Care Navigator Service in Barking & Dagenham Havering and Redbridge (BHR)

NHS NEL CCG sought an experienced provider for Care Navigator services in Barking and Dagenham, Havering and Redbridge (BHR).

The service provided will meet the gap in the Acute Frailty Service (AFS) programme by providing a link between the client and the health and social care professionals and help address people's difficulties in navigating health and social care systems. The Care Navigator service will continue to build on the positive experience of working within health and social care multidisciplinary team to support vulnerable clients with complex needs and reduce demand for health and social care services by linking a Care Navigator to the AFS to help prevent hospital readmissions. The Service will aim to support over 100 clients per year.

The Care Navigator will be responsible for:

• Carrying out person-centred conversations with the person about their needs, wishes and preferences helping to identify their goals and co-produce a holistic care plan of support.

• Providing information/advice to individuals about a range of services to promote health and wellbeing and maintain independence within communities.

• Facilitate access to services available in the community including introducing clients to new activities and motivating them to have an active role in the community.

This support will include providing information/advice to individuals about a range of services and facilitating access to services in the community to maximise independence and wellbeing. E.g. income maximisation checks with benefits applications, transport assistance (including Blue Badge, Dial-a-Ride and other transport options) and support networks to reduce isolation, build a network of support and enhance quality of life. This may include accessing befriending and support groups, opportunities to keep fit and exercise, access to carer support including carer assessments, accessing day centres, etc.

The service aims to:

• Support people with multiple long-term conditions to self-manage ensuring they have maximum support at home, enabling choices and access to services in the community to achieve the best possible quality of life and independence.

• Support integration of services across health, social care and voluntary sectors.

• Reduce demand on statutory services to prevent avoidable hospital admissions, residential care placements and GP referrals.