Job summary
This is
an exciting opportunity to provide a new model of care across Plymouth, through
the establishment of the Inclusion Health Service.
In line with current
best practice this service is being developed using the “Pathway” approach,
providing ‘end to end’ support for individuals who are homeless. It involves
not only medical staff, but a range of multidisciplinary professionals with
expertise in social care, housing law and benefits issues, ensuring that a
person’s full range of needs are supported. More information about the "Pathway" approach can be found here www.pathway.org.uk
The aim of the
Inclusion Health service is:
- To create a
comprehensive service, for adults with complex needs related to
homelessness, health, contact with the criminal justice system and
substance misuse issues.
The
Service will:
- Prevent more entrenched and
longer-term homelessness.
- Contribute towards improving
outcomes and addressing health inequalities for some of the most disadvantaged individuals in Plymouth.
- Achieve truly joined up and
effective care for this most vulnerable group of individuals and ensure
engagement and completion of treatment wherever
possible.
Main duties of the job
The Housing Worker will improve the quality of care for those with complex needs through:
- Specialist advice.
- Advocacy.
- Support.
- Quality discharge interventions, with particular focus on accommodation options.
As a key part of a multi-disciplinary service, the role aims to help patients to improve and maintain their health, by linking them with suitable housing, support and other relevant services on discharge, and supporting them to access accommodation, benefits, primary health care and to attend follow up health and other appointments following discharge.
About us
This service will be delivered through an exciting
and innovative partnership approach with collaboration from organisations such
as Livewell Southwest CIC, Adelaide and St Levan Surgery, University Hospitals
Plymouth NHS Trust and the Plymouth Alliance.
Livewell
Southwest is a recognised provider of integrated health and social care
services operating across South Hams, West Devon and Plymouth www.livewellsouthwest.co.uk
Adelaide
and St Levan Surgery is a GP practice in the most deprived area of Plymouth,
supporting many adults with complex needs. www.stlevansurgery.nhs.uk
The Plymouth Alliance was formed with a group of
local charities / community organisations with leadership from Plymouth City
Council to provide services to people with complex needs (homelessness, drug or
alcohol misuse, mental illness and offending).
Our Plymouth health and care system requires and
features strong and effective collaboration.
This role
will be employed by one of these partner organisations.
Job description
Job responsibilities
Service delivery:
- Carry out rapid, detailed housing assessments of new homeless patients referred to the team, identifying support needs, risks, and any possible rapid routes into housing for the most vulnerable homeless patients.
- Produce individualised, clear and patient led care plans around any issues affecting the homeless patient’s health and housing circumstances, including identifying and addressing risks to the patient, staff, and other patients.
- Provide direct assistance with housing, financial and wellbeing needs including access to primary and specialist health services on discharge.
- Coordinate and support reconnection of patients to housing and other services in areas of local connection as appropriate.
- Advise, signpost and refer patients to a range of external services relevant to homeless and multiply excluded patients in their local area.
- Proactively identify and act on safeguarding issues, ensuring Safeguarding of Vulnerable Adults and Children legislation and relevant service protocols are adhered to.
- Maintain regular contact with and support a caseload of patients.
- Accompany patients to housing offices to provide face to face advocacy and support when needed.
- Coordinate appropriate and planned handover of patients to community services upon discharge from the service.
- All team members are expected to work collaboratively and supportively with each other across Primary, Secondary Care and Community care boundaries to improve outcomes for people who are homeless.
- They should also work to the Pathway model (with flexibility as required), to attend team handover and MDT meetings, and to be present to take referrals, and undertake assessments and ward rounds where needed.
Partnership and team working:
- Positive, pro-active partnership, utilising the expertise of Pathway team colleagues as well as other staff to ensure care plans are holistic and facilitate safe and timely discharges of homeless hospital patients.
- Develop, maintain links and work in partnership with external services such as local authority housing departments, supported accommodation providers, street outreach teams, local specialist homeless GP services, substance misuse, and NRPF services and law centres to ensure patients care plans are coordinated effectively.
Patient involvement and empowerment:
- Involve patients in developing their care plan, working transparently by managing expectations, explaining potential options in a way that patients can understand.
