Mental Health Transitions and Step Down Coordinator

2 weeks ago

Luton, Luton, United Kingdom East London NHS Foundation Trust Full time

Luton Community Mental Health Hub (CMHH) is seeking a talented and dedicated Social Worker to join our dynamic and dedicated service.

This is a unique opportunity for someone who is passionate about making a positive impact on the lives of those struggling with mental health challenges from an early age and transitioning into adulthood and for those whose mental wellbeing is exacerbated by social care requirements.

If you are committed, relish new challenges and strive for excellence, this post is for you.

You will work within the Principles of the agreed model of care for the Service as laid down in the National Health and Social Care directives, local Operational Policy and transformation agenda.


  • Possesses extensive experience as a Social Worker in a Mental Health setting
  • Works effectively as part of a multidisciplinary team and to meet the needs of the individuals we serve
  • Has excellent communication and interpersonal skills
  • Demonstrates flexibility and can prioritize workload in a fastpaced environment
  • Provides professional and comprehensivesocial care caseworkto a caseload of people with mental health difficulties, some of which will be complex. All will require the highest of professional standards and in depth knowledge of relevant legislation and practice methods.
  • Undertakes practice and professionalLead responsibilityfor a specified area of Social Care in the day to day running of the team including supervision of social care staff.
  • Manage unpredictable situations while maintaining close working relations with inpatient clinicians, social care team, Community Mental Health Hub and multidisciplinary team members to deliver a highquality, service userfocused service
This role will require you to work flexibly. Prioritising your workload at all times.


If this position is reflective of you and you are ready for a new challenge and eager to make a difference, we encourage you to apply Join our mission for exceptional mental health care and be at the forefront of delivering the NHS Long-Term Plan.

The NHS Long Term Plan and You


The majority of Primary Care Networks in Luton, made up of GP Surgeries, were set up in 2019, as a response to the NHS Long Term Plan.

This, together with more recent documents on Mental Health and Social Care needs of the population, required new ways of working with partner organisations and within organisations.


This change saw the blending of specialist community and statutory organisations coming together to deliver and review, care and support services to individuals in their community.

It has also seen the overhaul of internal mechanisms of NHS organisations, in order to meet this necessary change.

It is driven by the need to create a more joined-up, less fragmented approach to health and care, making it more personal and meaningful for the recipient with care and support needs.


This way of working with partner agencies, is less about 'them and us,' but more about implementing an approach which see progression in co-producing and co-delivering care and support, to the most vulnerable individuals in our community.


As a result, the successful applicant will need to work, not only autonomous but as a practitioner who honours and invites the insights and input of other disciplines/partners as part of the blended offer.

Key Responsibilities

  • Complete a set and agreed number of 3 reviews per week for the Mental Health Hubs to support the social care aspect
  • Oversee and manage transition cases for the Community Mental Health Hubs, involving local authority, care leavers team and CAMH Services
  • Keep track of all transition cases on behalf of the Community Mental Health Hubs
  • Review complex transition cases to provide intense support around placements for 17+ year olds who require social care and accommodation
  • Attend transfer of care (discharge) planning meetings, Bed management meetings and raise any relevant issues with the multi-disciplinary team to ensure resolution prior to care transfer.
  • Attend pre-allocation, transfer meetings and be the point of contact with commissioning board members for young adults requiring specialist placements.
  • Ensure that all relevant transfer of care (discharge) information is recorded accurately, processed on time, and communicated to the multi-disciplinary team
  • Work flexibly to meet the needs of the service and prioritize workload at all times
  • Provide service users, relatives, and carers with information about transfer of care (discharge) planning. Ensure that the information and timescales are fully explained and the appropriate level of support is provided and in place prior to moving through services.
  • Keep abreast of developments in transfer of care/discharge practice in the NHS and community teams and support the implementation of policies
  • To recommend expenditure within strict criteria and policy, and always follow best value principle.
  • To maintain good working relationships

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