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 Deaf people mental health
The South Yorkshire service for deaf people with mental health needs provides specialized mental health support for those experiencing severe psychological challenges. Integrated within broader mental health frameworks, the service ensures that care is culturally and linguistically accessible by employing staff proficient in British Sign Language (BSL). The clinical nurse specialist, collaborates closely with existing mental health providers to facilitate comprehensive treatment plans
Beyond clinical intervention, the service emphasizes holistic wellbeing by supporting both Deaf patients and their caregivers, whether hearing or Deaf, throughout the recovery process. The program focuses on empowering individuals to improve their quality of life by fostering social connections, encouraging physical activity, and promoting healthy nutritional habits. A core component of the service is the promotion of emotional literacy, encouraging patients to engage in open, ongoing dialogues about their mental health rather than seeking support only during acute crises. By identifying personal strengths and facilitating constructive lifestyle changes, the service aims to provide a robust support network that addresses the unique intersectional needs of the Deaf community within the mental health sector.
Within the trust the service operates in Rotherham and Doncaster. Consultations took place with staff and feedback was received from patients who use the service. The service does well to support its patient while they are under their care but, what they have realised through feedback from patients that they have referred on to other mental health services with in the trust is that support in can sometimes fall short.
The is a recognised link between disability and poverty in the UK with figures suggesting deaf people are approximately 12% less likely to be in employment that the overall population. Deaf people who are British Sign Language users are also most twice as likely to have mental health issue compared to the general population. (British Society for Mental Heath and Deafness, 2019) With great stigma attached to mental health in the deaf community through this audit we look to make service accessibility better.
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 in March 2026 and 1 staff member attended.
Stage 2: scoping
Time was spent gathering information about the service and how it works and consultation were held with staff.
Stage 3: patient and community consultations
We received feedback from 4 individuals.
Stage 4: feedback session
A feedback session was held with Barbara Taylor, Service Manager and Rebecca Walls, Clinical Nurse Specialist where findings were discussed, and changes were collaboratively discussed that could be implemented.
Stage 5: review
Around 12 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 Deaf people mental health 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 in British Sign Language
The was a consistent theme on how great it was to be able to communicate in British Sign Language. Just like being able to have an interpreter present when a healthcare intervention is being done this can help in improving confidence that one is being listened to
“I can video call people directly in their language, which other services can’t do.”
“Being able to communicate with someone who understands without the need of a translator is great.”
Accessible communication
Flexible communication methods are being used although digital, patient can communicate via Text messages, WhatsApp video Calls and face to face visits are also offered. Care plan and information shared can also sometime be made available in British Sign Language.
“I can provide them information in British Sign Language.”
Barriers and challenges
Over reliance on telephone-based systems
The reliance on telephone-based communication within healthcare systems creates a systemic barrier that frequently leads to the marginalization of Deaf patients. When appointment protocols mandate phone contact for cancellations or rescheduling, Deaf individuals who cannot utilize voice-based systems are often unfairly discharged for non-attendance.
“We regularly put on our letters that if people need to contact to phone, a deaf person can’t.”
Lack of accessible feedback
This exclusion is compounded by a lack of accessible feedback mechanisms and persistent shortages of qualified interpreters, which impede effective clinical communication. Furthermore, written information is often ineffective due to the linguistic reality that many British Sign Language (BSL) users may have lower English literacy levels, rendering standard NHS correspondence and digital booking platforms inaccessible.
“A deaf person’s reading age is average nine years old… they really struggle to read leaflets.”
“They struggle to use care opinion because it’s English based.”
“Patient alerts say don’t phone but they still get phone calls and then get discharged as not engaging.”
While digital solutions are increasingly promoted, many Deaf patients find NHS apps and online portals difficult to navigate, and there is significant scepticism regarding AI-driven translation tools, which are often perceived as unreliable and prone to misinterpreting the nuanced, spatial nature of sign language.
Recommendations for communication
Accessible communication
- Replace phone only contact instruction with text or email option across all services.
- Introduce British Sign Language versions of key documents, including appointment letters, care plans, forms.
- Adapt did not attend (DNA) policies to include access checks before discharge.
- Introduce accessible feedback tools in British Sign Language.
- Ensure alerts on patient records actively prevent telephone contact being used.
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
Most patients are entitled to free prescriptions, reducing financial pressure. Staff avoid recommending products or interventions that require out of pocket payments. When technology is suggested (e.g. apps or tools), free options are prioritised.
“Most of them… get free (prescriptions) because they’re on benefits.”
“There’s bits of technology that I’ve recommended… but nothing that they’ve had to purchase.”
Barriers and challenges
Cost to patients
Hidden costs still exist, which include cost for data and internet access required for video appointments, travel costs where remote contact is not possible. Some patients are unsure whether they can raise affordability concerns with staff. There is also interpreter funding gaps that are for non-NHS which patients may be referred to.
