Re: Care Navigator

September 2016

Dear Applicant

Re: Care Navigator

Thank you for your enquiry in response to our advertisement for the above position. I have pleasure in enclosing the following:

·  Background to the post of Care Navigator

·  Job description and Person Specification

·  Background information about Age UK Bromley & Greenwich

·  Application form

·  Equal opportunities monitoring form

We regret that we only contact applicants who are shortlisted for an interview. Therefore, if you have not heard from us by Wednesday 19th October 2016 you should presume that unfortunately on this occasion your application has not been successful.

I look forward to receiving your completed application form no later than 5pm on Monday 17th October 2016. Interviews will be held on Thursday 20th or Friday 21st of October 2016. Candidates shortlisted for an interview will be contacted by email and or telephone so please include an email address and mobile telephone number or any other telephone number where you can be reached. Please note that we do not accept CV’s.

Thank you for your interest in this role.

Yours sincerely

Maureen Falloon

Maureen Falloon
Chief Executive

BACKGROUND TO THE POST

Discussions with colleagues in General Practice, Secondary Care, Third Sector, Bromley Council and Bromley Clinical Commissioning Group (CCG) have identified the need to develop a model for providing more integrated care services for people in Bromley. The model, Integrated Care Network (ICN) has been co-developed with key stakeholders across the sectors to provide more coordinated, accessible and proactive out of hospital services. The model enables services to be more responsive to the needs of people and is focused on preventing ill health and proactively managing and supporting people in a more coordinated way. Fundamental to this approach will be ensuring that services work together to provide a seamless service which adds both financial and patient value, reduces unnecessary duplication, builds relationships between services and manage perceived gaps in care.

The ICN model includes the new Proactive and Frailty Pathways which will support individuals with complex or long term conditions who are at high risk of future admission to hospital, helping them stay healthier at home. It will include a holistic assessment carried out with the person, a Multi-Disciplinary Team (“MDT”) review resulting in developing an integrated and coordinated plan to manage their care needs. This will be shared with the person, and the actions implemented by health and care professionals across the sectors. There will be three ICNs in Bromley, each covering around a third of the population and they are due to go live from October 2016.

Age UK Bromley & Greenwich (on behalf of the Bromley Third Sector Enterprise (BTSE)) is appointing 3.6 Care Navigators to join a dynamic team committed to supporting the provision of high quality health care to people living in the London Borough of Bromley.

The Care Navigator post is a newly created role with a primary focus on the mobilisation of the new pathways; in the first phase this will be the Proactive and Frailty Pathways, and will include being part of the MDT meetings working alongside the MDT Liaison Coordinator, Community Matrons. The role is a non-medical approach to people’s care, carrying out non-medical holistic assessments, encouraging and supporting self-care and self-management and sign posting people to access third sector services.

KEY RELATIONSHIPS

·  MDT Liaison Coordinators and Community Matron

·  Patients/service users within the networks

·  GPs as providers within the ICN and MDT GP Chair

·  Interface Geriatrician

·  Mental Health professional

·  Other Care Navigator posts within Bromley

·  St Christopher’s Hospice staff working on the end of life pathway

·  Transfer of Care Bureau at the Princess Royal University Hospital

·  Social Care

·  Third Sector colleagues as required

Job Description and Person Specification

Job Title: Care Navigator

Accountable & reporting

to: Care Navigation Manager

Day to day operational relationship with Multi-Disciplinary Team (MDT) Liaison Coordinator within Integrated Care Network (ICN)

Purpose: The new role includes supporting people with complex needs identified through the Proactive Care and Frailty pathways by providing emotional support, motivating them to self-manage and signposting them to the most relevant services (non-clinical/medical, social care third sector support) to enable those individuals to achieve improved health and care outcomes.
The post holder will have responsibility for non-medical assessments; development and co-ordination of plans for individuals in association with the other professionals in the ICN, monitoring those services and their impact on people’s care. They will work with colleagues from across a number of services in developing a multi-disciplinary approach to patient care, ensuring a holistic approach is taken.

MAIN DUTIES AND RESPONSIBILITIES:

Enabling access to third sector and local health and social care services:

·  To provide person-centred support to people who have been assessed as benefiting from coordinated care and who require access to self-management/third sector services in Bromley and help them to navigate the system.

