Job overview
Job Summary:
1. Supporting Operational Pathway Lead for Home First (Discharge to Assess - D2A) with service managerial activities.
2. To work collaboratively within the specialist multi-disciplinary team (MDT)
3. 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
4. To bring a holistic therapeutic approach to the multi-disciplinary team. Concentrating specifically on admission avoidance strategies and interventions.
5. To have a role in the responsibility for the management of patients care pathway through the D2A service
6. To be responsible for a designated caseload of patients, where you will implement and evaluate treatment plans, and coordinate interventions within Home First.
7. As a registered Allied Health Care Professional, you will assist in the organisation, development, and delivery of the Home First
8. 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.
9. To provide a specialist service to patients in their own home/usual residence
Main duties of the job
10. Divide managerial and clinical duties to support the Home First Lead.
11. Assist with staff management, appraisals, leave approvals, and sickness reporting.
12. Promote holistic, patient-centred care for functional improvement.
13. Support Home First with triage, care pathways, and discharge strategies.
14. Collaborate with patients, carers, families, and health services.
15. Deliver individualized treatments autonomously and within the MDT team.
16. Be flexible and skilled in various treatment interventions.
17. Use advanced communication for motivational and emotional support.
18. Have expert knowledge of long-term conditions and prognosis.
19. Manage patients through their care episodes from assessment to discharge.
20. Work with primary, secondary, and third-sector services for seamless care.
21. Provide urgent 2-hour responses for crisis patients.
22. Manage complex, housebound patients with social services.
23. Recognize and escalate deteriorating patient conditions.
24. Advocate for patients and direct them to support resources.
25. Handle a caseload independently and support MDT peers.
26. Ensure interventions are evidence-based and professionally compliant.
27. Stay updated on Discharge to Assess literature.
28. Conduct risk assessments per Trust/National Protocol.
Working for our organisation
·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 you recognise that
·commissioners and users of our services are the people who generate and pay for our work.
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Detailed job description and main responsibilities
29. Division of duties between managerial and clinical activities, supporting the Home First Operational Pathway Lead in managing the service facilitating efficiency, effective and safe activity of Home First service activity.
30. Support Operational Pathway Lead with service management activities: appraisal and supervision of junior staff, approving annual leave, reporting on sickness using Health Roster.
31. Promote a holistic, supportive, and patient centred service that facilitates an intervention approach to promote change, acceptance and promotes self-management aiming to optimises functional improvement
32. Work with Home First: supporting with triage, patient care pathway, and sharing knowledge related to the discharge to assess and admission avoidance strategies
33. Work with patients, carers and families, and other statutory health related services
34. Work autonomously and within the MDT team delivering individualised treatment interventions and management programmes
35. Be flexible in the approach to delivering treatment and advice, have skills to deliver a variety of treatment interventions
36. Have advanced communication skills that would include motivational and emotional support skills
37. To have expert knowledge and understanding of long-term conditions and symptoms, and prognosis
38. Manage a patient through the entirety of their care episode in relation to Home First assessment, symptom management, support and discharge.
39. Where appropriate to work collaboratively with primary and secondary health care services, third sector services and social prescribing, education and social services, to ensure the delivery of a seamless and high-quality service.
40. Have a broad skill set which can include advanced skills in delivering therapy intervention in order to provide an urgent response for patients in a crisis.
41. Manage severe complex, house bound patients. The Home First service offers a domiciliary service to severely affected individuals; this requires collaborative working with social services and other attending care agencies.
42. Be able to recognise the signs and symptoms of a deteriorating patient, having the skills to escalate accordingly.
43. Be an advocate for the patient.
44. Knowledge of where to sign-post patients for support, e.g. local or national support groups
45. To be responsible for a caseload and work without direct supervision, and provide peer support for members of the MDT
46. To ensure patient care and planned interventions are supported by available evidence base and experiential knowledge and are in accordance with Code of Professional conduct.
47. To keep up to date and monitor literature related to Discharge to Assess and Crisis Response.
48. To carryout risk assessment in line with Trust/National Protocol.
Use of Artificial Intelligence (AI)
AI can be used as a support tool, not a replacement for the applicant’s own work. Applications must remain personal, accurate, and reflective of the candidate’s real experience. AI-generated content must not misrepresent skills, qualifications, or experience. Over reliance on AI-generated content is discouraged and may diminish the applicant's chances of success.
We monitor applications for any behaviour that could create an unfair advantage, and we check all references carefully. You are likely to be tested on your experience at interview, so be honest and make sure all the information in your application is correct. Please note that the use of Artificial Intelligence (AI) is prohibited during the interview process.
Vaccination
The successful applicant may have contact with patients or service users. As an NHS Trust we strongly encourage and support vaccination as this remains the best way to protect yourself, your family, your colleagues and of course patients and service users when working on our healthcare settings.
49. Due to the high response levels we receive for some vacancies, we may expire any of them prior to the advertised closing date and advise you to submit your application as soon as possible.
50. Applications from job seekers who require sponsorship to work in the UK are welcome and will be considered alongside all other applications. Before submitting your application and to avoid disappointment please check that you are eligible under the
51. Our Agenda for Change employment contracts are subject to a contractual 13 week probationary period.