Poverty proofing Doncaster specialist nursing services 2026

Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Trust to fulfil its ambitious promise to “poverty proof” all of its services by December 2025. The trust has committed to piloting a bespoke Delivery Partner Model developed in partnership with Children North East (CNE).

Poverty Proofing is a nationally recognised tool, designed to educate and enable health care professionals to identify, acknowledge, and reduce the impact of poverty, advocating for equality of access to healthcare, services and technologies that contribute to overall health outcomes experienced by those living in poverty.

A locally trained team (LTT) of people have been trained and are being supported by Children North East to carry out this work in line with the ethos and principles of Poverty Proofing.

• Phase 1: 3 model audits carried out by Children North East
• Phase 2: a further 6 audits carried out by the locally trained team with support from Children North East
• Phase 3: all other trust services will engage in the Poverty Proofing process during 2025 and 2026. Children North East will deliver training to all staff; the locally trained team will carry out scoping of services and engage patients and staff in consultations; and the trust strategy team members will deliver feedback and write reports for each service. Moving forward, services will become more poverty informed, learning how to work with their patients to identify barriers, so that poverty becomes everyone’s business, and no-one is left out or left behind

This whole system approach is unique and has accountability at every level and a commitment to alleviate barriers that apply across the whole system.

Poverty proofing Doncaster specialist nursing services

This report focusses on specialist nursing service on continence, respiratory, diabetes and tissue viability and lymphoedema services.

The specialist continence service is based in Doncaster and provides assessment and treatment for adults registered with a Doncaster GP who experience bladder, bowel or pelvic floor dysfunction. The service supports people with urinary urgency and frequency, stress incontinence, urinary leakage, bowel complaints, constipation and pelvic floor dysfunction.

The service provides advice, support and tailored treatment based on individual assessment. It also provides catheter clinics and trial without catheter clinics. Patients can self-refer through the online referral system, and clinics are delivered from the Opal Centre.

The respiratory specialist nursing and home oxygen review service supports adults registered with a Doncaster GP who have a confirmed diagnosis of significant respiratory disease, excluding asthma. The service supports patients who are struggling to manage worsening symptoms, attending the emergency department, or at risk of hospitalisation due to the complexity of their condition. The service provides holistic assessment with patients and carers, develops written management plans, makes onward referrals where needed, and offers advice following discharge. The home oxygen review element reviews all adult oxygen users with a Doncaster GP to ensure safe, effective and appropriate use of prescribed oxygen therapy. The service also provides capillary blood gases in patients’ homes at the request of respiratory clinicians. Referrals are made via single point of access by GPs or other clinicians. Previous patients can self-refer and will be triaged in the same way. Patients are seen at home or near to home

The diabetes specialist nursing service is based in Doncaster and provides clinic-based specialist nursing appointments for people living with type 1 or type 2 diabetes. The service provides diabetes management advice, including medication guidance, lifestyle advice, blood glucose monitoring support and education to support long-term health and wellbeing. The service can signpost people to local diabetes support groups and educational resources. Referrals are made through a GP or healthcare professional for people with complex diabetes needs who would benefit from specialist assessment and advice. Once referred, patients are offered a clinic appointment with a diabetes specialist nurse to discuss their needs and agree a personalised care plan. The diabetes service provides education sessions, group work, insulin management support, clinics across Doncaster, home visits for housebound patients, and follow-up by telephone or clinic,

The tissue viability and lymphoedema service is based in Doncaster and provides assessment, treatment, specialist advice and expertise in tissue viability, wound care management and lymphoedema for Doncaster residents registered with a Doncaster GP. The service supports people living in their own homes and in registered care homes, with or without nursing. The service supports patients, carers, families and professionals through education, clinical advice, wound management, lymphoedema management and treatment planning. It focuses on skin care, external support, exercise programmes and simple lymphatic drainage, while also supporting independence, reducing avoidable hospital admissions and enabling timely hospital discharge. Referrals can be made by healthcare professionals, social care professionals, carers or patients through the single point of access or online self-referral. The service is contactable through SystmConnect and is based at Cantley Health Centre, with patients also supported in homes and care homes depending on need.

Poverty proofing ethos

No activity or planned activity should identify, exclude, treat differently or make assumptions about those whose household income or resources are lower than others.

Voice

The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.

Place

We recognise that poverty impacts places differently, and so understanding place is vital in our response. Organisationally we also need to be clear about why and how decisions are made. This understanding of context is essential.

Structural inequalities

The root causes of poverty are structural. What structural changes can we make at an organisational level to eliminate the barriers that those in poverty may face.

Poverty proofing process

Stage 1: training and consultation with staff

​​Staff were invited to attend the 3-hour training on poverty proofing between April to June and 2 staff members attended from the four services attended training. Which is a low figure so encouragement for further uptake is needed. ​

Stage 2: scoping

Time was spent gathering information about the service and how it works and consultation were held with staff. Consultation with staff took place for Continence (5 staff), Respiratory (6 staff) and Diabetes (3 staff).

Stage 3: patient and community consultations

We received feedback from 56 individuals inclusive of all four services.

