Senior Integrated Flow Lead

Job overview

This post is for the Bexley population

To work directly with hospital discharge teams (in acute units mostly the Queen Elizabeth Hospital, Princess Royal University Hospital and Darrent Valley) and our community and social care teams to proactively ensure the management of patients being discharged from acute services into the community or social care provision.

Ensuring that discharges from acute settings for individual patients are managed in an integrated way and provide a fast and efficient pathway for each individual patient.

To proactively assess and identify issues within patient pathways, across our Intermediate Care community beds, and between the continuing healthcare, community and social care support services to provide recommendations on timely patient discharge.

Implement actions, where appropriate and influencing change amongst stakeholder partners.

Provide system wide reporting directly to senior leaders i on behalf of the Bexley ICB Executive Team and the LGT Site Operations Director

To participate in the on-going development and implementation of the Transfer of Care Collaborative (TOCC).

Oversee the delivery of the local Discharge to Assess Models, working with local partners, and contributing to the development of systems and processes that will support patient flow.

The post holder will also have an honorary contract to work within NHS Southeast London ICB offices as necessary for the delivery and function of the role

Main duties of the job

To ensure a responsive service (across the range of support services for discharge) for complex discharge of patients from acute trusts.

To identify within the current systems  “blockages” that are preventing effective discharge and to provide recommendations on solutions  to the Director of Integrated Commissioning

To monitor the taverage length of stay for our Intermediate Care beds, liaising with senior clinicians and the contract manager, making recommendations for change.

To ensure daily SITREPs for Intermediate Care beds to provide Ready fof Discharge and patient projections.

To work closely with the contract manager for integrated care (Head of Integrated Commissioning for Older People) to monitor the performance of the Intermediate Care services and ensure it plays a full part in managing the flow of patients out of the acute setting, including the application of flex criteria at critical points when appropriate.

To work closely with the Head of Integrated Commissioning for Mental Health to ensure that that mental health services, especially for older people, are supportive in the management of people with mental health needs upon discharge from an acute admission.

To work closely with our neighbouring Discharge Flow Teams (e.g. Greenwich) and work on shared solutions.

To monitor daily Ready for Discharge (RFD) and long length of stay activity and provide reports to senior leaders.

Detailed job description and main responsibilities

To work with hospital discharge teams

To ensure that discharges from acute settings for individual patients are managed in an integrated way - to provide fast, safe and efficient pathways of care for each individual patient.

To provide system wide reporting directly to senior leaders

• To work closely with the team to ensure escalations are consistently de‑escalated and resolved in a timely and appropriate manner
• As the role evolves, there is potential for closer operational alignment with the TOCH Hub, including defined links and possible direct accountability to the TOCH Lead, reflecting emerging system governance and delivery arrangements.
• To support partnership working, with commissioners, providing high‑level case management for complex discharges, contributing significantly to system performance and reputation. Future alignment with the TOCH Hub, including links to the TOCH Lead, may form part of the evolving remit.

To prepare reports on patient flow and acute activity that will include the analysis of complex and multiple data sources, in conjunction with the ICB and LGT Business Analytics Team.

To liaise with organisations within the health and social care system at both an operational and strategic level.