Poverty proofing Doncaster drug and alcohol 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 drug and alcohol

Aspire drug and alcohol services help adults who have problems with drugs or alcohol. They offer support such as catching issues early, helping people safely stop using drugs or alcohol in their own communities, and working in groups to get better together. They provide a full range of drug and alcohol support to people aged over 18 across the city of Doncaster.

The team offers support and someone to talk to straight away. Adults can phone, email or drop in for advice and information. Staff will talk them through all the treatment options and agree a treatment plan with them. Aspire is a partnership organisation set up by Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and registered charity The Alcohol and Drug Service (ADS).

Aspire offers services in Bentley, Mexborough, Rosslyn House and Stainforth. There is also an inpatient detoxification unit called New Beginnings, in Balby.

Other drinking support services include Project 6. Project 6 is a voluntary sector drug and alcohol charity which offers support to people using alcohol and other drugs and their families.
Consultations with staff and clients in various drug and alcohol services were carried out by Children North East staff during the week beginning 26 January 2026.

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 completed a three-hour training session.

Stage 2: scoping

Time was spent gathering information about the setting and how it works. Consultations were held with 8 staff.

Stage 3: patient and community consultations

We spoke to 47 people in total.

Stage 4: 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 drug and alcohol 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

Staff communication

Staff communication was consistently described by clients as friendly, caring and approachable, with many highlighting the importance of feeling treated with warmth and respect. This relational approach appears to play a key role in engagement, particularly for those who may be anxious or hesitant about accessing support. Clients responded positively to staff who took time to communicate in a human and empathetic way. This suggests that the existing strengths in staff communication provide a strong foundation to build on, particularly when combined with clearer and more accessible systems of contact.

It is well documented that private-number healthcare calls are less likely to be answered by people in poverty, because of rational, protective communication behaviours shaped by financial uncertainty, digital exclusion and fear of harm.

One staff member explained:

“On our system there is an option to send a message that says ‘Hi it’s X your link worker calling’, I’ll do that but I don’t know if others do.”

This option to notify clients who is calling them, goes a long way to ensure transparency and could be used more widely across the service.

Barriers and challenges

Digital exclusion and low digital literacy

Many clients in the service struggle to use digital tools. This makes simple appointment processes more difficult and far slower for those without computers, internet access or digital confidence. Relying solely on digital systems excludes people who cannot use phones, have low digital literacy, or are only just beginning to re engage with day to day life.

“I keep getting texts with links to book appointments, not all of us have computers. A week long process can become a month with the back and forth and the likes.”

“It’s all on phones. I’m only just starting to be able to function in the real world, I can’t use phones anymore.”

“Communication needs to be strengthened, it should be personal to everyone. Like we should be asked at the start about how we want to be communicated with. It needs more personal touch.”

Staff:

“We had a guy yesterday, he was struggling with texts cos he didn’t know how to open them on his phone.”

Lack of information given about appointments

When you don’t have money, every unnecessary journey or mistake has a cost. When appointments are given, there is often insufficient detail provided. Clients might not know who the appointment is with or where it will take place. At the very least, this means having to contact the service to clarify the missing information, which may prove difficult for some. Sometimes clients spend time and money travelling to an appointment, only to discover that it should have been over the telephone, but that the system did not allow it to be recorded as such.

“I got a message to say that I had a 12:30pm meeting with X, I don’t know who that is or where I’m supposed to go.”

“There’s no location on the texts that go out, it just says ‘RDaSH’ on them. That could be anywhere in the entire trust.” (colleague)

“They should add a box on SystmOne to put in the location. It’d be a quick thing to do and would save so much time and money and energy for everyone.” (colleague)

“Telephone appointments get put in as face-to-face appointments, there’s no telephone option, so people show up here when it’s just a telephone thing.”

“It only says you have an appointment with RDaSH, it doesn’t say where.”

“RDaSH messages are a nightmare. We need more detail like who and where. Add a second reminder text with details so we can see.”

