Responsibilities
* Supporting Operational Pathway Lead for Home First (Discharge to Assess - D2A) with service managerial activities.
* To work collaboratively within the specialist multi-disciplinary team (MDT).
* To work with the acute Multi-Disciplinary Team & Transfer of Care Hubs to promote an efficient, effective discharge from hospital to the patient's own home.
* To bring a holistic therapeutic approach to the multi-disciplinary team, concentrating specifically on admission avoidance strategies and interventions.
* To have a role in the responsibility for the management of patients care pathway through the D2A service.
* To be responsible for a designated caseload of patients, where you will implement and evaluate treatment plans, and coordinate interventions within Home First.
* As a registered Allied Health Care Professional, you will assist in the organisation, development, and delivery of the Home First.
* To liaise with health, and adult social care, working in partnership with primary and secondary care, social prescribers, and other external agencies to ensure the delivery of a high-quality service, and facilitate effective discharge from the Home First Service.
* To provide a specialist service to patients in their own home/usual residence, divide managerial and clinical duties to support the Home First Lead.
* Assist with staff management, appraisals, leave approvals, and sickness reporting.
* Promote holistic, patient-centred care for functional improvement.
* Support Home First with triage, care pathways, and discharge strategies.
* Collaborate with patients, carers, families, and health services.
* Deliver individualized treatments autonomously and within the MDT team.
* Be flexible and skilled in various treatment interventions.
* Use advanced communication for motivational and emotional support.
* Have expert knowledge of long-term conditions and prognosis.
* Manage patients through their care episodes from assessment to discharge.
* Work with primary, secondary, and third-sector services for seamless care.
* Provide urgent 2-hour responses for crisis patients.
* Manage complex, housebound patients with social services.
* Recognize and escalate deteriorating patient conditions.
* Advocate for patients and direct them to support resources.
* Handle a caseload independently and support MDT peers.
* Ensure interventions are evidence-based and professionally compliant.
* Stay updated on Discharge to Assess literature.
* Conduct risk assessments per Trust/National Protocol.
Values and expectations
* As a member of the clinical team, we expect you to show COMPASSION, contribute to a caring and kind environment and recognise that what you do and say helps can make the lives of others better.
* We expect you to RESPECT everyone and acknowledge and welcome people's differences rather than ignore them or see them as problematic.
* We expect you to EMPOWER others and continually try to provide information, resources and support to help others make their own decisions and meet their own needs.
* We expect you to work in PARTNERSHIP and behave in a way that shows that commissioners and users of our services are the people who generate and pay for our work.
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