Poverty proofing Doncaster physical health rehabilitation 2026

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 physical health rehabilitation

The poverty proofing audit for stroke rehabilitation, dietetics, speech and language therapy and wheelchair services began in October 2025 to better understand the experiences of families and individuals who are living in poverty.

The work was carried out in partnership with staff, families and adults to build up a rich picture of the barriers and challenges faced by those accessing the Doncaster stroke rehabilitation, dietetics, speech and language therapy and wheelchair services.

2.1 Stroke rehabilitation

The service looks to deliver high-quality, personalised, interdisciplinary rehabilitation for stroke survivors and their families within community settings.

The team provides rehabilitation and guidance to people who have suffered from a stroke within the last 6 months. The team includes specialist nurse, physiotherapists, occupational therapists, speech and language therapists, clinical psychologist, assistant practitioner and rehabilitation assistants. The team conduct individual assessments and provide therapy tailored to the patient’s personal goals as agreed upon. Follow-up appointments are a mixture of one-to-one and group sessions, depending on and individual’s needs.

The rehabilitation clinic is based at Evergreen, Tickhill Road Hospital. For those who are housebound, the service offers home visits. The service says that by offering clinic appointments, it allows our staff to devote more time to patient care and less time to travel. It also allows people to meet others affected by stroke.

2.2 Dietetics

The dietetic service consists of dietitians and dietetic assistants. Dietitians assess, diagnose, and treat nutritional problems by educating and giving practical, personalised advice to patients, carers, and colleagues.

Community referrals are accepted for adults aged 18 and above with a Doncaster GP.

Patients cannot self-refer but can be referred by a healthcare professional such as GP or nurse or registered care home manager. The service offers clinic appointments, home visits, phone, and video appointments.

Inpatient referrals are accepted for adults aged 18 and above and who are under the care of Rotherham or Doncaster inpatient units. Patients cannot self-refer but can be referred by a healthcare professional such as doctor or nurse.

Referrals are only accepted for nutrition support:

• oral nutrition support, for example, fortified food, additional snacks and sip feeds
• enteral tube feeding, the delivery of a nutritionally complete feed directly into the gut via a tube

2.3 Speech and language therapy

The speech and language therapy (SLT) service provides specialist assessment and therapy to adults throughout Doncaster who have communication or swallowing difficulties because of a neurological condition. These difficulties can be a result of acute conditions such as stroke and head injury, or a long-term condition such as Parkinson’s Disease and multiple sclerosis.

Services are provided to inpatient rehabilitation wards, people in community settings and support end-of-life care within the hospice service. The service also advise on alternative methods of communication and provide training in a variety of healthcare settings.

The service is open to people aged 18 or over that have difficulties with communication or swallowing. Referral to speech and language therapy are via a GP or another named professional involved in a person’s care.

2.4 Wheelchair service

The wheelchair and specialist seating service offers manual and powered wheelchairs, buggies, and specialised seating to assist children and adults dealing with mobility and posture challenges.

This service caters to children and adults who are registered with a Doncaster GP or reside in the Doncaster borough without GP registration, and have a permanent disability affecting mobility.
However, the service isn’t suitable for individuals requiring exclusively outdoor-powered mobility or those in nursing or residential homes needing transit wheelchairs only.

The service aims to support patients with disabilities and their caregivers by enhancing mobility to maintain independence and enhance overall quality of life.

Assessments consider an individual’s lifestyle, medical conditions, and ongoing requirements to determine the most suitable equipment.

The service also provide emergency replacement service for manual provision after hours for known patients through the single point of access (SPA).

According to the Indices of Multiple Deprivation 2019, Doncaster is ranked 48th most income-deprived out of 316 local authorities. Of the 194 neighbourhoods in Doncaster, 68 were among the 20% most income-deprived in England.

In research by the Joseph Rowntree Foundation and King’s Fund:

“The authors describe how patients may struggle to access NHS diagnosis and treatment due to issues such as the cost of travelling, difficulties accessing online services, and paying for NHS charges. They also note that the stigma of poverty can lead to a reluctance to come forward for treatment, or to seek help more broadly, for example by accessing financial advice. Additionally, administrative processes, such as claiming back travel expenses, can be complex.”

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

30 staff completed a three-hour training session.

4.2 Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management, observing interactions and reviewing key areas such as the website and communications.

4.3 Stage 3: patient and community consultations

We spoke to 2 people and 1 family member who use the service, and 49 people completed a survey (including easy read surveys). We spoke to 3 staff who work in the services and received 43 surveys from staff.

4.4 Stage 4: feedback session

A draft of the findings was shared with Jayne Brocklehurst prior to publication. We will discuss our findings and collaboratively consider various changes that could be implemented at the poverty proofing community of practice group.

