CSH Surrey Intermediate Care Team (ICT) Overview
CSH Surrey Intermediate Care Team (ICT) is a 7‑day service that provides specialist individualised rehabilitation packages of care to patients referred from the community in crisis, preventing unnecessary hospital admissions and supporting complex discharges from hospitals to enable patients to maximise independence in the most appropriate care setting.
In partnership with members of the multidisciplinary team, including the Transfer of Care Hub based at St Peter’s Hospital, the post holder will develop, implement and evaluate a seamless specialist ICT service, ensuring that patients receive the highest standard of clinical and rehabilitation care and support.
The post holder will take a leading role in the identification and clinical assessment of patients who will benefit from advanced complex discharge care or admission avoidance, with care provided in the patient’s own home by the Intermediate Care team, Reablement, Community Rehabilitation team and the wider multidisciplinary team.
The post holder will demonstrate a high level of expertise in providing advice, education and support to health care professionals, patients and their families. They will actively case‑find and promote the service working closely with GPs, adult social care and the voluntary sector.
Main duties of the job
Clinical Practice
* Act as a lead specialist therapy resource using highly developed clinical skills in theoretical knowledge and practical experience.
* Work as part of the ICT team to provide an efficient and effective 7‑day service.
* Operate autonomously to undertake a substantial specialist clinical workload and use clinical reasoning to formulate specialised programmes of care for patients with complex and rapidly changing needs.
* Carry out therapy assessments and interventions, including advanced techniques and therapeutic handling.
* Use investigative and analytical skills to assess complex patients and support junior staff.
* Formulate accurate prognoses, evaluate patient progress, reassess and alter treatment programmes, recommend best interventions, and develop comprehensive discharge plans.
* Assess the need for specialist equipment to maintain patients in their own homes.
* Encourage and manage appropriate referrals, attend total triage meetings and represent service leadership at discharge action groups.
* Promote person‑centred care and maintain supportive relationships with patients and families during assessment, treatment and transfer of care.
* Act as patient advocate when appropriate, respecting confidentiality and diverse cultural backgrounds.
Communication
* Manage potentially stressful, upsetting or emotional situations in an empathetic manner.
* Communicate highly complex information sensitively to patients to gain cooperation and valid consent, including those with difficulties in understanding or communicating.
* Establish, develop and maintain effective working relationships between clinicians, practitioners and managers across trusts and the Ashford & St Peters Foundation Trust.
Quality
* Facilitate a high‑quality, cost‑effective specialist service through monitoring, audit and other quality initiatives.
* Set and monitor therapy standards and code of conduct.
* Demonstrate high understanding of clinical governance and lead key developments that promote high‑quality patient focus.
* Initiate corrective action plans and identify unsafe environments for patients and staff.
Education
* Provide professional leadership for therapy colleagues.
* Contribute to CSH Surrey’s clinical supervision programme for staff.
Research and Development
* Undertake evidence‑based projects, recommend changes in practice and lead departmental and service evaluation/research.
* Participate and lead relevant work‑related research and evaluation projects, staying current with research in the specialty.
* Disseminate relevant research information to staff.
Management and Leadership
* Provide a leadership role model and demonstrate expert knowledge and high standards of clinical practice.
* Develop the role according to patient needs and research findings within available resources.
* Maintain accurate records of the clinical service, ensuring confidentiality of information.
* Organise own work and manage caseload, maintaining supportive networks for self and staff.
* Implement new initiatives to run a cost‑effective, timely service.
* Provide monthly reports of case mix, workload and education activity.
* Assist in recruitment, selection and retention of staff.
* Develop policies, protocols and clinical guidelines in support of the specialist service.
About us
CSH Surrey is part of the NHS and provides community health services. Employees receive NHS pay and pension, along with a 5% Fringe High‑Cost Allowance. Training and development opportunities are available, including the Care Certificate, apprenticeships, numeracy and literacy courses, access to the Nursing Associate programme and a wide range of management and leadership courses.
We value Compassion, Accountability, Respect and Excellence. Our active employee council, The Voice, ensures staff voices are heard at board level.
We welcome candidates from all backgrounds who meet the essential criteria of the job, and we provide reasonable adjustments if required.
Job responsibilities
Roles detailed in the preceding sections cover clinical practice, communication, quality, education, research, and management responsibilities.
Person Specification
Experience
* Experience working autonomously at an advanced level delivering patient‑focused care.
* Experience assessing and treating patients independently.
* Proven evidence of advanced organisational/leadership skills and autonomous practice.
* Experience of audit, research and evidence‑based care.
* Experience of delivering change management.
* Community/primary care experience.
* Teaching and assessment experience.
Qualifications
* BSc/Diploma in Occupational Therapy or equivalent.
* Registered with HCPC.
* Minimum 5 years postgraduate experience, including 2 years in a specialist area.
* Continuing Professional Development.
* Development diary with reflective practice, training and clinical experience evidence.
* Member of relevant specialist section.
Skills
* Advanced clinical assessment and leadership skills in specialty.
* Decisive, assertive decision‑making.
* Excellent listening and counselling skills for complex situations.
* Teaching ability to help patients manage conditions.
* Clinical leadership and influence.
* Current knowledge of clinical and professional issues.
* History taking, physical and holistic assessment skills.
* Time management and organisational skills.
* Project evaluation and audit skills.
* Understanding of national agenda for the specialty.
* Knowledge of quality standards and NICE recommendations.
* IT skills.
Other
* Ability to conduct home visits and supervise complex clinical situations, attend community‑based meetings and MDTs.
Disclosure and Barring Service Check
This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and requires DBS checking for any previous convictions.
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