Job summary
Transforming care is all about improving health and care services so that more people with a learning disability and/or autistic people can live in the community, with the right support, and close to home. This means that fewer people will need to go into hospital for their care.
As a Transforming Care Case Manager, you will be at the forefront of advocating the Transforming Care agenda. You will establish and maintain good relationships with key stakeholders to ensure timely discharge for our patients. You will be a key team player by attending and facilitating reviews, whilst adhering to clinical governance and have excellent communication skills.
Main duties of the job
- Facilitating Care, Education and Treatment Reviews (CETR) for both inpatient and community patients. There will be some requirements to travel to hospital settings to complete the inpatient reviews.
- Facilitating emergency meetings such as Local Area Emergency Protocol (LAEP) meetings.
- Attend Care Programme Approach (CPA) meetings as well as Ward Reviews, Child in Need meetings, and Mental Health Act Section 117 reviews.
- Work closely with the team to work towards NHS England set trajectories for the TCP inpatient cohort, this will include attending regular discharge planning meetings, housing meetings, transition planning meetings and accommodation groups.
- Manage a defined caseload of patients with complex health needs, ensuring a high-quality service is delivered.
- Work in situations of potential and actual conflict where the assessment/review outcome is being opposed by families.
- Participating in Dynamic Support Register meetings, providing updates where necessary and evaluating individuals' risks.
- Have frequent contact with wider multi-agency teams building strong working relationships.
- Participating in the development of person-centered service specifications with inpatient clinical teams.
- Accurate recording of complex clinical information into the Key Lines of Enquiry (KLOE) document.
- Ability to cross cover where necessary in the absence of the Transforming Care Manager.
- Provide detailed information for Oversight Panels.
About us
NHS Midlands and Lancashire Commissioning Support Unit (MLCSU) is part of the NHS family, both 'of' and 'for' the NHS and are pivotal in supporting major improvements in health and wellbeing for organisations across our partner Integrated Care Systems (ICSs) and their populations. We are integral to the healthcare systems we work in partnership with, and our philosophy is to face every new challenge and opportunity together with our partners.
Our mission is to be a great place to work, to be great people to work with, striving to be better tomorrow than we are today.
We live and work in line with our organisational values. They underpin who we are and how we build relationships both within our organisation, and with our clients, partners and the patients we serve.
We strive to achieve excellence in everything that we do, where everyone matters: our patients, our clients and you.
MLCSU is committed to our process of redeployment at risk members of our existing workforce to new roles. As such, all job adverts are subject to this policy and we reserve the right to close, delay or remove adverts while this process is completed. If you do experience a delay in the shortlisting stage of the recruitment cycle, please bear with us while this process is completed, and contact the named contact if you have any questions.
Job description
Job responsibilities
- The postholder will be required to establish and maintain effective links and good communication with all stakeholders including Local Authorities, NHS England, specialist services, Care Provider organisations and specialist mental health and learning disability service providers (NHS and independent sector).
- Support processes and mechanisms that will ensure that patients in specialist mental health/learning disability services receive high quality and clinically appropriate treatment in accordance with identified individual care pathways and in the least restrictive setting.
- Support on the commissioning of individual packages of care in the community (with the support of business and brokerage teams) and monitor assurance outcomes whilst working to ensure individuals are safe and packages of care meet their needs.
- Support risk of admission processes in order to avoid inappropriate hospital admissions and keep people safe in the community, where appropriate. Coordinate the Dynamic Support Register (DSR) and support the needs of people sitting within this framework. Facilitation of Local Area Emergency Protocol Meetings (LAEPs), Care (Education) Treatment Reviews (CETRs) and other appropriate Multiagency Meetings. (There will be some requirements to travel to hospital settings to complete the inpatient reviews)
- Provide clinical case management for existing and new transforming care patients, including but not limited to unscheduled participation in CTRs to facilitate crisis intervention.