Complexity of the system

For clients experiencing poverty, whose lives may already be chaotic and stressful, too many appointments in too many locations becomes overwhelming. Such complex systems can push people away from engagement, through no fault of their own. Clients have described feeling frustrated and confused because they do not know which services messages relate to. This can then contribute to feelings of failure and inadequacy.

“There should be a system where we can send a text that says which service the text is coming from or relating to, for example, New Beginnings, Rosslyn House, otherwise, people just don’t know and it’s another thing, it’s confusing.” (colleague)

“You get that many appointments, it’s hard to keep up with them all. So many services, locations. You end up thinking you’re a failure if you get things wrong, go to the wrong place for the appointment, or the wrong time.”

No notifications about training days or closures

Clients described occasions of turning up to groups, only to find the building closed. Unexpected closures disproportionately affect people with a low income, as it potentially means unnecessary and avoidable costs, on travel to get there and back, missed unpaid time off work, and childcare arrangements. For those without enough money as it is, these unnecessary costs can be overwhelming.

Similarly, it was explained that staff training days tend to be scheduled on Mondays, Wednesdays and Fridays, which clients described as the busiest, most important days.

“There was a staff training day here yesterday and no one bothered telling us. We all showed up and the building was closed. Nothing we could do, we all just needed to go back.”

“They always seem to have staff training days on a Monday, Wednesday or Friday but they’re the most important days for us, the ones that the heavy stuff is on.”

Lack of personalised communication

Clients have described a “one-size fits all” approach to communication within the service, with no real choice of preferred method. They feel this does not take into account people’s different needs, based on their stage of recovery or commitment, and also on their financial circumstances. Personalisation is an important step towards reducing health inequalities.

“Personal connections feel better.”

“There’s only one blanket approach to everyone, we’re all different and we’re all approaching it at different stages of commitment.”

“No one sends letters anymore but they were much better, they have more detail and it’s something to hold on to. What if my phone breaks or is stolen or whatever?”

Recommendations for communication

Digital exclusion and low digital literacy

• Offer multiple communication options at first contact (for example, phone call, letter, text, WhatsApp, email, face‑to‑face reminders), and record the client’s preferred method.
• Reintroduce non-digital pathways for those who rely on it, such as paper appointment letters, printed schedules and physical reminder cards.
• Provide low‑tech support at reception, including help opening texts, booking online, or completing forms with staff assistance.
• Provide simple, step-by-step printed guides (for example, how to open a text link) for those beginning to re-engage with phones.
• Where possible, enable outgoing caller identification (ID) display (rather than private numbers) to improve answer rates.

Lack of information given about appointments

• Mandate a minimum‑information standard for all appointment messages, to include: name of worker, address and postcode, room or venue, appointment type (for example, phone, video or in‑person), service name (for example, Aspire, Rosslyn House, New Beginnings) and a contact number for queries.
• Add a clear action line in every message (for example, if you cannot attend, text or call this number).
• Ensure the digital system can specify whether an appointment is face to face or telephone.
• Ensure all appointment correspondence is written in plain English and is clearly set out, with only essential information included.

Complexity of the system

Label all messages by specific service.

No notifications about training days or closures

• Send reminders 48 hours and 24 hours before training days.
• Display closures via multiple channels simultaneously (text, door signage, verbal).
• Move training days off key client days (avoid Monday, Wednesday or Friday if these are high‑importance).
• Ensure reception and answerphone messages are updated with same‑day closure information.
• Provide an alternative offer, for example, a remote check‑in for clients affected by closures.

Lack of personalised communication

• Ask every client at assessment, How do you want us to communicate with you? and record this clearly.
• Offer paper letters as an alternative.
• Regularly review communication preferences as needs change over time.

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

Clients really appreciate a hot cuppa and a warm welcome. However, this relies on the generosity and ability of staff to afford to buy refreshments.

Barriers and challenges

Loss of income to attend appointments

Clients described the loss of income to attend groups and appointments. The financial burden of engaging with treatment, attending appointments, and participating in recovery activities is significant, especially for those struggling financially. What might be small, practical issues for others, are major obstacles when money is scarce. Some clients even lost their job, because of the need to take time off for recovery support.

