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 acute urgent mental health services
The locally trained team engaged with Doncaster acute mental health services during July and September 2026, in order to understand the experiences of people and families who are living in poverty.
The work was carried out with staff to build up a rich picture of the challenges and barriers faced by those accessing or attempting to receive mental health services in Doncaster. Staff in the service also looked to get the voice of people who use the service as well.
Acute and urgent mental health services in Doncaster are provided for people across a different range of types and settings. This includes:
- crisis: crisis service is for an individual or someone they know who is experiencing a mental health crisis, feeling suicidal or in need of urgent support to keep them safe
- home treatment: home treatment service offers short-term assistance for individuals needing extra support in managing their mental health requirements
- hospital liaison: offer mental health assessments for individuals aged 16 and above, either in the accident and emergency department or on inpatient wards typically in physical health acute settings
Some services are clinic or hospital based; others are based upon visiting the person in their home.
People can self-refer, and healthcare professionals can also refer into the service.
In Doncaster, 16.6% of the population was income-deprived in 2019. Of the 316 local authorities in England, Doncaster is ranked 48th most income-deprived, with 1 being the most deprived.
Key findings of a Mind Report in August 2021 tells us:
“There’s still a lot of shame about money and mental health. There’s a lot of worry about privacy for people facing poverty and worry that they don’t deserve support. Many feel mental health is a white, middle-class conversation they can’t tap into.”
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
9 Staff from both the service an inpatient wards attended 3-hour training between July and September 2026. We also received 20 survey responses from staff in the service.
Stage 2: scoping
9 Staff from both the service an inpatient wards attended 3-hour training between July and September 2026. We also received 20 survey responses from staff in the service.
Stage 3: patient and community consultations
We received feedback from one person who used the service. It was agreed at the start of the audit that we would not ask people who are in crisis. The service did ask other people who use the service, but they did not want to answer questions.
Stage 4: feedback session
The report was shared with the Service Manager, Paula Thompson, to consider the findings. We then produced this final report.
Stage 5: review
Around 12 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward. This will be part of the trust’s poverty proofing community of practice.
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 Poverty proofing Doncaster acute urgent mental health services were:
- communication
- health-related costs
- navigating and negotiating appointments
- people 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
People compliment services
Whilst we did not get much patient voice for this audit, the person who did was complimentary about staff. We also have feedback from Care Opinion to tell us what people thought about the service. For example, we have had over 20 people tell us their experience of the Crisis Service, and three quarters would recommend the service. The Home Treatment team and hospital liaison teams also got similar responses.
“There have been some genuinely positive experiences along the way, and I feel it is important to recognise these. The Crisis team have been supportive where they have been able to be, and there were members of staff at Tickhill Road who treated Dad with kindness, patience and dignity.”
“I felt heard and it made me feel like a human being and not a burden.”
“I was supported with genuine care and understanding, I was believed and heard many times and given a lifeline… My struggles are still continuing but I am being supported for the first time in my life. Jodie, Miki, Hazel. Thank you will never be enough.”
“Nurse Tesh and student Nurse Obu acting kind, compassionate, caring towards my husband.”
Barriers and challenges
Getting the patient voice to understand their experiences of poverty
Through the Doncaster acute and urgent services audit, we have sought the views and experience of poverty from patients and carers. It was agreed that it would be inappropriate to ask people in crisis when their mental health support was the immediate priority. Therefore, the direct voice of one person from this service are not present in this report.
Instead, we have incorporated common recommendations from our other poverty proofing work in the trust for the service to consider that have been picked up through the patient voice in other audits that are similar services. The service may want to consider other ways of engaging with patients and carers on the challenges of the cost of living, utilising the poverty proofing training that staff have received and further training that can be provided by Children North East. Having financial conversations is important to understanding the quality-of-life people are experiencing, which can also impact their mental health.
The language we use may mean some people don’t understand what is being asked of them, or what is available
A number of staff said that the way we communicate with people might be a barrier to them understanding what is on offer to mitigate poverty. It is important to understand a person’s communication needs and ability, so they know what is available, what treatment they will receive and don’t feel embarrassed if they don’t understand information provided to them.
Recommendations for communication
Staff engaging in financial conversations with people
- Open up financial conversations routinely as part of someone’s care.
