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 inpatient mental health services
The locally trained team engaged with Doncaster inpatient mental health services during July and September 2026, in order to understand the experiences of people and families who are living in poverty.
The work was carried out with people (patients, families and carers) and staff to build up a rich picture of the challenges and barriers faced by those receiving mental health services in Doncaster in the inpatient settings. Staff in the service also looked to get the voice of people who use the service as well.
The Inpatient mental health services in Doncaster are provided for people across a different range of types and settings. This includes adult mental health units Cusworth, Brodsworth ward and Skelbrooke, serving as our acute inpatient wards for patients aged 18 to 65.
Older adults mental health unit at Windermere Lodge, which specialises in assessment and treatment for patients with memory difficulties or dementia.
Referrals to our adult mental health inpatient services are assessed by the Crisis team and your care coordinators. Assessments are based on individual needs, for both voluntary and detained patients under the Mental Health Act.
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
Three staff from the four inpatient wards attended 3-hour training between July and September 2026. We had conversations with nine staff and received 25 survey responses from others
Stage 2: scoping
Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management.
Stage 3: patient and community consultations
We received verbal feedback from three persons who used the service. we also had 8 survey responses from patients as well.
Stage 4: feedback session
The report was shared with the Service Manager, Catherine Collins and the ward managers, to consider the findings. We then produced this final report.
Stage 5: review
Around 12 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward. This will be part of the trust’s poverty proofing community of practice.
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 inpatient mental health services were:
- communication
- health-related costs
- navigating and negotiating appointments
- People empowerment
- staff awareness and guidance
- travel
- housing
- staff poverty
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
Strong communication support and access to information
The wards have established several mechanisms to support communication and help patients remain connected during admission. Translation services are available and routinely used, information can be made available in different languages, and patients without personal phones or credit can use ward telephones. Free Wi-Fi is also available, helping patients maintain contact with families and support networks. Staff also support practical communication needs by charging phones and devices when required.
“If a patient needs information translated, we have this available sometimes we can get this printed for them.”
“We make use of the translation services and have not had any problems with them.”
“Patients can use the ward phone to contact relatives.”
“Visible information of their opening times when visitors are able to come through and this is available in different languages.”
Good communication with families and carers
The service demonstrates flexibility in involving families and carers in care planning and review processes. Virtual participation in multidisciplinary team meetings helps ensure family members can contribute, particularly where travel costs present a barrier.
“Sometimes we send video links for patients’ family to be able to join multidisciplinary teams and in some instances this is because they would have shared their inability to afford travel to attend in person.”
“We are helping apply for benefits, communicate with families.”
Barriers and challenges
Digital exclusion and connectivity issues
Communication barriers associated with poverty were one of the most consistent themes identified by staff. Lack of access to mobile data, phone credit, internet connectivity and digital resources can affect patients’ ability to maintain relationships, access support and engage with services. Communication barriers were repeatedly identified across multiple wards as a significant challenge
“Communication (no data or access to credit Wi-Fi et cetera).”
Health literacy barriers
Many staff highlighted difficulties some patients experience understanding written information, verbal communication and healthcare processes. This can reduce patients’ ability to engage fully in treatment and support services.
“Health Literacy (understanding of written materials / verbal communication).”
Under-utilisation of formal feedback channels
While patients and families provide feedback, it is often routed through individual clinicians rather than formal service feedback mechanisms, potentially limiting opportunities to capture learning systematically.
“Sometimes they will e-mail directly to a clinician while we have a ward e-mail this is not widely used for feedback so we could look to use it more frequently.”
Recommendations for communication
Digital exclusion and connectivity issues
Develop a standard digital inclusion offer for inpatients, including information on free Wi-Fi, telephone access and digital support.
Feedback
Promote formal patient feedback routes and Care Opinion more consistently throughout admission.
Communications
- Improve awareness of communication support available to patients and relatives on admission.
- Make communication and health literacy checks part of admission and discharge planning.
- Produce easy-read and pictorial information resources for key ward processes and discharge arrangements.
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
Basic needs are supported during admission
The service works hard to ensure patients have access to essential items including food, toiletries and clothing. Additional support is available through People Focussed Group and ward funds where required.
“Food and drinks. These are provided by the ward for free.”
“If someone arrived with nothing the ward would supply small samples of toiletries.”
Prescribing needs are generally addressed clinically
Where a clinical need is identified, patients can receive prescribed supplements and medications.
“Where a need has been realised for them, they do get prescribed.”
Barriers and challenges
Limited awareness of prescription support
There appears to be low awareness of prescription payment support among some staff, and this information is not routinely shared with patients.
“Not aware of prescription payment info never heard of it.”
“At discharge we provide patients with to take out medication (TTOs), but we don’t share much about the prescription services.”
Staff meeting gaps through personal spending
Staff reported purchasing nutritional supplements form their own pockets because required products are not always readily available through ward processed.
“Staff now purchase flapjacks high protein bars built up milkshakes form their own pocket and bring them into the ward.”
