At UHBW we are creating two new Transfer of Care Hubs which will form the Home First Team to support our patients with discharge planning from admission through to leaving hospital and into the community; one Hub will be on the Bristol Site and one at Weston General Hospital. The Transfer of Care Hubs will bring together our community partners (Sirona), Local Authorities and Voluntary Sector colleagues across BNSSG to create a new team from multidisciplinary backgrounds.

The Transfer of Care Hub will bring together a multidisciplinary team consisting of, Acute Trust Case Managers, and Patient Flow Coordinators, Social Workers, Local Authority Discharge Coordinators, Sirona Case Managers, Community OT’s, the Homeless Team, Voluntary Services and Flow and Discharge Coordinators.

The aim is to work collaboratively and holistically to support patients building on the  ‘Home First’ concept.

If you’re unsure, have a go at our 5 question quiz to make sure this is the right role for you!

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Staff Benefits

The Trust is delighted to offer you a wide range of flexible benefits as outlined below:

  • We understand that life is not all about work, so in return for your hard work and dedication you will benefit from 27 days annual leave (increasing on length of service) plus bank holidays.
  • Industry leading pension scheme.
  • Access to a multitude of local and national NHS Benefits and Discounts.
  • Extra authorised unpaid Annual Leave.
  • Cycle Salary Sacrifice Scheme.
  • Blue Light Card Discounts
  • Car Park Discounts.


Complex Discharge Manager

The purpose of this role is to be an adaptable, driven and proactive leader for the Integrated Discharge Service which includes a team of specialist case managers and patient flow coordinators. The IDS’ purpose is to ensure timely discharges of all patients who require more than a simple return to existing home setups.

There is significant engagement with multiple internal and external stakeholders, mentoring and coaching for the team members and involvement in various projects, with the ultimate goal of providing the best for our patients throughout UHBW

Some of the clinical responsibilities include:

  • Provide specialist knowledge and advice to multi-professional team members in relation to discharge planning.
  • Take a proactive role within the ward multi-professional meetings across the Trust and System.
  • Be aware of, and proactively manage, the needs of patients and carers within discharge planning.
  • Take a lead on planning and facilitating complex discharge at UHBW.
  • Support and lead complex discharge planning meetings / best-interest meetings for particularly complex discharges at UHBW.
  • Ensure that the Hospital Discharge and Community Support guidance is utilised and followed within IDS / HDT.
  • Ensure staff adhere to the CHC Fast track procedure where patients have an end of life prognosis
    in collaboration with the Clinical Commissioning Group
  • Provide expertise and knowledge on Patient Discharge policies, procedures and regulations.


Acute Trust Case Manager

You will report to the Band 7  Complex Discharge Manager and below are some of the purpose of the job role.

  • Use your expert knowledge to coordinate, facilitate and drive all patient discharges on the wards.
  • Be responsible for a defined caseload working with specific wards on a rota to manage complex discharges, supporting /completing initial assessments for Continuing Health Care (CHC) fast-track assessments, and referrals to Community Transfer of Care Hub (CToCH) for pathway beds
  • Liaise with the wider MDT, Clinical Commissioning Group (CCG), local authorities (LA) and CToCH to drive discharge at all levels.
  • Ensure that National policies and guidelines are adhered to and to ensure that patients and relatives are at the heart of everything we do, involving, supporting and communicating with them throughout the discharge process.
  • Line manage the Discharge Flow Coordinators.

Discharge Flow Coordinators

The Discharge and Flow Coordinator aims to guide the patient’s inpatient journey from admission to discharge, supporting patients to leave the hospital setting at the earliest opportunity with the support and care they need to remain safe in their discharge location. The Discharge and Flow Coordinator will have early conversations with patients/ families/ carers around discharge and work closely with the ward MDT to ensure that the discharge process is efficient.

By doing this, the Discharge and Flow Coordinator will ensure that patients only remain in the hospital for as long as they need to and will optimise their length of stay, making sure ‘flow’ is maintained and beds are available for patients that need them.

