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Job description

J O B V A C A N C Y

Community Integrated Teams (CIT) Living Well Link Worker

Permanent Contract

35 hours per week, £22,750 per annum

The purpose of the CIT Living Well Link Service is to put older people in personal control of their health & wellbeing and provide them with integrated care and support in their local community, focusing on prevention of ill health and the promotion of wellbeing.

The CIT Living Well Link Service aims to enable older people to have improved health outcomes and independence whilst reducing the burden on NHS services in Sunderland through the reduction in need for GP visits, out of hours contacts, and emergency admissions/readmissions.

The successful applicant will be responsible for the delivery of the CIT Living Well Links Programme across the City of Sunderland. A good standard of education is required at NVQ level 3 level preferably in Health & Social Care. The post holder must drive and have access to their own vehicle for work.

Job Description

Post: CIT Living Well Link Worker

Contract Type: Permanent

Hours: 5 days (35 hours) per week.

Salary/benefits: £22,750 pa inclusive; access to pension scheme

Location: Across Sunderland with an HQ at Bradbury Centre, Stockton Road

Responsible to: CIT Living Well Link Manager

Accountable to: Age UK Sunderland

Key working Relationships:

• Statutory and Community based providers
• Integrated Care Teams
• Older people
• Carers and Carer Organisations
• Other clinical and non-traditional provider groups as required

Background:

Integrated care is a way of better coordinating care for older people with one or more long term conditions. Integrated care in Sunderland is defined as collaborative working between key stakeholders, including GPs, health and social care and voluntary organisations, to integrate and organise patient care more effectively.

The purpose of the Living Well Link Service is to put older people in personal control of their health & wellbeing and provide them with integrated care and support in their local community, focusing on prevention of ill health and the promotion of wellbeing.

The Living Well Link Service will enable older people to have improved health outcomes and independence whilst reducing the burden on NHS services in Sunderland through the reduction in need for GP visits, Out of Hours Contacts, emergency admissions/readmissions etc.

Purpose of the post:

The post provides an interface between voluntary sector provider organisations and service users, health and social care multi-disciplinary teams (MDT) and other statutory bodies. The Living Well Link Worker will support individuals to self-manage their needs. The post holder will work in a designated Sunderland locality visiting older people in their homes as well as other community settings. Many older people will have complex health needs and the service will focus on practical support to encourage the utilisation of services within the local communities. This may include:

• Assisted signposting to services in the community which help maintain older people’s health & wellbeing such as leisure & learning, social groups etc.
• One to One Support to help with issues such as arranging for support to access appointments, travel, access to community care assessments (or carers assessments), where appropriate advise on main choices regarding personal budgets and helping with domestic support etc.
• Social Contact to establish support from befriending services for those in social isolation or risk of and make referrals to a group to a group of Age UK Sunderland volunteers to maximise capacity for delivering support
• Interim support to help support the older person whilst other support is put in place such as a visit from a volunteer befriender

The post holder will also identify unpaid carers and enable access to appropriate services.

Key Responsibilities

The post holder will be an excellent communicator and develop a wide knowledge of the services offered by non-traditional providers. The post holder will require strong organisational skills, must be flexible in approach, able to exercise initiative and demonstrate a consistently high standard of professionalism, being aware of the need for confidentiality and integrity.

Tasks:

• Liaison with Community Integrated Locality Teams
• Assessments & home visits
• GP & professional liaison
• Patient information gathering & analysis to provide a holistic plan of support (social, financial, health & wellbeing etc.)
• In depth knowledge gathering on available services (community & statutory), multidisciplinary services etc.
• Publicity & promotion of offering
• Record keeping, monitoring & evaluation
• Identification of step up care and safeguarding
• Identification of gaps in services to inform future development Key skills Integrated Care Coordination
• Signposting older people to the multitude of support services that are available through voluntary and statutory providers tailored to the person’s specific needs
• Be the point of liaison for service users and carers principally with voluntary sector providers as well as useful commercial services, and liaising with other statutory professionals involved in patient’s care
• Delivering case work to support older people to reach specific goals in accordance with KPIs
• Promote the independence & empowerment of older people
• Build strong relationships with partners and providers
• Deal in a professional, helpful & sensitive manner with older people, staff, carers & other agencies.