·  To improve people’s experience and quality of care by providing a point of contact for non-medical queries, and for signposting to medical services (with support from the MDT Liaison Coordinator).

·  To support the Community Matron in carrying out guided conversations with people about their needs, leading to a holistic care plan of support.

·  To be part of the MDT meetings for people on the Proactive and Frailty Care Pathways.

·  To inform health and social care colleagues of the potential third sector services which can support people to self-manage.

·  To assist in documenting patient history in sufficient detail to enable health and care professionals to plan and deliver effective and timely interventions.

·  To assist people who may be eligible to access community care and carers assessments.

·  To escalate any issues which cannot be resolved at local level to the relevant Line Manager.

·  To respond appropriately in emergency situations.

Supporting and supervising volunteers:

·  To liaise with CLB Volunteer Centre for volunteer health champions who will work with individuals to support self-management of their long term condition(s).

·  To liaise with Age UK Bromley & Greenwich’s Time Bank for volunteers who will support and encourage people to enable them to pursue their interests.

Record keeping and reports:

·  To input data on EMIS database system and keep all online records up-to-date (training will be provided).

·  To collate, input and produce relevant data for analysis using IT packages.

·  To ensure all recorded information is accurate, up to date and factual.

·  To carry out written reports e.g. case studies requested by the Care Navigation Manager and MDT Liaison Coordinator.

Communication:

·  To establish good relationships with the health and care professionals within the ICN, including Community staff, Primary Care (i.e. GPs and practice staff within the named ICN) and MDT Liaison Coordinators to support and coordinate care.

·  To establish good communication with people receiving coordinated care and their carers / families.

·  To deal effectively and diplomatically with telephone and face to face enquiries, taking messages or appropriate action as required.

·  To ensure any complaints and serious incidents are managed and dealt with in line with the latest governance and policy guidance.

Learning and Development:

·  To attend and participate in an induction programme and all relevant training.

·  To learn from good practice on how to successfully support MDTs.

·  To attend regular monthly supervision sessions and annual appraisals with the Care Navigation Manager taking responsibility to comply with agreed personal development.

·  To attend regular weekly Care Navigation team meetings with the Care Navigation Manager. Plus any other appropriate meetings to ensure good team working with the MDT Liaison Coordinator and wider community teams.

·  To take part in Age UK Bromley & Greenwich events and activities as appropriate to the role.

Quality and General responsibilities:

·  To establish strong links with other Age UK Bromley & Greenwich staff and contribute to the wider aims and objectives of the organisation.

·  To show flexibility to cover for other staff members in the Care Navigation team, in other networks locally, and undertake any other duties commensurate with the purpose and remit of the post.

·  At all times to maintain the professional integrity and reputation of the Charity and represent their main interests in any dealings with other bodies, groups and individuals.

·  To use and maintain resources efficiently and effectively and encourage others to do so.

·  To evaluate the quality of own work and raise quality issues and related risks with the relevant people through the relevant channels.

·  To support the introduction/ maintenance of quality systems/processes in own work area.

·  To ensure documentation is accurate and up to date, and monitor and promote high standards of documentation within the team.

·  To follow quality standards relevant to the role, including the Standard Operating Procedures (“SOP”) agreed by the Joint Operational Group (JOG).

·  To support the collation of information and data for any relevant audit requirements.

Service Improvement

·  To contribute to the identification and development of service improvements initiatives sharing the suggestions with other MDT members.

Equality and Diversity

·  To comply with Age UK Bromley & Greenwich’s policies with particular regard to Diversity, Health and Safety and Confidentiality and policies adopted by the Bromley ICNs that apply to the Proactive Care and Frailty pathways.

Health, Safety and Security

·  Safeguarding, keeping adults safe from abuse, ensuring that all alleged abuse is reported as per Age UK Bromley & Greenwich and ICN Standard Operating Procedures and aligned to Borough wide regulations and reporting procedures. Ensure that safeguarding is embedded in all decisions.

·  To familiarise and fully comply with Age UK Bromley & Greenwich policies and procedures.

·  At all times respect patient confidentiality and in particular the confidentiality of electronically stored personal data in line with the requirements of the Data Protection Act.

