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 Magnolia Lodge
Magnolia Lodge neurorehabilitation is located on the Tickhill Road Hospital site in Doncaster. It caters for patients dealing with cognitive, physical, or emotional symptoms following severe brain injuries or other neurological conditions. It is an 8-bed inpatient unit providing 24 hour, 7 days a week specialised care.
The unit gives each patient a personalised care plan to support them with cognitive problems, physical problems, emotional impairments, and social or behavioural functioning problems, resulting from their injury or illness.
While staying at Magnolia Lodge, patients get regular support from physiotherapy, occupational therapy, speech and language therapy, dieticians and neuropsychology.
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 will complete a three-hour training session. 3 staff were consulted with on the ward.
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
We spoke to 7 people in total, who were inpatients in Magnolia ward.
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.
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 Magnolia Lodge were:
- communication
- health-related costs
- navigating and negotiating appointments
- patient empowerment
- staff awareness and guidance
- travel
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
Everything provided
From a patient perspective, if there is any necessary toiletries item they do not have, they say that the ward will provide it for them. This is reassuring to the patient, to know that they will not go without. It means patients without much financial resource are not denied personal hygiene and grooming supplies.
“If push comes to shove, they can supply me with what I need.”
“You can bring your own toiletries in. When I first came in from Doncaster Royal Infirmary I didn’t have shampoo, and they said don’t worry we’ll find it for you. It’s available if you need it.”
This inclusivity also applies to food and drinks. Every patient is provided with three meals a day, with a choice from a selection, and additional hot drinks are available between meals.
“Food here, 7 and a half out of 10.”
In readiness for going home, patient homes are assessed and equipment provided, in order to support that transition and enable patients to have the best chance of managing safely in their home environment. Any equipment deemed necessary will be provided and fitted without cost to the patient.
“Worried about getting around so they’ve got me a commode to get fitted in. They’ve got a resting stool for the kitchen. They provide all of those things.”
“Physiotherapy came to see if I needed anything. Got a Zimmer frame, something on the toilet, I got those and reclining chairs.”
Barriers and challenges
Reliance on donations and staff purchases
Patients with a support network, who receive visitors, tend to have everything they need, including snacks, toiletries and clean clothes. Patients without this support, and those with limited financial resources, rely more heavily on the ward to meet these needs.
As described above, through the patients’ eyes, the ward can provide anything needed. However, staff described the reality of what happens in the background to make this possible. While some stock is purchased out of ward budget, there is a reliance on donations and in some cases staff purchasing essentials out of their own pocket.
“Wife brought all the stuff I need.”
“Friend gave me a whole package.”
Staff:
“We have people who don’t have much support. We have spares that come out of ward budget.”
“Some families bring in snacks, body wash, clean clothes, et cetera. Some don’t have body wash, so we provide it.”
“Body wash, staff buy it for them. Otherwise, it would be very basic soap. Families donate stuff. Might share stuff.”
“Sometimes we make up a basic pack from ward stock. If domestics have ordered bread and we have spare, but it’s not often.” (for outpatients in the community)
“Staff help with laundry and grooming equipment mostly through donations.”
“All the toiletries they have to provide or we’ll buy them stuff.”
Recommendations for health related costs
Reliance on donations and staff purchases
- Send out comms on social media asking for donations of toiletries, clothes, et cetera. Many people donate clothes to charity shops; hospital wards could be an alternative donation route.
- Contact local funeral homes, as families may wish to donate clothing following a bereavement.
- Place “collection bins” and relevant information in communal hospital areas such as reception areas and cafés, 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.
- The service could liaise with community champions from local supermarkets to ask for donations.
- Link with local voluntary and community organisations (for example, homeless charities, food banks, community hubs) for regular supply rather than ad-hoc donations.
- Provide clear guidance for staff on what is available, where to access it, and how to request additional items without personal expense.
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
Long visiting hours
Extended visiting hours on the inpatient wards allow maximum opportunity for visitors to attend. Times are essentially 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, their family will be allowed in to accompany them to the appointment. Staff manage visiting flexibly on a case-by-case basis. Where in-person visits are not possible, some patients maintain contact with family and friends by phone or video calls, such as FaceTime.
“Had visitors every day, my two daughters take it in turn to come in. Don’t have far to travel, 15 minutes and parking is free. 10am to midday then come back at 1pm to 5pm, then leave for an hour. Daughters would nip to the café whilst I’m having lunch.”