Information and Data Coordination

• To be proficient in using Microsoft office packages and other identified IT systems and support other team members in their use
• To record relevant patient documentation on identified IT systems as required
• Facility for learning new software packages which may be in continued development
• Maintain Excel, Charity Log and other databases to input patients’ engagement
• Support completion of patient referrals, record electronically and feedback to team members
• Extract caseload information from the patient database as required, and undertake analysis of caseload information for audit and performance management purposes, including running reports and converting data into charts and tables for sharing with the team
• Input data onto the patient information management systems to update patient details, and periodically use reports to ensure patient details are correct
• Be responsible for updating the electronic service directory on a regular basis, sourcing referral criteria and ensuring these are accessible to all relevant parties Patient Support
• Ensure older people’s requirements are managed smoothly with no fragmentation in service delivery.
• Ensure appropriate actions from Multi-Disciplinary Team (MDT)/Integrated team meetings are completed in a timely fashion.
• Communicate with members of the MDT/Integrated teams as required.
• Communicate effectively with older people and their families/carers, other staff both internal and external and members of the public.

General

• The post holder must at all times carry out duties and responsibilities with due regard to the organisations’ equal opportunity policies and procedures.
• The post holder must 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.
• The post holder will be expected to take responsibility for self-development on a continuous basis, undertaking on-the-job training as required.
• The post holder must be aware of individual responsibilities under the Health and Safety at Work Act, and identify and report as necessary any untoward accident incident or potentially hazardous environment.
• The post holder will ensure they accurately represent Age UK Sunderland and ensure the values of Age UK Sunderland are upheld at all times in carrying out their work
• The post holder must work in general accordance with the organisation’s policies and guidelines at all times. The post holder must adhere to the organisation’s information governance policy at all times, in particular ensuring that there is no breach of confidentiality as a result of his/her actions.

This job description is intended as a guide to the main responsibilities of the post and not as an exhaustive list of duties and tasks. The post holder may be required to undertake other duties appropriate to his/her grade, which are not listed above, at the direction of his/her manager. The job description may be amended from time to time after consultation with the post holder.

This post is subject to a Disclosure & Barring Service (DBS) Enhanced check.

Person Specification

Post: CIT Living Well Link Worker

Location: City wide with an HQ at the Bradbury Centre, Stockton Road

Responsible to: CIT Living Well Link Manager

Essential Criteria

• NVQ Level 3 in health, social care or equivalent
• At least 2 years’ experience in health/social care or information & advice or work in direct contact with people, families & carers (paid or voluntary capacity)
• IT competence and experience of Microsoft packages and admin skills
• Proven record of written and verbal communication skills
• Able to deal sensitively with patients
• Able to work as part of a team
• Able to prioritise and manage own workload
• Analytical skills and be able to interpret information and data and present it in a clear concise manner
• Good people skills with a friendly approachable style and ability to generate trust and form positive relationships
• A good listener
• Flexible & responsive to changing needs of clients
• Ability to communicate and extract information sensitively & tactfully
• Creative approach to problem solving
• Tactful and diplomatic, able to build a rapport with people from a wide range of backgrounds
• Experience in use of databases
• Experience of working in a voluntary, NHS or social care setting delivering services to vulnerable people
• Experience of risk assessment & risk management
• Knowledge of voluntary care organisations (preferably within the Sunderland area)
• Understanding of patient confidentiality
• Understanding of health and social care processes
• Understanding of the complexity of older people’s lives & the barriers they face
• Understanding of safeguarding responsibilities
• Knowledge of the range of voluntary, statutory and private sector orgs/services working with older people
• Understanding of welfare benefits available to older people
• Knowledge of GDPR
• Willingness to undergo further training or development
• To abide by and implement all policies and procedures of Age UK Sunderland, including being aware of and responsible corporately and as an individual for Health and Safety policy.
• Possess a full clean driving licence and have access to a car for work

Desirable

• Experience in motivational interviewing
• Experience of person centred planning

This post is subject to DBS Enhanced Disclosures

To request an application pack you can email or download one directly from our website www.ageuksunderland.org.uk. Alternatively send a large SAE for 93p to Age UK Sunderland, Bradbury Centre, Stockton Rd, Sunderland. SR2 7AQ. Tel: 0191 5141131. CV’s are not accepted for this role.

Closing date: Thursday 13th July 2023

Interview date: Thursday 20th July 2023

Job Types: Full-time, Permanent

Salary: £22,750.00 per year

Day range:

• Monday to Friday

Work Location: In person

Application deadline: 13/07/2023