“I don’t get paid off work to come here, I need to take the shift off work to be here. That’s why I got finished off my last job, for needing so much time off to come to groups and that.”

“It should become law, it should be considered confidential. I got paid off to leave my last job when it came out (that I was attending an addiction programme).”

Clients also spoke about the stigma attached to addiction, and how employers often do not view it as a genuine reason for time off work, as they would with cancer, for example. Economic insecurity means people might avoid disclosing health needs, rather than face the risk of discrimination and stigma and loss of employment. It feels like a choice between recovery or employment. And yet:

“Being in employment can enhance recovery, improve symptoms and adherence to treatment and prevent relapse.” (Burns et al., 2007; NTA, 2010)

“The UK’s National Drug Strategy recognises that in the past a lack of effective employment support has, for many individuals, eroded the benefits that treatment offered them.”(HM Government, 2010)

“Some people’s employers make them get a note to be able to take the time off. It can be embarrassing and invasive and some employers can be funny about that.”

“Employers need to have protected time for clients to attend their appointments.”

“There should be a drive for employers to destigmatise these appointments. Employers wouldn’t mind if the appointment was for cancer like.”

Lack or loss of funded support

Staff spoke about the importance of a hot drink; how inviting that can be for people, especially for those living on the streets. Clients echoed this. However, staff explained how they fund refreshments themselves, as they are not provided for the groups. This relies on the goodwill of staff and the assumption that they can afford these additional costs.

“We have to buy our own tea and coffee, we’re the only group that has a warm drink for people now. It’s really inviting, especially if people are coming in off the streets.” (colleague)

“We pay for the cuppas, tea, coffee and that, they don’t get supplied for the groups.” (colleague)

“Not everywhere provides a hot drink for us.”

Another source of funding, which no longer exists, was for three-month gym passes for clients in recovery. Staff described these gym passes as “massive”. Not only did they allow people in recovery to take up healthy activities, many of whom would not ordinarily be able to afford it; they also provided a warm space indoors, and added an important social aspect to wellbeing. People in poverty lost access to basic, stabilising tools that others can pay for.

“Gym passes were massive, got them into the gym. A lot of clients that wouldn’t usually have gone, if you gave them the gym passes they would.” (colleague)

“Gym passes were great, they lasted for three months and people could use them to get indoors, get healthy and it would be a social thing that was massively beneficial for recovery.” (colleague)

“We used to get gym passes for the clients too, any gym for three months, it got people out and about.” (colleague)

Workers also described resources for groups being in short supply:

“We have a lack of materials, have to beg steal and borrow for them.”

“Changing Lives used to have a childcare centre where parents could have children watched when they were in appointments.”

Recommendations for health related costs

Loss of income to attend appointments

• Explore the possibility of introducing “protected appointment time” agreements with employers, for clients in recovery
• Create neutrally worded letters confirming “a health appointment”, without specifying addiction treatment. Allow clients the choice of whether to use this.
• Expand scheduling to put on groups early mornings, lunchtimes, evenings and weekends, for those unable to miss work to attend.
• Support clients to stabilise income, challenge unfair dismissals, and navigate sick pay, Universal Credit rules, and in‑work benefits. This might be through Citizens Advice.
• Offer remote or hybrid attendance options (phone or video) where clinically appropriate, to reduce need for unpaid leave.

Lack or loss of funded support

• Allow groups a refreshment budget, high impact at low cost.
• Explore the possibility of reinstating gym passes. Look at different ways of funding this, for example, corporate social responsibility schemes, charitable partnerships. Explore off-peak memberships or group bookings.

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

Client experiences of New Beginnings shows what good poverty-informed design can look like. This includes taxis provided to transport the client; medication arranged in advance; clear communication and coordinated planning (call before arrival, prescriber contact); and aftercare located close to home.

