Shift Co-ordinator

We require a Discharge Co-ordinator on a permanent basis to work on the wards across the acute and community hospitals to increase patient flow and optimise patient experience surrounding all transfers of care.


There is full support from within the Discharge team and the training is provided with a robust induction programme.


We work within the hospital setting and have good relationships across the discharge system and with the community teams. This role may have the potential to become full-time working hours.


We work within the hospital setting and have good relationships across the discharge system and with the community teams. Support MDT to work in accordance to current Torbay and South Devon NHS Foundation Trust/Devon Discharge policies


Identify through use of appropriate IT systems (Paris, Care First etc), medical notes, liaising with patients and/or carers relevant health and social care history including any existing services and which authority (Torbay and South Devon NHS Foundation Trust/Devon Partnership Trust/Devon County) is responsible for care provision


Having gained informed consent from the patient and/or carer share relevant information with wider MDT to facilitate appropriate care and discharge planning.


Assimilate appropriate information from hospital stay input re-referrals directly onto Paris in a timely manner or onwards referrals to the Discharge Hub.


Maintain regular contact throughout hospital stay with Zone teams, specialist teams, Hospital Assessment and Discharge Team and Care Direct Plus/Devon Hospital Discharge Team ensuring all those involved in the ongoing care of the patient and/or their carer are aware of discharge planning processes, throughout hospital stay and at the point of discharge


Meet with consultants/junior doctors regularly to obtain medically appropriate estimated dates of discharge (EDDs) liaise with the wider MDT to ensure EDD set take into account the holistic needs of the patient


Meet regularly with ward manager and wider MDT to ensure clinical delays are appropriately identified, recorded and reported in line with legislation and local policy


Support nursing and medical staff in ensuring that the patient and their carer/families are aware of EDD, particularly if it changes during the episode of care.


Support medical and nursing staff to ensure that patients and their families/carers are fully involved in discharge planning and are aware of all plans


To participate in an Discharge Co-ordinator duty rota for weekend cover


Maintain the overview of discharge planning arrangements for all patients on the ward act as central point or contact for patients, carers, families, other professionals and specialist teams and the ward-based MDT with regards to issues relating to discharge


Carry out baseline assessments, record those assessments and request simple services or alterations to packages of care for Torbay and South Devon NHS Foundation Trust service users within the Paris IT system. Work closely with Hospital Assessment and Discharge Team and Discharge Liaison Nurses to ensure that patients, their families and carers have access to appropriate and timely information about Torbay and South Devon NHS Foundation Trust policies and processes including financial assessment ensure that patients families and carers are appropriately supported whilst looking for suitable placements and/or care and are aware of timescales within legislation and local policy


To develop an understanding and awareness of all the resources available to meet the needs of people in the community and to contribute to the assessment of patients and/or their families/carers identifying which resource can best meet their needs


Make onward referrals as appropriate to specialist teams or resources such as the Financial Assessment and Benefits (FAB) Team, Intermediate Care or Mental Health teams and where appropriate highlight the need for carers assessments.


Support the collation of any relevant statistical information as required by Torbay and South Devon NHS Foundation Trust or Devon Partnership Trust which will help with developing or improving services for patients and/or carers


Assist with patient or public involvement activity (PPI) as required such as follow-up phone calls or patient satisfaction questionnaires


Ensure any risks highlighted during the patients stay are recorded appropriately and identified to relevant individuals to ensure that risk can avoided or minimised where possible and that staff, the public or other agencies are not put at unnecessary risk.


To carry out any other duties commensurate with the grade of the post as may be assigned by the project lead from time to time


To work flexibly support and contribute to new ways of working to ensure continuous service improvement and development


Policy and Service Responsibility


Where safeguarding adults concerns are raised ensure that concerns are reported in accordance with legislation and policy


To work in adherence with policies and procedures of Torbay and South Devon NHS Foundation Trust and where acting on their behalf in accordance with policies of partner organisations (Devon Partnership Trust/Devon County) to include health and safety, confidentiality and data protection policies


To be responsible for own continuing professional development including participating in supervision and achievement review and undertaking training as required


Contribute to the training and development of new staff or staff new to the role to ensure the continuation of good practice
Degree level education or equivalent ILM 5 Knowledge and SkillsKnowledge of legislation and policy that has shaped current health and social care provision e.g Community Care Act Disability discrimination Act 'Your Health Your Care Your Say' Experience of health and/or social care IT systems. Excellent knowledge of community-based resources including those provided and commissioned by Torbay and South Devon NHS Foundation Trust and those provided by the voluntary sector. Knowledge of Single Assessment Processes (SAP) and documentation. Knowledge of targets and performance indicators affecting health and social care organisations. Knowledge and understanding of competing priorities in acute and community settings. Evidence of good problem-solving skills ability to think laterally and creatively under pressureConfidence within the work setting Knowledge of recent health and social care legislation and policy e.g. Putting People First Experience working in an acute hospital and community setting Special ExperienceRecent experience of working in a health or social care setting. Experience of carrying out assessments taking into account the wishes of the individual and/or their carer. Experience of working with service users with a wide range of disabilities and clinical conditions e.g. physical, sensory and learning disabilities, cardiac and respiratory conditions, neurological conditions Ability to demonstrate a clear understanding of differing needs of service users with different disabilities and clinical conditions. Experience of resolving conflict effectivelyExperience as a HSCC or CCW (or comparable health role) Experience of previous hospital or community working Experience of completing needs-led assessments with service users and/or carers resulting in provision of services Experience of completing care plans. Experience of teaching/training Experience of doing presentations Experience of completing risk assessments Personal RequirementsAbility to work autonomously and to work well within a Multi- Disciplinary Team Ability to use initiative manage competing priorities within own workload. Ability to use appropriate communication to motivate and influence a range of individuals of differing professional backgrounds (who might also be more senior to yourself). Degree level education or equivalent ILM 5 Knowledge and SkillsKnowledge of legislation and policy that has shaped current health and social care provision e.g Community Care Act Disability discrimination Act 'Your Health Your Care Your Say' Experience of health and/or social care IT systems. Excellent knowledge of community-based resources including those provided and commissioned by Torbay and South Devon NHS Foundation Trust and those provided by the voluntary sector. Knowledge of Single Assessment Processes (SAP) and documentation. Knowledge of targets and performance indicators affecting health and social care organisations. Knowledge and understanding of competing priorities in acute and community settings. Evidence of good problem-solving skills ability to think laterally and creatively under pressureConfidence within the work setting Knowledge of recent health and social care legislation and policy e.g. Putting People First Experience working in an acute hospital and community setting Special ExperienceRecent experience of working in a health or social care setting. Experience of carrying out assessments taking into account the wishes of the individual and/or their carer. Experience of working with service users with a wide range of disabilities and clinical conditions e.g. physical, sensory and learning disabilities, cardiac and respiratory conditions, neurological conditions Ability to demonstrate a clear understanding of differing needs of service users with different disabilities and clinical conditions.