- Assist patients to understand and obtain their welfare, housing and related rights, addressing any barriers to understanding and involvement such as language, culture, mental or physical health.
- Advocate on behalf of individual patients effectively, clearly communicating the relevant circumstances of patients’ lives to hospital staff multi-disciplinary teams.
- Advocate assertively on behalf of individual patients to external agencies to ensure health, care, support and housing needs are met on discharge.
General duties:
- Contribute to complex lives led multi-disciplinary team “MDT” meetings.
- As the housing expert for the team, advise and support Pathway team colleagues around knowledge of housing options and housing services.
- Provide regular training as well as ad hoc advice on housing and homelessness to staff, and promote the work of the team internally and externally.
- Alongside clinical colleagues, promote Pathway’s vision internally and externally, as role models for other staff in homeless healthcare.
- Proactively identify and address own learning needs, ensuring knowledge is up to date in relevant housing and welfare legislation, and local service provision.
- Assist colleagues in coordinating the service and ensuring high quality.
- Record work undertaken with patients accurately and timely.
- Contribute to ongoing quality service evaluation, providing in depth case studies, gathering patient feedback, and on occasion participate in research activity in collaboration with other Pathway sites.
- Contribute to local team’s service development and formalising and improving of processes.
- Supervise and support volunteers as needed.
- To suggest and critically explore new concepts without prejudice or assumption.
Values
- Empathy and compassion – providing care for patients that is rooted in the patient’s priorities.
- Collective responsibility – all team members take responsibility for patients and the team’s success, work collaboratively, and support each other.
- Creative persistence – team members tackle complicated problems together, seek practical solutions, and ‘never give up’.
- Challenging discrimination and poor practice – teams support the delivery of equitable health care, challenging poor attitudes, behaviours and practices.
- Inclusive approach to healthcare – teams subscribe to Pathway’s belief that everything about a person’s situation affects their health – not just their medical conditions.
- Promoting autonomy – patient empowerment and individual agency.
- Relationship builders and influencers – form strong networks within and outside of the hospital and influence the behaviour of different stakeholders across those networks including by teaching, training and inspiring others.
- Constantly improving – seeking new opportunities and ways to improve their service, its resilience, and the support it gives to, and receives from, others.
- Trauma-informed – the culture of the whole system, including all work practices and settings reflects a trauma-informed approach.
Additional Information
As a new service we are keen for the successful applicant to bring their expertise and experience to help shape and define the job role and the Health Inclusion Service. Equally, as this new service launches and evolves it may be necessary to review job responsibilities. Therefore, at this stage this is a draft job description.
Job description
Job responsibilities
Service delivery:
- Carry out rapid, detailed housing assessments of new homeless patients referred to the team, identifying support needs, risks, and any possible rapid routes into housing for the most vulnerable homeless patients.
- Produce individualised, clear and patient led care plans around any issues affecting the homeless patient’s health and housing circumstances, including identifying and addressing risks to the patient, staff, and other patients.
- Provide direct assistance with housing, financial and wellbeing needs including access to primary and specialist health services on discharge.
- Coordinate and support reconnection of patients to housing and other services in areas of local connection as appropriate.
- Advise, signpost and refer patients to a range of external services relevant to homeless and multiply excluded patients in their local area.
- Proactively identify and act on safeguarding issues, ensuring Safeguarding of Vulnerable Adults and Children legislation and relevant service protocols are adhered to.
- Maintain regular contact with and support a caseload of patients.
- Accompany patients to housing offices to provide face to face advocacy and support when needed.
- Coordinate appropriate and planned handover of patients to community services upon discharge from the service.
- All team members are expected to work collaboratively and supportively with each other across Primary, Secondary Care and Community care boundaries to improve outcomes for people who are homeless.
- They should also work to the Pathway model (with flexibility as required), to attend team handover and MDT meetings, and to be present to take referrals, and undertake assessments and ward rounds where needed.
Partnership and team working:
- Positive, pro-active partnership, utilising the expertise of Pathway team colleagues as well as other staff to ensure care plans are holistic and facilitate safe and timely discharges of homeless hospital patients.
