1 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.
2 Poverty proofing Doncaster Hazel and Hawthorn
Hazel and Hawthorn wards are located on the Tickhill Road Hospital site in Doncaster.
Both wards are dedicated to nurse-led rehabilitation services. Patients who have experienced illness or a fall may require rehabilitation to regain their independence at home, with or without support from social services or the Reablement team.
“Rehabilitation doesn’t just help people survive, it enables them to live well, stay active, and enjoy a better quality of life.” (Inequalities in Health Alliance: blog, November 2024)
Referrals to Hawthorn and Hazel wards are exclusively accepted from healthcare professionals in hospital and community settings. Patients can be admitted to the ward from various places including home, care homes, accident and emergency, or other hospital wards.
While the wards are not specifically for older people, many patients do fit that criterion, due to the prevalence of falls in that generation.
“Almost one in five (17%) pensioners are in relative poverty in the UK… The highest poverty rates are among pensioners aged 85 and over, with more than one in five (21%) people in this age group living in poverty. Pensioner poverty rates vary across the country. The highest rates are in Yorkshire and the Humber (20%)” (Financial Security, The State of Ageing, 2025)
3 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.
3.1 Voice
The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.
3.2 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.
3.3 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?
4 Poverty proofing process
4.1 Stage 1: training and consultation with staff
Staff will complete a three-hour training session. 3 staff were consulted with on the wards.
4.2 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.
4.3 Stage 3: patient and community consultations
We spoke to 7 people in total. These people were inpatients in either Hazel or Hawthorn ward.
4.4 Stage 4: feedback session
A feedback session will be offered, 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.
4.5 Stage 5: review
Around 12 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward.
5 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 Hazel and Hawthorn were:
- health-related costs
- navigating and negotiating appointments
- patient empowerment
- staff awareness and guidance
- travel
5.1 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.
5.1.1 What works
5.1.1.1 Food and drinks on the wards
Patients are served meals and hot drinks either at the table in the day room or by their beds on a portable table. This gives them the opportunity to socialise with others over mealtimes, or to eat more privately. Patients can choose what they want to eat from a menu sheet. This is filled in a few days in advance, so by the time the meal is served, patients will often have forgotten what they chose. Staff showed flexibility at mealtimes, by offering choice in the moment where possible. Drinks are also offered in between mealtimes.
“Food is magnificent! Have to order three days in advance.”
“Three visits a day for drinks, and the one with meals too.”
The availability of food and drinks served by the hospital is the same for all patients, regardless of their financial circumstances. Differences occur in the “extras” some patients have, because they have been brought snacks and alternative drinks options by friends and family members. Patients without that support network are unlikely to have these “extras”.
5.1.1.2 Adaptations provided for going home
Patients spoke of home assessments being carried out by members of the service, to ensure that they have the best chance of safely adapting back to life at home. Adaptations are provided free of charge to the patient. Examples spoken about include handrails inside and outside, “skis” to go on a Zimmer frame for carpet use, perching stools, shower chair, a stand to raise the toilet height, and beds. Again, such equipment will be provided on a needs basis, irrespective of financial circumstances.
“Got handrails. I’ve got skis for the Zimmer frame for carpets and that. All in all, I’m apprehensive, not having the freedom I used to have. Have done assessment, woman coming soon to talk about the handrails.”
“They go and assess your property. You tell them what you can do and they tell me what I need to manage. Already been to my house today. They’ll have that all ready for me for when I go home.”
5.1.2 Barriers and challenges
5.1.2.1 Lack of toiletries and clothes
For those patients with a support network of friends and family, and the money to afford things, access to clean clothes and an ongoing supply of toiletries is readily available. However, staff have described some patients as coming into hospital with nothing. Some patients may get no visitors, so are not able to send clothes home to be washed or have clean clothes brought in for them. They might end up wearing the same clothes for several days, getting increasingly dirty; or they may be forced to wear inappropriate hospital gowns or clothes from lost property, because they have nothing else to put on. Staff spoke of the impact of this on patients, who may feel embarrassed or stigmatised because they do not fit in with the others.
Staff:
“One guy came in with nothing, didn’t have any family. All sourced here, left us with all of those clothes.”
“Don’t know what happens in terms of clothes going in the wash, two weeks to come back. So people will wear stained clothes. Wish we had more spare clothes, lost property that aren’t different from everyone else’s, not identifying.”
