• Job Description

  Req#: B9849-049-25?language=en&page=368&sort=publicationDateDesc

  Job summary

  New and exciting post! Are you caring and compassionate in nature and a natural problem solver motivated by making a difference to peoples lives? Are you resilient, organised, and creative with a passion to think differently to overcome complex issues?

  ECCH are proud to be partnering with our local ICS to introduce a new and exciting Transfer of Care Co-ordinator role in our Transfer of Care team.

  The Co-ordinator will need a range of experience, which may include hands on care, or similar experience in a Health and Social Care setting, but the primary requirement is that the candidate must be passionate about providing effective support to our people to ensure they get the best care.

  You will need to enjoy learning from colleagues and enjoy supporting people to access the right care, at the right time and in the right place.

  As the co-ordinator you will be at the heart of the team supporting team members to be efficient, effective and get the best results for the people within the service.

  If you are the person described above and relish the opportunity for career development, we want to hear from you!

  Main duties of the job

  Being an integrated role, the post holder will work closely with system partners from the ICB, ECCH, JPUH, SCC and NCC and their respective teams, such that the postholders work and views are representative of the five organisations working collaboratively and together on behalf of the GYW place.

  This post is a key part of the Integrated Transfer of Care Team supporting safe transfers of care for patients who live in the Great Yarmouth and Waveney Locality (East Place).

  The post holder will, using the Home First ethos and effective communication proactively promote community patient flow with system partners. In close liaison with acute hospital wards, operations centre, and transfer of care teams, the post holder will analyse and co-ordinate incoming referrals for community hospital and beds with care.

  The post holder will liaise with the patient, their family, primary care home and social care teams to coordinate transfer of cares from the community hospital into beds with care or home. The post holder is expected to redirect patient pathways as needed to support the patient being in the right place.

  The Post will chair the daily review of patients, contribute to daily board rounds for the East Place Beds with Care, taking action to prevent delays in patient care, escalating concerns appropriately.

  The service operates 7 days a week, MondayFriday 08:45 17:30, Saturday 09:0017:00 and Sunday 10:0016:00. Applicants will be required to work a variety of shifts.

  About us

  ECCH is well established health care provider and has been successfully delivering NHS care within the community since 2011. We provide a range of NHS, community health and social care services predominantly across the easterly region of the Norfolk/Suffolk borders.

  We are aligned to NHS terms and conditions, and offer many employee benefits, to find out more about us visit our website - www.ecch.org. We are a social enterprise and staff owned organisation which means staff can opt to be shareholders and have a real say in how ECCH is run and evolves to deliver healthcare for the future.

  At the heart of our ambition, we work in partnership with and for the community to become the provider and employer of choice for community healthcare.

  We encourage you to apply as early as possible as this job may close earlier than the advertised closing date once enough applications have been received.

  Details

  Date posted

  09 May 2025

  Pay scheme

  Agenda for change

  Band

  Band 4

  Salary

  £26,530 to £29,114 a year

  Contract

  Fixed term

  Duration

  12 months

  Working pattern

  Part-time

  Reference number

  B9849-049-25

  Job locations

  James Paget Hospital

  Lowestoft Road

  Gorleston

  Great Yarmouth

  Norfolk

  NR31 6LA

  
  

  Job description

  Job responsibilities

  Communication

  Review all referrals for appropriateness ensuring all relevant information and assessments are completed and signpost on where needed

  To receive and interpret/analyse sensitive information and accurately document information

  Excellent communication skills. Aim to develop and maintain effective interpersonal relationships with all members of the multidisciplinary team

  Actively give and receive constructive feedback

  Manage patient information and analyse referral information to make an informed decision

  Have a thorough understanding and knowledge of transfer of care pathways, criteria to reside and criteria for transfer of care

  Liaise with Operations centre and Virtual Transfer of Care Hubs

  Network and liaise with Social Care Colleagues and Care Agencies to source packages of care

  Liaise with voluntary services, housing and charities in order to support patients needs on transfer of care

  To maximise patient flow, admissions and transfer of cares and to utilise bed stock to maximum capacity according to referrals received

  Updates ward/PCH/Transfer of Care hub staff re referrals accepted/declined verbally and on S1

  Patient Care

  Work as part of a team whilst taking independent responsibility for referrals

  Liaise with Health and Social Care colleagues, able to use escalation routes when delays occur e.g. awaiting Social Worker allocation, waiting a Mental Capacity Assessment (MCA)