- Develop, maintain links and work in partnership with external services such as local authority housing departments, supported accommodation providers, street outreach teams, local specialist homeless GP services, substance misuse, and NRPF services and law centres to ensure patients care plans are coordinated effectively.
Patient involvement and empowerment:
- Involve patients in developing their care plan, working transparently by managing expectations, explaining potential options in a way that patients can understand.
- Assist patients to understand and obtain their welfare, housing and related rights, addressing any barriers to understanding and involvement such as language, culture, mental or physical health.
- Advocate on behalf of individual patients effectively, clearly communicating the relevant circumstances of patients’ lives to hospital staff multi-disciplinary teams.
- Advocate assertively on behalf of individual patients to external agencies to ensure health, care, support and housing needs are met on discharge.
General duties:
- Contribute to complex lives led multi-disciplinary team “MDT” meetings.
- As the housing expert for the team, advise and support Pathway team colleagues around knowledge of housing options and housing services.
- Provide regular training as well as ad hoc advice on housing and homelessness to staff, and promote the work of the team internally and externally.
- Alongside clinical colleagues, promote Pathway’s vision internally and externally, as role models for other staff in homeless healthcare.
- Proactively identify and address own learning needs, ensuring knowledge is up to date in relevant housing and welfare legislation, and local service provision.
- Assist colleagues in coordinating the service and ensuring high quality.
- Record work undertaken with patients accurately and timely.
- Contribute to ongoing quality service evaluation, providing in depth case studies, gathering patient feedback, and on occasion participate in research activity in collaboration with other Pathway sites.
- Contribute to local team’s service development and formalising and improving of processes.
- Supervise and support volunteers as needed.
- To suggest and critically explore new concepts without prejudice or assumption.
Values
- Empathy and compassion – providing care for patients that is rooted in the patient’s priorities.
- Collective responsibility – all team members take responsibility for patients and the team’s success, work collaboratively, and support each other.
- Creative persistence – team members tackle complicated problems together, seek practical solutions, and ‘never give up’.
- Challenging discrimination and poor practice – teams support the delivery of equitable health care, challenging poor attitudes, behaviours and practices.
- Inclusive approach to healthcare – teams subscribe to Pathway’s belief that everything about a person’s situation affects their health – not just their medical conditions.
- Promoting autonomy – patient empowerment and individual agency.
- Relationship builders and influencers – form strong networks within and outside of the hospital and influence the behaviour of different stakeholders across those networks including by teaching, training and inspiring others.
- Constantly improving – seeking new opportunities and ways to improve their service, its resilience, and the support it gives to, and receives from, others.
- Trauma-informed – the culture of the whole system, including all work practices and settings reflects a trauma-informed approach.
Additional Information
As a new service we are keen for the successful applicant to bring their expertise and experience to help shape and define the job role and the Health Inclusion Service. Equally, as this new service launches and evolves it may be necessary to review job responsibilities. Therefore, at this stage this is a draft job description.
Person Specification
Experience
Essential
- Experience of successfully advocating for homeless individuals and applying the Housing Act/Homelessness Reduction Act to obtain housing.
- Significant experience of working with vulnerable adults in a supporting, advisory or advocacy role.
- Experience of successful and assertive advocacy for individuals facing social exclusion to other agencies and statutory services.
- Experience of positive and proactive joint working in addressing individual needs, communicating effectively with partner organisations.
Desirable
- Experience of joint working with healthcare services or working in healthcare settings.
- Experience of delivering training or presentations to groups or willingness to develop this area.
- A lived experience of homelessness is often an asset.
Knowledge and Skills
Essential
- A practical understanding of the Housing Act/Homelessness Reduction Act and other statutory entitlements of vulnerable, homeless adults.
- Good knowledge of the welfare system, supported housing pathways, and other services for the rough sleepers.
- Understanding of safeguarding of vulnerable adults principles and procedures.
- Understanding of the importance of involving patients as fully as possible in the process of care planning.
- Personal experience of homelessness OR able to demonstrate a good understanding of the challenges that homeless and vulnerably housed people face when accessing housing, healthcare, and other services.
- Can demonstrate an understanding of the needs of vulnerable homeless patients, including those with issues around their mental health and/or drug and alcohol dependency.
