowledge
Essential criteria
- Significant Post-Registration Experience.
- Demonstrate understanding of the needs of the patient and the key issues relating to complex discharge management
- Demonstrate expert ability to carry out trusted assessor model of assessment of patients within caseload
- Experience of completion of Mental Capacity Assessment and Best Interest Decision Making
- Demonstrate professional awareness and knowledge of relevant legislation and policies.
- Understanding of current issues in Acute NHS setting
- Specialist clinical knowledge to advise on the management of the discharge process and policy
- Demonstrates an understanding of clinical governance and evidence based practice.
Desirable criteria
- Significant experience in leading and managing a team
- Experience in human resource and budgetary management
- Demonstrate experience in the development and implementation of Standard Operating Procedures, guidelines and policies
- Experience in developing and implementing a clinical governance programme
- Inter -disciplinary collaboration within the team and by working across boundaries with other disciplines
- Understanding of Community Services and other relevant Organisations.
Employer certification / accreditation badges
Applicant requirements
You must have appropriate UK professional registration.
This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service.
Documents to download
Further details / informal visits contact
- Name
- Sarah Holbrook
- Job title
- Lead Nurse for Patient Flow
- Email address
- [email protected]
List jobs with Royal Surrey NHS Foundation Trust in Nursing and Midwifery or all sectors