Discharge And Transitions Lead

Job summary This exciting role places you at the heart of patient care in North East Essex, acting as a vital link between Community Teams and inpatient services.
Your mission will be to facilitate safe and effective discharges, ensuring that individuals transition smoothly back to their local communities, whether locally or from out of area.
You will work flexibly alongside multidisciplinary teams, conducting thorough reviews of care plans and identifying community resources that will enhance the discharge process.
Importantly, you will play a key role in passing care over to long-term care coordinators where needed, ensuring continuity and ongoing support for individuals.
Your expertise in The Care Act, Section 117 aftercare, and relevant legislation will empower you to navigate complex discharge barriers and implement solutions, all while fostering a patient-centred approach.
Main duties of the job To be responsible, as part of the MDT, for the assessment, planning, implementation and evaluation of the evidence based care required, including health promotion for a named service user/group, working towards meaningful admission and safe, appropriate discharge.
Responsible for clinical risk assessment of service users accessing services providing effective advice, guidance and decision making process culminating in the coordination of any reviewed plan of care.
Responsible for participating in the development of the service, setting of quality standards, including the auditing, monitoring and reviewing in line with current clinical guidance practice and policy.Responsible for ensuring the post holder understands and meets their professional responsibilities under Safeguarding Vulnerable Adults Legislation.Responsible for ensuring that the requirements of the Mental Health Act 1983 are observed, adhered to and implemented.
Responsible for the promotion of carer and service user involvement within the service and for its provision.
Responsible for establishing therapeutic relationships with service users, and the implementation of evidence based therapeutic interventions with appropriate boundaries in accordance with Nursing and Midwifery Councils professional code of conduct and/ or Social Work England, HCPC.
About us EPUT are looking for motivated staff who shares our Trust values of Care, Learn and Empower.
In return, EPUT can offer you a range of benefits and development including; Season Ticket Loans NHS discounts for staff Excellent Training facilities and opportunities Buying and Selling annual leave scheme The opportunity to work bank shifts and expand knowledge and experience in other areas Salary Sacrifice schemes including lease cars and Cycle to Work Day One Flexible Employer The Trust supports and actively encourages flexible working for all employees.
We offer many options and you are encouraged to ask the recruiting manager what is possible for this role.
If appointed, you will have the opportunity to apply for a flexible working request from the first day of your employment Join our Staff bank What is Staff Bank?
Our EPUT NHS staff bank is an entity managed by the trust that hires clinical and non-clinical healthcare professionals to take on shifts at our trust hospitals and community settings.
Here at EPUT we maintain our own bank of specialist staff to ensure that we are able offer safe and effective care at all times.
All our permanent staff are automatically enrolled onto the staff bank however this does not mean you have to work any additional shifts, but the option is there for you if you wish.
If you are joining our Trust in a fixed term role, please indicate on your New Starter Paperwork that you wish to join our staff bank.
Job description Job responsibilities In this position, you will play a pivotal role in creating personalised care plans that reflect the unique needs of each individual, engaging families and carers in the care planning process to ensure their voices are heard.
Effective communication will be key as you establish strong pathways for collaboration among all stakeholders.
You will also be responsible for promoting equality, diversity, and rights in accordance with best practices and legislation, alongside identifying training needs to enhance the quality of evidence-based care within the team.
This is a rewarding opportunity for someone passionate about making a meaningful impact in the lives of individuals, ensuring their safe and appropriate discharge, and contributing to the overall improvement of community mental health services.
Will be based within the North East Essex locality, acting as the link between Community teams and inpatient services , linking in as part of the process of safe discharge.
Local and out of area.
Work flexibly with Community Teams across North East Essex reviewing care plans and identifying community resources which will support and augment the discharge process back to the locality.
Will work with the MDT identifying barriers to discharge, and how these can be resolved, ensuring the safe discharge of the individual.
Wil be completing Care Act and commissioning experience with the local authority and ICB.
Knowledge of Section 117 aftercare needs and being part of this process in discharge planning in partnership with the inpatient teams.
Will be responsible for supporting the assessment, planning, implementation, and evaluation of interventions within agreed parameters, to ensure meaningful admission and safe, appropriate discharge.
Acknowledge that part of the move away from CPA that care plans will be personalised and individualised to meet the needs of the individual in the local community setting.
Involved family and carers as part of the care planning/discharge process acknowledging their views.
Have a working knowledge of local, national policies and legislation, which govern current service provision and audit Care Act 2014, The Mental Health Act 1983/2007, Mental Capacity Act 2006/2007 and our responsibilities within such legislation.
Tribunal report writing with an understanding of the Mental health Act Will be responsible for ensuring effective communication pathways exist.
Will be responsible for ensuring the promotion of equality diversity and rights in accordance with good practice and legislation.
Will be responsible for identifying and contributing to the training needs necessary in providing quality evidence based care as appropriate.
Providing CMHT staff with guidance and advice regarding processes.
To provide professional advice and support to other agencies and members of the multidisciplinary team, and act up for the Team Manager in their absence as appropriate.
To act as a role model and supervise less experienced staff.
Person Specification Education/Qualifications Essential Registered Mental Health Nurse, or, Social Worker, or, Occupational Therapist Desirable Evidence of appropriate CPD post-qualification Skills/Experience Essential Appropriate post registration experience at qualified practitioner level within Mental Health of at least 2 years Desirable Experience of providing supervision to Junior staff and or consultation for other professionals