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 Phoenix ward
The locally trained team engaged with Phoenix ward during July 2026 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 and staff to build up a rich picture of the challenges and barriers faced by those receiving mental health services on the ward.
Phoenix ward is a 16 bedded high dependency rehabilitation unit (HDRU). The high dependency rehabilitation unit is a specialised mental health service which focusses on intensive support for people with more complex mental health needs. The high dependency rehabilitation unit offers holistic, therapeutic care for people who need more structured and intensive support than they can get in the community or other inpatient settings.
The service provides specialised care that focuses on rehabilitation and follows trauma-informed approaches. It seeks to be a safe and supportive place where people can understand their own needs, rebuild daily skills, strengthen personal abilities, and prepare for a successful return to their local communities. The high dependency rehabilitation unit does not accept self-referrals. Referrals into the service can be made by a medical professional on a person’s behalf.
There are high levels of deprivation in the places we serve. In Rotherham, for example, 16.8% of the population was income-deprived in 2019. Of the 316 local authorities in England, Rotherham is ranked 45th 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
No staff attended the 3-hour training. We did receive 9 surveys 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, which included 6 staff.
Stage 3: patient and community consultations
We received feedback from 3 people who use the service.
Stage 4: feedback session
The report was shared with the Service Manager, Katie Merrils 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.
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 the Doncaster Phoenix ward were:
- communication
- health-related costs
- navigating and negotiating appointments
- people empowerment
- staff awareness and guidance
- travel
Communication
Communication is important to consider in Poverty Proofing both from a health literacy perspective of how information is communicated and understood and in ensuring there are reciprocal lines of communication between services and service users. O’Dowd (2020) reported that availability of care was a particular concern for those on a low income and there were significant inequalities in care availability for the most deprived areas. Communication is a key factor in ensuring availability of care.
What works
The service is welcoming
People told us that they felt the service is welcoming to them.
“Everyone seems friendly.”
Interpreters
Staff told us that they had access to interpreters, and would also use technology to communicate with people where English wasn’t their first language.
“Where needed we have access to using interpreters especially where vital information need to be shared and multidisciplinary team.”
“We had a patient who we supported using their mobile phone for translating of general day-to-day conversations.”
Barriers and challenges
The language we use may mean some people don’t understand what is being asked of them, or is available
A number of staff said that the way we communicate with people might be a barrier to them understanding what is on offer to mitigate poverty. Health literacy (understanding of written materials or verbal communication) was seen as a barrier by staff. It is important to understand a person’s communication needs and ability, so they know what’s available and what treatment they will receive.
Recommendations for communication
Communicating with people based upon their needs and ability
- Make sure people are asked about their communication needs and preferences, and this is recorded on SystmOne.
- Make sure communication needs and preferences are recorded in SystmOne.
- Check with people that they understand what is being communicated to them. Get them to explain what is being said.
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.
The Institute for Health Equity and World Health Organisation said that:
“A person’s mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk.”
What works
People haven’t missed healthcare because of money
We asked people if they had ever missed appointments due to the cost or money. All three people who responded confirmed this wasn’t something that they had experienced.
People will be supported in their choice of food
We were told by staff that people would be supported to have meals they wanted that may not be on the usual menu. In a lot of healthcare settings, people would have to use their own money for items ‘off menu’: Phoenix Ward are showing this doesn’t have to be the case.
“Three meals a provided to patient on the ward. However, if a patient chose to self- cater, they get approximately £53.34 per week to cater for their own meals, they would still have access to snacks on the ward and drinks.”
“We support a patient who has chosen to self-cater for their breakfast as they prefer having a cooked breakfast a few times during the course of the week.”
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
Regular meetings with people
We were told by staff that there were scheduled meetings with people on the ward to attend, to let them know what activities are available. Whilst these types of activities are not what some may see as traditional healthcare appointments, having therapeutic activities has demonstrated its effectiveness in supporting someone’s health recovery.
Giving people control over visits
Staff told us that they treat visits to people on the Ward as an appointment, with visits often forming a strong part of someone’s recovery. People were given the control to decide if they wanted to receive visitors, or not.
“Patients are allowed visitor and these are treated as appointments always checking with patient if they are happy to receive visitors.”
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
People can choose the activity to be involved in
We were told by staff that a schedule of activity was available for people to get involved in. This is seen as important in creating a therapeutic environment. People can choose what to get involved in, and staff will also encourage people to do so as part of their recovery.