Stage 4: feedback session

Feedback was shared with Kate Asquith (matron) and Michaela Delahunty (tissue viability and lymphoedema), Dawn Warner (respiratory), Leander Parkinson (diabetes) and Donna Atkinson (continence) on findings opportunity offered to discuss, any changes were collaboratively discussed that could be implemented.

Stage 5: review

Around twelve months after completion, the trust will complete a review identifying good practice and potential considers

Common themes

The next sections of this report highlight the most common themes to come out of the poverty proofing consultations. For each theme the report covers:

• what works, what you do now that supports those experiencing poverty
• the barriers and challenges faced by those experiencing poverty
• recommendations, each recommendation comes with a set of considerations for “poverty proofing” the service

The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Doncaster specialist nursing services were:

• communication
• health-related costs
• navigating and negotiating appointments
• patient empowerment
• staff awareness and guidance
• travel

Communication

Communication is important to consider in Poverty Proofing both from a health literacy perspective of how information is communicated and understood and in ensuring there are reciprocal lines of communication between services and service users. O’Dowd (2020) reported that availability of care was a particular concern for those on a low income and there were significant inequalities in care availability for the most deprived areas. Communication is a key factor in ensuring availability of care.

What works

Communication

Patients consistently described staff as friendly, welcoming, polite, professional and helpful. This was particularly strong in the tissue viability and lymphoedema service patient feedback, where many respondents rated the service highly and described positive staff interactions

Examples include:

“Polite friendly staff and lovely setting at St Johns.”

“Staff were all very helpful.”

“The nurses are lovely, explain everything and can’t do enough to help.”

“Always friendly, caring, knowledgeable and informative.”

There is also evidence that services adapt communication to patients’ needs. The diabetes service described using simple language, pictures, easy-read materials and translated resources where available. Staff also reported adapting care for cultural and religious practices, including fasting during Ramadan.

The respiratory service demonstrated strong practice in co-producing information with patients. Staff stated:

“We wrote that with patients. They were round the table when we wrote it.”

Barriers and challenges

Despite positive staff interactions, communication barriers remain a recurring issue. Tissue viability and lymphoedema service patients reported difficulty contacting the service and confusion between appointment sites. One patient stated:

“Always friendly but are hard to get in touch with.”

Another patient described:

“Very courteous but often confusion between St Johns and Cantley appointments.”

The Diabetes consultation identified significant pressure on triage and communication capacity:

Respiratory and tissue viability and lymphoedema service:

“It’s very difficult for patients to speak to their named clinician.”

Tissue viability and lymphoedema service:

“We can have hundreds on the triage list.”

Language barriers were also a major issue in both diabetes and respiratory feedback. Diabetes staff reported:

“Patients with language and digital barriers can’t access the feedback system easily”

Respiratory:

“It’s hit and miss… interpreters don’t always turn up.”

Respiratory staff highlighted the difference between conversational English and understanding complex health advice:

“It’s the difference between being able to speak conversational English and knowing what we’re talking about.”

Recommendations for communication

Interpreter services

• Strengthen interpreter booking processes and consider escalation routes where interpreter non-attendance affects care.
• Provide translated and easy-read materials for common conditions and appointment processes.

Communication

• Ensure all services have access to easy read, translated and culturally appropriate information.
• Improve patient-facing information about money, travel, prescription, food and digital support using posters, screens, leaflets and websites.
• Enhance use of waiting areas, digital screens and printed leaflets to share support information for patients who may feel uncomfortable asking staff directly.

Feedback

• Provide non-digital feedback options (paper, verbal or text message)
• Explore an anonymous route for patients to ask for financial help, reflecting staff feedback that patients may need “anonymous ways” to ask for help without embarrassment.

Digital exclusion

• Ensure digital access is not the only route to support.
• Provide printed information alongside online resources.
• Use reception screens, posters and appointment letters to promote support.
• Offer telephone alternatives for patients unable to use online forms.

Health related costs

“Money buys goods and services that improve health; the more money families have, the more or better goods they can buy.” (Joseph Rowntree Foundation, How does money influence health? 2014).

The Food Foundation (2023) found that in order for the poorest fifth of the population in the UK to meet the Government recommended healthy diet guidance they would need to spend half of their disposable income, compared to just 11% for the least deprived fifth.

What works

Cost to patients

There is evidence that services already identify and respond to some health-related costs. Respiratory staff described asking about benefits as part of general assessment:

“Part of that generic assessment includes asking about benefits and giving benefits advice.”

The respiratory service also provides practical support where patients cannot immediately afford items linked to oxygen therapy:

“We do have samples and we give those out, particularly to the ones that we know have got challenges, just to tide them over until we get it on prescription or they’ve purchased it.”

Patient with pulmonary fibrosis may be referred to Pulmonary Fibrosis Trust which helps with funding for scooters, stairlifts, holiday opportunities and social emotional support

“They support our patients buying bits of equipment.”

Continence staff described supporting patients to access appropriate products and signposting to schemes that may reduce household costs, such as water bill reduction schemes.

