Job summary 30 hours per week. Discharge to Assess is a multi-skilled team consisting of occupational therapists, physiotherapists, nurses, social workers, community care workers and support workers. The team is based at Mount Gould hospital main site in Plymouth. Their purpose is to support a safe and timely hospital discharge of people who are medically fit and no longer need hospital care, to a place more suitable to the persons needs. Assessments and care provision can then be tailored to support people to regain strengths and skills so that they can live as independently as possible. The DTA model aims to support better outcomes for people leaving hospital by: Reducing the time people spend in hospital when they no longer need acute care, preventing hospital acquired infections and deconditioning. Assessing people in a more appropriate environment than the hospital, giving a more accurate indication of their strengths and needs. Providing multidisciplinary reablement and rehabilitation plans, and if necessary short term care and support, to help people gain and re-gain independence; preventing or reducing need for longer term care. The model also enables the urgent care system to prioritise acute hospital care for those people who need it. This role may not be eligible for sponsorship under the Skilled Worker route. Please note that Livewell may close the job advertisement earlier than the specified deadline. All staff are expected to be able and willing to work across a 7 day service. Main duties of the job The team work in partnership with individuals and families to identify their own needs and goals, recognising that person-centred care planning is key to the person accomplishing the outcomes they want to achieve. Home First is the default pathway for people leaving hospital and should be the first consideration for everyone. People who are discharged via Home First will be seen by a member of the DTA multidisciplinary team who will work with them to identify the type of care, support or rehabilitation that they need to meet the outcomes they want to achieve. The Bedded Pathway supports people who are unable to go home immediately from hospital but placed in residential or nursing care where they will be seen by a member of the DTA multidisciplinary team. The DTA team will work with the person to identify the type of care, support or rehabilitation they need to meet the outcomes they want to achieve including, wherever possible, a return home. The aim is always to support people to be as independent as possible. If however, someone is identified as having long term care needs, these will be assessed under the Care Act, and long term care and support arranged where such needs are eligible.Provision of care for these eligible needs will be subject to a financial assessment and the person will be expected to pay all or some of the costs of such care. About us Livewell Southwest is an independent, award-winning social enterprise delivering integrated health and social care services across Plymouth, South Hams, and West Devon, with specialist services in parts of Devon and Cornwall. Our teams work in community hospitals, GP practices, sports centres, and health hubs. As an organisation with a strong social conscience we are guided by our values,kindness, respect, inclusivity, ambition, responsibility, and collaboration. We focus on transforming services to ensure sustainability, while empowering staff and those we serve. We involve the people we care for, along with their families and carers, in shaping the care they receive, striving to deliver the right care at the right time and place. Centering our work on individual needs helps people lead healthy, independent lives. We prioritise employees' development, offering protected CPD time, training pathways, leadership programs, and funding for qualifications like the Care Certificate and Nurse Training Scholarships. Our induction and preceptorship programs ensure a smooth transition into our organisation. Livewell Southwest values diversity and encourages applications from all sections of the community, including those with armed forces experience, lived experience of mental health, neuro-diverse conditions and learning disabilities. If you need assistance or reasonable adjustments during the application process, contact the Recruiting Manager listed in the job advert. Date posted 27 February 2025 Pay scheme Agenda for change Band Band 6 Salary £37,338 to £44,962 a year pa, pro-rata Contract Permanent Working pattern Part-time, Job share, Flexible working Reference number B9832-2025-SOPCC-238 Job locations 200 Mount Gould Road Mount Gould Plymouth Devon PL4 7PY Job description Job responsibilities The post holder is required to discharge statutory social care functions on behalf of the organisation and to uphold the standards outlined in the Professional Capabilities Framework for Social Work. As such, they are required to undertake complex and proportionate assessments that are evidence-based. Examples include mental capacity assessments and health and social care assessments of people who have a variety of needs that may create a high level of risk to their wellbeing. The post holder is also required to arrange and review the delivery of social care support. Wherever possible the post holder is required to support people to take risks in complex situations so that their outcomes and wishes are promoted. The post holder is also required to undertake safeguarding investigations and consider decisions made in a persons best interest that may deprive them of their liberty. The post holder needs to be accountable for; Their actions or omissions. Promote and uphold the privacy, dignity, rights, health and wellbeing of people who use health and care services and their carers, at all times. Work in collaboration with colleagues to ensure the delivery of high quality, safe and compassionate healthcare, care and support. Communicate in an open and effective way to promote the health, safety and wellbeing of people who use health and care services and their carers. Strive to improve the quality of care and support through continuing professional development Uphold and promote equality, diversity and inclusion. To be legally literate with the Care Act 2014, the Mental Capacity Act 2005 and Human Rights Act 1998. To have a good understanding of the Mental Health Act 1983 and its subsequent amendments and the Children Act 1989. To have an awareness of national policy and guidelines and how these should be used in practice. Preparing legal documents for court and representing the organisation in a court setting. DEPARTMENTAL POSITION The post holder will be accountable to their line manager, who in turn will be accountable to the service or locality manager. The post holder will be employed in the Adult Social Care service. 