Poverty proofing report Danescourt 2024

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 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.

2 Poverty proofing Danescourt

The Poverty Proofing audit for Danescourt Forensic Residential Care Home began in April 2025 to better understand the experiences of families and individuals who are living in poverty.

The work was conducted in partnership with staff, families, and adults to build up a rich picture of the barriers and challenges faced by those accessing Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) Danescourt. Due to the nature of the service, it was believed it would be better for the residents to be supported in a group discussion together with staff. Staff were then provided the opportunity to share further comments using questionnaires and in part of the scoping.

Danescourt is a forensic residential care home close to Doncaster town centre. Danescourt has five ensuite bedrooms with large communal spaces as well as an annex with its own living room function for males with a Learning Disability who have historically presented a risk to others, who may have ongoing supervision requirements under the Ministry of Justice.

The service is based in Doncaster on Rectory Gardens in the DN1 2 area and provides forensic and community learning disability services to people across the city of Doncaster.

Doncaster is ranked 37th most Deprived (from 317) local authorities in England in the 2019 English Indices of Multiple Deprivation (IMD) where one is the most deprived and 317 is the least deprived. This is a rise of five places from forty-two in the previous IMD of 2015. The overall rank of Doncaster in the Indices has remained much the same over a 15-year period following IMD’s in 2004, 2007, 2010, 2015 and 2019 with the average rank over those studies being forty. Doncaster is in the top 20% most deprived local authorities in England. Sixty percent of Doncaster population live in areas ranked in the “most” deprived or “worse than average” quintiles. The data collected in 2024 is due to be released in late 2025.

Research by Prison Reform Trust in 2019 tells us:

“People with learning disabilities are more likely than their non-disabled peers to be exposed to a range of ‘social determinants’ of poorer health. These include poverty, poor housing conditions, unemployment, social exclusion, violence, and exposure to overt acts of abuse, victimisation, and discrimination.”

People with learning disabilities are more likely to experience poverty, which can result in poorer nutrition, unstable housing, higher stress levels and limited participation in community activities which ca n have negative impact on health outcomes. Those with learning disabilities residing in forensic residential setting are often found to have limited personal budgets, face delays of getting benefits, experience digital exclusion and may face barriers in accessing therapeutic an s social activity. By focusing on how to reduce all this it aligns with the NHS Long Terms Plans commitment to reducing health inequalities and improve outcome for those with learning disabilities (Public Health England, 2016) (NHS England, 2019).

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

Staff were invited to attend the 3-hour training on poverty proofing in April 2025 and 1 staff member attended. Further offers for other staff to attend on 14 May and 17 June 2025.

4.2 Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with 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 five people who use the service. We spoke to eleven staff who work in the service. This was a mixture of surveys and face to face conversations.

4.4 Stage 4: feedback session

A feedback session was held with Racheal Deakin (Modern Matron) and Julie Newitt (Home Manager) where findings were discussed, and changes were collaboratively discussed that could be implemented. We then produced this final report.

4.5 Stage 5: review

Around twelve months after completion, the trust will 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 Danescourt forensic residential care home 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 What works

5.1.1.1 The service is welcoming

For those service users residing at Danescourt there was strong evidence in support of a positive and welcoming atmosphere that strive to create.

“The staff are very good to me.”

“I feel I can get help from staff when I need it, sometimes I try myself but when I can’t, I know they can help.”

5.1.1.2 Accessible communication

Staff always make an effort to ensure that information shared with patients where possible is made available in easy read. They will also try and source this with external organisation that offer support to service users.

“The health action team sometimes attends the setting to provide easy-read material to patients on what they will have come to share.”

5.1.1.3 The service can identify poverty

Staff who work at Danescourt shared that as a service they can identify if their service user maybe experiencing poverty, as at point of admission they will have a picture of what benefits or financial support they have access to or not.

“When a patient s admitted we find ourselves having to fill in forms and apply for benefit on the patient’s behalf.”

5.1.2 Barriers and challenges

5.1.2.1 Accessible communication

While accessible communication materials are available in easy read, this is not consistent in all cases and sometimes this is not available especially on things like benefits and entitlement, which is where the support is needed.

5.1.2.2 Digital restrictions

While the patients have restrictions to accessing digital and this is needed for ensuring that their benefits are managed. Presently this can only be accessed by one member of staff which can make some difficulty should they not be around.

5.1.3 Recommendations for communication

5.1.3.1 Accessible communication

Develop easy-read printed packs on benefits, entitlements, and local support.

5.1.3.2 Digital restrictions

Have more staff who can update the benefits for service users or have centralised email that staff can access to do this on behalf of service user to remove reliance on one individual.

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.

5.2.1 What works

5.2.1.1 Cost to patients

Those who reside at Danescourt suggested they did not have to pay for any items or services as part of their healthcare and agreed that the service was accessible and affordable for everyone, regardless of their financial situation. They were however some comments shared where costs had been incurred and had to be covered due to things not being in place on time or due to systemic changes being made.

“One patient used to get shampoo on prescription, but now they must purchase it as no longer covered under prescription.”

5.2.1.2 Appointments

As the service user reside at Danescourt there are no appointment related cost that they incur from the service. It is only when they must attend appointment elsewhere that they may have to cover the cost of a taxi or bus fares this also include any social activities that they may want to attend.

“Patients have access to bus passes for their travel. One of the patients has one that covers for them and their carer with whomever they are travelling. For those that do not then it would be their responsibility to cover the cost of travel for the carer travelling with them.”

5.2.2 Barriers and challenges

5.2.2.1 Cost to patients

Although those who reside at Danescourt were said not have to pay for any items or services as part of their healthcare, it was reported by staff that they sometimes had to pay for items or services as part of their healthcare. When staff were asked what more the service could do to support families on low incomes to take up the care on offer, staff reported:

“We had a patient who we once took to see a dentist however as they did not have the relevant HC2A certificate to show they were in receipt of benefit their appointment was going to be cancelled. In the end we ended up using the trust credit card to cover the cost so that they could be seen as we were still waiting to get the benefits sorted out.”

5.2.2.2 Appointments

When staff were asked what they believed were the barriers to patient accessing services their services who maybe experiencing poverty, they reported that this was not directly with their service but with services that they have to ensure that their service user have access to such as GP, dentist et cetera.

“Travel and transport (cost of parking, public transport, taxi’s et cetera).”

5.2.3 Recommendations for health related costs

5.2.3.1 Health related cost

• To systematically check prescription exemptions and apply early.
• To partner with pharmacies for low-cost essential product no longer available on prescription.

5.2.3.2 Financial support

To embed formal financial screening into care planning to ensure that care requests are not hindered due to incomplete paperwork.

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.”

5.3.1 What works

5.3.1.1 Appointments

The service users at Danescourt require staff support for attending appointments and managing documentation related to their health to ensure that it is readily available when they attend appointments outside the service. Due to this approach the service users have less challenge with navigating and negotiating appointments.

5.3.2 Barriers and challenges

Although the above, when staff were asked which poverty-related barriers apply to patients accessing services one staff members informed:

“Complex Health Systems (difficult to navigate, referrals appointments et cetera).”

This was voiced to say even though we are supporting our patients at times it is also difficult for them to navigate the system on behalf of their patient to make sure they get to be seen. This included some service that are provided within the trust as well.

“Their appointment was going to be cancelled due to missing benefits paperwork.”

5.3.3 Recommendations for health related costs

5.3.3.1 Complex health systems

Pre appointment readiness checks to make sure all paperwork needed to attend is available beforehand.

Page last reviewed: September 01, 2025
Next review due: September 01, 2026

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