- Can demonstrate an understanding of the health issues associated with chronic homelessness and social exclusion, and the benefits of addressing housing and support needs.
- Understanding of both patient and personal safety issues on/off site.
- Understanding of data protection regulations and the need for patient consent.
- Able to demonstrate an understanding of the need for boundaries when working with vulnerable and socially excluded adults.
- Excellent organisational skills and an ability to prioritise own caseload in a rapidly moving, reactive service.
- Excellent oral and written communication skills, ability to engage with and manage expectations of patients with complex needs, and explain the Pathway service and other complex issues in a way that is appropriate for the audience.
- Willingness to challenge social exclusion and institutional practices that perpetuate exclusion, overcoming gatekeeping of services.
- Can demonstrate an ability to advocate assertively and effectively for service users with a range of services, while balancing this against the need to maintain strategic relationships with key services.
- Effective administrative and IT skills, including ability to use databases and case management systems, Microsoft Office applications, internet and email etc.
- Ability to identify solutions for the most multiply-excluded individuals (including those fleeing violence and abuse; facing barriers due to immigration issues; with mental health and substance misuse issues for example).
- Positive attitude towards working collaboratively and supportively within a multi-disciplinary team, seeking expertise of colleagues appropriately.
- Self-motivated and able to make independent decisions on complex cases when needed.
- Ability to identify and address own learning needs, and to reflect on own practice.
Person Specification
Experience
Essential
- Experience of successfully advocating for homeless individuals and applying the Housing Act/Homelessness Reduction Act to obtain housing.
- Significant experience of working with vulnerable adults in a supporting, advisory or advocacy role.
- Experience of successful and assertive advocacy for individuals facing social exclusion to other agencies and statutory services.
- Experience of positive and proactive joint working in addressing individual needs, communicating effectively with partner organisations.
Desirable
- Experience of joint working with healthcare services or working in healthcare settings.
- Experience of delivering training or presentations to groups or willingness to develop this area.
- A lived experience of homelessness is often an asset.
Knowledge and Skills
Essential
- A practical understanding of the Housing Act/Homelessness Reduction Act and other statutory entitlements of vulnerable, homeless adults.
- Good knowledge of the welfare system, supported housing pathways, and other services for the rough sleepers.
- Understanding of safeguarding of vulnerable adults principles and procedures.
- Understanding of the importance of involving patients as fully as possible in the process of care planning.
- Personal experience of homelessness OR able to demonstrate a good understanding of the challenges that homeless and vulnerably housed people face when accessing housing, healthcare, and other services.
- Can demonstrate an understanding of the needs of vulnerable homeless patients, including those with issues around their mental health and/or drug and alcohol dependency.
- Can demonstrate an understanding of the health issues associated with chronic homelessness and social exclusion, and the benefits of addressing housing and support needs.
- Understanding of both patient and personal safety issues on/off site.
- Understanding of data protection regulations and the need for patient consent.
- Able to demonstrate an understanding of the need for boundaries when working with vulnerable and socially excluded adults.
- Excellent organisational skills and an ability to prioritise own caseload in a rapidly moving, reactive service.
- Excellent oral and written communication skills, ability to engage with and manage expectations of patients with complex needs, and explain the Pathway service and other complex issues in a way that is appropriate for the audience.
- Willingness to challenge social exclusion and institutional practices that perpetuate exclusion, overcoming gatekeeping of services.
- Can demonstrate an ability to advocate assertively and effectively for service users with a range of services, while balancing this against the need to maintain strategic relationships with key services.
- Effective administrative and IT skills, including ability to use databases and case management systems, Microsoft Office applications, internet and email etc.
- Ability to identify solutions for the most multiply-excluded individuals (including those fleeing violence and abuse; facing barriers due to immigration issues; with mental health and substance misuse issues for example).
- Positive attitude towards working collaboratively and supportively within a multi-disciplinary team, seeking expertise of colleagues appropriately.
- Self-motivated and able to make independent decisions on complex cases when needed.
- Ability to identify and address own learning needs, and to reflect on own practice.
Disclosure and Barring Service Check
This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
Additional information
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).