·  To be aware of individual responsibilities under the Health & Safety at Work Act and identify and report as necessary any untoward accident, incident or potentially hazardous environment.

·  To initiate and undertake routine risk assessments, both of environmental and individual case management, and advise others in determining appropriate management specifically relating to moving and handling, safe use of medical devices.

·  To be aware of and adhere to health and safety legislation in all aspects of their own and their teams work.

·  To monitor work areas, and practices, and ensure that they are safe and free from hazards, conform to health safety and security legislation, policies, procedures and guidelines.

·  To take the necessary action in relation to risk with support from the Line Manager.

INFECTION PREVENTION AND CONTROL RESPONSIBILITIES

Employees must adhere to relevant infection control policies placed on them by The Health Act 2006: Code of Practice for the Prevention and Control of Health Care Associated Infections. The prevention and control of healthcare associated infections must be embedded into everyday clinical practice and applied consistently to ensure prevention or containment of infections.

It is the responsibility of all patient-facing staff to ensure that they have sound working knowledge of standardinfection control precautions. They must ensure that no act or omission on their part or within their sphere of responsibility is detrimental to the interests or safety of patients or clients. They must also keep their infection control knowledge and skills up to date by attending mandatory infection control training as required to enhance infection control practice and to maintain a safe environment for patients, visitors and colleagues.

This job description reflects the immediate requirements and objectives of the post and is intended as a summary of the main elements of the job described. This is not an exhaustive list of duties and responsibilities and the post holder may be required to undertake other duties which fall within the grade of the job, as directed by their line manager. This job description will be reviewed regularly and may be varied from time to time in consultation with the job holder without changing the general character of the duties or the level of responsibility entailed. Such variations are a common occurrence and cannot of themselves justify a reconsideration of the grading of the post.

CARE NAVIGATOR PERSON SPECIFICATION

Method of Assessment: A=application, I=interview, E= exercise

Qualifications / Essential / Desirable /
Two (2) or more and GCSEs including English and Mathematics (A) / X
A-levels (A) / X
A relevant qualification, degree (or equivalent experience in health, social care or information and advice) (A / I) / X
Evidence of continued learning and development (A / I) / X
Adult safeguarding - level 3 training (A / I) / X
Basic life support training (A / I) / X
Experience
Minimum three years’ experience of working in health, social care, or third sector or information and advice, in direct contact with people. (A / I) / X
Experience of building relationships in health, social care or third sector environment (A / I) / X
Experience of delivering services to people with complex needs (A / I) / X
Experience of person-centered planning (A / I) / X
Experience of collating data and producing reports (A / I) / X
Experience of working with volunteers (A / I) / X
Experience of being an advocate (paid/unpaid role) and negotiating with providers to achieve the best outcomes for people (A / I) / X
A basic knowledge/ understanding of (or a willingness to learn) health and social care terminology (A / I) / X
Skills and knowledge
Knowledge of health and social care policy (A / I) / X
Strong motivational skills to support people to self-care (A / I) / X
Ability to gain knowledge and understand local services (A / I) / X
Innovative with good problem solving skills (A/I) / X
Team Working
Able to build effective relationships (A / I) / X
Ability work on own initiative and with minimum supervision (A / I) / X
Ability to work as part of a team (A / I) / X
Communication Skills
Excellent communication skills, both verbal and written (A / I / E) / X
Diplomatic with sensitive information/managing potential conflict (A / I) / X
Understands the importance and limits of confidentiality (A / I/E) / X
Personal attributes
Demonstrate compassion and empathy for people in a professional manner (A / I) / X
Ability to recognise limitations (A / I) / X
Able to deal with conflict, complaints and distress (A / I) / X
Ability to recognise and manage risk (A / I) / X
Organised; adaptable and flexible (A / I) / X
Able to promote equality and diversity principles (A / I) / X
Information Management and Technology
Good literacy and IT skills; confident in use of a range of software, including Microsoft Office (Word, Excel and PowerPoint) (A / I) / X
Able to use electronic records, databases, spreadsheets relevant software packages and associated electronic equipment (A / I / E) / X
Travel
Ability to travel across assigned ICN and wider borough (A / I) / X
Full UK driving license (A / I) / X

TERMS & CONDITIONS OF EMPLOYMENT