4. SCOPE AND RANGE Social workers primarily work with people in complex situations. Complex is defined as - unpredictable or ambiguous situations where the person may be resistant, coerced or a significant risk to self and others. These situations are often time-consuming owing to the multiple factors that have led the person to becoming socially excluded. Decisions require proportionality and analysis of many different views and factors, such as psychological, biological, legal, environmental and economical. Livewell Southwest is fully committed to an integrated health and social care workforce which operates a shared skills model, whilst adhering to the core principles of the social work profession. MAIN DUTIES/RESPONSIBILITIES Responsibility for People Management Supervise and or train students and colleagues as and when required to ensure their practice is safe and professional. Provide supervision on a 1:1 basis or through peer supervision as and when required to ensure practice is safe and professional. Support the delivery of induction training for new staff within the service as and when required to ensure practice is safe and professional. Responsibility for financial and or physical resources Responsibility for the occasional short-term security of a persons cash, legal documentation or valuable items e.g. house keys until they can be securely deposited. Duty to consider best value option when planning for peoples care and support.Responsibility for administration Plan and organise day-to-day work using an online calendar, recording systems, and workload management tools that are available on the intranet in accordance with departmental guidelines. Ensure records are timely, kept up-to-date, accurate and used in accordance with the GDPR and organisational guidelines. Have a good understanding of the various computer programmes essential for the completion of daily work, such as Microsoft office. Arrange and plan meetings with colleagues and or people who use services and be willing to chair them if required. Responsibility for people who use our services Maintain contact with people who use our services either face-to-face, telephone or assistive technology such as video links and conference calls. Design, implement and review care and support plans, which may involve the input of other professionals and disciplines. Work to a number of protocols and procedures such as lone working, risk management and health and safety. Complete carers assessments and seek feedback from people who use the service. Learning some basic clinical skills to enable the undertaking of holistic assessments and liaison with the multi-disciplinary team. Take an asset-based approach, including signposting to universal services, advice and information and considering the persons links and integration with their community and services such as advocacy. Duty of candour and supporting people to make complaints if they wish too. Increased level of responsibility and autonomy in relation to analysing and making professional judgements, informed by practice experience and underpinned by theory and best practice guidance. Ability to work independently, utilising knowledge and skills with regular support from management, work is managed rather than supervised. Ability to act following broad policies and regulations, working within guidelines and protocols, utilising monthly supervision. Responsibility for implementation of policy and or service developments Contribute ideas and advocate on behalf of the people who use our service towards the development and implementation of policies and or services. Work in other teams and across the organisation in order to support organisational demands and pressures. Represent the team organisation on planning or developmental groups as and when required. A flexible and adaptable approach to organisational change. Other Responsibilities Correct use of computer hardware and software, security, processing and generating information; creating, updating and maintaining information databases. Awareness of current social care research trends and to take part in development activities, such as Safeguarding Adult Reviews. COMMUNICATIONS AND RELATIONSHIPS Maintain positive working relationships and communicate clearly with team colleagues, line manager, other professionals, people who use our service and their families or carers which may include highly sensitive issues. Listen to and work in partnership with the people who use our services and families and carers. Maintain professional conduct and communicate clearly when faced with competing demands and in situations that are potentially highly emotive, such as being challenged by families or other professionals. Present evidence-based decisions and judgements about potentially complex and ambiguous situations in a manner fit for the audience. This includes writing court reports, explaining legal requirements to people and their families and projecting social work values in a multi-disciplinary setting. PHYSICAL DEMANDS OF THE JOB Travel between different offices to attend meetings. Visit people at home, community setting, hospital, care home or prison. Visiting people in their own homes may be prejudicial to health and wellbeing. Some visits may be out of county and on occasion may require an overnight stay. Protective equipment may be required such as gloves and facemask in certain settings. Sitting at a computer either in