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.

• To provide a proactive, personalised and multidisciplinary case management approach to people who are being discharged from hospital.
• To co-ordinate a timely, safe and effective discharge home for people which supports their ongoing care and health needs being assessed at home.
• 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.
• To pro-actively draw on personal expertise and the skills and knowledge of all team members to improve outcomes for people and their carers.
• To work in partnership with Home Care agencies to facilitate and support a reablement approach to care provision. Ensuring proactive right sizing of packages.
• 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.
• To identify gaps in the provision of care and changing needs through flexible and adaptable care planning, sign posting, onward referral and supported interventions.
• To document the required information to support information sharing and monitoring of service key performance indicators.
• To follow agreed case management pathway to ensure consistency of process.
  
  

• 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.
  
  

• 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.
  
  

• 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.