Integrated Transfer of Care Co-ordinator

NHS; Great Yarmouth; On-site; GBP 30,000 - 40,000; Full time

Job summary

A community healthcare provider in Great Yarmouth is seeking a passionate Integrated Transfer of Care Co-ordinator. The ideal candidate will manage patient flow, ensure timely transfers of care, and work collaboratively with multidisciplinary teams. Experience in health and social care is preferred. This full-time position offers opportunities for career development and is integral to supporting safe transfers of care for patients in the locality.

Benefits

Employee benefits

Career development opportunities

Qualifications

• Experience in a Hospital and/or community setting in a multidisciplinary team.
• Good working knowledge of patient flow and the Care Act 2014.
• Ability to interpret and analyse complex patient information.

Responsibilities

• Coordinate patient care across health and social care services.
• Manage patient flow and ensure timely transfers of care.
• Develop and maintain effective relationships with multidisciplinary teams.

Skills

Communication skills

Problem-solving skills

Teamwork

Attention to detail

ICT skills

Ability to analyse patient information

Education

NVQ level 4 in health or social care or equivalent experience

ILM level 3

Job description

Integrated Transfer of Care Co-ordinator

Exciting post - Integrated Transfer of Care Coordinator (ITOC). Are you caring and compassionate and a natural problem solver motivated by making a difference to peoples lives? Are you resilient, organised and creative with a passion to think differently to overcome complex issues?

East Coast Community Healthcare (ECCH) are proud to be partnering with our local Integrated Care Systems to introduce another full time ITOC role in our Transfer of Care team.

The successful candidate will need a range of experience, which may include hands on care, or similar experience in a Health and/or social Care setting, but the primary requirement is that the candidate must be passionate about providing effective support to our people to ensure they get the best care.

You will need to enjoy learning from colleagues and enjoy supporting people to access the right care, at the right time and in the right place.

As an ITOC you will be at the heart of the team supporting team members to be efficient, effective and get the best results for the people within the service. This is a Full time post and applicants will be required to work a variety of shifts across different locations.

If you are the person described above and relish the opportunity for career development, we want to hear from you!

Undercurrent UK immigration rules, this role does not meet the eligibilityrequirements for sponsorship under either the Health and Care Worker visa orthe Skilled Worker visa routes.

Main duties of the job

Being an integrated role, the post holder will work closely with East Place Great Yarmouth and Waveney system partners (Norfolk and Suffolk Adult Social Services, James Paget University Hospital, ECCH, ICB), such that, the post holder's, work and views are representative of the five organisations working collaboratively and together.

This post is a key part of the Integrated Transfer of Care Team supporting safe transfers of care for patients who live in the Great Yarmouth and Waveney Locality (East Place). The post holder will, using the Home First ethos and effective communication proactively promote community patient flow with system partners.

• Join our Team to coordinate seamless patient care across health ad social care services. Review referrals, manage patiet flow from hospital to community, working closely with multidisciplinary teams, care agencies and voluntary services.
• This role requires strong communication, decision making and problem -solving skills to ensure timely transfers of care and optimal use of resources.
• Be able to work flexibly and independently meeting the demands of the role and East place systems - supporting integrated working across health and Social care, and optimising bed capacity and transfer pathways.
• Contribute and analyse performance data and sensitive information to support transformation within the East Place.
• Confident with using IT systems and digital programmes.

About us

ECCH is well established health care provider and has been successfully delivering NHS care within the community since 2011. We provide a range of NHS, community health and social care services predominantly across the easterly region of the Norfolk/Suffolk borders.

We are aligned to NHS terms and conditions, and offer many employee benefits, to find out more about us visit our website - www.ecch.org. We are a social enterprise and staff owned organisation which means staff can opt to be shareholders and have a real say in how ECCH is run and evolves to deliver healthcare for the future.

At the heart of our ambition, we work in partnership with and for the community to become the provider and employer of choice for community healthcare.

We encourage you to apply as early as possible as this job may close earlier than the advertised closing date once enough applications have been received.

We are a small and friendly team who are privileged to work alongside great colleagues within the integrated Care system. Our team is passionate about our local population and ensuring we always follow our 'home first ethos' with the patient being in the right place at the right time of their health and social care journey.

If you feel you have the right skills and knowledge and want to make a difference please apply or contact the named person in the advert for a informal discussion.

