Integrated Transfer of Care Lead

Job description

Job summary

Great Yarmouth and Waveney Locality - Hosted by ECCH, on behalf of JPUH, NCC, SCC and N&S ICB

Are you an experienced system leader who thrives in fast-paced, multi-agency environments? Do you bring the operational credibility, strategic grip and collaborative mindset needed to improve flow, strengthen discharge pathways and champion a Home First approach? if so, we would love to hear from you.

About this Role - The Integrated Transfer of Care (ITOC) Lead provides visible, senior operational leadership across acute, community, social care and VCSE partners. You will lead the ITOC hub as a single integrated function, ensuring consistent processes, shared priorities and a unified approach to discharge flow and admission avoidance.

Drawing on real-time intelligence, frontline insights and strong cross-organisational relationships, you will coordinate partners to activate community pathways, prevent unnecessary admissions and support timely, safe discharge home. You will act as the consistent point of escalation for the locality - unblocking delays, resolving operational pressures and aligning decision-making across organisational boundaries.

This is an integrated post, funded by five organisations offering a unique opportunity to influence system-wide improvements whilst maintaining strong operational presence within acute and community settings.

Main duties of the job

Key responsibilities

• Provide visible, senior operational leadership for discharge flow and community coordination across all partners
• Lead the ITOC hub as one integrated service, ensuring shared priorities and consistent standards
• Maintain a strong on-site presence across acute and community settings to support real-time problem solving
• Act as second-line escalation for complex discharges, working with senior managers across organisations
• Coordinate cross-system responses to operational pressures, including during critical incidents
• Use data, dashboards and intelligence to identify trends, variations and bottlenecks, driving improvements
• Lead targeted transformation to strengthen Home First pathways and reduce delays
• Support workforce leadership, culture and well-being across the integrated hub
• Ensure compliance with national discharge guidance and contribute to system-wide planning and assurance

Why this role matters - this is a pivotal leadership role at the heart of system flow. You will shape how partners work together, influence culture and practice across organisations, and directly improve the experience of people, families and carers.

If you are motivated by collaborative working, operational excellence and meaningful system impact, this role offers a rare opportunity to make a difference.

The post holder will be required to work across sites to ensure a operational presence between the acute and community.

About us

ECCH is well established health care provider and has been successfully delivering NHS care within the community since 2011. We provide a range of NHS, community health and social care services predominantly across the easterly region of the Norfolk/Suffolk borders.

We are aligned to NHS terms and conditions, and offer many employee benefits, to find out more about us visit our website - www.ecch.org. We are a social enterprise and staff owned organisation which means staff can opt to be shareholders and have a real say in how ECCH is run and evolves to deliver healthcare for the future.

At the heart of our ambition, we work in partnership with and for the community to become the provider and employer of choice for community healthcare.

Job description

Job responsibilities

Operational Leadership & Daily Management

• Provide visible, senior operational leadership for the Integrated Transfer of Care (ITOC) function across acute, community, social care and VCSE partners.
• Lead the ITOC hub as one integrated service, ensuring consistent processes, shared priorities and a unified approach to discharge and flow.
• Act as the daily operational lead, coordinating actions, responding to pressures and ensuring timely decision making across all discharge pathways including admission avoidance at the front door.
• Maintain a strong on site presence within acute and community settings to support real time problem solving and unblock delays.
• Serve as second line escalation above team managers for discharge issues, working directly with senior managers across all organisations and escalating where appropriate.
• Provide expert oversight of complex and delayed discharges, ensuring risks are identified early and escalated appropriately.
• Ensure discharge processes are aligned with the needs of the GYW Locality, local population characteristics and neighbourhood models.

Integrated System Coordination

• Strengthen integration by aligning the four ITOC teams into a single coherent hub, removing operational silos and promoting shared accountability.
• Ensure the ITOC service is fully accessible to all partner organisations, supporting consistent decision making and shared ownership of flow.
• Coordinate cross organisational responses to operational pressures, ensuring partners work collectively to maintain safe and timely flow.
• Represent the locality at system operational meetings as required and, during critical incidents, providing clear updates, risks and actions relating to discharge.
• Hold and communicate shared priorities across all five partner organisations, ensuring alignment with national and local requirements.