The Discharge and Flow Coordinator will be expected to undertake a range of practical duties without direct supervision but will be required to report back on those delegated responsibilities to the MDT ward team and the Acute Trust Case Managers (including, booking transport, prompting assessments to be undertaken, access to the patient’s property).

Top tips for a successful application form

Once you have successfully found a position you wish to apply for, you need to make sure your application does you justice and provides you with the best possible chance of getting an interview. This means reading the job description and person specification and taking time over your application demonstrating your skills and experience.

How good a match are you?

All employers will be judging how well your application matches the ‘person specification’ for the position you are applying for. The applicants who closely match the person specification will be the ones that are shortlisted for interview.

You will need to demonstrate that you do have the skills and experience as set out within the person specification and provide clear examples within the supporting information section.

Complete all the parts of the form!

Read the instructions within the advertisement and application form very carefully and make sure that you complete all the sections of the application form. The information you give in the ‘application for employment’ section will be used to decide if you should be shortlisted for interview.

The ‘personal information’ and ‘monitoring information’ sections will not be used for shortlisting, but will be kept for administrative purposes only.

Provide good supporting information.

The ‘supporting information’ section is your opportunity to sell yourself therefore make sure you use it to your advantage. You  should:

  • Include any information here that has not been covered elsewhere on the form.
  • Be clear and concise, give specific examples of how you meet the essential criteria.
  • Simple reading formats (bullet points are good, long sentences could be less impactful).
  • Demonstrate why you would be suitable and how you meet the person specification.
  • Convince the recruiter that you have the required skills, knowledge and experience.
  • Be sure to identify any employment gaps


Apply today:

Band 6 & 7 Roles 

Band 3 Roles

Please note the advert  is highly likely to close early due to the high volume of expected applications. We urge you to apply early to avoid disappointment.


Our Service Partners- Sirona Care & Health

Sirona care & health is a Community Interest Company committed to providing local communities with a range of high quality specialist health and social care . For us, it’s about the personal approach; we take pride in what we do and deliver the high standard of care that we’d expect for ourselves and our families.

The Community Transfer of Care Hub (CToCH) manage all referrals into the Discharge to Assess Pathways across BNSSG .

Following a hospital stay, the ethos across Bristol, North Somerset and South Gloucestershire (BNSSG) for all people being discharged is ‘Home is Best’, for some service users who have complex needs or need a period of further assessment this is not practicable and they transfer to a complex assessment bed which is generally in a care home.

During their stay, service users will be given support, along with their carers and families around complex discharge planning. This will enable a timely and safe discharge to the person’s usual residence or to a more suitable location if appropriate.

We actively promote a multi-disciplinary model where staff work closely with social workers, GPs as well as other Acute and Community colleagues, to ensure the people we are supporting are kept at the heart of every decision.

The services operate: 7 days per week, between 08:00 & 18:00

Our Service Partners- North Somerset Council

North Somerset Council are pleased to be part of the Transfer of Care Hub, to assist in the seven-day co-ordination of safe discharges, through a trusted integrated system wide approach. We have developed a range of innovative prevention services  to support people’s recovery through maximising independence and enabling the optimisation of their outcomes, through a personal and positive experience of discharge.

We are looking for social workers and occupational therapists to be part of our established Hospital Discharge and TEC and Reablement Intervention teams. Working in the Hospitals along with our Community Navigators and Home from Hospital services, who link people into the voluntary sector to maximise the opportunity to discharge people at the point people are ready to leave, preventing long hospital waits and deterioration in physical and mental ability. The roles are hospital based and have a pivotal role in the integrated hub with line management responsibility sitting with North Somerset Council.

Our Service Partners- Bristol City Council

Bristol City Council are please to be partners in the Transfer of care hubs, to assist in the co-ordination of safe discharges through a trusted integrated whole system approach. We have developed a range of innovative preventions services to support people’s recovery by maximising independence and enabling the optimisation of their outcome, through a personal and positive discharge from a hospital setting.

We are looking for occupational therapists and social workers to join us to be part of our established Discharge to Assess service. Working along side our hospital, community nursing and voluntary sectors we will strive to create a person centred service to maximise the opportunity to discharge people at the point they are ready to leave.

The roles are based over two hospital trusts within Bristol.