- Provide a basic level of training for staff, to empower them to have financial conversations.
Communicating with people based upon their needs and ability
- Make sure people are asked about their communication needs and preferences, and this is recorded on SystmOne.
- Make sure communication needs and preferences are recorded in SystmOne.
- Check with people that they understand what is being communicated to them. Get them to explain what is being said.
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 Institute for Health Equity and World Health Organisation said that:
“A person’s mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk.”
Barriers and challenges
Non-health costs of accessing services
Staff told us that there were indirect costs to people, such as childcare or time off work, that could make attending appointments difficult.
Recommendations for health related costs
Non-health costs of attending appointments
- To continue to offer flexibility in appointment for example video or telephone if appropriate.
- Make sure people know they can change their appointment times through the appointment link they are provided.
- To continue to offer appointments that are flexible around work arrangements, to ensure no extra cost is incurred.
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.”
As most people who use these services need to be seen immediately, the service is not delivered in what could be called an NHS appointments way as other services are. This is more likely to take place when people are discharged from this service to, for example, community teams for on-going support.
Barriers and challenges
Complexity of health systems
A number of staff said that the health system itself can make it difficult for people to get the support and treatment they are entitled to. Not only does this mean it can delay a person’s treatment, but it can also mean that it can prevent people from accessing other healthcare.
“Out of hours Doncaster Metropolitan Borough Council systems being much easier to navigate.”
Recommendations for navigating and negotiating appointments
Complexity of health systems
- Identify on the patient pathway where people come into contact with other health and care services.
- Look to work with those organisations to make the process as simple as possible.
- Make sure people understand what the steps are, either being taken by the service or that they need to do themselves on their pathway.
- Access peer support for the person to help them navigate the system where it is needed.
People empowerment
Being in poverty can be hugely disempowering and contribute to reduced literacy skills (Literacy Trust, 2012), lower educational attainment, lower levels of confidence and less engagement with health behaviours and healthcare (Sheehy-Skeffington and Rea, 2017). Services can support this by tailoring support to different education and literacy levels, working alongside patients and families to build health literacy and confidence in managing their health as independently as possible and ensuring there are opportunities to share their views and shape services.
Barriers and challenges
Access to digital devices
A number of staff said one thing they could change in your practice to make life better for people experiencing poverty is access to digital devices. Citizens Advice Doncaster run a programme on behalf of the integrated care board to help with digital literacy, devices, and data: like the barrier on what financial assistance is available, people may not be aware of this opportunity. The trust also has a programme where it can provide devices for free, and Citizens Advice can get access to data for people on low incomes.
“I think there is a lot of hidden poverty, especially including for older people who are not tech savvy.”
Access to food
A number of staff told us that people being able to afford to pay for food was a real challenge. Staff do signpost to food bank, but opening hours and access to transport for people can be difficult. Whilst staff might make arrangements for people to get food, this still remained a problem which can impact upon a person’s recovery.
“Food parcels accessible for patients who can’t travel and have no money to travel.”
Recommendations for people empowerment
Access to digital devices
- Ask people about their digital needs and barriers.
- Refer people to Citizens Advice Doncaster digital support programme (a link is at the end of this report).
Access to food
- Use the food cupboards that are in the trust to support people who may be struggling with paying for food.
- Refer people to Citizens Advice Doncaster for support (a link is at the end of this report) who can get access to food banks.
Staff awareness and guidance
This theme is around identifying the social and economic needs of patients and giving holistic care so that they can be fully supported. Research has shown that those living in England’s most deprived areas tend to receive the worst quality healthcare, for example with longer waits and worse experiences accessing appointments (O’Dowd, 2020). Patients will have different needs depending on individual, demographic, systemic and social needs, and countless other factors.
What works
There are some clear examples how services support people experiencing poverty.
Staff told us of a range of ways their service identified people who may be experiencing poverty. This then led to action being taken to support people. Here are some examples.
“Yes, we support with debt management, food parcels, will see patients where we can which is better for them.”
“Awareness of services that we can refer and arrange food parcels via – although these are limited.”
“Can refer on line to Citizens Advice bureau for appointment for further advice and support around benefits or entitlements.”
“Offer food parcels, collect and deliver these to the patients. Visit at home to reduce travel costs and time. Have longer service time to reduce the necessity for time of work.”