Data, Insight & Performance Management

• Maintain transparent, real time oversight of community capacity, bed availability and flow, enabling proactive planning and escalation.
• Use dashboards, intelligence and performance data to identify trends, variation and bottlenecks, supporting partners to act on insight.
• Analyse data from including complaints and patient/carer feedback to drive improvement.
• Produce high quality reports, briefings and performance summaries for senior leaders and system partners.
• Lead the development of seasonal workforce and capacity plans, including drafting assurance documents for the ICB and other partners.

Improvement, Transformation & Pathway Redesign

• Lead targeted transformation work to improve discharge pathways, reduce delays and strengthen the home hirst model.
• Identify where processes are not working and coordinate multi agency improvements, ensuring actions are delivered and embedded.
• Facilitate a continuous learning environment, embedding learning cycles, reflective practice and shared governance across the ITOC function.
• Support redesign of pathways between acute and community settings, ensuring alignment with neighbourhood and INT developments.
• Promote a culture of action focused problem solving, not just advisory oversight, enabling teams to resolve issues quickly and consistently.

Workforce Leadership & Culture

• Provide day to day leadership for staff within the ITOC hub, ensuring a supportive, collaborative and high performing culture.
• Ensure staff are equipped with the skills, tools and information required to deliver safe and effective discharge processes.
• Support workforce planning, development and wellbeing, including preparation for seasonal demand and surge periods.
• Promote cross organisational working, shared learning and consistent standards across all teams within the integrated hub.

Governance, Risk & Assurance

• Identify risks and issues early, ensuring mitigating actions are agreed, monitored and escalated where required.
• Ensure compliance with national discharge guidance, local policies and system wide governance frameworks.
• Contribute to system wide planning, commissioning and performance discussions, providing local intelligence and operational insight.
• Support partners to deliver safe, person centred discharge processes that improve patient, family and carer experience.

Staff Management

• Responsible for the day-to-day range of staff management matters, which will include responsibility for supporting appraisals, development of staff, recruitment and where necessary processes such as grievance and disciplinary matters.
• Responsible for an individual's development on the job and job performance management. Work in conjunction with line managers and other job managers to assess and manage confidential information about an individual's performance and capability development.

Mandatory Responsibilities

Appraisal

The post holder will be expected to participate in an annual appraisal of their work where the job description will be reviewed and objectives set. In line with the annual personal development plan the post holder will be expected to undertake any training or development required to fulfil their role.

Mobility

Employees may be required to work at any of the other sites within the organisation subject to consultation. The organisation is in a period of rapid change due to developments and rationalisation of services. This will lead to modification of structures and job descriptions. The post holder will be expected to co-operate with changes subject to consultation, at any time throughout the duration of your contract.

Data Use and Quality

All staff employed by the organisation or an external agency, working in the NHS are bound by a legal duty of confidence to protect and input personal information accurately, securely, efficiently and effectively, in order to deliver the best possible care.

• All roles within East Coast Community Healthcare CIC (ECCH) require staff to demonstrate our Values and Signature Behaviours in the care and service they provide to patients, service users, stakeholders and colleagues. All members of staff should consider these as an essential part of their job role.
• Our Values outline the core behaviours that we can all achieve and are summarised as an acronym within the word 'CARE'. These stand for: Compassion, Action, Respect and Everyone.
• Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together.

Job description
Job responsibilities

Operational Leadership & Daily Management

• Provide visible, senior operational leadership for the Integrated Transfer of Care (ITOC) function across acute, community, social care and VCSE partners.
• Lead the ITOC hub as one integrated service, ensuring consistent processes, shared priorities and a unified approach to discharge and flow.
• Act as the daily operational lead, coordinating actions, responding to pressures and ensuring timely decision making across all discharge pathways including admission avoidance at the front door.
• Maintain a strong on site presence within acute and community settings to support real time problem solving and unblock delays.
• Serve as second line escalation above team managers for discharge issues, working directly with senior managers across all organisations and escalating where appropriate.
• Provide expert oversight of complex and delayed discharges, ensuring risks are identified early and escalated appropriately.
• Ensure discharge processes are aligned with the needs of the GYW Locality, local population characteristics and neighbourhood models.