  Contribute to daily board rounds for the East Place Intermediate care beds and Beds with Care, support transfer of care planning meetings, identify and discuss potential transfer of care issues at the earliest opportunity. Ensuring Estimated Dates of Transfer of care are reviewed and updated accordingly

  Organise and facilitate planning meetings as required

  Participate in Place and partner calls giving clear and concise information on admissions. Liaise with NHS CHC team re packages of care and placements

  Contribute to supporting evidence to meet the Care Quality Commission (CQC) fundamental standards as required

  Understanding of multidisciplinary and integrated working proactively manage patient flow Acute to community

  Meet the demands of the pace of patient flow in the wider system

  Contribute to a professional working environment

  Professional

  Proactively reviews acute hospital waiting list to seek out appropriate referrals for bed based rehabilitation

  Be able to analyse dashboard data and identify trends for onward discussion with service leads

  Communicate effectively, develop, and maintain productive working relationships with system partners

  Provides timely and accurate information re admission/referral information to daily system calls

  To facilitate early transfer of care from community hospital/beds with care

  Able to work flexibly and be able to adjust to constant changing demands of the role

  Act as a resource, advisor and role model to other colleagues in relations to patient flow processes

  Demonstrate a sound knowledge of the Care Act 2014 and NHS Continuing Healthcare (CHC)

  Utilise advanced decision making and problem solving skills when reviewing referrals

  Demonstrates a high level of judgement, acting autonomously within role to accept/decline referrals

  Support with the development of admission/transfer of care process/polices proposing any changes to the benefit of patient pathways

  Contribute to financial performance

  Contribute to efficient use of our resources

  All roles within East Coast Community Healthcare CIC (ECCH) require staff to demonstrate our Values and Signature Behaviours in the care and service they provide to patients, service users, stakeholders and colleagues. All members of staff should consider these as an essential part of their job role.

  Our Values outline the core behaviours that we can all achieve and are summarised as an acronym within the word CARE. These stand for: Compassion, Action, Respect and Everyone.Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together

  Job description

  Job responsibilities

  Communication

  Review all referrals for appropriateness ensuring all relevant information and assessments are completed and signpost on where needed

  To receive and interpret/analyse sensitive information and accurately document information

  Excellent communication skills. Aim to develop and maintain effective interpersonal relationships with all members of the multidisciplinary team

  Actively give and receive constructive feedback

  Manage patient information and analyse referral information to make an informed decision

  Have a thorough understanding and knowledge of transfer of care pathways, criteria to reside and criteria for transfer of care

  Liaise with Operations centre and Virtual Transfer of Care Hubs

  Network and liaise with Social Care Colleagues and Care Agencies to source packages of care

  Liaise with voluntary services, housing and charities in order to support patients needs on transfer of care

  To maximise patient flow, admissions and transfer of cares and to utilise bed stock to maximum capacity according to referrals received

  Updates ward/PCH/Transfer of Care hub staff re referrals accepted/declined verbally and on S1

  Patient Care

  Work as part of a team whilst taking independent responsibility for referrals

  Liaise with Health and Social Care colleagues, able to use escalation routes when delays occur e.g. awaiting Social Worker allocation, waiting a Mental Capacity Assessment (MCA)

  Contribute to daily board rounds for the East Place Intermediate care beds and Beds with Care, support transfer of care planning meetings, identify and discuss potential transfer of care issues at the earliest opportunity. Ensuring Estimated Dates of Transfer of care are reviewed and updated accordingly

  Organise and facilitate planning meetings as required

  Participate in Place and partner calls giving clear and concise information on admissions. Liaise with NHS CHC team re packages of care and placements

  Contribute to supporting evidence to meet the Care Quality Commission (CQC) fundamental standards as required

  Understanding of multidisciplinary and integrated working proactively manage patient flow Acute to community

  Meet the demands of the pace of patient flow in the wider system

  Contribute to a professional working environment

  Professional

  Proactively reviews acute hospital waiting list to seek out appropriate referrals for bed based rehabilitation

  Be able to analyse dashboard data and identify trends for onward discussion with service leads

  Communicate effectively, develop, and maintain productive working relationships with system partners

  Provides timely and accurate information re admission/referral information to daily system calls

  To facilitate early transfer of care from community hospital/beds with care

  Able to work flexibly and be able to adjust to constant changing demands of the role

  Act as a resource, advisor and role model to other colleagues in relations to patient flow processes

