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 young onset dementia
The young onset dementia service offers assistance and evaluation upon referral from primary care for adults under 65 displaying symptoms of dementia.
The focus is on supporting younger patients and their families dealing with dementia onset before the age of 65.
These services encompass:
- assessment
- counselling
- continual support
- guidance for employers, occupational health, and personnel staff
The service collaborates with other organisations to aid this demographic, facing unique challenges like maintaining employment, managing financial responsibilities such as mortgages, or caring for young children.
Referrals primarily originate from the patients GP. This allows the GP to conduct initial investigations, ruling out other potential causes for memory or cognitive issues, such as different mental health conditions, menopause symptoms, or substance misuse.
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
3 staff completed a three-hour training session. 1 member of staff was consulted with via a survey.
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 1 people in total. In order to truly represent the patients in these services, it would have been ideal to have more patient input.
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 6 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
We have also taken some feedback from Care Opinion to support the service in their continuous improvement:
“Just had her yearly check up from X who was very professional kind and friendly. It’s a massive help to know that you have help at hand if you ever need it.” Care Opinion Feedback
“The visits were carried out by X, she has known my husband and myself for many years, so this consistently led to a good experience.”
The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Doncaster young onset dementia were:
- staff awareness and guidance
- travel
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.
It must be noted that the low number of staff engaged in the poverty proofing audit means that creating recommendations which honestly reflect the needs of the service is incredibly challenging. The Locally Trained team have created these recommendations (and others within this document) based upon very minimal data and, therefore, it is imperative that the audit process continues within the service in some form to ensure accessibility for all patients.
What works
Colleagues are having financial discussions with patients
Out of the 1 colleague who engaged with the audit, they were able to confirm that some verbal screening does take place within the service to ascertain which patients are a risk of poor financial wellbeing.
Staff: verbal screening, asking those we think need help
This data provides a good foundation around having financial conversations for colleagues to build upon. If one member of staff is already doing this as part of their routine, it is likely possible for all colleagues to be engaging in this dialogue with the patients on their caseload.
Barriers and challenges
Only asking those we think need help
If it is the case that colleagues are only offering financial screening to those they think need help, then it is possible some patients are slipping through the net.
Staff: verbal screening, asking those we think need help
It is really important the financial conversations become a routine and universal part of patient and clinician discussions to ensure that patients are able to fully access the service without barriers. From a poverty perspective, asking everyone about their financial circumstances or difficulties in a tactful and sensitive way, will 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.
A need for improved staff awareness about support available
During staff consultations, it could be suggested that the colleagues within the service would benefit from some additional support to understand what is available to patients, should they need financial help.
This evidence is based on the lack of staff engagement with the Poverty Proofing programme, as an assumption has been made that staff have their own barrier when it comes to supporting patients in poverty.
Recommendations for staff awareness and guidance
Only asking those we think need help
- Develop a “script” for engaging all patients in a conversation about their financial circumstances. Tailor this to the context of rehabilitation and going home.
- Embed financial wellbeing questions into routine assessments, so conversations happen consistently rather than opportunistically.
- Normalise financial conversations, framing them as a standard part of holistic care to reduce stigma for patients.
- Empower staff with poverty proofing training, which is bookable via the staff portal.
- Empower staff to attend the new “having financial conversations” training which will be delivered by Children North East on learning half days starting this summer. These sessions will be bookable via the staff portal.
A need for improved staff awareness about support available
- Colleagues do not need to have the answer to everything, but they do need to be able to signpost appropriately.
- Colleagues should look to utilise the trust Citizens Advice scheme for any patient who has expressed concerns about money, food, transport or bills. Referrals can be made via the staff intranet page.
- Colleagues should familiarise themselves with the trust Travel Scheme process, which patients can access free bus passes to attend their appointment.
- The service should develop a bank of resources which are specific to their service, and they can quickly refer to if needed.
Travel
For inpatients on the wards, travel difficulties are generally related to the ability of their friends and family to visit, rather than the patient themselves travelling. Any travel required by the patient will be arranged by the hospital, for example, to and from 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. The costs incurred through travel can mean the difference between receiving regular visitors or none at all.
Barriers and challenges
A need for improved staff awareness about transport support available
During staff consultations, there was a very specific point raised by a colleague about how it would be useful to have more transport options available to their patient cohort. This is something which has repeatedly been raised during poverty proofing audits in other services across the trust which means that it has been brought to the attention of senior colleagues as a consistent barrier to access of services.
Staff: the one thing I would improve within the service to support our patients is transport
Some of the travel issues have been addressed by the trust at a trust-wide level, so there may be no need for any additional interventions at this time (unless the service can specify otherwise). There is an trust Travel Scheme process which is open to all patients (more details about this on the staff intranet) and an trust Citizens Advice service which colleagues can refer patients to. Citizens Advice have dedicated days in Doncaster to be able to support patients with any queries they may have.
Recommendations for travel
A need for improved staff awareness about transport support available
- Colleagues should look to utilise the trust Citizens Advice scheme for any patient who has expressed concerns about money, food, transport or bills. Referrals can be made via the staff intranet page.
- Colleagues should familiarise themselves with the trust Travel Scheme process, which patients can access free bus passes to attend their appointment.
References
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- 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: May 29, 2026
Next review due: May 29, 2027
Problem with this page?
Please tell us about any problems you have found with this web page.