- Work collaboratively with stakeholders to agree appropriate care and treatment needs and facilitate timely discharge.
- Work closely with the team to work towards NHS England set trajectories for the TCP inpatient cohort, this will include attending regular discharge planning meetings, housing meetings, transition planning meetings and accommodation groups.
- Ensure attendance and representation at pre-discharge planning meetings. Care Programme Approaches (CPAs), Transition meetings, section 117 aftercare meetings of the Mental Health Act 1983 (amended 2007).
- To ensure that the DSR CTR policy January 2023 is implemented, support the ICB/ICS with acquisition of information for their CETR oversight panel processes.
- Act in accordance with the legal requirements and statutory rules related to practice and registration, NMC Code of Conduct and MLCSU Policies and Procedures including Financial Procedures, Health & Safety Policies and Safe Systems of Work
- Participating in the development of person-centered service specifications with inpatient clinical teams.
- Excellent communication skills are essential.
- The post holder will require tact, diplomacy and sensitivity to handle all types of communication and undertake assessments in the person's family's home/community setting, or via virtual means (where necessary).
- Work in situations of potential and actual conflict where the assessment/review outcome is being opposed by families.
- Extract complex information in situations where there may be barriers to understanding, such as cognitive or behavioural or mental health issues. Understanding of sensory and communication assessments and implementation. Able to make reasonable adjustments to support patient participation.
- First-rate written and word processing skills are necessary to produce assessments and reports, and management of the Transforming care processes.
- Employ excellent oral communications skills to present the outcomes of complex assessments to multi-agency panel operations.
- Establish communication and liaison with multi-agencies, other disciplines and internal MLCSU colleagues, working in a collaborative manner.
- Must be registered with the Nursing and Midwifery Council as a Registered Mental Health Nurse or Learning Disability Nurse, and other recognised registration [ e.g., Mental Health SW / AMHP] as per the person specification essential criterion. Educated to a degree level or equivalent experience in Healthcare Service
- Post registration specialist knowledge and gained experience and evidence of CPD.
- Knowledge and experience of clinical governance, within their current/past field of practice
- Have knowledge and understanding of safeguarding procedures and act in accordance of local safeguarding procedures.
- To have an understanding of The Dynamic Support Register Care (Education) Treatment Review Policy January 2023 and its processes.
- Undertake personal and professional training and enhanced professional development in general and in relation to, patient discharge processes and healthcare funding processes.
- Analytical and judgement skills will be required to understand the specific issues around the management of the healthcare funding and application process, the assessment of clients and the choices associated care provision.
- To ensure maximum benefit the post holder will be required to use their own judgement in prioritising their workload.
- Planning and organisation are pivotal elements of this role and will form the foundation of the post holders daily function to ensure that the referral process, assessment functions and review processes are completed in a robust and timely manner, in accordance with local timeframes.
- Have access to car and ability to drive.
- Required to take part in assessments and reviews across county borders where required.
- Required to take part in virtual online platform for communication/meetings/assessments.
- Excellent keyboard skills for the timely and accurate processing of data, production of documents and reports: Key Lines of Enquiry documents (KLOE), LAEP minutes, Multiagency Meeting Minutes.
- Required to use Visual Display Screens for long periods (part of working remotely/at home where required)
- The post holder will make sure that all Midlands and Lancashire CSU Policies are applied and will play an integral part in ensuring that the DH&SC policies and local policies around Healthcare funding are adhered to.
- As a member of the TCP team, the post holder will also be involved in the development and implementation of policies and procedures for the service, where required.
- Understanding / knowledge of different legislation: Mental Capacity Act 2005, Mental Health Act 1983 (amended 2005), Autism Act 2009, Down Syndrome Act 2022, Equality Act 2010.
- You are responsible for limiting your actions to those, which you feel competent to undertake. If you have any doubts about your competence during your duties, you should immediately speak to your line manager / clinical supervisor.
- Registered Health Professional.
