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Hospital Link Worker

4 months ago

Harlow, United Kingdom Hospital and Community Navigation Service Full time

At the request of Hertfordshire County Council, ten voluntary organisations have formed a partnership to develop a new service bringing together Hertfordshire’s current Community Navigation and Hospital Discharge Services.

The Countywide Hospital and Community Navigation Service (IHCNS), has locality based teams that understand their local populations, and support people over the age of 18 who are returning home from hospital or are in need of additional support due to ill health. Helping to find, navigate and access community-based support.

Delivering within a new, innovative social prescribing model, the outcomes of this new service are as follows:
1. Reducing hospital admissions;
2. Reducing GP visits;
3. Reducing reliance on home care providers;
4. Reducing social isolation;
5. Improving health and wellbeing.

**Main purpose of the post**:

- Provide the delivery of the Hospital and Community Navigation Service
- Work as part of an Integrated Discharge Team (IDT) for older and/or vulnerable people leaving hospital and A&E/ Urgent Care departments to assist service users and carers to settle back in at home
- Work as a full member of the IDT team to support people being discharged from Hospital and reduce the likelihood of readmission by helping them to regain and retain independent living.
- To adhere to IDT Policies & Procedures
- Support the partnership and the voluntary and community sector and other local partners to deliver of an effective and service which helps people access the support they need in their own communities.
- To liaise with other hospital staff as required
- To conduct training & Information sessions to ward staff about HertsHelp/HCNS services
- Work as full member of the HCNS locality team, supporting people in their homes who are perceived to have some kind of risk (for example isolation, not understanding or managing their condition or situation) and making sure they have any advice and help needed to access appropriate support.
- Research and make appropriate referrals as well as finding and accessing further support.
- Deliver the service alongside a network of volunteers and local providers across Hertfordshire.
- Activate and link existing resources in the community to meet the needs of the service user; where this is not possible highlight areas of unmet need.
- Target groups/communities which are evidenced as having worse health and wellbeing outcomes and being less able to use advice which will improve their health to make use of services
- The above is not an exhaustive list of duties and you will be expected to perform different tasks as necessitated by your changing role and overall business objectives within the organisation.

**Principal responsibilities**

**Service Delivery**
- Work as part of an Integrated Discharge Team (IDT) for older and/or vulnerable people leaving hospital and A&E/ Urgent Care departments to assist service users and carers to settle back in at home.
- To communicate in a proactive and positive manner with the IDT Team
- Work with community based health and social care providers such as GP surgeries, and adult care services to assist individuals who are in need of additional help, support and guidance (outside of statutory services) to ensure problems and issues do not worsen and lead to ‘crisis’.
- Contact prospective service users, either in hospital, immediately after discharge or within the community to ascertain their needs and preferences, via a service user assessment, using appropriate guidance and paperwork and training.
- Ensure that clients and service users develop sustainable relationships with organisations and services that can help service users to live well and avoid crisis.
- Provide emotional and practical support and advice where needed following a service user assessment.
- This may include the following:

- Provide transport to service user’s home by car on discharge from hospital wards, A&E departments & community hospitals.
- Carry out essential shopping or collecting prescriptions.
- Provide on-going assessment and support planning for service users’ needs, to provide appropriate support and achieve positive outcomes.
- Carry out follow-up welfare checks and visits as required and assist service users with their activities to re-enable their daily living skills (within a set time criteria).
- Assess the service users living environment through carrying out a risk assessment and providing information/advice whilst respecting their individual dignity, choice and rights.
- Provide support and information to clients and service users so that they can build sustainable relationships with, groups and activities which help build resilience and independence.
- Record and report activities undertaken and highlight any changes in a service user’s condition or circumstance and ensure that appropriate actions are taken to support the person.
- Liaise with social care, health, housing and other professionals to ensure