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 enhanced care home
The Enhanced Care Home team provides services to care homes in Doncaster. Their base of operation is Tickhill Road Hospital, but they are a community-based service which visit patients in the Care homes.
The Doncaster Enhanced Care Home team (ECHT) is part of the trust home first model and provides a multidisciplinary approach to supporting residents in care homes. The team includes general nurses, mental health nurses, occupational therapists, and physiotherapists. The service undertakes holistic assessments, supports personalised care planning, and provides specialist mental health, physical health, therapy and falls prevention interventions. The overall aim is to improve outcomes for residents, avoid unnecessary hospital admissions and support care homes to meet increasingly complex needs.
Referrals to the Enhanced Care Home team are accepted for permanent care home residence and these and be made through the Single Point of Access.
Doncaster is ranked 37th most Deprived (from 317) local authorities in England in the 2019 English Indices of Multiple Deprivation (IMD) where one is the most deprived and 317 is the least deprived. This is a rise of five places from forty-two in the previous IMD of 2015. The overall rank of Doncaster in the Indices has remained much the same over a 15-year period following IMD’s in 2004, 2007, 2010, 2015 and 2019 with the average rank over those studies being forty. Doncaster is in the top 20% most deprived local authorities in England. Sixty percent of Doncaster population live in areas ranked in the “most” deprived or “worse than average” quintiles. The data collected in 2024 is due to be released in late 2025.
Doncaster has 44 Care homes for 65 and over residents based over the four geographic areas. These like most services in health and social care are navigating financial pressures as vacancy rates continue to rise.
Poverty is strongly linked to health inequalities, lower life expectancy, and higher burden of chronic health conditions. The prevalence of health issue among disadvantaged groups increases the need for comprehensive health and social care services including care homes.
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 between October 2025 to January 2026; and seventeen staff members completed. A total of twenty-nine survey responses were received from staff
Stage 2: scoping
Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management, observing interactions and reviewing key areas such as the website and communications.
Stage 3: patient and community consultations
We received survey feedback from four care homes. And utilised comments made by patient about the service using Care opinion.
Stage 4: feedback session
A feedback session will be held with Rose Robinson-Smith, Modern Matron and Ryan Smedley, Team Lead where findings will be discussed, and changes are collaboratively discussed that could be implemented.
Stage 5: review
Around twelve 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 enhanced care home 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
Positive interaction with therapy staff
Residents reported meaningful, helpful interactions with the therapy staff.
Care home resident:
“I’m attending physiotherapy. They are good. I look forward to them coming. I like to do exercises.”
Responsiveness
The care homes described the team as supporting and timely in attending to request. The availability of the Single Point of Access is also seen as a structured point of communication which ensures that referral come through using one pathway.
Care home:
“When we have enquired about the service, they have been able to visit and help us support our patients.”
Barriers and challenges
Communication
People in depravation often feel less empowered to challenge request clarification or re- ask questions. A key concern raised by a patient was:
Care home resident:
“I could not communicate to the nurse openly. She didn’t give enough time for me.”
When staff were asked what poverty proofing barriers affect their patient accessing their service communication and health literacy were the frequently listed. While this may not be directly with the care home residence given then low response rate from the care home there may be a need for better understanding of Enhanced Care Home team being shared with the care homes.
Misalignment between expectations and actions
Care home staff:
“They came out to look at care plans and told us what we already know and things we need done don’t get done!”
This can create frustration, duplication and time wasted which can have cost implication for both the care home and the service and detrimental effect to the health of the patients.
Recommendations for communication
Communication
- Encourage staff to use “teach back” to check understanding which can allow for equitable time being given to patient to make sure they have understood Strengthening person-centred communication.
- Advertise the service more with the care homes so they know more about what the service offers and how to get in touch.
- Strengthen inter-service communication to avoid task duplication and misalignment in expectations. This can be achieved through shared checklist, joint multidisciplinary communication huddles.
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
Reduced cost burden due to in-home delivery
Patient noted that the service coming into the care home avoids travel and appointment cost. This is one of the strong poverty proofing features provided by the home first teams with the trust. Having therapist that come in and visit patients in the care home identifying the intervention and equipment needed to help support and improve their independence and safety.
Care home:
“The service comes to our patients, so they don’t incur any additional cost to receive care.”