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 physical health rehabilitation were:

• communication
• health-related costs
• navigating and negotiating appointments
• patient empowerment
• staff awareness and guidance
• travel

5.1 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.

5.1.1 What works

5.1.1.1 The service is welcoming

The majority of people told us that they felt that the service is welcoming. This is also supported by the positive feedback Doncaster stroke rehabilitation, dietetics, speech and language therapy and wheelchair services get on Care Opinion.

“The staff are polite and helpful with your needs.”

“Everyone is 100% committed to their job and clients.”

“The service responds promptly to my telephone queries. Face to face appointments are easy to arrange and are helpful.”

“Always very polite on the phone when enquiring about what we need or making appointments to have the wheelchair serviced.”

5.1.2 Barriers and challenges

5.1.2.1 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. It is important to understand a person’s communication needs and ability, so they know what is available and the treatment they will receive. People also told us that better communication and outreach would be a good thing to introduce.

5.1.3 Recommendations for communication

5.1.3.1 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.

5.2 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.

5.2.1 What works

5.2.1.1 Service support if people can’t afford care

We asked people if they felt the service would support them if they couldn’t afford their care. Most people told us they though the service would.

5.2.1.2 Service is seen as affordable

Most people said that they felt the costs of the service was affordable, regardless of a person’s financial circumstances. The people saying this did not have any extra costs themselves.

5.2.2 Barriers and challenges

5.2.2.1 Staff might not feel confident in talking to people about money

Some people told us the service asked them to pay for items they do not necessarily provide like walking aids, eating and drinking equipment. What isn’t clear is if the person has been asked if they have the money to pay for such items. This may mean people either don’t buy them or go without something else. Most people were not sure if the service would offer advice on other services who may be able to support. People are all provided with a personal wheelchair budget to meet their need when assessed. However, this might not always meet all the costs to a person.

“We are still in a position where all the cost of our child wheelchairs is covered. We did have some additional extras that we paid for ourselves.”

“I have my main wheelchair, but I had to purchase something to use in the house which allows me to move around. I am waiting to get sorted for a prosthetic so hopefully I will be sorted soon.”

5.2.2.2 Cost of prescriptions

There are some instances where people will be entitled to free prescriptions. It may be that these people are entitled to Universal Credit or another benefit and should be referred to Citizens Advice for a money check. People told us that help with the cost of prescriptions would be a good thing to introduce.

5.2.2.3 Cost of food and equipment for specialist diets

We were told by people and staff that the cost of food for people to both have their assessment and resulting recommended diet can be difficult. In community speech and language or dietetics people may be assessed as needing a bespoke diet and fluid plans. There are barriers with getting care homes to purchase required foods or drink to support with this.

There was also a barrier in some people not having the relevant resources at home to complete assessments or ability to self-purchase resources. Some people did not have food at home or finances to purchase food to be able to complete a swallow assessment. Some also struggled with the finances to purchase recommended equipment, for example, specialist cutlery, cups, leg lifters, dressing aids etc and therefore not being able to access essential equipment to complete activities in their daily lives.

“The cost of some foods for my diet can be so expensive. Sometimes travelling to where you can get the food is costly.”

5.2.2.4 Paying for services due to secondary waits

We were told by someone who works in the stroke service that sometimes people pay for services via the private sector due to waiting for support for their treatment. Physiotherapy was the example given.

5.2.3 Recommendations for health related costs

5.2.3.1 See if people are entitled to help with prescription costs

• Advise patients about the HC2 form and how to fill it in effectively.
• Advise that patients who are paying for prescriptions whilst their HC2 form is being processed, should keep their receipts to be reimbursed.

5.2.3.2 See if people are entitled to financial support to help with health treatment costs (for example, specialist diets)

• Make all staff aware that the NHS Travel Costs Scheme exists. Provide clear information on who can apply and what they are entitled to claim for (this may not only be people who are on benefits, others can be eligible through the NHS Low Income and Healthcare Travel Costs Schemes).
• Refer people to Citizens Advice Doncaster to see if they are entitled to support with transport or other costs and other benefits (link at the end of this report)

5.3 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.”

5.3.1 What works

5.3.1.1 People value the flexibility to have home or clinic appointments

We asked people whether they preferred home or clinic appointments: some people said they prefer a home visit or clinic, the majority told us they prefer both options. Staff also told us if someone has told the service that affordability is an issue to attend appointments, they will try and arrange a home visit.

“I can save money of a taxi.”

“Sometimes I have to come in if I need my wheelchair to be serviced.”

5.3.1.2 Service will be flexible to meet people’s needs

Staff told us that depending upon a person’s circumstances, they would try to offer appointments in different ways and different times to meet needs better.

