Poverty proofing Doncaster 5 to 19 health promotions 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 5 to 19 health promotions

The locally trained team engaged with Doncaster 5 to 19 health promotion services during May and June 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 receive these early years services in Doncaster.

The 5 to 19 services include:

Community nursing service

The Children’s Community Nursing team is a Doncaster wide service for young people. Operational hours are Monday to Friday, 9am to 5pm, they work flexibly to meet the needs of families and will often arrange visits between 8am to 9am and 5pm to 6pm ensuring children are not missing their education and carers their work. The service is offered face to face or telephone and will take into account urgency and any language barriers or complexity. They also work hospitals on discharge planning.

Continence

Comprehensive assessment for children and young people aged 4 to 19 years with urinary or faecal incontinence. The service is inclusion of children with additional needs. Referrals received from young person or family or professionals. Referrals triaged as routine, urgent, or emergency.

Epilepsy nursing service

The Children’s Community Nursing team is a Doncaster wide service for young people. Operational hours are Monday to Friday, 9am to 5pm, they work flexibly to meet the needs of families and will often arrange visits between 8am to 9am and 5pm to 6pm ensuring children are not missing their education and carers their work. They also work hospitals on discharge planning.

Special school nursing

The Special School Nursing team is a Doncaster wide service for young people aged 0 to 19. Operational hours are Monday to Friday, 9am to 5pm. they work flexibly to meet the needs of families and will often arrange visits between 8am to 9am and 5pm to 6pm ensuring children are not missing their education and work. Referrals can be made through the single point of contact (SPOC). The service is offered face to face or telephone and will take into account urgency and any language barriers or complexity.

Tuberculosis nursing

The community tuberculosis nursing service offers specialised nursing care, guidance, and assistance to individuals, children, families, and caregivers undergoing treatment for active or latent tuberculosis.

Children in care

Health support for children in care.

Vaccinations and immunisation (health bus)

The School Age Immunisation team comprises registered nurses and healthcare support workers dedicated to administering the national school-age immunisation programme. This is conducted in schools, with community clinics arranged for home-educated children and those who missed vaccinations in school. If needed, home visits can also be arranged.

Zone 5 to 19 which covers school nursing, contraception and sexual health, substance misuse and child exploitation

It is a dedicated service for children, young people and families. The service primary focus is on people aged 5 to 19 and people aged 25 with special educational needs and disabilities (25 SEND). Zone 5 to 19 provides support for various concerns, including: keeping healthy; emotional wellbeing; nutrition and staying active; contraception and sexual health; drugs and alcohol; and smoking.

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.

The Children’s Commissioner for England has told us that from their research:

“Children do not talk about poverty as an abstract concept. They talk in simple but powerful terms about how it feels to not have enough money to do the same things as their friends, or to feel a sense of shame at being seen as ‘lesser’. Children should not be ashamed of their family’s financial situation, instead, it’s society at large and decision makers that should be ashamed of the fact that children don’t have enough money.”

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

60 staff attended 3-hour training on learning half days in May and June 2025. We also received 92 survey responses from staff and spoke to 20 staff.

Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management.

Stage 3: patient and community consultations

We received feedback from 16 people who use the service. These could be young people or their carers.

Stage 4: feedback session

The report was shared with the Service Manager, Kate Watkins, 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.

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 5 to 19 health promotions 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

The service is welcoming

People who used the service overall felt that the service is welcoming. Everyone agreed or strongly agreed when asked this question.

“Felt comfortable and it was wicked.”

“Always been very nice. Even when my youngest is a challenge.”

“Staff are friendly and welcoming and building is very easy to find.”

Services use technology to communicate with people

We were told of examples where services use technology such as social media to communicate with people who use the service. As an example, the school nursing service uses its social media presence to promote its activity in schools, to build knowledge and awareness of the services it can offer children and young people. Services also have contact numbers on the website for people to get in touch. Also, the use of the innovative e-clinic to both support and engage young people in their care.

Service offers are promoted in different setting and with different groups

We were provided with examples where the services get involved in different ways to promote the services available for children and young people. This includes attendance at family hubs, community events, and through faith groups and schools.