Patients often say that the hospital provides everything they need. However, discussions with staff revealed this is only possible because staff bring in supplies themselves. They might buy items, such as toiletries, using their own money; or they bring in unwanted Christmas presents. There was uncertainty amongst staff as to whether there is any ward budget to provide toiletries for patients.
Staff:
“Do see it occasionally. People who ain’t got toiletries. Have raided boxes to find stuff, they’ve stopped us bringing in stuff but I’ve gone to the supermarket and bought stuff, which is out my pocket. Should have some funding. You get homeless. They’ve got no support, no items.”
“Manager got money, deodorants and bodywash in case.”
“We get vouchers but not very many.”
Staff survey:
“Sometimes we provide patients with toiletries and clothes that are appropriate for the weather if no family visit them.”
5.1.2.2 Money and food waste
It was clear that some staff felt there was wasted money and food in hospital, which could be used more effectively. One example was about the amount of money they felt had been wasted on unnecessarily repurposing a ward space several times over.
Staff:
“Stop wasting money on the ward and give it to patients. The middle bay has been an office, network, office, how much money has gone into that?”
“Spend money on meetings and things but we’ve got mould in the ward, instead of treating it properly.”
“Amount of food we waste is unbelievable.”
5.1.3 Recommendations for health related costs
5.1.3.1 Lack of toiletries and clothes
- Send out comms on social media asking for donations of toiletries, clothes, et cetera. Many people donate clothes to charity shops, so why not donate to hospital wards instead?
- Contact local funeral homes. When an elderly person has passed away, their family may wish to donate clothes to the hospital wards.
- Place “collection bins” and relevant information in communal hospital areas such as reception areas and cafes, for people to donate items.
- In addition to food pantries, set up a collection of toiletries and clothes that staff can donate to. Ward staff can then access these instead of buying items themselves.
- Establish a ward budget for the purchase of essential items for patients without them. Research the cheapest way to source these items in bulk, to be cost effective.
- Explore how the hospital might wash the clothes of those patients without any other means.
- Introduce a standardised “essential items pack” for patients without personal belongings, containing basic toiletries and underwear, to be provided automatically on admission.
- Develop a clear protocol outlining staff responsibilities and escalation routes when a patient lacks clothing or toiletries, reducing reliance on individual staff goodwill.
- Ensure dignity and non-stigmatisation by sourcing neutral, non identifiable clothing rather than visibly mismatched or lost property items.
5.1.3.2 Money and food waste
- Put patient needs at the forefront of budgeting.
- Explore ideas to reduce hospital food waste.
- Explore redistribution options for unopened or surplus food, where safe and appropriate, such as staff managed snack supplies for patients without external support.
- Review of food ordering and waste patterns on ward to identify where over-ordering or unsuitable choices are occurring.
5.2 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.”
5.2.1 What works
5.2.1.1 Long visiting hours
Extensive visiting times on the inpatient wards allow maximum opportunity for visitors to attend. Visiting is generally from 10am until 10pm, excluding meal times between midday to 1pm and 5pm to 6pm. However, for patients requiring assistance with meals, a family member is allowed in during mealtimes to provide that necessary support. Similarly, if a patient has an appointment at Doncaster Royal Infirmary before 10am, a family member will be allowed in to accompany them to the appointment. Staff deal flexibly with situations as they arise.
Staff:
“We allow family to support mealtimes. Wife said she could only come at 5pm, so we let her in the squirrel room as a one-off. They can come before visiting, if a patient needs to go to Doncaster Royal Infirmary before 10pm a family member can come with them to accompany them. Otherwise it takes one of us off the ward.”
“Only today I asked my son to call and pick some clothes up, I’m going home tomorrow but they wouldn’t let him in cos it was dinner time. But it’s been sorted.”
5.2.2 Barriers and challenges
5.2.2.1 Appointment difficulties
Discussions with patients revealed a couple of challenges around external appointments. Firstly, a telephone appointment was given for what was meant to be a wound inspection, and was therefore completely unsuitable. Secondly, a patient had received a text message only that morning to say they had an appointment that day. This meant that the service had to quickly organise patient transport to get the patient to this appointment. He should have received a letter in advance of this, but said he did not receive anything.