  Demonstrate a sound knowledge of the Care Act 2014 and NHS Continuing Healthcare (CHC)

  Utilise advanced decision making and problem solving skills when reviewing referrals

  Demonstrates a high level of judgement, acting autonomously within role to accept/decline referrals

  Support with the development of admission/transfer of care process/polices proposing any changes to the benefit of patient pathways

  Contribute to financial performance

  Contribute to efficient use of our resources

  All roles within East Coast Community Healthcare CIC (ECCH) require staff to demonstrate our Values and Signature Behaviours in the care and service they provide to patients, service users, stakeholders and colleagues. All members of staff should consider these as an essential part of their job role.

  Our Values outline the core behaviours that we can all achieve and are summarised as an acronym within the word CARE. These stand for: Compassion, Action, Respect and Everyone.Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together

  Person Specification

  Personal Attributes

  Essential

  • Ability to work without supervision
  • Ability to work as a team
  • Excellent time management skills, punctual and reliable
  • Assertive
  • Able to remain effective and efficient under pressure
  • Able to use own initiative
  • Able to negotiate effectively
  • Able to contribute to team, service and organisational development
  • Aware of requirements for confidentiality
  • Ability to embrace our Culture, Values and Signature Behaviours:
  • (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together)
  • Willingness and ability to work across different sites and travel to alternative sites and across the community as required

  Qualifications

  Essential

  • NVQ level 4 in health and social care or equivalent experience in a Health and Social Care setting

  Desirable

  • ILM level 3

  Experience

  Essential

  • Working in a hospital and community setting in a multidisciplinary team
  • Experience of developing/implementing processes in line with service need
  • Good working knowledge of patient flow, The Care Act 2014 and NHS CHC

  Skills and Knowledge

  Essential

  • Excellent communication skills
  • Able to interpret/analyse complex patient information which maybe distressing as relates to patients diagnosis and prognosis
  • Tact and diplomacy
  • A team player
  • Good ICT skills including word, excel and emails
  • Attention to detail with accurate, clear documentation
  • Ability to analyse information and use reasoning and problem solving skills to assess referrals
  • Ability to prioritise and plan workload unsupervised
  • Assertive with the ability to challenge situations and manage situations where conflict may arise

  Person Specification

  Personal Attributes

  Essential

  • Ability to work without supervision
  • Ability to work as a team
  • Excellent time management skills, punctual and reliable
  • Assertive
  • Able to remain effective and efficient under pressure
  • Able to use own initiative
  • Able to negotiate effectively
  • Able to contribute to team, service and organisational development
  • Aware of requirements for confidentiality
  • Ability to embrace our Culture, Values and Signature Behaviours:
  • (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together)
  • Willingness and ability to work across different sites and travel to alternative sites and across the community as required

  Qualifications

  Essential

  • NVQ level 4 in health and social care or equivalent experience in a Health and Social Care setting

  Desirable

  • ILM level 3

  Experience

  Essential

  • Working in a hospital and community setting in a multidisciplinary team
  • Experience of developing/implementing processes in line with service need
  • Good working knowledge of patient flow, The Care Act 2014 and NHS CHC

  Skills and Knowledge

  Essential

  • Excellent communication skills
  • Able to interpret/analyse complex patient information which maybe distressing as relates to patients diagnosis and prognosis
  • Tact and diplomacy
  • A team player
  • Good ICT skills including word, excel and emails
  • Attention to detail with accurate, clear documentation
  • Ability to analyse information and use reasoning and problem solving skills to assess referrals
  • Ability to prioritise and plan workload unsupervised
  • Assertive with the ability to challenge situations and manage situations where conflict may arise

  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

  East Coast Community Healthcare CIC

  Address

  James Paget Hospital

  Lowestoft Road

  Gorleston

  Great Yarmouth

  Norfolk

  NR31 6LA

  
  

  Employer's website

  https://www.ecch.org/ (Opens in a new tab)

  Employer details

  Employer name

  East Coast Community Healthcare CIC

  Address

  James Paget Hospital

  Lowestoft Road

  Gorleston

  Great Yarmouth

  Norfolk

  NR31 6LA

  
  

  Employer's website

  https://www.ecch.org/ (Opens in a new tab)

• About the company

  National Health Service (NHS) is the umbrella term for the publicly-funded healthcare systems of the United Kingdom (UK). The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the United Kingdom apart from dental treatment and optical care.

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