Poverty proofing Doncaster urgent community response 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 urgent community response

The poverty proofing audit for Doncaster urgent community response and virtual ward 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 urgent community response and virtual ward.

Virtual ward offers swift evaluation and comprehensive care to patients whose needs can be effectively managed within the comfort of their homes.

This approach enables patients to stay in familiar surroundings while healthcare professionals monitor their condition until recovery.

The team delivers daily clinical support, offering various forms of assistance:

• specialised assistance from community mental health nurses for diagnosis, treatment, and support
• general nurses addressing physical health needs
• physiotherapists and occupational therapists promoting overall well-being, exercise, daily living activities, posture improvement, and mobility
• referral options to the enhanced care home team (ECHT) for additional support in case of falls
• senior assistants available for blood tests and electrocardiograms (ECGs), if necessary

Urgent Community Response (UCR) team offers immediate care and assistance for patients experiencing health crises within their homes.

The team provides rapid access to various health and social care professionals within two hours for older adults and individuals with complex health needs who urgently require care at home.

Services provided include:

• facilitating access to and supplying equipment to help maintain independence
• administering necessary medication as prescribed
• referring patients to other essential services if required
• conducting blood, urine, and other diagnostic tests
• assessing symptoms and offering clinical observations
• offering catheter care if needed

Both the services are part of the Home First team combining seven services to make it easier for people to receive the care they need and, if they are well enough, to be cared for at home.

The services covered are:

• specialist falls
• enhanced care home team (ECHT)
• community rehabilitation
• intermediate care (rehabilitation inpatient wards)
• therapy hub (physiotherapy and occupational therapy)
• virtual ward
• urgent community response

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

1 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 6 people who use the service, 12 completed a survey (including easy read versions). We spoke to 5 staff who work in the service, and all 5 staff competed a survey.

4.4 Stage 4: feedback session

A draft of the findings was shared with Caroline Shaw 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 urgent community response 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.

“Gives me comfort and assurance that I am being looked after.”

“Excellent service- I was able to come home early,”

“Staff are very professional and caring.”

“Very informative and professional,

“Happy staff.”

5.1.2 Barriers and challenges

5.1.2.1 Health literacy

In terms of poverty-related barriers that might apply to patients accessing the service, staff reported that health literacy and an understanding of written materials or verbal communication was sometimes a challenge.

5.1.2.2 Digital communication

Sometimes digital communication can be a barrier staff reporting that patients sometimes do not have access to appropriate means, they may have insufficient data allowances for no access to Wi-Fi to enable effective communication via digital means.

5.1.2.3 Patient information

Some participants (staff and patient) felt that more patient information relating to other services also supporting patients would be helpful.

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.

5.1.3.2 Health literacy

• Check with people that they understand what is being communicated to them. Get them to explain what is being said
• Leaflets for patients with how to access help (not relying on digital access to information).

5.1.3.3 Ease of digital access

• Redesign virtual ward for digital poverty to prevent inequality.
• Simple referral process to community diagnostic centre (CDC).

5.1.3.4 Patient information

• Patient information available for other supporting services.
• Staff awareness of other services outside their own particularly those most frequently needed or requested.

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 Barriers and challenges

5.2.1.1 Items not included

Patients reported that they were sometimes asked to pay for items that were not included as part of their health care provision. This included items such as prescriptions, car parking costs, taxi fares or equipment. No patients taking part felt that these items were felt to be “affordable” costs.

“Sometimes I have had to pay for equipment items online because of waiting lists.”

5.2.1.2 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 Recommendations for health related costs

5.2.2.1 Support patients to access support with prescription costs where appropriate or eligible

• 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.

5.2.2.2 Support patients to access financial support for healthcare related items where eligible

• 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 Home visits are welcomed

All patients reported preferring home visits. One patient relied on a mobility scooter to get around so would find it difficult to attend a clinic appointment.

5.3.2 Barriers and challenges

5.3.2.1 Missed appointments

One patient reported that they had missed appointments previously, with the reason being lack of childcare and transport costs.

5.3.3 Recommendations for navigating and negotiating appointments

5.3.3.1 Home visits

Consider offering home appointments first where clinically suitable.

5.3.3.2 Appointment times

• Consider if appointment times are meeting the needs of the whole family and if there are any caring (including childcare) responsibilities that create a barrier to accessing appointments.
• Identify which appointment times are suitable with patients during assessments.

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

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