“I self-referred in Bridlington, was doing group sessions and one-to-one and saw a prescriber and then they put me on a waiting list and cancellation list. I got a call the week before I came in. About an hour and a half, all been funded, got a taxi here. Came on Monday 19, go home on Friday. Supposed to be here till Monday but not much groups happening at the weekend. Looking forward to seeing my daughter. Daughter hasn’t visited because it’s a while away. Taxis booked for going home and that’s all sorted, medication arrived already. The after care in (place name), groups or sessions 10 minutes’ walk.”

“NHS pay for it (taxi to New Beginnings). They paid for taxi from Hull to here. They’ll get me one back as well.”

Barriers and challenges

Uncoordinated appointment systems

Drug and alcohol services can be complicated and difficult to navigate. Clients find themselves with the responsibility of trying to coordinate appointments with several different services, who “don’t talk” to each other, such as Aspire, the Department for Work and Pension and the Probation Service. People often receive multiple appointments, in different places, on the same day, with large gaps in between, leaving them ‘begging for help’ to organise it all. Those on a low income, without their own vehicle, cannot afford to travel back and forth between appointments, so are forced to hang around in between times. Without money, they have nowhere safe to wait: no cafés to relax in, no transport home. This makes long gaps stressful and potentially triggering. Some staff even went as far as to say that Probation services ‘set people up to fail’ by creating gaps in their day, exposing them to triggers.

“I need to ring my key worker and my probation officer to coordinate appointments, they don’t talk to each other really.”

“Some days I might be hanging around for hours between appointments.”

“Aspire don’t talk with mental health and mental health won’t talk with Aspire, and mental health will ask about substances, which is triggering.”

“I’ve had appointments with key workers, then the Department for Work and Pension, then social workers, then my probation officer, all at different times… I’ve begged for help (to organise them) but no one helps me.”

“We can never get through to probation, there’s no flexibility.”

“Probation aren’t flexible at all. Still waiting to hear back from them. Of course people kick off, it’s cos they know they’ll be going back to prison.”

“You have to know what you’re doing, but if you’re accessing mental health support as well, it all gets a bit confusing and chaotic.”

“I’ve had to go to the job centre early and just sit there for hours. When you’ve got no money there’s nothing else you can do, and going around Donny can be triggering. There’s people I don’t really want to see.”

“Being in the town centre isn’t a good thing for a lot of us.”

“One man was sent by probation services to group in number 3, then a one-to-one with Aspire, then had a probation meeting 90 minutes later, so for that hour and a half was supposed to wander around town, which can be very triggering for them.” (colleague)

“I tried ringing them (probation service) to change it but they wouldn’t change it. I have to ring them to ask to change appointments or it’s a breach of probation.” (colleague)

“Probation services specifically set them up to fail by creating gaps between meetings and appointments. They literally send them here because of substance caused issues, then expect them to wander around a town full of pubs for three hours.” (colleague)

“We need support services to work in unison with probation services.” (colleague)

“Appointments aren’t always linked up, so can end up with a client being left for two hours in Doncaster city centre, which is triggering, obviously.” (colleague)

Working people penalised

Groups tend to be on during the day, limiting access for anyone working standard hours. People in low paid jobs are unlikely to have paid leave or protected time to attend these groups or appointments, so risk losing their jobs in the pursuit of recovery. Yet, as already said in the previous section:

“Being in employment can enhance recovery, improve symptoms and adherence to treatment and prevent relapse.” (Burns et al., 2007; NTA, 2010)

“Why should people who are working be penalised? That should be picked up at assessment.”

“A lot of the group sessions are bang in the middle of the day. I couldn’t go until I lost my job.”

“Working makes it much harder to get help.”

“We should have groups on a night or evening, it’s crap that they can only access them during the day. If you have to wait for a partner to get home to look after the kids or you work, you’re being reprimanded for working!” (colleague)

“People that work can’t come to the day groups. Some people who own their own business or work for themselves can work around it, but for others it feels like they’re being penalised for working.” (colleague)

“We had a guy who it took 12 weeks to do the detox programme, cos he was working, someone else it would take three.” (colleague)

Lack of accessible and suitable locations

The needle exchange is only available in one central location, meaning people who live far away, who rely on expensive public transport or difficult journeys to get there, will find it really challenging to access.