Job responsibilities

Communication

• Review all referrals for appropriateness ensuring all relevant information and assessments are completed and signpost on where needed.
• To receive and interpret/analyse sensitive information and accurately document information
• Excellent communicationskills. Aim to develop and maintain effective interpersonal relationships withall members of the multidisciplinary teamand East place
• Actively give and receive constructive feedback
• Manage patient informationand analyse referral information to make an informed decision
• Have a thorough understanding and knowledge of transfer of care pathways, criteria toreside and criteria for transfer of care
• Liaise with Operationscentre and Virtual Transfer of Care Hubs
• Network and liaise withSocial Care Colleagues and Care Agencies to source packages of care.
• Liaise with voluntaryservices, housing and charities to support patients needs on transfer of care
• To maximise patient flow, admissions and transfer of cares and to utilise bed stock to maximum capacity according to referrals received
• Updates wards/PCH/ToC hub re-referrals accepted/declined verbally and on IT systems.
• Work as part of a team whilst taking independent responsibility for referrals
• Liaise withHealth and Adult Social Services colleagues, able to use escalation routes when delays occur e.g. awaiting Social Worker allocation, waiting a Mental CapacityAssessment (MCA)
• Contribute to daily board rounds for the EastPlace Intermediate care units, support transfer of care planning meetings,identify and discuss potential transfer of care issues at the earliest opportunity. Ensuring Estimated Dates of Transfer of care are reviewed and updated accordingly.
• Organise and facilitate planning meetings as required
• Participate in East place calls giving clear and concise information on admissions. Liaise with NHS Continuing Healthcare (CHC) team regarding packages of care and placements
• Contribute to supporting evidence to meet the Care QualityCommission (CQC) fundamental standards as required
• Understanding of multidisciplinary and integrated working proactively manage patient flow Acute to community
• Meet the demands of the pace of patient flow in the wider system
• Contribute to a professional working environment

Professional

• Proactively Reviews acuteHospital waiting list to seek out appropriate referrals for rehabilitation
• Be able to analyse dashboarddata and identify trends for onward discussion with service leads
• Communicate effectively, develop, and maintain productive working relationships with East place partners
• Provides timely and accurate information re admission/referral information to daily system calls
• To facilitate early transferof care from Pathway 2 intermediate care beds
• Able to work flexibly and be able to adjust to constant changing demands of the role
• Act as a resource, advisor and role model to other colleagues in relations to patient flow processes
• Demonstrate a soundknowledge of the Care Act 2014 and NHS CHC.
• Utilise advanced decisionmaking and problem solving skills when reviewing referrals
• Demonstratesa high level of judgement, acting autonomously within role to accept/decline referrals
• Support with the developmentof admission/transfer of care process/polices proposing any changes to the benefit of patient pathways
• Contribute to financial performance
• Contribute to efficient useof our resources
• All roles within East CoastCommunity Healthcare CIC (ECCH) require staff to demonstrate our Values andSignature Behaviours in the care and service they provide to patients, serviceusers, stakeholders and colleagues. All members of staff should consider theseas an essential part of their job role.
• Our Values outline the corebehaviours that we can all achieve and are summarised as an acronym within theword CARE. These stand for: Compassion, Action, Respect and Everyone. Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, AchieveTogether.

Person Specification

Experience

• Working in a Hospital and/or community setting in a multidisciplinary team
• Experience of developing/implementing processes in line with service need
• Good working knowledge of patient flow, The Care Act 2014 and NHS CHC

Skills and Knowledge

• Able to interpret /analyse complex patient information which maybe distressing as
• relates to patients diagnosis and prognosis
• Tact and diplomacy
• A team player
• Good ICT skills including word, excel and emails
• Attention to detail with accurate, clear documentation
• Ability to analyse information and use reasoning and problem-solving skills to assess referrals
• Ability to prioritise and plan workload unsupervised
• Assertive with the ability to challenge situations and manage situations where conflict may arise

Qualifications

• NVQ level 4 in health or social care or equivalent experience in a Health and Social Care setting
• ILM level 3

Personal Attributes

• Ability to work without supervision
• Ability to work as a team
• Excellent time management skills, punctual and reliable
• Able to remain effective and efficient under pressure
• Able to use own initiative
• Able to contribute to team, service and organisational development
• Aware of requirements for confidentiality
• Ability to embrace our Culture, Values and Signature Behaviours:
• (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together).

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Integrated Transfer of Care Perf & Dev Manager