5.2.2.2 Limited café opening times for visitor access
Staff highlighted that the café is only open at limited times, meaning there are no refreshments available for visitors who come outside of these hours, particularly in the evenings. There are some vending machines available in the building.
Staff survey:
“The cost of food in the café. Can we get staff discount? And also somewhere open for longer until visiting hours finish as some family want to stay but cannot get any food while waiting, especially after tea time.”
5.2.3 Recommendations for navigating and negotiating appointments
5.2.3.1 Appointment difficulties
- Where possible, ensure appointment type is clinically appropriate, particularly where physical assessment is required, to avoid unsuitable telephone or remote appointments.
- Improve advance notice of appointments, with clear expectations that patients receive timely written or verbal confirmation.
- Strengthen communication between services, so inpatient teams are informed of external appointments with sufficient time to plan transport and staffing.
5.2.3.2 Limited café opening times for visitor access
- Explore the possibility of extending café opening hours to align more closely with visiting hours.
- Offer refreshments to visitors who are in attendance when the refreshment trolley comes round the ward.
- Review affordability of refreshments, including consideration of discounted options for visitors.
- Consider alternative low-cost refreshment options, such as hot drink stations or visitor refreshment points during evenings.
5.3 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.
5.3.1 What works
5.3.1.1 Positive relationships with staff
Patients generally spoke very positively about relationships with staff, describing them as going “above and beyond” and being “really down to earth”. Particular mention was made about some of the younger staff.
“Staff are bullets. If they don’t have the answers, they’ll find them. Work the best they can.”
“9 out of 10, can’t knock it.”
“Can’t fault that young girl, had to tell senior staff how good she was, always so kind and understanding, knows how much pain I’m in.”
“The young ones are really caring.”
“Staff are marvellous!”
“Fantastic service!”
“Brilliant, very friendly, understand you as a person, which is important, we’re all different. You can talk to them to tell your position. They’re very very good, plain Yorkshire English. Fantastic food. I have difficulty swallowing, one meal was sandwiches, and it got stuck, they immediately got me something else. They are on your side, they know that you want to be home.”
5.3.2 Barriers and challenges
5.3.2.1 Mixed experiences of being kept informed
Some patients spoke of having their questions answered and of staff explaining things clearly to them. They talked about a 6-week care package being put in place for when they leave hospital, and about adaptations to their home to make it easier and safer to manage. They understood what was happening and why.
“I’m going to get a carer. I’ve had to accept there’s things I can’t do. The hospital gives me a care package for 6 weeks, someone will be there for me for 6 weeks.”
“Had problems with Doncaster Royal Infirmary but here everything explained well.”
“They’ve answered every question I’ve had. Yeah, explained clearly.”
Other patients have not felt included in their care and have been left with questions unanswered. One patient spoke of the pain she is often in and how a plan was put in place by senior staff to help address this. However, she said the plan was not followed after the first couple of days and “I don’t know why it’s not being done.” Other examples include a wound not being dressed as well as it should be, and cream not being applied as often as was directed. In situations like this, patients are left feeling ignored and not listened to.
“Meant to be creamed three times a day but just when people can be bothered.”
“They listen and sometimes ignore.”
“Came in here to become more mobile but it’s not happened… nobody’s listening.”
Through a poverty lens, it is important that a service is forthcoming with information for patients, rather than expecting patients to ask if they have any questions. It is well documented that people experiencing especially prolonged poverty, are less able to advocate for themselves:
“Poverty impedes the exercise of agency through its adverse effects on an individual’s aspirations, self-esteem, dignity, and mental bandwidth, among other potential mechanisms.” (Poverty, Agency and Development, Cambridge University Press, 2024)
5.3.3 Recommendations for patient empowerment
5.3.3.1 Mixed experiences of being kept informed
- Adopt a proactive approach to information-sharing, ensuring patients are routinely updated about their care without needing to ask questions.
- Use clear, plain language when explaining care plans, treatments, and next steps, tailored to different literacy and confidence levels.
- Provide information in multiple formats (verbal, written, visual), to support understanding and retention.
- Introduce regular check-ins where staff explicitly ask patients if they have any unanswered questions or concerns.
- Ensure care plans are consistently followed and reviewed, with clear communication to patients if changes occur and why.
- Support patients to understand and agree their care plans, reinforcing shared decision-making and patient involvement.
- Embed patient empowerment principles into everyday practice, recognising that people experiencing poverty may be less able to self-advocate and therefore require more proactive support.