Patient highlighted the need for wider financial support
Patients identified prescriptions, benefits, food support and money advice as areas where additional help would be beneficial.
“Support with prescriptions.”
“Information about benefits.”
Recommendations for health related costs
Financial support
- Develop a ward resource guide covering benefits, NHS Low Income Scheme and community support.
- Introduce routine discussion of prescription support schemes during discharge planning.
- Ensure financial wellbeing support forms part of discharge planning conversations
- Review purchasing arrangement for nutritional supplements to eradicate staff expenditure
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.”
As most people who use these services need to be seen immediately, the service is not delivered in what could be called an NHS appointments way as other services are. This is more likely to take place when people are discharged from this service to, for example, community teams for ongoing support.
What works
Person-centred support is provided
Staff reported taking time to work alongside patients, helping them understand care plans, appointments and support options.
“We do make provision for adult time to sit with patients.”
“Individual centred care. Patients circumstances for admissions are being discussed and planning within 72 hours of admissions.”
Staff advocate and navigate services on behalf of patients
Staff frequently support benefit applications and make referrals or contact agencies directly.
“Navigate to the right service, if need it, contact services behalf of patient.”
“We helping apply for benefits.”
Barriers and challenges
Complexity of health systems
Many staff identified complex systems, referral pathways and appointment processes as barriers for patients experiencing poverty. This can result in a delay in treatment or in some cases difficulty in accessing other healthcare services.
“Complex Health Systems (difficult to navigate, referrals appointments.”
“Scheduling longer appointments can be a bit harder.”
Hidden costs create additional barriers
Appointment attendance can be affected by indirect costs including childcare, transport costs and lost income. This was seen where family still provide support to patient for other appointments outside mental health inpatient services.
“Hidden costs of appointments (time off work, childcare, missed free school meals).”
Recommendations for navigating and negotiating appointments
Complexity of health systems
- Create a ward-based directory of local financial, housing and community support services.
- Introduce poverty screening as part of admission and multidisciplinary team discussions.
- Develop staff guidance on support available for travel, benefits and practical needs.
- Ensure appointment planning routinely considers transport, childcare and affordability issues for the family and carers who are included in the care planning of patients and needed to aid in their recovery post discharge if required.
People 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
Patients have opportunities to provide feedback
Multiple methods exist for patients and families to share experiences, including Care Opinion, direct communication, cards and letters.
“We have available the online and paper version of the care opinions which is shared with patients.”
“We do receive cards and letters of thanks from patients and family members.”
Advocacy and inclusion support
Patients are supported with advocacy, spiritual needs, cultural requirements and practical support.
“Advocacy services is used for every detained patient.”
“We can get prayer mats or the Quran if patients ask, we also consider halal and other dietary requirements.”
“People Focussed Group drop off deodorant and other toiletries.”
Barriers and challenges
Advocacy awareness appears inconsistent
There were conflicting accounts regarding advocacy provision, suggesting awareness may vary across wards and staff groups.
“Advocacy services is used for every detained patient.”
“We’re not aware of any advocacy”
Financial vulnerability may remain hidden
Staff highlighted concerns that patients’ financial difficulties sometimes become apparent only near discharge.
“Concerns sometimes get realised at point of discharge where they might share, they might struggle with food once they are discharged.”
Recommendations for people empowerment
Advocacy
- Strengthen awareness of advocacy services across all wards.
- Introduce routine conversations about finances, food security and discharge readiness.
- Increase visibility of advocacy support organisations and community resources.
Service improvement
Expand opportunities for patients and families to influence service development.
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 demonstrate commitment to supporting patients
Staff frequently provide practical and emotional support, assist with benefits and signpost patients to appropriate services.
“Staff complete their Personal Independence Payment (PIP) forms for benefits.”
“We are helping apply for benefits.”
“Staff are aware of the struggle that some of our patients have.”
Barriers and challenges
Knowledge gaps around available support
Several staff identified limited awareness of available financial and practical support schemes.
“Not aware of the travel fund.”
“Not aware of the prescription payment information.”
Poverty is often identified through judgement
Many responses indicate identification relies on professional judgement rather than a consistent approach.
“Judgements of staff.”
“Verbal screening, asking those we think need help.”
Staff want more training
Several staff respondents highlighted the need for additional knowledge and skills.
“Further training on how-to spot and support.”
“It would be useful if in our multidisciplinary teams we had a list of services that we can signpost patients to.”
Recommendations for staff awareness and guidance
Making staff aware of financial support available
- Communicate with staff the nationally publicised help that is available for people which is published on the trust website (a link is at the end of this report):
- help with transport costs
- NHS Low Income Scheme
- help with health costs for people on Universal Credit
- help when you need to pay for NHS care (prescriptions, dental care, eye care wigs and fabric supports)
- personal health budgets
- Standardise poverty identification and recording processes on patient records and incorporate poverty related discussion into multidisciplinary team reviews and discharge planning.
Staff engaging in financial conversations with people
- Open financial conversations routinely as part of someone’s care.
- Provide a basic level of training for staff, to empower them to have financial conversations.
