High Intensity User/ Frailty Liason

To work collaboratively with partner organisations to prevent inappropriate/unnecessary hospital admission and to support timely discharge acting as a liaison between acute services and the community / local authority using expert knowledge of pathways and services. To act as a high intensity lead to support frequent attenders in the Kingston Emergency Department, (ED) as well as acting as a key link into the Kingston Hospital Frailty Team based in the Clinical Decision Unit, (CDU) to support timely discharge home. To closely link into the transfer of care hub as part of the national Hospital Discharge and Community Support: Policy and Operating Model and the Community Health Services Two-Hour Crisis Response Standard Guidance.

The post holder will work closely with the Richmond Response and Reablement team to support the prevention of admission and the High Intensity User Lead in Your Health Care. To develop key links into local primary care networks to support anticipatory care and MDT working. To lead the implementation of national and local quality initiatives as identified as relevant to the role to support the principles of reducing the use of unplanned services by this client group both in frailty pathways and same day unplanned care pathways.

The post holder will have bases at both Kingston Hospital and within the community

To act as a high intensity lead to support frequent attenders in the Kingston Emergency Department, (ED) as well as acting as a key link into the Kingston Hospital Frailty Team based in the Clinical Decision Unit, (CDU) to support timely discharge home.

To develop close working relationships across community, acute, borough and voluntary services supporting admission avoidance with a range of stakeholders by daily liaison with the Frailty Team leads, Kingston Hospital ED team leads, and Local Authority. To attend daily Frailty Team MDT meetings and provide expert advice / liaison to support same day discharge as appropriate and daily liaison with the Transfer of Care Hub. To liaise daily with the ED team leads to identify vulnerable patients who are at risk of re-admission. To liaise daily with the Clinical Decision Unit to facilitate home first/early discharge.

Community healthcare is unlike any other part of the NHS. It’s personalised care that helps people to retain their independence. It’s the NHS at its best and the difference you make is truly tangible.

Our colleagues often describe us as a family, and we know how important that sense of belonging and support is when you start a new job. It’s simple - happy, engaged staff provide better services.

In 2018, we were named ‘Best Place to Work for Employee Satisfaction’ by the Nursing Times. The same year, we won the Workforce category at the HSJ Awards.

In the latest NHS Staff Survey results 2020, we had the best response rate amongst community trusts nationally.

We are the top community trust in the country on the theme Quality of care for the third year. We had the highest percentage of staff who felt they are able to deliver the care they aspire to and are satisfied with the quality of care they give to patients or service users. If you enjoy a challenge and want to go home each day knowing you made a difference, you will thrive in our organisation.

Infection Control

As an NHS Trust we strongly encourage and support vaccination uptake as this remains the best line of defence against COVID19.

To act as a high intensity lead to support frequent attenders in the Kingston Emergency Department, (ED) as well as acting as a key link into the Kingston Hospital Frailty Team based in the Clinical Decision Unit, (CDU) to support timely discharge home.

Please refer to the full Job Description and Person Specification attached.