As part of an integrated Capacity and Discharge Team to work in partnership with social services and external stake holders, patients and their carers to proactively support and facilitate timely and safe discharge from hospital to home or onward care settings. To provide a single point of contact on a named ward for patients, families, carers and associated people and co-ordinate/contribute to the safe and timely hospital discharge in partnership with other multi-disciplinary colleagues. Maintain momentum of discharge planning throughout the entire process; supporting and working in partnership with other members of the MDT; doctors, nurses , occupational therapists , physiotherapists and other Hospital Assessment and Discharge Team members and constructively challenging where appropriate decisions with regards to discharge planning. To screen all patients on admission and identify those who will require further social care assessment and input; complete the appropriate referral documentation and/or input directly to the relevant IT system to activate a referral or re-referral

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