People value the staff and the service provided

People provided good feedback about the service overall. For example of the 39 stories told on Care Opinion, this shows that all would recommend the services. Here is an example about the Zone 5 to 19 service.

“I had my contraceptive implant in for 4 months. I was having issues with it. I went in recently to have it removed and the woman, Ashleigh, who has put it in was there to remove it when asked. She offered many alternatives and she’s fun to chat with. Pleasant experience. Although she did have to talk me through it as I felt slight pain while having a hole put in my arm (humour). Thanks for being by my side.”

Barriers and challenges

The language we use may mean some people don’t understand what is being asked of them, or is available

Over half the staff told us that the way we communicate with people (understanding written materials or communication) might be a barrier to them understanding what is on offer in terms of the service and 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. Some staff also told us that having information already translated into other community languages for people who English isn’t their first language would be helpful in their role.

“To improve the language barrier on the consent forms for vaccinations for parents to read. This would help to improve the amount of consent forms being returned.”

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.

Supporting people where English isn’t their first language or they don’t have access to public funds

The tuberculosis service shared their experience of supporting asylum seekers. They work closely with the hospital and tertiary centre, where they provide shared care for periods of 6 to 12 months while this person is undertaking tuberculosis treatment. The people don’t often speak English very well, if at all. The families would find it of benefit if they could get their travel expenses, as they have got access to very little funds. The cost of translating information was also seen as a barrier.

“So, it’s not just about having a service leaflet in different languages. Its particular things around their treatment plans, and they’re the barriers that you’re facing.”

Recommendations for communication

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.

Interpreting service

• This is a consistent theme across the poverty proofing audits, 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

Translating information

• Make sure key service information (e.g. what the treatment involves) is available in plain English.
• Have this information available on the website.
• Use the “Google Translate” on the website to translate the information.
• Share via screen or download a copy for people.

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 50% of their disposable income, compared to just 11% for the least deprived fifth.

In 2025, Moneyhelper said about a child’s early years

“You’re already nearly £600 down in the first month but add in the costs from the other eleven months and even with very basic costs of £95 a month (based on product data from price comparison site idealo), you’re looking at £1,645. But in reality it could be much more, as LV estimates parents spend a whopping £12,400, per year on raising a child. With many having taken maternity leave and therefore a cut in their pay it’s likely to be putting a strain on your budget. It’s estimated that in years one to four parents are typically spending on average £63,224 in childcare fees.”

This would be before any affordability is taken into account, where families may be experiencing poverty and low income.

What works

Staff do try and find ways to support families with the costs of bringing up children

Whilst people told us that there were no costs to care, staff recognize the financial challenges that families face, and do go out of their way to support people with items that may be beyond direct health costs. This is a reflection of their care for the people they support. One example is supporting children in care by providing passes to leisure centres. A couple of other examples of what services do are given in the comments below.

“Offer care packages with toiletries etc.”

“Provide food vouchers for families who attend to help them purchase food for meals.”

Barriers and challenges

Cost of prescriptions

There are some instances where people will need prescriptions, for example care leavers or people with long-term conditions. They may be above or below income thresholds to receive free prescriptions. It may be that these people are entitled to Universal Credit or another benefit and should be referred to Citizens Advice for a money check. People told us that help with the cost of prescriptions would be a good thing to introduce.

“I think for the care leavers have to fund their own health prescriptions at the minute unless they’re on benefits and the receiving the correct benefit to get free prescriptions. But currently Doncaster and South Yorkshire are working towards providing free prescriptions for all care leavers, but that’s not in place yet.

“It’s traumatic going to doctors speaking to different people about what’s wrong with them (care leavers). They’re very unlikely to engage in the 1st place. So, we then got to factor in them paying for things they weren’t very rarely would they go and pay for a prescription without.”

Cost of paying to use equipment as part of a person’s health need

We were told of examples where people had a long-term condition, and had been assessed with needing additional support. They were supplied with items such as suction machines, ventilator, nebulizer, oxygen saturation monitor which are used as life-saving equipment. Whilst the equipment is provided free of charge, the electricity cost of using them might not be covered: it may be paid from a person’s Personal Independence Payment or carers budget, but as the cost of electricity has risen over the years this might still be unaffordable.

