An exciting opportunity has arisen to join the Home First Team in Buckinghamshire.

The team is still in its infancy of becoming a substantive service and this provides team members with the opportunity to influence and contribute to growing and shaping the service.

We are looking for a skilled and motivated, health or social care professional to join the service, which supports patients that have recently been discharged from hospital, to regain their independence and remain in their own homes.

This specific role will involve working as the lead Home First representative within the Transfer of Care Hub (TOCH), working as part of a multi-disciplinary team. The successful candidate will be required to ensure that referrals meet the criteria for the service and that all of the relevant information is available, to ensure that referrals are processed in a timely manner.

The ideal candidate will have excellent communication skills and attention to detail. They will have the ability to accurately interpret and relay information relating to a patients health and social care needs, as part of a multi-disciplinary approach. Knowledge and experience of discharge processes and pathways is key to the role. Experience of working in both an acute and community setting would be an advantage.

The successful candidate will be required to work both remotely, on site and visit patients at home or on the wards as required.

Main duties of the job

1. To provide a proactive, personalised and multidisciplinary case management approach to people who are being discharged from hospital.

2. To co-ordinate a timely, safe and effective discharge home for people which supports their ongoing care and health needs being assessed at home.

3. To work with patients and therapy staff to identify appropriate goals are set for each person and that these are reviewed, revised and updated to best support a person's recovery using a strength-based approach.

4. To pro-actively draw on personal expertise and the skills and knowledge of all team members to improve outcomes for people and their carers.

5. To work in partnership with Home Care agencies to facilitate and support a reablement approach to care provision. Ensuring proactive right sizing of packages.

6. To proactively facilitate the person through their pathway in a way that facilitates timely discharge from Home First whilst ensuring the appropriate intervention reablement/rehabilitation takes place to minimise the need for long term care.

7. To identify gaps in the provision of care and changing needs through flexible and adaptable care planning, sign posting, onward referral and supported interventions.

8. To document the required information to support information sharing and monitoring of service key performance indicators.

9. To follow agreed case management pathway to ensure consistency of process.

About us

Listen to why colleagues think we are a great place to work! -https://bit.ly/3DNEQfD

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 workingopportunities,alongside your NHS benefits ofgenerous annual leave entitlement, pension andaccess toNHS discount schemes.
• We provide a range of health and wellbeing services to promote a healthy, happy workforce.

Why work for us?

• We'recommitted 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 withinourBHT familyimprovespositive 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.

Job responsibilities

For a comprehensive list of responsibilities and duties, please kindly refer to the Job Description and Person Specification by downloading the JD and PS attachment in the advert.

If you are an internal applicant there is the option for secondment, all applicants must have the endorsement/support of their line manager prior to application.

If you have a disability that makes submitting this online application difficult and would like assistance, please contact us on bht.recruitment@nhs.net quoting the vacancy reference number.

Person Specification

Education, Qualifications & Training

• NVQ Level 2 or 3 in Health and Social Care
• Commit to undertaking Foundation Degree and any associated training once available
• Ability to learn / ability to selfinitiate learning (evidence within the last 2 years)
• Training/Formal Courses in courses appropriate to post

Experience

• Experience of working in an NHS/patient facing setting
• Able to accept and undertake responsibility for designated tasks
• Knowledge of discharge pathways and processes
• Experience of working as part of a multidisciplinary team
• Experience of supporting peers and the induction/training of new staff
• Experience of supervising staff
• Experience of delegating tasks/workload
• Experience of processing referrals/triaging
• Knowledge of assessment processes, including assessment of risk

Skills, Abilities & Knowledge

• Excellent communication skills (verbal & non-verbal) and interpersonal skills
• Ability to accurately interpret and convey information relating to patients' health & social care needs
• Able to maintain accurate and contemporaneous records and documentation
• Effective partnership working with health and social care colleagues
• Excellent problem solving and coordination skills
• Proven ability to use a variety of IT programmes and databases
• Ability to prioritise and manage time effectively. Including the ability to reprioritise according to competing demands
• Able to work under pressure
• Knowledge of legislation relevant to post (Care Act, Mental Capacity Act, Health and Safety, Data Protection)
• Awareness of own limitations and knowledge of when to escalate

Special Circumstances

• Willingness to work flexibly across locations
• Ability to work flexibly (weekends/bank holidays)

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.