Integrated System Coordination

• Strengthen integration by aligning the four ITOC teams into a single coherent hub, removing operational silos and promoting shared accountability.
• Ensure the ITOC service is fully accessible to all partner organisations, supporting consistent decision making and shared ownership of flow.
• Coordinate cross organisational responses to operational pressures, ensuring partners work collectively to maintain safe and timely flow.
• Represent the locality at system operational meetings as required and, during critical incidents, providing clear updates, risks and actions relating to discharge.
• Hold and communicate shared priorities across all five partner organisations, ensuring alignment with national and local requirements.

Data, Insight & Performance Management

• Maintain transparent, real time oversight of community capacity, bed availability and flow, enabling proactive planning and escalation.
• Use dashboards, intelligence and performance data to identify trends, variation and bottlenecks, supporting partners to act on insight.
• Analyse data from including complaints and patient/carer feedback to drive improvement.
• Produce high quality reports, briefings and performance summaries for senior leaders and system partners.
• Lead the development of seasonal workforce and capacity plans, including drafting assurance documents for the ICB and other partners.

Improvement, Transformation & Pathway Redesign

• Lead targeted transformation work to improve discharge pathways, reduce delays and strengthen the home hirst model.
• Identify where processes are not working and coordinate multi agency improvements, ensuring actions are delivered and embedded.
• Facilitate a continuous learning environment, embedding learning cycles, reflective practice and shared governance across the ITOC function.
• Support redesign of pathways between acute and community settings, ensuring alignment with neighbourhood and INT developments.
• Promote a culture of action focused problem solving, not just advisory oversight, enabling teams to resolve issues quickly and consistently.

Workforce Leadership & Culture

• Provide day to day leadership for staff within the ITOC hub, ensuring a supportive, collaborative and high performing culture.
• Ensure staff are equipped with the skills, tools and information required to deliver safe and effective discharge processes.
• Support workforce planning, development and wellbeing, including preparation for seasonal demand and surge periods.
• Promote cross organisational working, shared learning and consistent standards across all teams within the integrated hub.

Governance, Risk & Assurance

• Identify risks and issues early, ensuring mitigating actions are agreed, monitored and escalated where required.
• Ensure compliance with national discharge guidance, local policies and system wide governance frameworks.
• Contribute to system wide planning, commissioning and performance discussions, providing local intelligence and operational insight.
• Support partners to deliver safe, person centred discharge processes that improve patient, family and carer experience.

Staff Management

• Responsible for the day-to-day range of staff management matters, which will include responsibility for supporting appraisals, development of staff, recruitment and where necessary processes such as grievance and disciplinary matters.
• Responsible for an individual's development on the job and job performance management. Work in conjunction with line managers and other job managers to assess and manage confidential information about an individual's performance and capability development.

Mandatory Responsibilities

Appraisal

The post holder will be expected to participate in an annual appraisal of their work where the job description will be reviewed and objectives set. In line with the annual personal development plan the post holder will be expected to undertake any training or development required to fulfil their role.

Mobility

Employees may be required to work at any of the other sites within the organisation subject to consultation. The organisation is in a period of rapid change due to developments and rationalisation of services. This will lead to modification of structures and job descriptions. The post holder will be expected to co-operate with changes subject to consultation, at any time throughout the duration of your contract.

Data Use and Quality

All staff employed by the organisation or an external agency, working in the NHS are bound by a legal duty of confidence to protect and input personal information accurately, securely, efficiently and effectively, in order to deliver the best possible care.

• All roles within East Coast Community Healthcare CIC (ECCH) require staff to demonstrate our Values and Signature Behaviours in the care and service they provide to patients, service users, stakeholders and colleagues. All members of staff should consider these as an essential part of their job role.
• Our Values outline the core behaviours that we can all achieve and are summarised as an acronym within the word 'CARE'. These stand for: Compassion, Action, Respect and Everyone.
• Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together.