- All employees of the Midlands and Lancashire CSU who are required to register with a professional body, to enable them to practice within their profession, are required to comply with their code of conduct and requirements of their professional registration.
- All staff are expected to ensure the confidentiality and security of all information that is dealt with while performing your duties in accordance with the requirements of the Data Protection Act 2018 and adhere to the principles of Caldicott.
- Be aware that the CSU has an Information Governance Handbook which provides the framework and procedures in which information should be managed. They should become familiar with the handbook and code of conduct and keep up to date with any changes that are made, including the completion of mandatory IG Training on an annual basis. Breaches of the procedures within the handbook and code of conduct could be regarded as gross misconduct and may result in serious disciplinary action being taken, up to and including dismissal.
- Comply with and keep up to date with the requirements of legislation such as the Freedom of Information Act 2000 and Computer Misuse Act 1990.
- Ensure to maintain the confidentiality and security of all information that is dealt with while performing their duties is in accordance with the requirements of the Data Protection Act 2018 and the principles of Caldicott; and
- Ensure that you are aware of your obligations under legislation such as the Freedom of Information Act 2000; Computer Misuse Act 1990, and that staff are updated with any changes or additions relevant to legislation.
Safeguarding Children and Adults
All CSU employees are required to act in such a way that always safeguards and promotes the health and well-being of children and vulnerable adults. Familiarisation with and adherence to the policies and procedures of the Local Safeguarding Boards (Children and Adults) and those of the CSU is an essential requirement of all employees as is participation in mandatory safeguarding training in accordance with the employees roles and responsibilities.
Personal Development
The CSU is committed to supporting the development of all staff. All employees have a responsibility to participate in the personal development process with their manager, which will provide an opportunity to:
- establish and act towards achieving goals
- have a conversation about job role, career aspirations and personal development
- align personal aspirations with corporate objectives
agree actions that are underpinned by the CSUs value base.
As part of development, employees have joint responsibility with their line manager for the development of skills and competencies through identification and participation in training and development activities relevant to their role.
This job description will be reviewed regularly in the light of changing service requirements and any such changes will be discussed with the post holder.
This job description is intended as an outline indicator of general areas of activity and will be amended in the light of the changing needs of the organisation. It will be reviewed in conjunction with the post holder on an annual basis.
Job description
Job responsibilities
- The postholder will be required to establish and maintain effective links and good communication with all stakeholders including Local Authorities, NHS England, specialist services, Care Provider organisations and specialist mental health and learning disability service providers (NHS and independent sector).
- Support processes and mechanisms that will ensure that patients in specialist mental health/learning disability services receive high quality and clinically appropriate treatment in accordance with identified individual care pathways and in the least restrictive setting.
- Support on the commissioning of individual packages of care in the community (with the support of business and brokerage teams) and monitor assurance outcomes whilst working to ensure individuals are safe and packages of care meet their needs.
- Support risk of admission processes in order to avoid inappropriate hospital admissions and keep people safe in the community, where appropriate. Coordinate the Dynamic Support Register (DSR) and support the needs of people sitting within this framework. Facilitation of Local Area Emergency Protocol Meetings (LAEPs), Care (Education) Treatment Reviews (CETRs) and other appropriate Multiagency Meetings. (There will be some requirements to travel to hospital settings to complete the inpatient reviews)
- Provide clinical case management for existing and new transforming care patients, including but not limited to unscheduled participation in CTRs to facilitate crisis intervention.
- Work collaboratively with stakeholders to agree appropriate care and treatment needs and facilitate timely discharge.
- Work closely with the team to work towards NHS England set trajectories for the TCP inpatient cohort, this will include attending regular discharge planning meetings, housing meetings, transition planning meetings and accommodation groups.
- Ensure attendance and representation at pre-discharge planning meetings. Care Programme Approaches (CPAs), Transition meetings, section 117 aftercare meetings of the Mental Health Act 1983 (amended 2007).