Staff:
“That comes down to families not living close by, or if they haven’t got family or friends. I think they all have visitors. Man had no visitors for a week, but they came yesterday. Sometimes they are on the phone, and Face Time.”
Barriers and challenges
Difficulties engaging with family and friends
While visiting hours are flexible, not all patients are able to benefit equally. Families who live further away, have work or caring responsibilities, or experience financial constraints may struggle to visit regularly. For some patients, limited digital access or confidence may also restrict their ability to maintain contact via phone or video calls.
In addition, the need to attend appointments at other hospital sites can create challenges for patients who rely on family support, particularly when appointments fall outside standard visiting hours or change at short notice.
Recommendations for navigating and negotiating appointments
Difficulties engaging with family and friends
- Support patient to access phone or video calls where in-person visits are not possible.
- Consider basic digital support (for example, help set up FaceTime or WhatsApp) for patients who are less confident with technology.
- Provide clear, timely notice of appointment changes, so families can plan attendance where needed.
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
Activities put on for patients
The ward has an activities co-ordinator, who runs various activities at different times of the week, as set out on a displayed timetable. At other times, they make themselves available for friendly banter and company, and make alternative activity suggestions, tapping into patients’ personal interests and hobbies, for example, cross-stitch. Such activities are beneficial, to encourage mental and physical stimulation, which aids a person’s rehabilitation. As all materials are provided, patients experiencing poverty have the same opportunities to participate as others.
“Anything that you need you can just say. Activities co-ordinator encourages you to go into the dayroom and do crosswords, the cupboards have absolutely everything you need. You just need to ask and they find it for you. Cross stitching, I did it when my kids were small. Activities co-ordinator, she asked if I wanted to give it a go so I’ve done quite a few.”
Patients also have opportunities to go outside for walks, visit other wards to be involved in activities, or observe local wildlife in the gardens outside.
“Activities in the day room, depends what’s going on. The activities co-ordinator will come in and say we’re doing this, do you want to? They’ll say we’re going for a walk and there’ll be a group of us. There’s a craft shop nearby and she will ask if I want to come. It’s cheap, cost me £4, my own money I’ve spent. If we want to go to a different ward they’ll take me somewhere else (squirrel room et cetera).”
Importantly, while activities are offered and encouraged, there is no pressure on patients to join in. Some patients prefer their own company, away from the busyness of the day room.
“No, I don’t go down to the dayroom. I like to get on the bed with my legs flat. Noisy.”
Good relationships with staff
Overall, patients expressed positive comments about ward staff and the relationships they have been able to develop. Building trusting relationships is particularly important through a poverty lens, as it helps patients feel empowered to ask questions, feel listened to, and be involved in decisions about their care. It means people will feel more able to be honest about their situation and anything they are struggling with.
“Marvellous! Nothing’s too much for them.”
“Explain everything.”
“Brilliant, absolutely brilliant! Sitting in bed, dropping the needle, four or five of them will come running. They take time to help you understand and if you don’t understand then they’ll go a different way to make you understand. Can ask anything. Press buzzer, and wait, not long at all.”
“When I came here, they were there to help me. I can’t fault them. People here were walking with me to the toilet. I’m doing all the different courses to get me better.”
“Staff are excellent. They ask you things before you need to ask. Nobody ever said no, even with trivial things. Very approachable, all got the right attitude. One night a lady brought me a Horlicks. I haven’t had a Horlicks in 50 years! They don’t wait on you, they want you to get up and do things for yourself.”
Good preparation for going home
Patients explained that when a person is getting close to being able to return home, they get the opportunity to do a home visit. This enables the patient to have a taste of what it will be like to be back home, with the safety net of having an occupational therapy with them. They will be able to identify what they can do independently and what they will need extra support with.
For a person living in unsuitable accommodation, this is usually the point in time it will be discovered, if not already known. Staff explained that discharge may be delayed if housing problems need to be resolved.
Staff:
“They don’t go home unless there’s a safe place to go.”
“When you’re approaching going home, they encourage a home visit, look at whether you need any equipment. On Friday I’m going home for one night to see how I manage. Physiotherapist, occupational therapist came with me on Thursday to see how it is. Husband was disabled, so the house is fit for me, shower not bath. They were just watching how I was around the house. Five weeks in Doncaster Royal Infirmary, two weeks here. Don’t push you too much and up to you, if they give me something then I’ll try. Training me to go up and down steps.”
