Discharge Coordinator - Integrated Discharge Team | North Tees and Hartlepool NHS Foundation Trust

Overview

The post holder is a member of the Discharge Liaison Team/Frailty Team that aims to facilitate effective, efficient and timely discharge of patients from hospital. Particular emphasis is placed upon complex multi disciplinary assessments and case conferences including patients with complex needs, palliative care and rehabilitation needs. The role involves working across professional boundaries with multi agencies including local health and social care staff. Working with minimal supervision the post holder will maintain positive communication links between community and secondary care staff, social services and allied health professions to promote collaborative working.

We are excited to offer a secondment/ fixed term contract to work within the Integrated Discharge Team based at UNHT. You will work closely with the frailty Team, local partners including social care and voluntary agencies to support care transitions and complex discharges from Hospital to the community.

We require a qualified professional who has excellent communication skills and who is confident working across professional boundaries. You will need to be flexible, adaptable and a good team player with the ability to work as part of a team as well as independently provide a whole person approach to the care and management for patients within this setting.

This is an exciting and opportunity to work across health and social care and will include devising and implementing care support plans with the support of the Integrated Discharge Team.

At North Tees & Hartlepool NHS Foundation Trust our main priority is, and always will be, to provide safe and high quality care to our patients every day; the kind of care we would want for ourselves and our loved ones. We want our organisation to be the best place to work with the right staff, in the right roles, at the right time, to ensure we deliver exceptional patient care and experience.

We will support staff through providing an inclusive and supportive workplace with health and well-being initiatives, staff benefits and opportunities for personal and professional development. Staff recognition is very important to us; as well as performance reviews and appraisals, we recognise staff through Star and Team of the month, colleague recognition – a note of thanks, Managers Awards, Shining Stars and Service Awards.

We recruit for values and “Together we are North Tees & Hartlepool”

Key Result Areas

1. Demonstrate commitment to IWL principles and flexible working patterns, to meet the needs of the service and staf
2. Tackle discrimination and harassment, and promote equality and diversity in the workplace
3. Reduce sickness absence; work place accidents; and promote zero tolerance on violence against staff
4. Take responsibility for personal development and education and the development of a Personal Development Plan.
5. To act as a specialist professional resource to community staff, secondary care staff, social services and allied health professionals.
6. To facilitate complex discharges and case conferences.
7. To act as a point of contact for nursing staff that require expert advice regarding complex discharges.
8. Assume responsibility for management and organisation of work and staff on each shift.
9. To attend daily discharge meetings with members of the Intermediate Care Team to facilitate appropriate discharge, ensuring referral to the most appropriate health or social care professional.
10. To coordinate referrals to appropriate specialist team to facilitate early effective discharge i.e. District Nurses, Social Workers, Rapid Response Team and other community teams.
11. To review and heighten awareness of discharge policies and procedures to ensure that patients are discharged at the right time with arrangements in place to ensure that ongoing health and social care needs are met following their discharge from hospital.
12. To act as an educational and training resource and identify training needs of professionals internal and external to the trust.
13. The collection and presentation of delayed discharge dates to identify reimbursement charges.
14. To follow the National guidance for reimbursement working closely with social services and wards to ensure that the correct processes are followed.
15. To communicate complex patient related information effectively to ensure collaborative working across multidisciplinary health care teams.
16. To adhere at all times to trust policies for the protection of vulnerable adults.
17. To act as advocate and support for patients/carers/relatives to improve their experience and discharge from hospital, negotiating and liaising with medical and nursing staff on a regular basis.
18. To initiate and design clinical audit of the service and acting on findings making recommendations on change to hospital discharge practice.
19. To evaluate the effectiveness of the discharge liaison role by auditing practice.
20. Develop, assist and co-ordinate development of junior staff within the Discharge Liaison Service by providing strong clinical leadership.
21. To be an expert on current legislation around discharge planning and reimbursement.
22. Prioritise and delegate work using staff and time appropriately.
23. Maintain professional development and keep up to date with developments within nursing and research.
24. Promote the service by acting as a representative at events such as lectures.
25. Undertake mandatory training.
26. Maintain accurate and comprehensive documentation in line with both trust policy and NMC guidelines.
27. Participate and initiate in quality standard setting.
28. Take part in audit, research and development activity.
29. Support new service development in line with the government’s modernisation agenda and local developments.
30. Contribute to development of community protocols.
31. To continue professional development, complying with KSF through a variety of strategies including study days, lectures and appraisal.
32. To ensure participation in clinical supervision.

This advert closes on Wednesday 1 Oct 2025