Barriers and challenges
The response to supporting people experiencing poverty is mixed and not consistent.
Whilst the above paragraph shows structured ways to support people, with staff citing examples of where the service supports people experiencing poverty, this can be dependent upon judgements of other individual staff or verbal screening. The response to the staff survey is also mixed: around half the staff think there is a way their service can identify someone in poverty, whereas the other half don’t think there is. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.
“Have better access to room accessible for patients who do not want to be seen at home but cannot afford to travel to the Onyx.”
“To be able to offer support from a central service.”
Recommendations for staff awareness and guidance
Making staff aware of financial support available
- Communicate with staff the nationally publicised help that is available for people which is published on the trust website (a link is at the end of this report):
- help with transport costs
- NHS Low Income Scheme
- help with health costs for people on Universal Credit
- help when you need to pay for NHS care (prescriptions, dental care, eye care wigs and fabric supports)
- personal health budgets
- Make sure this is communicated to people and their peer support.
Staff engaging in financial conversations with people
- Open up financial conversations routinely as part of someone’s care.
- Provide a basic level of training for staff, to empower them to have financial conversations.
- Get information from charities and food banks on what is available in Doncaster and how people can access them.
Access to benefits and debt advice
- Refer people to Citizens Advice Doncaster for an income and benefits check, a link is provided at the end of this report.
- Hold an awareness session with staff on how to access this service for people.
Travel
Healthwatch UK (2019) showed that travel is a key issue for people, with 9 out of 10 people consulted saying a convenient way of getting to and from health services is important to them. Difficulties with transport were also identified as a common reason that people will miss appointments. There is a phenomenon known as the poverty premium, where those with less money end up having to pay more for essential items, which further perpetuates the cycle of poverty. For some families (who do not have access to a car) public transport and taxis are more expensive than it would be to drive.
Barriers and challenges
Cost of travel
We were told by many staff that the cost of travel has been a barrier to people accessing the service. Staff strongly also told us access to transport would be a help for people as well. The person using the service told us the same. People struggled to pay for the bus fare, petrol or taxis. Where possible, people wanted home visits due to travel costs. Particular concerns were raised by the Hospital Liaison Team, who support people that attend Accident & Emergency (A&E) Departments at the acute hospital.
“Access to transport for patients.”
“Having access to free bus passes or funding for transport.”
“Being able to arrange taxi’s for patients experiencing poverty to attend their urgent appointments or to return home from emergency assessments in A&E.”
“Transport issues in A&E at night to get patients home.”
“An identified plan and a framework of support with transport would be a benefit to our patients. I personally feel having to send people back onto the streets when they have attended A&E because of their mental state or a factor relating to this because they have no money for taxi or no means to get home safely (A&E will not always provide one) is not good practice, as a practitioner it feels unsafe and quite frankly comes across as uncaring.”
“People not being able to get home from there, if for example,l they’ve been brought in by ambulance, wearing slippers, they can’t go home on the bus.”
Recommendations for travel
Promote Healthcare Travel Cost Scheme
Ensure patients, staff know about the trust travel scheme, and how it works.
Re-imbursing travel costs for people on low incomes
Where people have to attend clinics, and are at risk of did not attend (DNA) due to the affordability of travel, make sure the Travel Fund Scheme is used.
Home visits
Identify people for home visits, where cost and affordability of travel is a problem where this is possible.
Community appointments
Look to hold appointments in community settings, which are closer to where people live and help avoid unnecessary travel.
Digital appointments
Look at where, clinically, an appointment can be undertaken digitally that will reduce the travel need of the person and staff alike.
People at the emergency department
Work with Doncaster and Bassetlaw NHS Trust on travel solutions where people are being discharged and struggling to pay for transport.
References
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- Fenney, D. and Buck, D. (2021), The King’s Fund, The NHS’s role in tackling poverty: Awareness, action and advocacy.
- Literacy Trust (2012), Adult Literacy
- Sheehy-Skeffington and Rea (2017) How poverty affects people’s decision-making processes.
- Healthwatch UK (2019) There and back, People’s experiences of patient transport.
- Help with health cost
- Doncaster Citizens Advice referral form
Page last updated: November 06, 2026
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