Macmillan Hospital and Community Link Worker / Macmillan Social Prescriber

Hospital and Community Navigation Service

This role is Home based but it requires travel throughout Hertfordshire, including home visits and supporting local hospitals. Salary listed is yearly salary, so for 6 months it is £13,527.50

The Macmillan Social Prescriber service is a new service that will form part of the Hospital and Community Navigation Service.

Around 6350 people in Hertfordshire are diagnosed with cancer each year. In 2020/2021 40,717 people were recorded as living with and beyond a cancer diagnosis in Hertfordshire with a value of 3.2% of the population. The incidence rates for all cancers are projected to rise by 2% in the UK between 2014 and 2035 (CRUK). This equates to a predicted value in Hertfordshire in 2035 of 4.4% and potentially 55,986 people living with or beyond a cancer diagnosis.

The National Cancer Patient Experience Survey (2021) shows that across Hertfordshire only 44% of patients felt that they ‘definitely got enough care and support at home from community or voluntary services during treatment’, which is significantly lower than the national average rating of 51%. The Hospital & Community Navigation Service (HCNS) is an established care navigation and social prescribing service in Hertfordshire. In 2021 488 people with cancer had contact with the service and help with shopping was the most likely reason for referral.

Delivering within this service is a new, innovative Macmillan social prescribing model, the outcomes of this service are as follows:

1. Improving the experience of people diagnosed with cancer particularly for people with the highest levels of social deprivation
2. Reducing hospital admissions
3. Reducing GP visits
4. Reducing reliance on home care providers
5. Reducing social isolation
6. Improving health and wellbeing.

Main purpose of the post:

• Provide the delivery of the Macmillan Hospital and Community Navigation Service
• Directly contact and with consent, carry out Holistic Needs Assessment (HNA) and care navigation for people referred to the service or people identified by the secondary care provider organisations as diagnosed with cancer and living in an area identified as most deprived (through list generation)
• Provide proactive support and information for patients from diagnosis and beyond
• Promote collaborative working across all care providers aimed at facilitating a consistent offer of support for people with cancer
• Raise the profile social prescribing and strive to embed the offer for people diagnosed with cancer with both primary and secondary care providers aiming to bridge the gap between health care and social care with a personalised approach.
• Raise awareness of the need of cancer patients and support available both nationally (Macmillan Support Line, Macmillan information services, Macmillan digital services) and locally for other social prescribers working within the Herts Help organisation
• A clear need to increase awareness of Herts Help in the acute trusts and improve collaboration between Herts Help and secondary care providers.
• To embed social prescribing into the patient pathway.
• Work as full member of the locality team, supporting people who are perceived to have some kind of risk (for example isolation, not understanding or managing their condition or situation) and making sure they have any advice and help needed to access appropriate support.
• Work as a full member of the team to support people being discharged from Hospital and reduce the likelihood of readmission by helping them to regain and retain independent living. As well as finding and accessing further support.
• Deliver the service alongside a network of volunteers and local providers across Hertfordshire.

• Activate and link existing resources in the community to meet the needs of the service user; where this is not possible highlight areas of unmet need.
• Target groups/communities which are evidenced as having worse health and wellbeing outcomes and being less able to use advice which will improve their health to make use of services

Principal responsibilities

1. Service Delivery

• Work with the Secondary Care cancer teams, mental health and social care professionals as part of an integrated ‘Cancer Team’ bridging the patient pathway between care providers.
• Work with community-based health and social care providers such as GP surgeries, HomeFirst teams and adult care services to assist individuals who are in need of additional help, support and guidance (outside of statutory services) to ensure problems and issues do not worsen and lead to ‘crisis’.
• Contact prospective service users, either in hospital, immediately after discharge or within the community to ascertain their needs and preferences, via a service user assessment, using appropriate guidance and paperwork and training.
• Ensure that clients and service users develop sustainable relationships with organisations and services that can help service users to live well and avoid crisis.
• Provide emotional and practical support and advice where needed following a service user assessment.