“Needle exchange programme is very limited, that’s why there’s such high rates of AIDS and hepatitis.”

“The needle exchange being only here (Rosslyn House) is a big barrier. It’s ridiculous. Used to have it in chemists but they stopped that about two years ago now. Thing is, if they live miles away, they’re not going to come in, they’re going to use dirty needles and get massive abscesses and cause the NHS thousands. It just goes round and round.”

In addition, some of the locations used for groups have been described as not fit for purpose. Examples include uncomfortable temperatures, lack of ventilation, no windows, and being very unappealing in appearance, to the point of “depressing”. Through a poverty lens, poor quality buildings reinforce the stigma of substance use and deter attendance. It undermines the value of the support on offer.

“Rooms aren’t fit for purpose, there’s no ventilation and we can’t open the windows. It’s like an icebox in the winter, but in the summer it’s like a greenhouse. We’ve had people pass out here.” (number 3) (colleague)

“Buildings are not conducive.” (colleague)

“The reception here (Rosslyn House) is so depressing. It looks like a GP service.” (colleague)

Limited alternatives to face-to-face

Accessing support online rather than face-to-face, is often seen by various services as a good way of cutting travel costs and minimising difficult journeys. However, this was not viewed as a satisfactory alternative for people trying to access drug and alcohol support. In-person group work is seen as being more valuable than a telephone conversation. It offers opportunities to socialise with others and to share experiences and ideas. For someone struggling with feelings of isolation, that support network is invaluable.

“Social isolation is a big thing in recovery. Having that contact is so important.” (colleague)

“We do some telephone consults but not the same as group work.” (colleague)

“More telephone support than what we used to be doing, it’s harder though because it’s not getting people out and about. Especially if they’re stuck in a rut.” (colleague)

Online provision does nevertheless potentially enable a person to engage with the service, who may otherwise struggle with face-to-face. However, people experiencing poverty are the least likely to be able to benefit from online alternatives. They may not have the digital devices or be able to afford internet or data. They are also more likely to be living in unstable housing, which may not allow appropriate levels of confidentiality and privacy for online sessions.

“Hoping to get some online groups but might be an issue, when you’re in addiction, getting a laptop, that’s not possible.” (colleague)

“Only thing with online group meetings, confidentiality or privacy, if I’m at home and I’m talking about something and my dad walks in.” (colleague)

Recommendations for navigating and negotiating appointments

Uncoordinated appointment systems

• Provide warm, supervised indoor spaces where clients can wait between unavoidable appointments at no cost.
• Reducing risk during gaps between appointments:
  • minimise long gaps by actively scheduling appointments back-to-back where risk is identified
  • where gaps are unavoidable, offer structured alternatives (for example, access to groups, peer support, or safe spaces)
  • provide guided or supported transitions between appointments for high-risk individuals
  • consider location-aware scheduling, avoiding high-risk environments where possible
• Introduce a navigator or care coordinator whose role is to liaise between different organisations on behalf of the clients.
• Explore the possibility of creating cross-partnership timetabling.
• Cluster multiple appointments into one location where possible, to minimise travel.
• Advocate for probation service flexibility.

Working people penalised

• Expand scheduling to put on groups early mornings, lunchtimes, evenings and weekends, for those unable to miss work to attend.
• Provide predictable, recurring appointment slots to help clients plan around work.
• Create some guidance for employers on: why treatment improves work attendance, why flexibility reduces relapse risk and how to support an employee without stigma.

Lack of accessible and suitable locations

• Reintroduce other needle exchange locations. Partner with, for example, pharmacies, community centres, GP surgeries, mobile outreach vans.
• Improve building environments to make them more fit for purpose.

Limited alternatives to face-to-face

• Explore charities such as Good Things Foundation to provide digital devices that would enable clients to have the option of digital check-ins, when face to face is not possible.

Page last reviewed: May 29, 2026
Next review due: May 29, 2027

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