Barriers and challenges
Cost of equipment
Access to equipment can be restricted by eligibility criteria due to funding arrangements. Care home often must purchase recommended equipment, and reluctance or inability to do so creates inequality. This is the case where families may be self-funding for care, and this can lead to financial strain and lead to families declining full care packages.
Staff:
“Care homes are required to purchase equipment… care homes reluctant to buy.”
“Care homes are supposed to treat patients fairly. However sometimes equipment cost can lead to issues.”
Care home fees
Where families may be partially or fully funding the care of a resident this may have a negative effect on the wellbeing of the family, their ability to visit the resident and in turn affect their ability to accept additional care packages. All this can negatively impact the emotional and mental wellbeing of the resident and their families.
Staff:
“Family paying 3rd party costs similar to a mortgage or rent… reducing budgets for heating and food.”
“As a service we are not in control of the placements that patients get for which care home they live in.”
Recommendations for health related costs
Cost of equipment
- Develop clear, equitable standard for essential equipment provision. This should include agreed minimum equipment care homes must provide.
- An escalation route for when a care home cannot is unable to purchase equipment.
- Share with the care homes information on where equipment can be sourced at reasonable costs.
- Ensure staff routinely consider financial impact when recommending intervention, for example, access to aids provided by NHS, charity funding or self-funded.
- Strengthen signposting and support available through local grants, connection of social prescribing.
- Consider Commissioner dialogue: raise patterns ( for example, repeated refusals) with Doncaster Metropolitan Borough Council or integrated care board commissioners for system solutions (bulk purchase schemes, targeted grants).
- Systematically assess advocacy needs, particularly for residents with dementia or communication difficulties.
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
In home appointments
The Enhanced Care Home team model brings services into the care homes, reducing the need for residence to travel. Resident consistently not the benefit:
“They visit us in our care homes so as long as you are here you can access the service.”
Home First integration supports internal referrals.
A care home noted that:
“Being part of home first has helped us… they can easily refer without having to wait.”
This helps in reducing friction and delays of care provision where teams are working as a multi-disciplinary team.
Barriers and challenges
Although the above, when staff were asked which poverty-related barriers apply to patients accessing services one staff members informed:
“Complex health systems (difficult to navigate, referrals appointments et cetera).”
This was voiced to note the navigation issues that arise across the wider health and social care system.
Staff mileage
While staff attempt to manage workloads efficiently by clustering visits and working closer to home to make appointment navigable, mileage reimbursement is and are of concern.
Staff:
“Staff start, end or work from home but milage expenses are detected from base to home.”
“After 3000 miles the reimbursed mileage rate is reduced, although petrol and maintenance costs remain.”
Mileage reimbursement does not reflect real travel and maintenance costs. After a threshold, reimbursement rates reduce despite fuel costs remaining high. Staff reported: mileage is deducted from base to home, meaning some travel is effectively unpaid.
Recommendations for navigating and negotiating appointments
Complex health systems
- Offer named contacts for follow-up queries. Or have named contact for specific care homes.
- Ensuring provision of clear next steps when interventions have been put in place especially directly to the families that may be responsible advocate for residents.
- Implement mini huddles across Enhanced Care Home team, home first and care home leads for residents with multiple open actions, time boxing decisions and removing duplication.
Staff mileage to appointment
- Review mileage and expenses policies to reflect actual cost.
- Consider using nearest Rotherham, Doncaster and South Humber NHS Foundation Trust base or GP surgery as the default base for mileage calculations.
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
Holistic assessments
Holistic assessments and therapy input supports resident to maintain mobility, daily living skills, and quality of life. Some residence describe positive therapeutic experiences enhancing confidence.
Resident:
“… I like to do exercises”
This holistic model aligns well with empowerment principles. And when staff were asked what they fell their service does well to support patients and residents who may need additional income support they shared:
Staff:
“Home visits Signposting and referring for further benefits advice. Supporting care coordination, phone calls et cetera.”
Barriers and challenges
Communication limitations reduce confidence
Residents may feel limited in their ability to influence decisions, particularly when they’re not given the time to understand or seek clarity on what they may be going through.
Resident:
“… she didn’t give enough time for me.”
All care homes when asked about what more could the service do to support families on low incomes indicated that:
“Give clear communication about support available.”
Staff consistently reported “difficulties understanding written materials” or “difficulty understanding verbal instructions”. This disproportionately affect people in deprivations.