- To ensure that the DSR CTR policy January 2023 is implemented, support the ICB/ICS with acquisition of information for their CETR oversight panel processes.
- Act in accordance with the legal requirements and statutory rules related to practice and registration, NMC Code of Conduct and MLCSU Policies and Procedures including Financial Procedures, Health & Safety Policies and Safe Systems of Work
- Participating in the development of person-centered service specifications with inpatient clinical teams.
- Excellent communication skills are essential.
- The post holder will require tact, diplomacy and sensitivity to handle all types of communication and undertake assessments in the person's family's home/community setting, or via virtual means (where necessary).
- Work in situations of potential and actual conflict where the assessment/review outcome is being opposed by families.
- Extract complex information in situations where there may be barriers to understanding, such as cognitive or behavioural or mental health issues. Understanding of sensory and communication assessments and implementation. Able to make reasonable adjustments to support patient participation.
- First-rate written and word processing skills are necessary to produce assessments and reports, and management of the Transforming care processes.
- Employ excellent oral communications skills to present the outcomes of complex assessments to multi-agency panel operations.
- Establish communication and liaison with multi-agencies, other disciplines and internal MLCSU colleagues, working in a collaborative manner.
- Must be registered with the Nursing and Midwifery Council as a Registered Mental Health Nurse or Learning Disability Nurse, and other recognised registration [ e.g., Mental Health SW / AMHP] as per the person specification essential criterion. Educated to a degree level or equivalent experience in Healthcare Service
- Post registration specialist knowledge and gained experience and evidence of CPD.
- Knowledge and experience of clinical governance, within their current/past field of practice
- Have knowledge and understanding of safeguarding procedures and act in accordance of local safeguarding procedures.
- To have an understanding of The Dynamic Support Register Care (Education) Treatment Review Policy January 2023 and its processes.
- Undertake personal and professional training and enhanced professional development in general and in relation to, patient discharge processes and healthcare funding processes.
- Analytical and judgement skills will be required to understand the specific issues around the management of the healthcare funding and application process, the assessment of clients and the choices associated care provision.
- To ensure maximum benefit the post holder will be required to use their own judgement in prioritising their workload.
- Planning and organisation are pivotal elements of this role and will form the foundation of the post holders daily function to ensure that the referral process, assessment functions and review processes are completed in a robust and timely manner, in accordance with local timeframes.
- Have access to car and ability to drive.
- Required to take part in assessments and reviews across county borders where required.
- Required to take part in virtual online platform for communication/meetings/assessments.
- Excellent keyboard skills for the timely and accurate processing of data, production of documents and reports: Key Lines of Enquiry documents (KLOE), LAEP minutes, Multiagency Meeting Minutes.
- Required to use Visual Display Screens for long periods (part of working remotely/at home where required)
- The post holder will make sure that all Midlands and Lancashire CSU Policies are applied and will play an integral part in ensuring that the DH&SC policies and local policies around Healthcare funding are adhered to.
- As a member of the TCP team, the post holder will also be involved in the development and implementation of policies and procedures for the service, where required.
- Understanding / knowledge of different legislation: Mental Capacity Act 2005, Mental Health Act 1983 (amended 2005), Autism Act 2009, Down Syndrome Act 2022, Equality Act 2010.
- You are responsible for limiting your actions to those, which you feel competent to undertake. If you have any doubts about your competence during your duties, you should immediately speak to your line manager / clinical supervisor.
- Registered Health Professional.
- All employees of the Midlands and Lancashire CSU who are required to register with a professional body, to enable them to practice within their profession, are required to comply with their code of conduct and requirements of their professional registration.
- All staff are expected to ensure the confidentiality and security of all information that is dealt with while performing your duties in accordance with the requirements of the Data Protection Act 2018 and adhere to the principles of Caldicott.
