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 early interventions
Doncaster’s early intervention in psychosis and at-risk mental state (ARMS) employ diverse approaches to assist individuals.
This includes aiding in understanding their situation, medication, individual or family therapy, supporting education, employment, finances, and engaging in physical or group activities.
Anyone concerned that an individual may be experiencing psychosis, including the individual themselves, can contact the service for advice or referrals. However, before making a referral, the referrer must notify the person in question.
Referrals can be made by phone, in writing, or in person using the provided contact details.
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.
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.”
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
2 staff completed a three-hour training session. 11 staff were consulted with via a survey.
Stage 2: scoping
Time was spent by members of the locally trained team 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.
Stage 3: patient and community consultations
The service spoke to 11 people in total.
Stage 4: feedback session
A feedback session will be offered to the Service Manager, Barbara Taylor, where we will discuss our findings and collaboratively consider various changes that could be implemented. These findings will be fed into the bigger piece of work across the whole trust. This report is based on our findings.
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 early interventions 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
The service is welcoming
Everyone told us that they felt that the service is welcoming, and all gave us a positive reason why. This is also supported by the positive feedback Doncaster’s Early Interventions Service gets on Care Opinion. Some examples are shown below of what people said.
“I really do not know where I would be if it weren’t for the team effort.”
“I couldn’t of asked for a better team.”
“How I dealt with my grandad passing and current worries.”
“See from the staff. Everybody is nice, non-judgemental, try to help me out. More caring.”
“Every time we have had a visit or we have travelled, no matter who it is there is always a smile on their face and always calm.”
“Helpful posters to give advice. Nice seating area and garden. Staff are helpful and kind.”
“Service with early intervention team has been amazing. Great team-work can’t do enough for my son and family.”
“I am grateful for your 3 members Jenny, James and Jon for providing such a great care for my son and as a result are self-explanatory meaning I can see big change in my son’s behaviour and attitude.”
“I receive everything good here, usually quiet which I like, no distractions, like coming to Church. I talk to you and you listen, I feel something, less stress, afterwards.”
Barriers and challenges
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 available and what treatment they will receive.
“Giving people more easy read information or providing options to people so that we empower them to make an informed decision.”
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.
- Create some of what the service does in an easy read version.
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
People feel confident to talk to staff about costs
Some people told us that if they were unable to afford their healthcare-related they felt they could talk to staff if costs did arise.
Patient:
“I can speak to you, you try to help me so I feel comfortable speaking to you.”
“We got the HC2 that you helped me to apply for – so yes you can help me.”
Barriers and challenges
Affordability of costs
Some people told us that they have missed appointments due to financial struggles. which related to travel, prescriptions and childcare. Having no healthcare-related costs reduces financial stress and allows patients to focus on their well-being rather than worrying about bills. This makes preventative care more possible as patients are less likely to delay or avoid appointments because of financial concerns. The staff also told us there are barriers to reclaiming health related costs.
“In my experience the finance office at Tickhill Road site won’t process HC5(T) claims for people with ‘Help with Health Costs’ certificates, I’ve supported people to send their claims to NHS Business Services Authority directly to claim the refunds but this takes a long time.”
“People in different financial situations, it’s not good to leave them alone and not treat them for mental issue. This government helps people who can’t afford to pay for treatment.”
“The team is always open so I would ask if I needed help. More information about financial help could be given to people who can’t attend groups or appointments without it.”
Hidden costs of accessing services
Staff told us that there were indirect costs to people, such as childcare or time off work, that could make attending appointments difficult.
Prescription costs
We were told that it would be good to help people to see what support is available for prescription costs.
“Support with prescriptions, information about benefits, information about food banks or community support.”
“Support with prescriptions.”
Recommendations for health related costs
Money and debt
- Put patient needs at the forefront of budgeting.
- Leadership to consider how conversations around money and savings can lead to misinformation being given to staff around what can be done to support patients.
