Discharge Facilitator

Job description

Job responsibilities

Pinhoe Hospital Ward provides acute inpatient care to adults experiencing mental health difficulties. The role of Discharge Facilitator has been developed to specifically work with inpatient and community colleagues as well as family members/carers and service providers to support smooth discharge pathways out of hospital.

Using care management techniques and a multi-disciplinary recovery oriented approach the post holder will be expected to support individuals to access community resources and local provision to meet their needs in addition to brokering appropriate funded move on placements or support packages. This may also include services to support homelessness and dual diagnosis.

Duties and Responsibilities

Communication and Working Relationship Skills

• Develop working relationships with service users, carers/family members to facilitate discharge from hospital
• Establish firm working relationships with inpatient, community mental health team colleagues, and housing and support providers from public, private and third sectors.
• Develop and accurately record comprehensive support plans, risk assessments and relevant reports to inform care management and social care processes.
• Represent the Trust at meetings in an appropriate and knowledgeable manner including, on occasions, giving presentations using relevant media.
• Communicate highly complex and sensitive information effectively across all levels within and outside of the organisation, to advocate collaborative working and promote best outcomes.
• Contribute to Social Care funding panels in relation to providing information, advice or presenting applications.

Analytical and Judgemental Skills

The post holder will be expected to:

• Exercise judgement when resolving problems or issues in relation to provision of accommodation and support for mental health service users, requiring an analysis of a range of facts and situations..
• Have an understanding of the needs of adults with mental health difficulties who use the services of Devon Partnership Trust, including CPA and the provision of contracted services in terms of organisation and funding.
• Understand presentations of need and the interaction between inpatient and community provision to ensure accommodation and support providers promote further recovery and potential move on to independence.
• Ensuring their working practice is compliant with DPT policies and procedures.

Planning and Organisational Skills

The post-holder will be responsible for:

• Organising assessments, meetings, presentations and any other event that they need to hold in the pursuance of their duties.
• Plan and organise complex multidisciplinary meetings, some of which may involve the formulation and adjustment of plans
• They will need to provide data in relation to their performance as required.

Responsibility for Patient/Client Care, Treatment and Therapy

The post holder will be expected to:

• Provide a high quality and effective service, responding to service user needs in a timely manner and within statutory guidelines.
• Assess need, plan and deliver focused intervention to safeguard, promote, and protect positive mental health outcomes whilst working to best practice to support discharge from hospital
• Produce outcome focused and purposeful care plans within the context of managing risk and in line with protection procedures and financial implications.
• Promote independence and support service users to maximise their choice and control.
• Assess Carer need as appropriate
• To ensure clear and effective handover to community services for any follow up
• Maintain case records keeping them up to date and able to provide concise and accurate information about circumstances and plans within the limits of data protection. Make use of IT systems provided by the Service, complying with policy and relevant procedures.

Responsibility for Policy and Service Development Implementation

The post holder will be expected to:

• Work within Trust timescales, statutory responsibilities, performance targets, and Professional Body Code of Practice where appropriate.
• Contribute and comment on service developments in accommodation services within their network area under the guidance of their manager.
• On occasions, contribute to other DPT groups in their area and contribute to Devon wide strategic planning for accommodation and support services.
• Contribute towards gathering data to analyse, summarise and evaluate information relevant to their area to inform Trust Policies.
• Adhere to current legislative requirements.

Responsibility for Finance, Equipment and Other Resources

• The post holder will not hold a budget or be responsible for any physical resources

Responsibility for Human Resources, e.g. Supervision, Training, HR Advice and Management

The post holder will:

• Have no responsibility for supervising or managing staff but will be expected to work independently across multi-agencies using their own initiative.
• Receive monthly supervision from their line manager.

The post holder will be expected to:

• Maintain efficient and timely records in line with DPT and NHS guidelines.
• Provide information and guidance to service users, carers and staff regarding the provision of mainstream resources in addition to accommodation and support services.
• Be competent in the use of computer programmes such as Excel, Power Point and Word in order to fulfil their role.

Responsibility for Research and Development

The post holder will be expected to:

• Comment on areas for development or proposals for change relevant to accommodation and support in their network area to inform potential service developments
• Undertake surveys and care audits as necessary

Freedom to Act

The post holder will be expected to:

• Work within Trust, Professional Body and delegated policies, guidelines and regulations
• Organise their own diary and work plan.
• Work independently but with regular support

Any Other Specific Tasks Required

• The post holder is expected to impart knowledge to DPT staff, service users and carers in relation to housing and support issues and regulations in order to increase general knowledge in this area. This will require the post holder to keep up to date with housing issues, legal changes and local developments. They will have a particular remit to prevent homelessness or the risk of homelessness for people using mental health services

Review of this Job Description

This job description is intended as an outline indicator of general areas of activity and will be amended in the light of changing service needs. This job description is to be reviewed in conjunction with the post holder on an annual basis.

Person Specification

Experience

Essential

• Experience of care management and working with people with mental health difficulties.
• Experience of working with people with mental health difficulties in a community and inpatient setting.
• Experience of multi-disciplinary/multi-agency working, particularly regarding housing, accommodation and support providers.

Qualifications

Essential

• Educated to degree level or equivalent in: Health/Social Care or equivalent housing qualification or experience.
• Registration with Professional Body if qualified healthcare professional.
• Knowledge and understanding of the legislative framework around mental health, social care and housing, eg: Care Act Mental Health Act, Mental Capacity Act.

Skills and Abilities

Essential

• Develop working relationships with service users, carers/family members to facilitate discharge from hospital.
• Establish firm working relationships with inpatient, community mental health team colleagues, and housing and support providers from public, private and third sectors.
• Develop and accurately record comprehensive support plans, risk assessments and relevant reports to inform care management and social care processes.
• Communicate highly complex and sensitive information effectively across all levels within and outside of the organisation, to advocate collaborative working and promote best outcomes.
• Contribute to Social Care funding panels in relation to providing information, advice or presenting applications.
• Organising assessments, meetings, presentations and any other event that they need to hold in the pursuance of their duties.
• Assess need, plan and deliver focused intervention to safeguard, promote, and protect positive mental health outcomes whilst working to best practice to support discharge from hospital.

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.

Employer details

Employer name

Devon Partnership NHS Trust

Address

Pinhoe View

College Way

Exeter

EX1 3PZ

Employer's website

https://www.dpt.nhs.uk/ (Opens in a new tab)