“People have brought suction machines into school that have not been charged and parents have said because they can’t afford to maintain it on charge overnight.”

We were also told about challenges people face in the continence service. The cost of nappies is a problem for families when child does not meet criteria for free nappies from service. As children get bigger, the number of nappies in each pack gets less. Families were struggling with cost of washing or electricity so were delaying starting potty training.

Cost of contacting the service

Some staff told us that there may be ways to reduce or mitigate the costs to people when they access the service. This particularly related to the cost of telephone calls. These are some suggestions from staff.

“Free text and call back service.”

“Contact families instead of asking them to contact my service.”

Recommendations for health related costs

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 Doncaster to see if they are entitled to support with transport costs and attending day centres (link at the end of this report).

Refer people for money or debt advice that might help with energy bills

• Refer people to Citizens Advice Doncaster to see if they are entitled to support with transport costs and attending day centres (link at the end of this report).
• Citizens Advice can provide support for people to get help with their electricity bills (such as Warm Home Discounts).

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.

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

There is flexibility in when the services can be provided

Some of the services told us that they will deliver care outside a traditional 9am to 5pm setting, so that carers can be at work or to avoid children or young people missing valuable school time. This includes community nursing, epilepsy nursing and specialist school nursing.

There is flexibility where the services are provided

We were told that services will be flexible in where services can be provided. In some cases, this might be at a school, clinic, community setting. In other cases, home visits are offered. Services try different ways to engage with children and young people: we were given an example where going for a walk with a young person was seen as the best way of providing support. For Zone 5 to 19, young people who are home schooled still benefit from what would be seen as a school nursing service. The vaccination and immunisation service holds clinics, and supplements this through the use of the health bus travelling to different sites in Doncaster. A flexible approach is taken for children in care, who can be seen in their home setting or a community one.

“Appointments have been offered to be where I am at that current time, so no travel costs incurred.”

“We use a welcome approach. So that’s kind of where that young person wants to see us at what time.”

The service will follow-up if an appointment is missed or cancelled

We were told that some of the services had arrangements in place if an appointment was missed. Someone will contact the child, young person, carer or family to try and re-arrange an appointment. Some services also use text follow-up, with examples in the continence and long-term conditions service provided.

The services can be flexible where appointments are held

Services are offered or take place in a variety of setting such as schools, at home, or in the community. If a person’s circumstance means they can’t make it to the “standard” place, the respective service will be flexible.

“If a patient was unable to attend an appointment due to financial problems we would offer a telephone appointment, we work well with being flexible to facilitate what is the best route for the patient and family to ensure they receive the best care.”

“School age Immunisation programmes are delivered in school, so 90% of eligible cohort can access service easily. For those not in school we take the health bus across Doncaster to support accessibility and can also deliver home visits if necessary.”

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, it can also mean that it can prevent people from accessing other healthcare.

“As staff we go above and beyond for our patients it’s frustrating that at times we are unable to help when they are constraints beyond our control which are systemic.”

Hidden costs of accessing services

Whilst there are good examples of being flexible in the way services are delivered, around half the staff told us that there were indirect costs to people, such as childcare or time off work, children missing free school meals that could make attending appointments difficult.

Recommendations for navigating and negotiating appointments

Help create simpler 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.
• Access peer support for the person to help them navigate the system where it is needed.

Home visits, building upon good examples already in place

• Consider offering home appointments to people identified as being on low-income or with increased health risk, where this isn’t currently offered.
• Consider offering home appointments where possible, especially during the initial period of accessing the service. This could allow people to feel more comfortable and open up more than in a clinical setting.

Appointment times, building upon good examples already in place

• Consider if appointment times are meeting the needs of the whole family and if there are any caring responsibilities that create a barrier to accessing appointments.
• Identify which appointment times are suitable with patients during assessments or treatment sessions.
• Explore the possibility of providing more out of hours appointments so that those with zero hours contracts or the self-employed have more choice when booking appointments reducing the potential loss of earnings.

Page last reviewed: July 08, 2026
Next review due: July 08, 2027

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