office or remote working. Take pro-active steps to maintain self-care and resilience. Job description Job responsibilities The post holder is required to discharge statutory social care functions on behalf of the organisation and to uphold the standards outlined in the Professional Capabilities Framework for Social Work. As such, they are required to undertake complex and proportionate assessments that are evidence-based. Examples include mental capacity assessments and health and social care assessments of people who have a variety of needs that may create a high level of risk to their wellbeing. The post holder is also required to arrange and review the delivery of social care support. Wherever possible the post holder is required to support people to take risks in complex situations so that their outcomes and wishes are promoted. The post holder is also required to undertake safeguarding investigations and consider decisions made in a persons best interest that may deprive them of their liberty. The post holder needs to be accountable for; Their actions or omissions. Promote and uphold the privacy, dignity, rights, health and wellbeing of people who use health and care services and their carers, at all times. Work in collaboration with colleagues to ensure the delivery of high quality, safe and compassionate healthcare, care and support. Communicate in an open and effective way to promote the health, safety and wellbeing of people who use health and care services and their carers. Strive to improve the quality of care and support through continuing professional development Uphold and promote equality, diversity and inclusion. To be legally literate with the Care Act 2014, the Mental Capacity Act 2005 and Human Rights Act 1998. To have a good understanding of the Mental Health Act 1983 and its subsequent amendments and the Children Act 1989. To have an awareness of national policy and guidelines and how these should be used in practice. Preparing legal documents for court and representing the organisation in a court setting. DEPARTMENTAL POSITION The post holder will be accountable to their line manager, who in turn will be accountable to the service or locality manager. The post holder will be employed in the Adult Social Care service. 4. SCOPE AND RANGE Social workers primarily work with people in complex situations. Complex is defined as - unpredictable or ambiguous situations where the person may be resistant, coerced or a significant risk to self and others. These situations are often time-consuming owing to the multiple factors that have led the person to becoming socially excluded. Decisions require proportionality and analysis of many different views and factors, such as psychological, biological, legal, environmental and economical. Livewell Southwest is fully committed to an integrated health and social care workforce which operates a shared skills model, whilst adhering to the core principles of the social work profession. MAIN DUTIES/RESPONSIBILITIES Responsibility for People Management Supervise and or train students and colleagues as and when required to ensure their practice is safe and professional. Provide supervision on a 1:1 basis or through peer supervision as and when required to ensure practice is safe and professional. Support the delivery of induction training for new staff within the service as and when required to ensure practice is safe and professional. Responsibility for financial and or physical resources Responsibility for the occasional short-term security of a persons cash, legal documentation or valuable items e.g. house keys until they can be securely deposited. Duty to consider best value option when planning for peoples care and support.Responsibility for administration Plan and organise day-to-day work using an online calendar, recording systems, and workload management tools that are available on the intranet in accordance with departmental guidelines. Ensure records are timely, kept up-to-date, accurate and used in accordance with the GDPR and organisational guidelines. Have a good understanding of the various computer programmes essential for the completion of daily work, such as Microsoft office. Arrange and plan meetings with colleagues and or people who use services and be willing to chair them if required. Responsibility for people who use our services Maintain contact with people who use our services either face-to-face, telephone or assistive technology such as video links and conference calls. Design, implement and review care and support plans, which may involve the input of other professionals and disciplines. Work to a number of protocols and procedures such as lone working, risk management and health and safety. Complete carers assessments and seek feedback from people who use the service. Learning some basic clinical skills to enable the undertaking of holistic assessments and liaison with the multi-disciplinary team. Take an asset-based approach, including signposting to universal services, advice and information and considering the persons links and integration with their community and services such as advocacy. Duty of candour and supporting people to make complaints if they wish too. Increased level of responsibility and autonomy in relation to analysing and making professional judgements, informed by practice experience and underpinned by theory and best practice guidance. Ability to work independently, utilising knowledge and skills with regular support from management, work is managed rather than supervised. Ability to act following broad policies and regulations, working within guidelines and protocols, utilising monthly supervision. Responsibility for implementation of policy and or service developments Contribute ideas and advocate on behalf of the people who use our service towards the development and implementation of policies and or services. Work in other teams and across the organisation in order to support organisational demands and pressures. Represent the team organisation on planning or developmental groups as and when required. A flexible and adaptable approach to organisational change. Other