System Therapies Complex Discharge Lead

Job overview

This is a unique opportunity for an experienced therapist to be the lead Therapies representative in the new system discharge hub.

This role is being recruited to provide a service 1st Nov to 31st Dec.

Northampton is set to move to a system wide Transfer of care hub (ToCH) in November 2026. It will establish a single, integrated, multidisciplinary coordination function, bringing together professionals from acute, community, social care and voluntary sector organisations into a unified system approach (KGH & NGH hubs integrate). At its core, the model is underpinned by a “Home First” philosophy, ensuring that patients are supported to return home wherever possible, with decision-making guided by a strength-based approach and a system-wide focus on achieving the best outcomes for individuals.

The ToCH is intended to bring together teams involved in discharge planning through one coordinated system approach. Its core process runs from early identification of complexity through referral, triage, pathway allocation, brokerage and sourcing, discharge coordination and completion of discharge. There will be one hub across the system.

The successful candidate will be the consistent therapies representative in the hub. All hub representatives will function as a team, receiving and processing referrals throughout the working day, removing the daily hub meetings, and moving towards a more responsive model of referrals being received, reviewed and actioned as they come in.

The therapist will act as a central role, bringing significant experience as a clinician, whilst developing their understanding of system therapies services. The successful candidate will pull this knowledge together to help provide expert advice, signposting and system working to ensure best outcomes for patients and timely access to appropriate services during discharge planning.

The system ToCH will be based at Northampton General Hospital and therefore the therapist will be hosted by and line managed by the NGH Therapies management team with close links with system therapy leads. The hubs core hours will function between 8-4:30pm 7 days a week. This post is expected to provide the core provision mon - fri.

Main duties of the job

The System Therapies Discharge Lead will be the lead and consistent therapy presence within the Integrated Discharge Hub, bringing advanced specialist Occupational Therapy or Physiotherapy expertise into daily discharge decision-making and system working.

In November 2026 Northamptonshire will be moving to a system Integrated discharge hub model. The therapist in post will act as a system therapies representative and will have insights into therapies services across the county across health and social care. The therapist will provide support and decision making for patients across the county including from NGH, KGH, and community hospitals.

The post holder will provide expert therapy analysis, clinical reasoning, positive risk management and professional advice for patients whose complex clinical, functional, psychological or social needs are affecting discharge. They will hold oversight of a targeted caseload of complex cases in an advisory capacity, reviewing existing assessments and information, clarifying therapy-related needs and making recommendations to resolve barriers and support safe and timely discharge. The post holder will not routinely undertake hands-on clinical assessment, treatment or intervention.

Working across professional and organisational boundaries, the post holder will lead the therapy contribution to discharge planning, escalation and validation processes. They will build effective relationships with acute teams, community services, adult social care, mental health, care providers, brokerage and other system partners to support patient-centred decisions, appropriate use of resources and continuity of care.

As a senior therapist, the post holder will provide visible professional leadership, challenge constructively, support complex case resolution, educate colleagues and contribute to service improvement, audit, governance and evaluation. The role will promote a Home First and discharge-to-assess approach, where clinically appropriate, while maintaining professional standards and safeguarding patient choice, safety and dignity.

Base: Northampton General Hospital, with attendance at system settings according to service need. Operational accountability: Discharge Matron / Integrated Discharge Hub leadership.

Detailed job description and main responsibilities

Leadership within the Integrated Discharge Hub

• Act as the senior therapy representative and consistent therapy presence within the Integrated Discharge Hub.
• Lead the therapy contribution to daily hub meetings, complex case discussions, discharge delay validation and system escalation processes.
• Provide authoritative Occupational Therapy or Physiotherapy advice to support safe, timely and effective discharge decisions.
• Ensure therapy-related risks, functional needs, equipment requirements, rehabilitation potential and post-discharge support needs are clearly understood within system decision-making.
• Coordinate and prioritise therapy input for complex discharge cases, working with ward and specialist therapy teams to avoid duplication and secure timely action.
• Chair or lead multidisciplinary and multi-agency discussions where required, maintaining a clear focus on patient outcomes, agreed actions and accountability.
• Identify recurring therapy-related barriers to discharge and escalate operational or system risks through appropriate governance routes.
• Represent Therapies at relevant hospital and system forums, communicating decisions and actions back to therapy teams.

Specialist therapy advice for complex discharge

• Review and interpret existing therapy assessments, clinical information and multidisciplinary evidence for patients with complex clinical, functional, cognitive, psychological and social needs affecting discharge, providing specialist advice and recommendations.
• Hold a targeted advisory caseload of complex therapy cases across the system, coordinating information and liaising with the multidisciplinary team and system partners to support timely decisions.
• Use advanced clinical reasoning to analyse risk, safety, patient choice, independence, eligibility and environmental factors, and recommend proportionate discharge plans.
• Advise on the need for further therapy assessment or intervention and identify the most appropriate therapy team or service to undertake this.
• Provide expert recommendations on rehabilitation potential, functional prognosis, manual handling considerations, equipment, care needs and appropriate discharge pathways within own professional scope.
• Apply positive risk management and shared decision-making, ensuring the patient remains central to discharge planning.
• Lead or contribute to complex case conferences and communicate sensitive information clearly to patients, relatives, carers and professionals.
• Maintain accurate, contemporaneous discharge records and ensure therapy recommendations, risks, decisions and actions are clearly documented.

System working and discharge coordination

• Develop and maintain effective relationships with internal and external partners to support seamless discharge and appropriate use of available resources.
• Work daily across organisational boundaries to resolve delays and support coordinated pathways from acute care into community settings.
• Contribute specialist therapy knowledge to discharge-to-assess, Home First, complex care and end-of-life pathways where relevant to the individual case and within professional scope.
• Ensure discharge plans reflect the person’s goals, functional presentation, risks, informal support, home environment and available community provision.
• Provide timely information and professional challenge when proposed plans do not adequately address therapy, functional or safety considerations.
• Contribute to escalation reporting and the validation of discharge delays, ensuring therapy actions and dependencies are accurate and current.
• Support admission avoidance activity by providing advice to urgent care, community colleagues and care providers when requested.

See JD for full roles and responsibilities

Applicant requirements

You must have appropriate UK professional registration.

This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service.