1 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 CNE 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: Locally trained team roll out half day workshops to the remainder of the services. Through this approach, services will learn how to work with their patients to identify barriers and to apply the learning and approach to their own services and settings 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.
2 Poverty proofing Rotherham older adults mental health
The locally trained team engaged with Rotherham older adults mental health services during March and April 2025, in order to understand the experiences of people and families who are living in poverty.
The work was carried out with people and staff to build up a rich picture of the challenges and barriers faced by those accessing or attempting to received mental health services in Rotherham.
Older adults may experience the full range of common and severe mental health difficulties seen in younger adults, including complex emotional needs often associated with a diagnosis of personality disorder. However, older adults often have different care and treatment needs from younger people with mental health problems owing to different clinical presentations, physical health and cognitive comorbidities and other age related complexities.
Older adults mental health services in Rotherham are provided for people across a different range of types and settings. This includes:
- care home liaison.
- community mental health, through Swallownest Court, Badsey Moor Lane and home visits
- young onset dementia, through Ferham Clinic
- memory service, through Centenary Clinic
Some services are clinic based, others are based upon visiting the person in their home.
This service does not accept self-referrals. Referrals are exclusively made by healthcare professionals already involved in a person’s ongoing care.
In Rotherham, 16.8% of the population was income-deprived in 2019. Of the 316 local authorities in England, Rotherham is ranked 45th 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.”
3 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.
3.1 Voice
The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.
3.2 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.
3.3 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?
4 Poverty proofing process
4.1 Stage 1: Training and consultation with staff
18 staff completed a three-hour training session.
4.2 Stage 2: Scoping
Time was spent gathering information about the setting and how it works. This stage included conversations with patient-facing staff and management, observing interactions and reviewing key areas such as the website and communications.
4.3 Stage 3: Patient and community consultations
We spoke to 89 people in total who attended the service. This included adults, parents and carers and young people.
4.4 Stage 4: Feedback session
A feedback session was held with a senior member of the podiatry staff and a senior strategic development manager from the trust, where we discussed our findings and collaboratively considered various changes that could be implemented. We then produced this final report.
4.5 Stage 5: Review
Around 12 months after completion, Children North East will return and complete a review, identifying impact, good practice and potential considerations moving forward.
5 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 Rotherham older adults mental health were:
- communication
- health-related costs
- navigating and negotiating appointments
- patient empowerment
- staff awareness and guidance
- travel
5.1 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.
5.1.1 Barriers and challenges
5.1.1.1 Getting the patient voice to understand their experiences of poverty
Through the locally trained team, by the Rotherham older adults services themselves, or a combination of both, we have sought the views and experience of poverty from patients and carers. Unfortunately, we have not been able to do so, despite best efforts. Therefore, the voices of the patients 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. The service may want to consider other ways of engaging with patients and carers on the challenges of the cost of living utilising on the poverty proofing training that staff have received. Having financial conversations is important to understanding the quality of life people experiencing, which can also impact their mental health. Some of this is borne out from what staff told us they think services need to do.
- “More routine questioning around finances, although we do signpost around benefits.”
- “Asking where appropriate about their financial position and identifying if at all they need help then signpost to benefit advisers.”
- “Always being aware of what you see in practice and how to sensitively this subject.”
5.1.1.2 The language we use may mean some people don’t understand what is being asked of them, or 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 and what treatment they will receive.
- “easier information available staff and clients”
5.1.1.3 Interpreters
In some cases, people using the service require the use of interpreting service to be able to discuss their needs and treatment. Staff reported that the main issue that they experience is with interpreters, and that the service can be unreliable. One staff member shared an example of a gentleman who was on medication for longer than he needed to be as there was no interpreter available to have a conversation with the patient about his needs, and to discuss a change of medication.
- “We have a real problem with interpreters cancelling at short notice which means that patients who don’t speak English often end up waiting longer to be seen and, or have their assessments concluded.”
5.1.2 Recommendations for communication
5.1.2.1 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 Rotherham and how people can access them.
- Make sure staff are aware that they can refer people for money and debt advice to Citizens Advice Rotherham and District (a referral link is at the end of this report) and record this on SystmOne.
5.1.2.2 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.
5.1.2.3 Interpreting services
- This is a consistent theme across the Poverty Proofing audit, and the trust should make sure the new provider of the service has a reliable approach which is more appropriate for patients and staff.
- Report any missed interpreter appointments through Radar as an incident.
5.2 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.
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.”
5.2.1 Barriers and challenges
5.2.1.1 Health cost position cannot be determined
As the voice of the patient in this audit is limited, we can’t say clearly if there are costs that people have that they may also be entitled to make a claim against. Staff reported that there have been a couple of occasions where there has been issues with funding of a placement which has resulted in a resident having to move to a different care home, and the challenges this poses, particularly if a patient is suffering from dementia or Alzheimer’s. We were also told this by the person who responded to the consultation.
- “Petrol as travel 45 mins to collect patient and then 15 mins to the appt and back each time… a lot of costs are not considered in attending an appointment as you would just attend as the appointment is necessary for you or your family member.”
5.2.2 Recommendations for health related costs
5.2.2.1 See if people are entitled to support with transport
- Make all staff aware that the NHS Travel Costs Scheme exists. Provide clear information on who can apply and what they are entitled to claim for (this may not only be people who are on benefits, others can be eligible through the NHS Low Income and Healthcare Travel Costs Schemes).
- Refer people to Citizens Advice to see if they are entitled to support with transport costs and attending day centres.
5.2.2.2 See if people are entitled to help with prescription costs
- Advise patients about the HC2 form and how to fill it in effectively.
- Advise that patients who are paying for prescriptions whilst their HC2 form is being processed, should keep their receipts to be reimbursed.
5.3 Navigating and negotiating appointment
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.”