- Be aware that the CSU has an Information Governance Handbook which provides the framework and procedures in which information should be managed. They should become familiar with the handbook and code of conduct and keep up to date with any changes that are made, including the completion of mandatory IG Training on an annual basis. Breaches of the procedures within the handbook and code of conduct could be regarded as gross misconduct and may result in serious disciplinary action being taken, up to and including dismissal.
- Comply with and keep up to date with the requirements of legislation such as the Freedom of Information Act 2000 and Computer Misuse Act 1990.
- Ensure to maintain the confidentiality and security of all information that is dealt with while performing their duties is in accordance with the requirements of the Data Protection Act 2018 and the principles of Caldicott; and
- Ensure that you are aware of your obligations under legislation such as the Freedom of Information Act 2000; Computer Misuse Act 1990, and that staff are updated with any changes or additions relevant to legislation.
Safeguarding Children and Adults
All CSU employees are required to act in such a way that always safeguards and promotes the health and well-being of children and vulnerable adults. Familiarisation with and adherence to the policies and procedures of the Local Safeguarding Boards (Children and Adults) and those of the CSU is an essential requirement of all employees as is participation in mandatory safeguarding training in accordance with the employees roles and responsibilities.
Personal Development
The CSU is committed to supporting the development of all staff. All employees have a responsibility to participate in the personal development process with their manager, which will provide an opportunity to:
- establish and act towards achieving goals
- have a conversation about job role, career aspirations and personal development
- align personal aspirations with corporate objectives
agree actions that are underpinned by the CSUs value base.
As part of development, employees have joint responsibility with their line manager for the development of skills and competencies through identification and participation in training and development activities relevant to their role.
This job description will be reviewed regularly in the light of changing service requirements and any such changes will be discussed with the post holder.
This job description is intended as an outline indicator of general areas of activity and will be amended in the light of the changing needs of the organisation. It will be reviewed in conjunction with the post holder on an annual basis.
Person Specification
Qualifications
Essential
- Educated to degree level or equivalent level of qualification or experience in working at similar level in specialist area. Must hold any of the following Healthcare Professional Registrations, RMN, RNLD, NMC, AMHP and a valid driving license
Skills and experience
Essential
- Knowledge of care and or treatment pathways for people with LD and/or Autism, mental health disorder. Experience of working within mental health/ learning disability clinical settings, secure settings would be advantageous. Negotiation and conflict management skills with an ability to influence.
Knowledge and competences
Essential
- An understanding of the Transforming Care Programme. Understanding/knowledge of different legislation: Mental Capacity Act 2005, Mental Health Act 1983 (amended 2007), Autism Act 2009, Equality Act 2010. Experience in implementing treatment and care in line with NICE guidance.
Personal Qulaities
Essential
- Non-judgmental attitude. Unconditional positive regard. Tenacity and ability to work of own volition. Excellent communication skills: verbal and written. Good IT skills with frequent use of Microsoft Packages especially Excel and Teams.
Person Specification
Qualifications
Essential
- Educated to degree level or equivalent level of qualification or experience in working at similar level in specialist area. Must hold any of the following Healthcare Professional Registrations, RMN, RNLD, NMC, AMHP and a valid driving license
Skills and experience
Essential
- Knowledge of care and or treatment pathways for people with LD and/or Autism, mental health disorder. Experience of working within mental health/ learning disability clinical settings, secure settings would be advantageous. Negotiation and conflict management skills with an ability to influence.
Knowledge and competences
Essential
- An understanding of the Transforming Care Programme. Understanding/knowledge of different legislation: Mental Capacity Act 2005, Mental Health Act 1983 (amended 2007), Autism Act 2009, Equality Act 2010. Experience in implementing treatment and care in line with NICE guidance.
Personal Qulaities
Essential
- Non-judgmental attitude. Unconditional positive regard. Tenacity and ability to work of own volition. Excellent communication skills: verbal and written. Good IT skills with frequent use of Microsoft Packages especially Excel and Teams.
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).
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
Additional information
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).
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