Patient feedback also showed that people value support with prescriptions, travel, benefits and digital access. Several patients identified practical help that would be useful, including support with prescriptions, information about benefits, and help with travel cost.

Barriers and challenges

Cost to patients

Health-related costs appear across all services, but in different ways. Tissue viability and lymphoedema service patients described costs associated with travel, prescriptions, missed work, childcare, parking and wound dressings.

One patient stated:

“I just didn’t have money for fuel.”

Another patient identified the cost of wound care:

“Help with places to purchase cheaper wound care.”

Continence staff and patients highlighted the cost of continence products, equipment, prescriptions, washing and water bills. Staff feedback noted:

“Difficulty affording continence aids and paying for water bills due to the amount of washing required.”

The continence consultation also confirmed that some patients may need to buy products themselves where they do not meet criteria:

“There are occasions where patients are advised to purchase products themselves.”

For diabetes, the main health-related cost was not medication, as prescriptions for diabetes are free, but food affordability. Staff reported:

“Food’s expensive.”

“I can’t afford fruit and vegetables.”

Recommendations for health related costs

Health related cost

• Provide a health-related cost prompt within assessments, including travel, prescriptions, equipment, food, utilities, childcare and missed work.
• Develop clear guidance for staff on when and how to signpost to benefits advice, food support, WaterSure or water bill reduction schemes, prescription support, transport schemes and charitable funding.
• Share where required the trust travel fund support available to patients to attend appointments
• For diabetes, explore partnership work with food banks and community food providers to improve access to diabetes-appropriate food, including fresh produce and protein.
• For continence, ensure patients are routinely informed about water bill support where increased washing creates financial pressure.
• For the tissue viability and lymphoedema service, consider clearer advice on wound care supplies, prescriptions and options where patients are struggling to afford additional products.
• For respiratory service, explore a non-cost option to patient for provision of nasal lubricant for their oxygen therapy

Navigating and negotiating appointments

Life can be particularly unpredictable when living on a low income. The challenges, for example around childcare or zero hours’ contracts can make attending appointments very difficult. Pressures on the NHS around waiting times and stretched services can mean there is little scope for flexibility and strict discharge policies are applied for those who miss appointments, effectively severing access for those with changeable circumstances. Furthermore, social problems often accompany poverty, and sometimes life can be chaotic, which makes consistent appointment attendance difficult. Availability and flexibility of care are important for improving access to health care for those on a low income.

The King’s Fund (2021) report states that:

“Services need to be flexible, accessible, responsive and offer continuity of care.”

What works

Appointments

Services are already using flexible approaches to reduce barriers. Continence staff reported offering clinic choice and suitable times, home visits where possible, bus passes and telephone appointments for those unable to attend clinic. Respiratory is primarily home visiting, which significantly reduces travel barriers and allows staff to identify hidden poverty.

One staff respondent stated:

“We do offer clinic choice and time suitable. We do offer home visits for those in financial difficulty where possible. We have access to travel bus passes. We offer telephone appointments for those not able to get to clinic.”

Patient feedback also showed appreciation for local and flexible support. One diabetes patient said they had “already been supported” but would benefit from help with travel when their wife was at work. Tissue viability patients suggested local appointments, weekend appointments and multiple venues to reduce travel burden

“Sometimes I’ll just text the person beforehand.”

Barriers and challenges

Patients and staff described appointment barriers linked to travel, location, clinic availability, work, childcare and confusion about where appointments are held. A tissue viability and lymphoedema service patient stated:

“If no money, how can we travel.”

Another patient suggested:

“Have services in multiple areas, so people don’t have to travel as far.”

Tissue viability and lymphoedema service staff highlighted the impact of clinic location and wound care pathways:

“They request certain clinics as it is close by because they can’t get to clinics out of area without paying for taxis which they can’t afford. I find this unfair on patients.”

For diabetes, appointment targets can reduce flexibility:

“Initial appointments are 90 minutes… with a 4-week target.”

Within the diabetes service it was noted that missed appointments can result in letters asking patients to opt back in, with discharge if there is no response after two weeks. This creates a risk that poverty-related non-attendance could be interpreted as disengagement.

Recommendations for navigating and negotiating appointments

Appointments

• Offer appointment location choice where clinically possible and prioritise closer-to-home provision for patients known to have transport or financial barriers.
• Include a prompt in appointment letters and text messages asking patients to contact the service if travel, money, childcare or work makes attendance difficult.
• Continue telephone or remote follow-up where clinically appropriate, while ensuring digital exclusion is considered.

Clinic locations

• Offer appointment location choice where clinically possible and prioritise closer-to-home provision for patients known to have transport or financial barriers.
• Map clinic locations against areas of deprivation and public transport routes.
• For the tissue viability and lymphoedema service, work with GP practices to improve local wound care capability and reduce the need for patients to travel across Doncaster.

Did not attend (DNA)

• Review did not attend (DNA) and discharge processes through a poverty-proofing lens, particularly where non-attendance may be linked to money, transport, digital exclusion, language barriers or unstable circumstances.
• Include prompts in triage to ask whether the patient can afford to attend, has transport and understands where they need to go.

Page last updated: November 09, 2026

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