5.4 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.
5.4.1 What works
5.4.1.1 Staff empathy and awareness of the need for support
Generally, staff try their best to provide support, with one or two specific staff members singled out by patients, “she’s my angel”. Staff recognise and show empathy for the financial difficulties experienced by many patients, which is an important starting point in addressing the barriers in the section below.
“We do get homeless in and people who don’t know they can claim certain things.”
“Almost don’t want them going home because they’re better off here. A lot don’t know how to work heating or afford it et cetera.”
“A lot of the patients we get have had it quite hard.”
5.4.2 Barriers and challenges
5.4.2.1 Financial questions not asked routinely and universally
While patients described being asked about their home situation, they said they had not been asked specifically about their financial circumstances and any resulting challenges. Such information tends to be discovered more by chance during conversations, or because patients come in to hospital with nothing and may have no visitors, which will naturally lead on to a conversation with staff.
“No, staff haven’t asked.”
“Never asked about finances.”
From a poverty perspective, asking everyone about their financial circumstances or difficulties in a tactful and sensitive way, will help to remove the stigma or the feeling of being singled out. 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.
5.4.2.2 Staff don’t feel knowledgeable enough to provide support
As explained above, staff do have the empathy and desire to help people, but many have said they do not know enough about what kinds of benefits and financial support might be available, and therefore do not feel confident having that conversation with patients.
“We need specialised support, don’t tell me to fill out housing support, not within my job role and I don’t know what I’m doing.”
“Information would be really fabulous. I don’t know enough. It’s knowing the right information. A lot of people will ask but I’ll just answer with what I’d say to my own family.”
“Could do something with benefits, someone to help. Better to have someone that can guide. A lot of them don’t understand what kind of benefits they can have. They’ll ask us to do them but I don’t like doing them, like what if I write the wrong thing?”
“Knowing where to direct people. Not just about patient. About family too, the cost of getting here. We’ve had patient relatives come two bus routes to get here.”
5.4.3 Recommendations for staff awareness and guidance
5.4.3.1 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 Children North East’s talking about poverty training.
5.4.3.2 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 and community social enterprise to empower them with information.
- Consider employing some kind of support worker to be based in the wards, who will be the point of referral and reference. Or a knowledgeable volunteer could fulfil this role.
- 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 and community social enterprise partners), with feedback loops so staff know outcomes.
5.4.3.3 Suggestion from staff survey
“Have someone who assesses all patients before discharge to make sure that they are ok financially when discharged and won’t struggle and if anything is identified refer them on.”
5.5 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.
5.5.1 What works
5.5.1.1 Free parking
Car parks can be found adjacent to most facilities across the Tickhill Road Hospital and Woodfield Park sites and are free for visitors. Car parks are also used by staff, which means they can sometimes get busy, resulting in parking a bit of a distance away and walking to the wards. However, due to the flexibility of visiting hours, visitors will be spread throughout the day, rather than all turning up at given times, thus reducing congestion. Some of the patients spoken to also said their family lived locally, meaning travel to the site was easy for them.
“Yeah, my wife mainly cos she lives local. Son comes a few times, lives close by.”
“Friends come by car. Free parking.”
5.5.2 Barriers and challenges
5.5.2.1 Family might live far away
While many patients had family living locally, others had family a long way away, meaning visits tended to be less frequent. Some families rely on public transport and trains, which can prevent visits when there are disruptions such as train strikes. As stated earlier “Visits from loved ones are vital to the health and wellbeing of people receiving care in care homes, hospitals and hospices”.
“Daughter lives in Peterborough, never here. I need her here.”
“Eldest daughter lives just outside York, trains were on strike so she couldn’t come.”
“Son visits, 50 mile round trip.”
5.5.3 Recommendations for travel
5.5.3.1 Family might live far away
- Provide travel support information, including public transport routes, train timetables, and any available concessions or discounts for visitors.
- Promote local accommodation options, particularly for visitors who live a long distance away, including hospital-arranged deals or information about nearby budget hotels or hostels.
6 References
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- Literacy Trust (2012), Adult Literacy
- Fenney, D. and Buck, D. (2021), The King’s Fund, The NHS’s role in tackling poverty: Awareness, action and advocacy.
- 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: February 06, 2026
Next review due: February 06, 2027
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