Recommendations for patient empowerment
Communication
- Use accessible communication techniques if required. Repetitions, visual demonstration.
- Embed shared decision-making with financial awareness of: Will this cost the family or care home money, does no cost alternative exist. Can financially pressure limit engagement.
Staff awareness
- Staff have expressed an interest having more awareness on how to support their patients. It is recommended that staff can attend the bespoke training being offered by Citizens Advise which is available to book via the staff portal.
- Embed routine non, stigmatising questions about affordability into assessments.
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
There is evidence from the feedback that staff can recognise if residents are experiencing poverty and go above and beyond to support. Staff informed that their service does have ways to identify if a patient is experiencing poverty through:
“Verbal screening ask those we think need help.”
“Formal financial screening tools that are routinely carried out.”
“Judgements of staff.”
Staff even indicated that were concerns are noticed they will escalate.
Staff:
“Since the patients we look after are in other care settings it’s making sure we continue to highlight any safeguarding concerns that we may notice when we visit our patients.”
Some staff demonstrate proactive awareness and compassion, particularly where individuals recognise the complexity of residents’ circumstances:
Staff:
“Home visits, signposting and referring for benefits advice, supporting care coordination and phone calls.”
Barriers and challenges
Support offer provision
When staff were asked if people accessing the service would experience any poverty-related barriers, staff reported:
“Patient advocacy (unable to ask for and get help).”
A dominant staff response when asked how well the service supports people experiencing poverty was “3, not sure”. This indicates a willing ness to support, lack of tool and structured guidance and inconsistent confidence across the workforce.
When staff were asked what could better empower them to support people accessing their services and experiencing poverty, they reported:
“It would be worthwhile to link in with the care providers on this work and seeing if there is any collaborative work we can do together with them.”
Staff may lack confidence or being up-to-date with knowledge on poverty, benefits, local support which can limit signposting.
Perceived irrelevance
Some staff felt poverty was “not applicable” because residents live in care homes:
“Not applicable as all service users are in receipt of 24-hour care.”
This overlooks family poverty, self-funded residents, equipment cost and out of area placement which can reduce family contact.
Recommendations for staff awareness and guidance
Support offer provision
- Develop quick reference guides for the intervention the service offers and where items can be sourced.
- Shred communication with staff on nationally published offered which can help with healthcare cost such as:
- help with transport cost.
- NHS low-income Scheme
- personal Health budgets
- Partner with care home to work together with other Care Home Liaison teams with the trust to have more bespoke empowerment training that emphases the unique constraints of providing collaborative care with care homes.
Staff awareness
- Introduce poverty aware prompts in assessments.
- Develop and provide short practical poverty proofing refreshers focused on identifying financial barrier without judgement.
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
Residents in care homes generally do not incur travel costs for appointments as the Enhanced Care Home team services are delivered on site. Although residents do not typically travel to appointments, travel remains a hidden cost within the wider system, affecting families and staff.
Care home:
“As our patients are care homes there are no travel cost that they incur with the Enhanced Care Home team service.”
Barriers and challenges
Although residents do not incur travel issue with the service there are indirect travel costs for families visiting loved ones, particularly where finances are stretched.
Staff reported:
“Patients placed out of area which means family members cannot afford to visit.”
This is where a patient has been placed in a Doncaster Care Home and out of area to their loved ones who may become unable to visit. It can be beneficial for such to be recognised and where possible ensure that lines of communication with family are kept open with the service to keep them updated.
Recommendations for travel
Travel cost
- Consider family who advocate patients when scheduling visits and reviews. This can be through providing scheduled updates with family.
- Referral to Citizen advise seeing if there is support that can be provided for travel for the Service user to link to their current allowances.
References
- City Of Doncaster Council (2025) Health Inequalities and Inclusion Health in Doncaster.
- Disability Living Allowance (DLA) for adults
- Doncaster Citizens Advice referral
- Healthwatch UK (2019) There and back, People’s experiences of patient transport.
- Help with health cost
- Literacy Trust (2012), Adult Literacy
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- Public Health England. (2016). People with Learning Disabilities in England.
- Sheehy-Skeffington and Rea (2017) How poverty affects people’s decision-making processes.
Page last reviewed: February 20, 2026
Next review due: February 20, 2027
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