• This may include the following:

o Provide transport to service user’s home by car on discharge from hospital wards, A&E departments & community hospitals.

o Carry out essential shopping or collecting prescriptions.

o Provide on-going assessment and support planning for service users’ needs, to provide appropriate support and achieve positive outcomes.

o Carry out follow-up welfare checks and visits as required and assist service users with their activities to re-enable their daily living skills (within a set time criteria).

o Assess the service users living environment through carrying out a risk assessment and providing information/advice whilst respecting their individual dignity, choice and rights.

o Provide support and information to clients and service users so that they can build sustainable relationships with, groups and activities which help build resilience and independence.

o Record and report activities undertaken and highlight any changes in a service user’s condition or circumstance and ensure that appropriate actions are taken to support the person.

o Liaise with social care, health, housing and other professionals to ensure that the needs of the individual are consistently met.

o Support brokers and individuals to spend direct payments/personal budgets/own resources where this is appropriate on services people want from the community.

o Become the ‘go to’ person for both statutory and voluntary sectors when no obvious solution for a particular individual can be identified

2. Quality and performance

• Deliver great outcomes for individuals and the service and is accountable.
• To make clear, goal-oriented ‘plans’ with service users to support short, medium and longer term support. Helping people access existing services and longer term support from the voluntary sector within Hertfordshire.
• Comply with Health & Safety policies including, but not limited to, those on lone working, manual handling and infection control.
• Accurately record, collate and produce qualitative and quantitative data required to demonstrate outcomes.
• Ensure service users’ health and wellbeing is preserved and safeguarding policies and procedures are followed at all times.
• Effective administrative skills and a good standard of IT skills including MS Office, the internet and appropriate software.
• Desirable, but not essential, to have experience of using client management systems or databases i.e. Clear 2 system, Charity Log, Salesforce etc.…

3. Team Working

• Work within local health and social care teams (such as Multi-Disciplinary Teams, Multi-Specialist Teams, Community Hospitals, GP Surgeries and hospital cancer teams), encouraging appropriate referrals to the scheme, promoting the scheme, challenging poor practice and promoting the voluntary sector.
• Promote and map key partnerships with the District and Borough Councils, Housing Associations, local Voluntary Organisations and Forums to ensure that the project is effectively used and understood and gaps in service provision are discussed and solutions identified.
• Work with colleagues to ensure that health and safety legislation and risk assessments are understood and implemented and that staff and volunteer safety is secured.
• Adhere to policies and procedures regarding data protection and confidentiality.
• To undertake training as required and be prepared to travel throughout appropriate area’s to attend any relevant meetings.
• Undertake any other relevant duties that may be required by the management teams or wider service leads.
• Willingness to work flexibly around the needs of the service (for example evenings and weekends).

4. Personal Effectiveness

• Demonstrates a passion for delivering agreed outcomes
• An interest and basic understanding of the specific needs of people with a cancer diagnosis, although training will be provided.
• Works well under pressure
• Self motivated and able to carry out tasks with minimal supervision
• Strong team player and able to work effectively as part of a locality, area and Countywide team.
• Flexible, innovative and adaptable and has a ‘can do’ approach and attitude.
• Good understanding of the voluntary and statutory sector and ideally the specific locality area.
• Skilled at using user feedback to demonstrate outcomes and improve services.
• Demonstrates personal accountability.
• Works confidently with service users, partners and stakeholders to find effective solutions.

Additional Information

Disclosure and Barring Service Check: An enhanced DBS disclosure will be required for this post.

Confidentiality: Attention is drawn to the confidential aspects of this job and personable responsibility and liability under the Data Protection Act 1998.

Health & Safety: The post holder is required to take reasonable care of their own health and safety and that of other people who may be affected by their acts or omissions at work and to ensure that statutory regulations, service policies, codes of practice and safety rules are adhered to.

Equality and Diversity Policy Statement: We believe that equality for all is a basic human right and actively oppose all forms of unlawful and unfair discrimination. We celebrate the diversity of society and are striving to promote and reflect that diversity within this service.

Staff may not unreasonably refuse a request to undertake any task which is appropriate to their level for which they have the necessary skills and / or experience. Any resulting change to their objectives and priorities will be discussed and confirmed with their line manager.

Appointment to this position is subject to satisfactory references.