- Get information from charities and food banks on what is available in Doncaster and how people can access them.
- Develop a quick reference staff toolkit and signposting directory.
Access to benefits and debt advice
- Refer people to Citizens Advice Doncaster for an income or benefits check, a link is provided at the end of this report
- Hold an awareness session with staff on poverty proofing and increase awareness of support available via the trust.
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
Practical transport support is available
The service already provides practical travel assistance to support access to healthcare appointments and recovery activities. Transport support includes pool cars, taxis, discharge-related travel support and access to free bus passes where appropriate.
“We use pool cars to support any healthcare needs for appointments.”
“They provide taxi’s and transport for patients to attend their appointments.”
“People Focussed Group and the trust can support to provide free daily bus pass for appointments if required.”
Alternative approaches reduce travel burden
Virtual participation in multidisciplinary team meetings allows families to remain involved without incurring travel costs.
“Sometimes we send video links for patients’ family to be able to join multidisciplinary teams.”
Barriers and challenges
Cost of travel
ravel was the most consistently identified poverty-related challenge across both patient and staff feedback. Difficulties paying for buses, taxis, parking and transport impact patients’ ability to maintain appointments, access support and sustain recovery.
“Being able to pay for buses or taxis.”
“Travelling to appointments, when have no money mental health declines.”
“Travel and transport (cost of parking, public transport, taxi’s).”
Travel support during recovery and leave can be difficult
Staff reported challenges supporting travel associated with therapeutic leave and recovery activities, particularly where patients are informal admissions.
“We have issues with travel in relation to recovery, it is difficult where a patient is informal.”
Recommendations for travel
Promote Healthcare Travel Cost Scheme
- Ensure patients, staff know about the trust travel scheme, and how it works.
- Support patients where possible using the trust travel fund scheme.
- Ensure staff understand reimbursement and travel support options available through the trust and wider NHS Travel Scheme
Digital appointments
Expand virtual options for family participation where suitable also to include other multidisciplinary team staff to be able to attend.
Housing
King’s College London 2026 says:
“Mental ill-health does not occur in isolation from socio-economic disadvantage. Poverty, insecure housing, debt, unemployment, trauma and loneliness all drive poor mental health, while mental illness itself can make these challenges harder to overcome. Many people are therefore trapped in cycles where social adversity both causes and worsens mental distress”.
A lack of supported housing can result in delayed discharges for patients from mental health hospitals. In 2024, these delays cost the NHS an estimated £71,000,000. The delayed discharges have an impact on their health outcomes. (National Housing Federation 2025)
What works
Housing is recognised as a key discharge consideration
The service demonstrates a strong commitment to ensuring housing needs are addressed prior to discharge.
“Patients get supported with housing and are not discharged until this is sorted.”
“Discharge coordinator, H2H and POW would have conversations to work out what support may be needed at home.”
Barriers and challenges
Housing issues contribute to delayed discharges
Housing difficulties often depend on external agencies and funding arrangements which can create delays.
“Sometimes there housing issues due to funding and this can result in delayed discharge.”
Need for greater housing advice and financial support
Patients identified housing and financial advice as areas where additional support would be beneficial.
“Offering one to ones about housing and finance.”
Recommendations for housing
Housing support
- Strengthen links with housing providers and local authorities
- Begin housing planning as early as possible during admission.
- Introduce routine housing and financial wellbeing discussions prior to discharge.
- Improve signposting to tenancy sustainment and welfare advice services.
Staff poverty
Mallorie (2026) said poverty is a complex problem that will affect different groups in different ways. NHS staff are also impacted by poverty in different ways. They can experience poverty directly themselves, as well as treating patients who are experiencing the effects of poverty. This can be seen to have an adverse effect on sickens and absence rates as well as recruitment and retention with some staff leaving the NHS to work in other sectors.
What works
Awareness of available staff wellbeing support
Some staff were aware of support available through trust wellbeing resources.
“Staff are aware of financial wellbeing support information available on the trust intranet namely Vivup.”
Staff feel poverty support could be strengthened.
Barriers and challenges
Some respondents felt that financial hardship experienced by staff is not routinely recognised or addressed.
“Staff are not looked at at all.”
“During COVID staff have access to milk and bread on the ward but had to pay for it.”
Staff are absorbing costs personally
Staff reported purchasing items for patients using their own money.
“Staff now purchase flapjacks high protein bars build up milkshakes from their own pocket.”
Recommendations for staff poverty
Staff wellbeing
- Improve promotion of staff financial wellbeing support. Review whether staff are routinely covering patient costs that should be funded through ward budgets.
- Raise awareness of staff hardship, wellbeing and financial support schemes.
- Consider regular communication campaigns promoting staff financial wellbeing resources and support pathways.
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
- Mallorie, s. (2024) Illustrating the relationship between poverty and NHS services. The King’s Fund.
- National Housing Federation (2025), Supported housing crisis: mental health patients stuck in hospital for 109,000 days.
- 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.
- Help with health cost
- Doncaster Citizens Advice referral form
Page last updated: November 09, 2026
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