“Monthly challenges are set for patient to encourage supporting their health and wellbeing this month we have a walking challenge which is up on the notice boards.”
“We advocate for our patients to be able to have access to social activities while an inpatient, however, were need to have information on how we can get the set-up for such activities upon discharge especially when they are discharged outside of Doncaster.”
People are supported in budgeting
Staff told us that they support people to take control of their finances, not just whilst they are on the Wards but also in preparation for discharge. This includes support from the ward social worker, whose contribution was referred to by a number of staff.
“When preparing for discharge we support patient where needed on how and in some cases where to purchase items from, as way to help with budgeting.”
“Assisting patients to manage their finances well.”
“Refer to social worker, support with benefits review.”
“We have social worker who attend the ward twice a week who support the patients with any of their financial needs that they made.”
“We have a social worker who supports patients with housing and accommodation arrangements prior to discharge.”
Barriers and challenges
Access to digital data
A number of staff said that access to digital data or credit was a challenge for people. Citizens Advice Rotherham and District run a programme to help with digital literacy, devices, and data: like the barrier on what financial assistance available, that people may not be aware of.
People’s knowledge and awareness
Whilst there are clear good examples above of support for people, staff also suggested having some form of structured support for people to help to build their own financial independence would be helpful.
“Provide budgeting skills and knowledge around financial support before discharge.”
“Proper education on how to manage their finances.”
Recommendations for people empowerment
Helping people with their digital needs
- Ask people about their digital needs and barriers.
- Refer people to Citizens Advice Rotherham and District digital support programme (a link is at the end of this report).
Building people’s financial knowledge
Consider budget managing and finances as part of a person’s activity programme.
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
Use of financial screening tools
Some staff told us that they use financial screening tools to understand better a person’s financial circumstances.
Some staff cited examples of where the service supports people experiencing poverty:
“Assisting patients to manage their finances well.”
Barriers and challenges
The response to supporting people experiencing poverty is mixed and not consistent.
Whilst Some staff cited examples of where the service supports people experiencing poverty, such as the use of screening tools, for others, this is dependent upon judgements of individual staff and wasn’t something that was in place recognised by most. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.
Staff awareness of what is available or what to do
A number of staff said they or their colleagues may be unaware of what is available or how they can help someone who may be experiencing poverty including when they are discharged. This means that people may be losing out to support that they need or are entitled to. We also didn’t have any staff attend the poverty proofing training that was offered. The service may want to consider other ways of engaging with patients and carers on the challenges of the cost of living, utilising on the poverty proofing training that staff have received and further training that will be provided by CNE. Having financial conversations is important to understanding the quality-of-life people are experiencing, which can also impact their mental health.
“Offer more collaborate working and find out more about services in local areas and communities..”
“Increase staff awareness around finances (that is, Personal Independence Payment (PIP) and Employment and Support Allowance (ESA)).”
Recommendations for staff awareness and guidance
Having a consistent approach to finance
Agree a consistent way and process of identifying people’s financial needs.
Consider the use of Citizens Advice to support this process.
Make sure this is communicated to people and their peer support.
Staff engaging in financial conversations with people
Open up financial conversations routinely as part of someone’s care.
Provide a basic level of training for staff, to empower them to have financial conversations.
Access to other support
- Work with the council and voluntary and community sector to create a list of information of support available to people (such as access to white goods).
- Make that list accessible to staff (via website).
- Communicate to staff via team meetings, email.
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.
Barriers and challenges
Help with travel costs
Staff told us that the cost of travel and transport (costs of travel, parking) have been a barrier to people accessing the service. This may include where a person makes overnight trips prior to discharge (to settle back into a community) and, or their visitors.
“We have a patient who is due discharge and has had to make a few overnight trips home in Scunthorpe who has since raised a concern on the cost of travel.”
Recommendations for travel
Promote trust’s travel scheme
- Ensure staff are aware of the trust’s travel scheme.
- Feed back examples where the travel scheme doesn’t work for patients, to see if the process can be amended or flexed to meet a person’s need.
- Advertise it to people and people and peers, and how it works.
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.
- Help with health cost
- Citizens Advice Rotherham digital inclusion support
- Rotherham support for carers
- Rotherham Citizens Advice referral form.
Page last updated: November 09, 2026
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