“Last weekend was the first time I went home. Two days before I went home, two staff took me there to see what my house was like. I hadn’t had a bath since my accident. They found everything perfect, just a few suggestions, they sorted that. I felt confident before I went. When I got there, I wasn’t as confident as I thought I’d be. Getting into the bath was harder than I thought.”
Barriers and challenges
Going shopping when home
While all food is provided in hospital, patients spoke about concerns regarding how they would manage food shopping once they returned home, with most saying they will be relying on friends and family.
“Neighbour does the shopping for me sometimes.”
“Granddaughter will take me shopping, got a Spar too, grandson and people to support me.”
For patients without a support network of friends and family, this may be more challenging. They may not be physically strong or stable enough to get to the shops themselves, and may lack digital access or the digital literacy skills needed to order essentials online. A church community group was mentioned by one patient, who said they had gone shopping for her.
“Sheffield and church community went shopping for me. They said that might start up again. If you’ve been in hospital you can have it for four weeks. Ring up and get food ordered.”
The following theme explores the role of the discharge team, and food shopping may be addressed as part of this support. If so, perhaps this is something that patients could be reassured of or made more aware of, to know that they will continue to be supported with this task.
Recommendations for patient empowerment
Going shopping when home
- Review what food and essentials provisions are available for people after discharge. Is it sufficient and appropriate?
- Ensure every patient has a conversation about food shopping and access to essentials prior to discharge, so they feel confident about what will happen when they leave.
- Actively signpost patients to local charitable, faith-based, or community groups that can support food shopping in the weeks following discharge.
- Explore whether care co-ordinators could support patients on discharge.
- Encourage feedback from patients about what helps them feel confident and supported, and use this to inform improvements.
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
An effective discharge team
Both staff and patients spoke very positively about the discharge team. The team explores potential difficulties patients may face on discharge, and supports or signposts them to appropriate services where needed. This would include a patient having inappropriate or unsafe housing, and means their discharge may be delayed until the housing situation is sorted.
Staff:
“Great discharge team who support patients to make sure that they are signposted for help if needed.”
“When patients get discharged we check to make sure that they are not going to be facing difficulties and if this is identified we signpost them for support services.”
Barriers and challenges
Financial questions not asked routinely and universally
While staff are clearly proactive and empathetic in providing support for patients, there does not appear to be any standardised financial screening on admission. Instead, important information will be passed and learned about largely through everyday conversations, which may risk a patient slipping through the net. In terms of identifying people who may need help, most staff survey responses said they used verbal screening, ie asking those they think might need help. This raises the issue of assumptions being made about the level of support that may or may not be required.
“Not really. I suppose they would ask the question around finances if they thought” (I needed it).
Staff:
“We’d get an assessment officer involved, she comes in so many times a week. Lots of people are not forthcoming if they have problems. Assessment officer or carers deal with that side of things, but if we knew then we would tell her.”
From a poverty perspective, asking everyone about their financial circumstances or difficulties in a tactful and sensitive way, would 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.
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.
- Empower staff with Children North East’s talking about poverty training.
- 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 enterprises 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.
Suggestions from staff surveys
- Be able to refer onward to supportive or appropriate services. Some patients are asked just to complete forms and this is not appropriate due to cognition, communication and physical difficulties.
- More understanding and staff awareness.
- More financial information and training for staff to help people access the right services.
- Make it easier for them to be identified.
- An app with links for useful services.
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
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.
Barriers and challenges
Travel for visitors can be costly and difficult
As stated earlier:
“Visits from loved ones are vital to the health and wellbeing of people receiving care in care homes, hospitals and hospices.” (Visiting in care homes, hospitals and hospices, Department of Health and Social Care, 2023)
It was staff rather than patients, who spoke of the barrier around visiting and travel. Most staff survey responses corroborated this. Travel is more of a problem for family and friends who live out of area, with cost potentially prohibitive, and journeys on public transport potentially difficult to navigate.
Recommendations for travel
Travel for visitors can be costly and difficult
- 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.
- Consider targeted support for families visiting long-stay patients, for example vouchers, travel reimbursements, or volunteer-led transport assistance.
Staff suggestion on survey
If there was a way that we could get families supported to be able to come and see their loved ones, especially those who stay with us a long time.
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: March 17, 2026
Next review due: March 17, 2027
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