Pay: £13.82 per hour
Hours: 15 hours over 2 days a week (likely Tuesday and Thursday)
08.00 16.00 with a 30-minute unpaid lunch break
Accountable to: Head of Inclusion Health
Base: Blackpool Victoria Hospital main base
There will be some co-location work to support this role linking with housing teams across Blackpool, Fylde & Wyre
We offer NHS Pension
Cycle to Work Scheme
Attendance Bonus
Free Tea & Coffee
Eye Care Contributions
Overview of Role
This role will enhance and support the hospital discharge process for people who are homeless and are admitted to Blackpool Victoria Hospital. The successful post holder will also support patients who attend the Emergency Department and the co‑located Urgent Treatment Centre. This is an integrated care role, working across local health and housing teams and the wider multiple disadvantage partnership.
This provision is delivered collaboratively with the Hospital Discharge Team/nominated Discharge Facilitator, Housing Teams (Blackpool, Fylde, Wyre) and wider partners who provide care via the community system delivery model for complex and multiple disadvantaged patients.
Main duties of the job
The purpose of the role is to provide timely and expert advice, assessment and support to patients on all pathways and to ensure that housing needs are identified, and appropriate support and referrals actioned, especially when there are health concerns or when the person is at risk of rough sleeping and / or known to be vulnerable.
The Integrated Discharge Service is a multi‑agency single point of access that supports the Acute Trust in transitioning patients from hospital to their next care setting, whether that be home or to another facility.
Job responsibilities
Day to Day Duties to include, but not exhaustive:
Identification of inpatients who are homeless. This will include people with no fixed abode, people who are at risk of homelessness, and/or people who cannot safely return to their home.
Supporting people who are homeless, or at risk of homelessness, to have a safe, planned discharge from hospital following an inpatient admission.
Liaison between Fylde Coast Housing Teams and the Blackpool Teaching Hospitals Bed Flow Team and Emergency Department.
Reducing inappropriate and preventable A&E attendances at Blackpool Victoria Hospital and supporting the patient to access the services they need.
Taking referrals from Northwest Ambulance Service, NWAS, for people and who are identified with housing as a contributory factor to their health and social care needs.
Ensuring the delivery and raising the awareness of the discharge pathway for people who are homeless and ensuring the hospital Duty to Refer team, refer people who are homeless/threatened with homelessness into a Local Authority – completing these referrals when needed.
Supporting onward referrals and follow-up care including Transfer of Care and raising any safeguarding concerns.
Working across the Blackpool Multiple Disadvantage partnership to enable people to achieve a safe discharge from hospital and to access support from the right person to meet the patient’s needs.
Attending the weekly Multiple Disadvantage Partnership meeting and contributing to this from a homeless link worker position.
Working closely with the Care Navigators based in the homeless nursing team.
Ensure compliance to internal, local and national safeguarding procedures and advocate for patients who meet the criteria for assessment under the Care Act 2014.
Patient Identification
Use hospital systems and liaise with ward staff, discharge teams, and FCMS manager and frontline staff to identify homeless patients.
Attend wards and multidisciplinary team meetings to identify patients.
Work with Trust colleagues to support frequent A&E attenders and address underlying needs.
Help prevent unsafe or early discharges by coordinating with the hospital and community teams.
Complete initial needs assessments and share with local housing teams.
Notify housing teams and out‑of‑hours services of potential discharges.
Ensure compliance with housing legislation (Housing Act 2004, Homeless Reduction Act 2019, etc.).
Maintain discharge protocols and follow up post‑discharge to confirm support is in place.
Provide patients with alternative healthcare options and refer frequent callers to appropriate services.
Maintain a Housing Options resource pack for staff and deliver training as needed.
Provide patients with details of support services available prior to discharge and undertake any relevant referrals e.g. to substance use providers.
Work closely with BTHFT Safeguarding adult team for all service users of the Trust.
Build strong links with inpatients, ward staff, housing teams, GP practices, Primary Care Networks and partners supporting people experiencing multiple disadvantage.
Refer patients to housing providers for accommodation and make social care referrals when needed.
Work with homeless health team and substance misuse providers to support patients at risk of self‑discharge when it is believed unsafe to leave the hospital.
Attend Risk Management and Multi‑Agency Oversight Group meetings.
Ensure whenever possible that no patient is discharged to the street.
Service Development
Contribute to service improvement and protocol development.
Work within organisational policies and your own competence, seeking advice when needed.
Undertake training and awareness sessions to support role delivery.
Activity Monitoring and Reporting
Complete patient contact notes in the relevant hospital system and the Homeless Health Community Instance of EMIS to provide transparency and to aid in collating reporting data.
Complete the KPI data for to include:
- No of people who are homeless or at risk of homeless and have received support with a safe discharge.