Person Specification

Qualifications

Essential

• Educated to Master's level or equivalent level of experience of working at a senior level in specialist area.
• Extensive knowledge of specialist areas, acquired through post graduate diploma or equivalent experience or training plus further specialist knowledge or experience to master's level equivalent
• Evidence of post qualifying and continuing professional development
• Member of relevant professional body

Experience

Essential

• Must have an understanding of the background to and aims of current healthcare policy appreciate the implications of this on engagement
• Should have an appreciation of the relationship between the Department of Health & Social Care, NHS England, NHS Improvement, NHS East of England and individual provider and commissioning organisations
• Previously responsible for a budget, involved in budget setting and working knowledge of financial processes
• Ability to identify risks, anticipate issues and create solutions and to resolve problems in relation to project or service delivery.

Additional Criteria

Essential

• SKILLS AND KNOWLEDGE:
• Developed communication skills for delivering key messages to a range of stakeholders both internal and external (including outside the NHS) to the organisation, some at very senior level.
• Good presentational skills for conveying complex concepts.
• Ability to use informed persuasion to influence others.
• Evidence of planning and delivering programmes and projects and services on time.
• Abilities for financial and staff management
• Ability to work without supervision, providing specialist advice to the organisation, working to tight and often changing timescales
• Interpreting national policy for implementation
• Ability to understand a broad range of complex information quickly and making decisions where opinions differ/no obvious solution
• Working knowledge of Microsoft Office with intermediate keyboard skills.
• Will consider the most effective way to promote equality of opportunity and good working relationships in employment and service delivery and has the ability to take actions which support and promote this agenda.
• PERSONAL ATTRIBUTES:
• Team working skills
• Self-motivated
• Ability to move between details and the bigger picture.
• Demonstrates honesty and integrity and promotes organisational values.
• Embrace change, viewing it as an opportunity to learn and develop
• Ability to embrace our Culture, Values and Signature Behaviours:
• (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together).
• Willingness and ability to work across different sites and travel to alternative sites and across the community as required.

Person Specification
Qualifications

Essential

• Educated to Master's level or equivalent level of experience of working at a senior level in specialist area.
• Extensive knowledge of specialist areas, acquired through post graduate diploma or equivalent experience or training plus further specialist knowledge or experience to master's level equivalent
• Evidence of post qualifying and continuing professional development
• Member of relevant professional body

Experience

Essential

• Must have an understanding of the background to and aims of current healthcare policy appreciate the implications of this on engagement
• Should have an appreciation of the relationship between the Department of Health & Social Care, NHS England, NHS Improvement, NHS East of England and individual provider and commissioning organisations
• Previously responsible for a budget, involved in budget setting and working knowledge of financial processes
• Ability to identify risks, anticipate issues and create solutions and to resolve problems in relation to project or service delivery.

Additional Criteria

Essential

• SKILLS AND KNOWLEDGE:
• Developed communication skills for delivering key messages to a range of stakeholders both internal and external (including outside the NHS) to the organisation, some at very senior level.
• Good presentational skills for conveying complex concepts.
• Ability to use informed persuasion to influence others.
• Evidence of planning and delivering programmes and projects and services on time.
• Abilities for financial and staff management
• Ability to work without supervision, providing specialist advice to the organisation, working to tight and often changing timescales
• Interpreting national policy for implementation
• Ability to understand a broad range of complex information quickly and making decisions where opinions differ/no obvious solution
• Working knowledge of Microsoft Office with intermediate keyboard skills.
• Will consider the most effective way to promote equality of opportunity and good working relationships in employment and service delivery and has the ability to take actions which support and promote this agenda.
• PERSONAL ATTRIBUTES:
• Team working skills
• Self-motivated
• Ability to move between details and the bigger picture.
• Demonstrates honesty and integrity and promotes organisational values.
• Embrace change, viewing it as an opportunity to learn and develop
• Ability to embrace our Culture, Values and Signature Behaviours:
• (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together).
• Willingness and ability to work across different sites and travel to alternative sites and across the community as required.

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 .

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. .
UK Registration

Applicants must have current UK professional registration. For further information please see

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 .

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. .
UK Registration

Applicants must have current UK professional registration. For further information please see

Employer details

Employer name

East Coast Community Healthcare CIC
Address

James Paget Hospital

Lowestoft Road, Gorleston

Great Yarmouth

Norfolk

NR31 6LA

United Kingdom

Employer's website