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Job overview

Pre-admission and Post Discharge planning is a crucial element of managing the lifelong care for people with a Spinal Cord Injury (SCI) as when done effectively and in a timely manner both elements contribute to a reduction in hospital stay, reduction in co-morbidities and complications and therefore positively impact upon psychological impact and re-integration into the community.

This individual will support new patients prior to their transfer to the NSIC, through the outreach referral pathway, and follow them through their journey into and onwards from the NSIC – providing a level of continuity throughout the patient’s journey. The post holders caseload will also include complex re-admission patients, for example support in discharge of patients whose care and support needs have changed meaning existing care plans are no longer clinically suitable.

The post holder will work with our Outreach team to support patients who are awaiting transfer to the NSIC. They will be responsible for carrying out a pre-admission assessments with patients with a focus on planning discharge from the point of referral. They will then continue to support the patients through their rehabilitation pathway.

Main duties of the job

Support offered to all patients will be inclusive of consideration of personal and social needs, including application for benefits and early intervention to support discharge planning post rehabilitation. It is hoped that this enables the patient’s local services and external agencies to have the opportunity to be involved with the patients discharge planning at an earlier stage and that there will be a reduction in Delayed Transfers of Care (DTOCs).

The post holder will support and advise the NSIC senior management team and clinical multidisciplinary teams to maintain effective inpatient flow by providing a seamless, target driven, patient focused discharge service aiming to avoid delayed transfers of care.

To act as a key link / advocate between the patient, the NSIC clinical teams and external agencies across the East and South East of England, to ensure effective ongoing communication to ensure realistic discharge dates are agreed, and that integrated planning commences preadmission to ensure a seamless flow from patient admission to discharge.

The post holder will be expected to provide advice, information and education to patients, carers, ward staff and the multidisciplinary team to facilitate a safe and timely discharge for patients to an appropriate place to meet holistically assessed requirements in order to avoid delayed transfers of care.

Working for our organisation

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What does Buckinghamshire Healthcare NHS Trust offer you?

As part of our BHT family, you'll benefit from learning and development opportunities to support your career progression.

We offer flexible and agile working opportunities, alongside your NHS benefits of generous annual leave entitlement, pension and access to NHS discount schemes.

We provide a range of health and wellbeing services to promote a healthy, happy workforce.

Why work for us?

We're committed to promoting inclusion and making sure all colleagues feel they belong. We encourage new colleagues from a diverse range of backgrounds to apply.

As an employer, we aim to create a workplace where differences are valued and colleagues treat one another with dignity and respect.

Greater diversity within our BHT family improves positive outcomes for the people and communities we serve.

What do we stand for?

Our vision is to provide outstanding care, support healthy communities and be a great place to work.

Our mission is to provide personal and compassionate care every time.

Our CARE values are collaborate, aspire, respect and enable.