Responsibilities Correct use of computer hardware and software, security, processing and generating information; creating, updating and maintaining information databases. Awareness of current social care research trends and to take part in development activities, such as Safeguarding Adult Reviews. COMMUNICATIONS AND RELATIONSHIPS Maintain positive working relationships and communicate clearly with team colleagues, line manager, other professionals, people who use our service and their families or carers which may include highly sensitive issues. Listen to and work in partnership with the people who use our services and families and carers. Maintain professional conduct and communicate clearly when faced with competing demands and in situations that are potentially highly emotive, such as being challenged by families or other professionals. Present evidence-based decisions and judgements about potentially complex and ambiguous situations in a manner fit for the audience. This includes writing court reports, explaining legal requirements to people and their families and projecting social work values in a multi-disciplinary setting. PHYSICAL DEMANDS OF THE JOB Travel between different offices to attend meetings. Visit people at home, community setting, hospital, care home or prison. Visiting people in their own homes may be prejudicial to health and wellbeing. Some visits may be out of county and on occasion may require an overnight stay. Protective equipment may be required such as gloves and facemask in certain settings. Sitting at a computer either in office or remote working. Take pro-active steps to maintain self-care and resilience. Person Specification Experience Essential Post Qualifying Award Experience and knowledge in line with national standards and guidance Ongoing training and evidence of continuous professional development Relevant policies and procedures of the Department and Livewell South West Relevant legislation; e.g. The Care Act 2014, Health and Social care act 2012 and the Mental capacity Act 2005, Data Protection, Equal Opportunities, Freedom of Information Act, Disability Discrimination Act, The Human Rights Act 1998 Resources in order to provide advice and information to enable vulnerable adults and carers to make informed choices, e.g. Allowances, access to support advice and information Safeguarding for vulnerable adults and children and young people Working knowledge and experience of working to address a range of human needs, including personal crisis, disability, ill health Awareness of the potential effects of providing regular and substantial unpaid care to a relative, friend or neighbour Practical and procedural knowledge for a range of tasks related to the service area, of the policies or procedures relating to Continuing NHS Healthcare eligibility and interfaces Personal Budgets and Support planning, policies, and standards Multi-disciplinary and partnership working Specialist equipment/Manual Handling Risk Management Qualifications Essential Degree or equivalent in Social Work e.g. DipSW, CQSW, CSS Professional knowledge gained through degree in social work underpinned by theory and through relevant practice experience. Evidence of Continuous Professional Development by producing documentation to meet the Standards of Proficiency for Social Worker registration Registration with Social Work England as a social worker Desirable Experience of working within an Adult Safeguarding team or service. Significant experience of working as a Social Worker. Person Specification Experience Essential Post Qualifying Award Experience and knowledge in line with national standards and guidance Ongoing training and evidence of continuous professional development Relevant policies and procedures of the Department and Livewell South West Relevant legislation; e.g. The Care Act 2014, Health and Social care act 2012 and the Mental capacity Act 2005, Data Protection, Equal Opportunities, Freedom of Information Act, Disability Discrimination Act, The Human Rights Act 1998 Resources in order to provide advice and information to enable vulnerable adults and carers to make informed choices, e.g. Allowances, access to support advice and information Safeguarding for vulnerable adults and children and young people Working knowledge and experience of working to address a range of human needs, including personal crisis, disability, ill health Awareness of the potential effects of providing regular and substantial unpaid care to a relative, friend or neighbour Practical and procedural knowledge for a range of tasks related to the service area, of the policies or procedures relating to Continuing NHS Healthcare eligibility and interfaces Personal Budgets and Support planning, policies, and standards Multi-disciplinary and partnership working Specialist equipment/Manual Handling Risk Management Qualifications Essential Degree or equivalent in Social Work e.g. DipSW, CQSW, CSS Professional knowledge gained through degree in social work underpinned by theory and through relevant practice experience. Evidence of Continuous Professional Development by producing documentation to meet the Standards of Proficiency for Social Worker registration Registration with Social Work England as a social worker Desirable Experience of working within an Adult Safeguarding team or service. Significant experience of working as a Social Worker. 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. Certificate of Sponsorship Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab). From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab). UK Registration Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window). Additional information 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. Certificate of Sponsorship Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab). From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab). UK Registration Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window). Employer details Employer name Livewell Southwest Address 200 Mount Gould Road Mount Gould Plymouth Devon PL4 7PY Employer's website https://www.livewellsouthwest.co.uk/ (Opens in a new tab)