“Third sector organisations… say we don’t have funding for an interpreter.”
“Travel and transport (cost of parking, public transport, taxi’s).”
Recommendations for health related costs
Health related cost
- Proactively discuss hidden cost of healthcare with patient to find out where these are to be able to support.
- Provide clear information (in British Sign Language) about: free prescriptions, travel support, data free or low data appointment option.
- Share where required the trust travel fund support available to patients to attend appointments.
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
Appointments are arranged flexibly to accommodate the diverse needs of service users. This includes scheduling later start times to align with the availability of free bus passes, ensuring that transportation constraints do not prevent attendance. Providers also facilitate home visits and utilize local venues to bring services closer to the individual. To further improve attendance rates, text reminders and personalised follow-ups are employed to reduce the frequency of missed appointments. Additionally, remote appointments via WhatsApp video calling are utilised where appropriate to maintain continuity of care and accessibility for those unable to travel.
“sometimes I’ll just text the person beforehand…”
“I tend not to see people first thing in the morning… the free bus passes don’t kick in until ten o’clock.”
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).”
This was voiced to say even though we are supporting our patients with appointment flexibility there is still issue when they are referred on to use other services within the trust that relate to their appointment bookings
“British Sign Language translators in other services and also staff awareness form other services not to call but to text or email us for appointments.”
Recommendations for navigating and negotiating appointments
Complex health systems
- Allow alternative confirmation methods to appointment (for example, simple yes or no text replies).
- Ensure did not attends (DNAs) trigger a supportive review not an automatic discharge for patient who are noted as Deaf on clinical records.
- Provide support for digital navigation (apps and booking systems).
Patient 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.
What works
Interactions
Patients report feeling welcomed when they use the service. The interaction that they have with the clinicians directly using BSL allows them to be able to engage with their care decisions. Support is sometimes offered in understanding complex information that may have ben shared from other services
“The service is a very welcoming place.”
“I’ll read the letters and I’ll explain that to them.”
Barriers and challenges
Limited accessible information reduces independence and when feedback mechanisms are inaccessible it becomes difficult to know how to improve the service to carer well for the deaf and hard of hearing community. This not only includes the patients but the carers who are deaf or hard of hearing who attend appointments.
“You’re not going to get a response… we’re missing people.”
“They struggle to use Care Opinion because it’s English based.”
Recommendations for patient empowerment
Feedback and information
- Co-produce materials with the Deaf community for providing feedback.
- Introduce peer support roles in that can support other team in the organisation where patients may be referred.
- Develop British Sign Language based education and self-management resources (video that can be shared).
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
Staff awareness
Within the mental health deaf service there is specialist knowledge and awareness of culture among the specialist staff with assessment being carried out that support to see if additional financial support is needed to support patients and or family’s and they are signposted to such services. Staff actively advocate for their patients and advise other teams of their need when referred on.
“Formal financial screening tools that are routinely carried out.”
“Judgements of staff.”
“Alerts added to inform to call or text only and not call.”
Barriers and challenges
The barriers identified are beyond the service with, other services often misunderstanding the Deaf practitioner’s role, treating them as an interpreter. This inconsistent awareness leads to, failure to book interpreters or in some cases reliance on Deaf staff to compensate for system gaps.
“I sometimes feel like a secretary… reading letters, chasing interpreters, explaining everything.”
Recommendations for staff awareness and guidance
Staff awareness
- Support in the development of a mandatory Deaf awareness and accessibility training for all mental health staff.
- Develop information sharing tool kit that can be shared with other services on how to support the deaf community that use trust services.
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.
What works
Appointment times are arranged to minimise travel costs. The use of local venues and home visits reduce financial strain for travel to appointment. Consideration of appointment flexibility to be after 10am, allows for use of free buss passed
“If I can’t make an appointment I know I can have a video call.”
“Free bus passes don’t kick in until Ten o’clock.”
Barriers and challenges
Travel cost will still affect some patients for instance if they are the ones not in receipt of free bus passes, but their carer is.
“Help with travel expenses would be most helpful.”
Recommendations for travel
Travel cost
- Support patient with free bus passes in line with the trust travel fund.
- Referral to Citizen Advice to see if there is support that can be provided for travel for the service user to link to their current allowances and situations.
- Proactively raise travel options during appointment booking.
References
- British Society for Mental Heath and Deafness. (2019). Mental Health for Deaf People. British Society for Mental Heath and Deafness.
- NHS England. (2019). NHS Long Term Plan.
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- 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.
- Public Health England. (2016). People with Learning Disabilities in England.
- Disability Living Allowance (DLA) for adults
- Help with health costs
Page last reviewed: June 02, 2026
Next review due: June 02, 2027
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