- To continue to promote Citizens Advice service at the trust, each patient can have their own one to one appointment with a trained advisor (staff can book these for patients via the intranet). There is lots of structure support available which does not come at a cost the service.
Improving care
- Where patients could have an improved quality of life and, or treatment cycle but are currently lacking the resources to do so, colleagues should make a referral into Citizens Advice, or consider other tertiary services or charities which might be able to offer support.
Hidden costs of appointments
- 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 people 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.
- Ensure people know about SytmConnect, which enables people to change their appointment to a more convenient time.
Prescription costs
- Make staff aware of financial support available Help when you need to pay for NHS care (prescriptions, dental care, eye care wigs and fabric supports).
- Make sure this is communicated to people and their peer support.
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
Home visits
Staff will offer home visits to some people, which means a reduction in did not attend (DNA) rates and ensuring that people receive the care that they need. Home visits also know to work well alongside social care and physiotherapists, promoting co-ordinated care. During staff consultations, it was widely recognised that travel or transport is one of the biggest barriers facing people.
“Meet people at home if it is safe to do so and pay for transport at times if required.”
“Flexibility to see people in their own home so that they do not have to spend additional money on transport. Although the patient contact targets set by the trust are reducing our capacity to be able to do this.”
“We do home visits where this is the preference (Although this is then timely for the service).”
“We have home visits now.”
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 accessing other healthcare needs.
Flexibility of appointments
Staff also said that whilst home visits were offered, more could be done to consider the time and venue of appointments.
“Provide options of where we meet in the community: home library or cafe. Survey patients and carer for their preferences on times of group sessions to maximise engagement and reduce financial strain.”
“Offer out-of-hours appointments.”
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.
Flexibility in appointments
- Look at options for delivering sessions in community settings, nearer to people’s homes.
- Consider how appointment times can be more flexible, to meet the needs of people.
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.
Barriers and challenges
Access to data to use digital devices
People also told us that information about access to digital devices would be a good thing to introduce. Citizens Advice Doncaster are working with other voluntary organisations on a programme to help with digital literacy, and devices. Staff also told us that access to data was a barrier, with people having no access to WiFi or phone credit as well.
Staff:
“provide internet data for people.”
“I think a lot of our people don’t have phones and so communicating with them to arrange appointments or check in becomes really hard.”
Information about other organisations who can help
Many people also told us that more financial assistance programmes, along with staff training, would be a good thing to introduce. Giving clear communication about what is available was also something people said we should introduce.
“Leaflets about financial help”
Support for people to know their rights
Staff told us that supporting and giving voice to people to know what they were entitled to or should get (often referred to as patient advocacy) can be a barrier to accessing services.
Recommendations for patient empowerment
Providing information to patients which they might not otherwise have access to
- Patients would like to know what is available to them as they are not always able to find out themselves. This could include charities, foodbanks and benefits.
- Make sure that staff are aware of what is available in Doncaster, and communicate this to people and their peer support
Staff awarenes
Staff expressed an interest in knowing more about how to support patients. It is recommended that more staff attend additional bespoke training being delivered by Citizens Advice on learning half days.
Technology awareness
Greater knowledge and ability to signpost patient for support with internet, Wi-Fi and technology support via Citizens Advice Doncaster.
Advocacy
- Make sure staff are aware of advocacy advice and support that is available to people.
- Make sure that this is communicated to people and they understand it.
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
Examples of how people are supported
Staff told us of examples where support was given to people experiencing poverty. This usually involved signposting to other services.
“We are good at offering the support we are aware of, and supporting people in accessing external support. Including things such as food parcels and emergency funds and grants.”
“Offering support with food parcels, advise and signpost to external agencies, support with budgeting or living skills, flexible working (for example, visiting at home or a local GP or family hub)”
“We are good at offering the support we are aware of, and supporting people in accessing external support. Including things such as food parcels and emergency funds and grants.”