“We will ask what time or day of week suits them for appointments and try and be flexible as able to accommodate their preference.”

“We offer a range of appointment types, including virtual via telephone or video at patient request, face to face in clinic and home visits. So, feel the service is flexible in meeting patient needs regarding accessibility.”

5.3.2 Barriers and challenges

5.3.2.1 Parking for people with limited mobility

We were told that for people with limited mobility, parking near to where the clinic is, can be difficult.

“It’s great that there is free parking on this site but the disabled parking near wheelchair service sometime people park with no blue badges.”

5.3.2.2 Carer availability to support to attend appointment

We were told by people that sometimes the timing of appointments was both difficult for carers and mean they lose out on earning money. Staff also told us that people do rely a lot relying on family members for appointments, for example, bringing parents to appointment and needing to get childcare (costing the family member). Staff said they need to think about appointments in school holidays, weekend appointments.

5.3.2.3 Size of reception space

We were told by people that the reception space was cramped, especially for those attending with a wheelchair.

“I was parked up in a waiting area that was a bit cramped up with chair and no room to manoeuvre my chair.”

“I have been here waiting before in the waiting room, but the space is not big enough to even get two people with wheelchairs. On one occasion it was family that had come through and there was very little to entertain the little one. I wanted to raise a concern before, but sometimes there’s rarely anyone about until you get seen.”

5.3.2.4 Multiple professional appointments on different days

We were told by staff there are times when people have appointments with multiple professionals with different services or same services on different days. This results in multiple travels to clinics and multiple days off work by service user and, or family. Staff told us that some services will check for other appointments service user has and if possible try to book as many appointments on the same day or even combine clinic appointments (for example, occupational therapy and physical therapy seeing together, or speech and language therapy on same day as consultant appointment). Whilst this is not always possible due to provision restrictions, not all services will check if the service user has any other appointments resulting in many appointments and many travel expenses or missed days at work.

Staff said that increasing appointment time flexibility or having more availability to onsite consultation spaces, and liaison within or between services to create combined or same day multiple appointments may reduce costs.

5.3.2.5 Location of clinics

We were told by staff that clinics can be limited to the Tickhill Road Hospital site only, making it difficult for those living on the outskirts of Doncaster to attend. Whilst a person’s mobility may be a factor in how they attend an appointment (mostly by car or taxi), the location of clinics may also reflect the means of transport people use.

“… I think that more local clinics in other locations across Doncaster would make it easier for patients to access our services.”

5.3.2.6 Complexity of health systems

A number of staff said that the health system itself can make it difficult for people to get the support and treatment they are entitled to. Not only does this mean it can delay a person’s treatment, it can also mean that it can prevent people from accessing other healthcare.

A member of staff told us we need:

“Easier navigation of communication systems within NHS.”

5.3.2.7 Hidden costs of accessing services

Staff told us that there were indirect costs to people, such as childcare or time off work, that could make attending appointments difficult.

5.3.2.8 Requesting home appointments

We were told by staff that a barrier to people asking for or requesting home appointments are the questions people need to answer for this to be decided. These questions are about mobility and a clinical decision, not affordability.

5.3.3 Recommendations for navigating and negotiating appointments

5.3.3.1 Help create simpler health systems

• Identify on the patient pathway where people come into contact with other health and care services.
• Look to work with those organisations to make the process as simple as possible.
• Make sure people understand what the steps are, either being taken by the service or that they need to do themselves.
• Access peer support for the person to help them navigate the system where it is needed.

5.3.3.2 Home visits

• Consider offering home appointments to people identified as being on low-income or with increased health risk, where this isn’t currently offered.
• Consider offering home appointments where possible, especially during the initial period of accessing the service. This could allow people to feel more comfortable and open up more than in a clinical setting.

5.3.3.3 Appointment times

• Consider if appointment times are meeting the needs of the whole family and if there are any caring responsibilities that create a barrier to accessing appointments.
• Identify which appointment times are suitable with patients during assessments or treatment sessions.
• Explore the possibility of providing more out of hours appointments so that those with zero hours contracts or the self-employed have more choice when booking appointments reducing the potential loss of earnings.

5.3.3.4 Parking near Evergreen

Work with Estates to see if parking spaces near Evergreen could become for use by those with a disability.

5.3.3.5 Location of clinics

• Identify where people live, based upon their postcode.
• Look to see if any venues are available in locations where lots of patients live and no local clinic is currently provided.

5.3.3.6 Multiple appointments

• Remind staff when making appointments to check is a person has other appointments and try to make these on the same time of day on the same day.
• Look to see how SystmConnect can help people have more control over appointment times.

5.3.3.7 Size of reception space

Work with estates on a potential shift, expand or move of the reception area.

Page last reviewed: February 10, 2026
Next review due: February 10, 2027

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