- Accommodation status
- How patients are identified
- Number of onward referrals and who the patient has been referred to.
- No Duty to Reside data.
- Quarterly Case Study
Accurately record advice and outcomes of assessment, care planning and interventions having due regard to legal aspects, confidentiality, and managerial information requirements.
Provide an update report highlighting successes and challenges, for discussion at the Joint Governance meeting between FCMS (NW) Ltd and Blackpool Victoria Hospital and housing providers.
Contribute to / complete a Homeless Checklist including Duty to Refer as per the Emergency Department pathway, checklist and toolkit PowerPoint Presentation (england.nhs.uk).
Working Relationships
The main people that the post holder will be expected to communicate with will be:
- Patients, their carers and relatives
- BTHFT Safeguarding Adults team (including ISVA & IDVA practitioners)
- Hospital bed flow and discharge team
- Local authority housing teams in Blackpool, Fylde and Wyre Councils
- Ward‑based teams
- Disabled Facilities Services
- Health and Social Care services.
Our key expectations are:
- Self‑awareness. Living authentically.
- Adaptability-Being ready to adjust depending on the situation.
- Openness. What you see is what you get.
- Positivity with a real sense of being able to strive for the impossible.
- Generosity of spirit. Everyday should be an opportunity to act with kindness.
- Ability to have fun. Taking the role seriously, whilst being yourself.
Disability Confident Employer
As users of the disability confident scheme, we guarantee to interview all disabled applicants who meet the minimum criteria for the vacancy.
DBS –
This post is subject to the Rehabilitation of Offenders Act (Exemption 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. This will require three forms of valid ID to be produced and verified. The onboarding process is also subject to an Occupational Health check, suitable professional references and eligibility to work in the UK (with the requirement to provide relevant documentation as evidence).
The organisation is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all staff to share this commitment. You will be expected to fulfil your mandatory safeguarding training at the level applicable to this role.
Person Specification
Experience
- Proven experience working with vulnerable groups, including homeless individuals.
- Firsthand experience delivering frontline services.
- Excellent communication and partnership‑building skills.
- Ability to manage complex cases and coordinate across multiple agencies.
- Strong problem‑solving and decision‑making skills.
- Proficient in IT systems and comfortable using multiple platforms.
- Ability to work independently and collaboratively within multi‑agency teams.
- Skilled in engaging with a diverse range of clients.
- Experience working in a multi‑disciplinary environment.
- Ability to work under pressure and meet deadlines.
- Effective caseload management and prioritisation skills.
- Competence in conducting assessment interviews.
- Identifying safeguarding concerns and reporting these appropriately.
- Good understanding of housing legislation and hospital discharge planning.
- Previous experience in health or social care environments.
- Knowledge of substance misuse and mental health issues.
- Familiarity with hospital systems and discharge protocols.
- Direct experience supporting individuals with alcohol, drug, or mental health challenges.
- Lived Experience relevant to the community we serve.
Qualifications
- A good standard of education
- GCSE English / Maths or equivalent
- Motivational Interviewing
- Up to date mandatory training e.g. Safeguarding.
- Health & Social Care NVQ 3 or equivalent
- CIH Level 3 Certificate in Providing Homeless Services or equivalent.
- IT Qualification EDCL
- DANOS
- Trauma Informed knowledge and training
Personal Qualities
- Technical and Organisational Skills
- High level of IT ability (IT is integral to the role and will form part of the interview process).
- Excellent record‑keeping and attention to detail.
- Strong organisational and time management skills, with the ability to prioritise workloads and meet deadlines.
- Ability to implement processes effectively to deliver all aspects of the role.
- Communication and Interpersonal Skills
- Excellent verbal and written communication skills, including active listening and adaptability to meet patient needs in stressful or complex situations.
- Effective negotiation and problem‑solving skills, including the ability to present issues persuasively and resolve challenging situations.
- Ability to build and maintain positive relationships with colleagues and partner agencies, even where agendas differ.
- Personal Attributes and Professional Approach
- Non‑judgemental attitude and ability to remain calm under pressure.
- Capacity to work independently and collaboratively within a multi‑agency team, managing a personal caseload and exercising sound judgement to achieve the best possible outcomes, even when complete information is not available.
- Creative and lateral thinking to identify opportunities for improvement.
- Reliable, conscientious, and committed to maintaining confidentiality.
- Ability to navigate complex social issues, including working with people experiencing homelessness who face stigma, discrimination, and systemic exclusion.
- Frequent concentration is required during patient assessment, care provision, and meetings.
- Knowledge of Core20PLUS5, an improvement approach designed to reduce health inequalities at both national and system levels.
- Understanding of local homeless services.
- Working knowledge of relevant legislation.
- Working knowledge of the benefit system and how it relates to the client group.
- Understanding of local and national homeless strategies.
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.
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