“Referrals for a care act assessment. Bus pass.”
“Support people to claim ‘Help with Health Costs’ via NHS Low Income Scheme if eligible.”
“We have several people assigned to provide food bank vouchers.”
Barriers and challenges
The response to supporting people experiencing poverty is mixed and not consistent.
Whilst the above paragraph shows structured ways to support people, with staff citing examples of where the service supports people experiencing poverty, but this can be dependent upon judgements of other individual staff or verbal screening. The response to the staff survey is also mixed: around half the staff think there is a way their service can identify someone in poverty, whereas the other half don’t think there is. This means the support families receive may depend upon the member of staff the person sees, rather than a consistent offer being made. A person experiencing the stigma and shame of poverty is highly unlikely to ask for help, so it falls on the service to create a “safe space” and ask the right questions in order to help ensure that support is given where it is needed.
“More awareness of any wider support available for people accessing our services.”
“Standardised routine assessment of all patients and carers around poverty.”
“I am not really sure of what is available.”
“I feel there are some but it’s not widely known about.”
Recommendations for staff awareness and guidance
Financial questions not asked routinely and universally
- Develop a “script” for engaging all patients in a conversation about their financial circumstances. Tailor this to the context of rehabilitation and going home.
- Embed financial wellbeing questions into routine assessments, so conversations happen consistently rather than opportunistically.
- Normalise financial conversations, framing them as a standard part of holistic care to reduce stigma for patients.
- Empower staff with poverty proofing training, which is bookable via the staff portal.
Staff don’t feel knowledgeable enough to provide support
- Spread the word about trust engagement with Citizens Advice. Ensure all staff know the who, what, where, when, why of this.
- Pull together a reference or database for staff of benefits and local charities and voluntary, community and social enterprise (VCSE) to empower them with information.
- Clarify staff roles and boundaries, ensuring staff understand they are not expected to provide benefits advice but to identify needs and refer appropriately.
- Establish a clear referral pathway to specialist support (for example, Citizens Advice, welfare rights, voluntary, community and social enterprise (VCSE) partners), with feedback loops so staff know outcomes.
Change the narrative
- Clarify staff roles and boundaries, ensuring staff understand they are not expected to provide benefits advice but to identify needs and refer appropriately.
- Ensure staff feel supported in cases where they need to make onward referrals.
Travel
For inpatients on the wards, travel difficulties are generally related to the ability of their friends and family to visit, rather than the patient themselves travelling. Any travel required by the patient will be arranged by the hospital, for example, to and from 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. The costs incurred through travel can mean the difference between receiving regular visitors or none at all.
Barriers and challenges
Cost of travel
The majority of staff told us that the cost of travel and transport (cost of parking, public transport and taxi’s) was a barrier to people attending appointments. We were also told by some people they missed their appointment due to costs of travel. Staff also told us that providing people with information and support for people’s travel would be a good thing.
“The cost of getting to or from appointments not being a barrier.”
“To be able to provide financial support for travel to appointments.”
“looking at cost of travel to appointments, our service users often have more than 1 appointment in a week which can be costly.”
Recommendations for travel
Home visits
Consider the offering of home visits, specifically to patients who have issues with getting to appointments. Staff are able to claim travel expenses via Easy.
Community venues
If home visits are not an option, colleagues may wish to consider booking community venues to offer appointments (a list of venues is available on the intranet). It may be possible to book venues for longer periods of time, meaning that a group of patients can be seen closer to their home over the course of a session.
Travel Fund
- Make sure staff know about the trust’s Travel Fund and how to access this.
- Make sure people are made aware of the Travel Fund is money is a barrier to attending an appointment.
References
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- Fenney, D. and Buck, D. (2021), The King’s Fund, The NHS’s role in tackling poverty: Awareness, action and advocacy.
- 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.
Page last reviewed: May 29, 2026
Next review due: May 29, 2027
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