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Poverty proofing North Lincolnshire acute and urgent mental health 2025

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 North Lincolnshire acute and urgent mental health

The locally trained team engaged with North Lincolnshire cute mental health services during July and September 2025, in order to understand the experiences of people and families who are living in poverty.

The work was carried out with staff to build up a rich picture of the challenges and barriers faced by those accessing or attempting to receive mental health services in Rotherham. Staff in the service also looked to get the voice of people who use the service as well.
Acute and urgent mental health services in North Lincolnshire are provided for people across a different range of types and settings. This includes:

  • crisis: crisis service is for an individual or someone they know who is experiencing a mental health crisis, feeling suicidal or in need of urgent support to keep them safe
  • home treatment: home treatment service offers short-term assistance for individuals needing extra support in managing their mental health requirements
  • hospital liaison: offer mental health assessments for individuals aged 16 and above, either in the accident and emergency department or on inpatient wards typically in physical health acute settings

Some services are clinic or hospital based; others are based upon visiting the person in their home.

People can self-refer, and healthcare professionals can also refer into the service.

In North Lincolnshire, 13.3% of the population was income-deprived in 2019. Of the 316 local authorities in England, North Lincolnshire is ranked 106th 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.”

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

6 Staff from both the service an inpatient wards attended 3-hour training between July and September 2025. We also received 10 survey responses from staff in the service.

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.

4.3 Stage 3: patient and community consultations

We did not receive feedback people who use the service. It was agreed at the start of the audit that we would not ask people who are in crisis. The service did ask other people who use the service, but they did not want to answer questions.

4.4 Stage 4: feedback session

The report was shared with the Service Manager, Natasha Jarrett, to consider the findings. We then produced this final report.

4.5 Stage 5: review

Around 6 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward. This will be part of the trust’s poverty proofing community of practice.

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 North Lincolnshire acute and urgent mental health were:

  • communication
  • health-related costs
  • navigating and negotiating appointments
  • people 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 Interpreters

Compared to other audits, staff were generally complimentary about the use of interpreters. Staff told us it was easy to book, and there was availability out of hours in accident and emergency.

5.1.2 Barriers and challenges

Getting the patient voice to understand their experiences of poverty
Through the North Lincolnshire acute and urgent services, we have sought the views and experience of poverty from patients and carers. It was agreed that it would be inappropriate to ask people in crisis when their mental health support was the immediate priority. The service felt that they were best placed to ask other people who use the service that weren’t in crisis, rather than the locally trained team, due to the needs of the people. Unfortunately, we have not been able to do so, despite best efforts. Therefore, the direct voices of the people from this service are not present in this report.

Instead, we have incorporated common recommendations from our other poverty proofing work in the trust for the service to consider that have been picked up through the patient voice in other audits that are similar services. 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 Children North East. Having financial conversations is important to understanding the quality-of-life people are experiencing, which can also impact their mental health.

The language we use may mean some people don’t understand what is being asked of them, or what 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, what treatment they will receive and don’t feel embarrassed if they don’t understand information provided to them.

“Do patients ever say they don’t understand NHS letters?”

5.1.3 Recommendations for communication

5.1.3.1 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.
5.1.3.2 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 Barriers and challenges

5.2.1.1 Paying for prescription costs can be difficult for people

Whilst in this audit the issue didn’t come up, in a similar service staff told us that the costs of prescriptions for patients can be difficult to meet. In addition, due to the nature of the condition of people they may also forget to collect prescriptions as part of their treatment. The trust’s pharmacy does deliver prescriptions when someone is in treatment, but after they are discharged the person needs to arrange this themselves. Whilst staff told us that they had knowledge of help with prescription costs, it was unclear how this was communicated to people.

5.2.2 Recommendations for health related costs

5.2.2.1 Paying for prescription costs can be difficult for people
  • 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.
  • Consider including information in discharge letters.
5.2.2.2 People not collecting prescriptions post-discharge
  • Look to partner with local pharmacies to support those at risk of not collecting medication.

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.”

As most people who use these services need to be seen immediately, the service is not delivered in what could be called an “NHS appointments” way as other services are. This is more likely to take place when people are discharged from this service to, for example, community teams for on-going support.

5.3.1 Barriers and challenges

5.3.1.1 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, but it can also mean that it can prevent people from accessing other healthcare.

“If it was hard for me as NHS staff, it must be equally hard for patients.”

5.3.1.2 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 Recommendations for navigating and negotiating appointments

5.3.2.1 Complexity of 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 on their pathway.
  • Access peer support for the person to help them navigate the system where it is needed.

5.4 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.

5.4.1 Barriers and challenges

5.4.1.1 Access to digital devices

A number of staff said one thing they could change in your practice to make life better for people experiencing poverty is access to digital devices. Citizens Advice North Lincolnshire run a programme on behalf of the integrated care board to help with digital literacy, devices, and data: like the barrier on what financial assistance is available, people may not be aware of this opportunity.

5.4.1.2 Getting the voice of the patient to feedback on their experience

Staff told us that processes to get feedback from people using the service could be better. They said that feedback or complaints process was unclear, informal compliments were not recorded, and there was little uptake to provide feedback on Your Opinion Counts.

“We’ve tried using paper so we can put the feedback on for the patient… but feedback forms could be more accessible if we sent them electronically.”

“It feels like written feedback goes into a black hole because it’s not on Care Opinion.”

“On the complaints process It is variable. It’s probably a piece of work that needs to be clearer and consistent.”

5.4.1.3 Access to food

A number of staff told us that people being able to afford to pay for food was a real challenge. Staff do signpost to foodbank, but opening hours and access to transport for people can be difficult. Whilst staff might make arrangements for people to get food, this still remained a problem which can impact upon a person’s recovery.

“If they’ve not got money to buy food, how are they going to get to the food bank?”

5.4.2 Recommendations for people empowerment

5.4.2.1 Access to digital devices
  • Ask people about their digital needs and barriers.
  • Refer people to Citizens Advice North Lincolnshire digital support programme (a link is at the end of this report).
5.4.2.2 Getting the voice of the person’s experience
  • Make sure that peers supporting people have knowledge of feedback processes (for example, Your Opinion Counts).
  • Ask peers to get feedback from people each time they engage with people.
  • Communicate with staff on processes to get feedback from people, for example a session on learning half days.
5.4.2.3 Access to food
  • Work with other organisations to establish referrals to food banks.
  • Look to develop food cupboards, to support people who may be struggling with paying for food.
  • Refer people to Citizens Advice North Lincolnshire for support (a link is at the end of this report).

5.5 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.

5.5.1 What works

5.5.1.1 There are some clear examples how services support people experiencing poverty

Staff told us of a range of ways their service identified people who may be experiencing poverty. This then led to action being taken to support people. Here are some examples.

“Appointments at home to reduce travel costs.”

“Individually staff are flexible and willing to work in ways that support people accessing services, for example, home visits.”

“Appropriate signposting and supported engagement to reduce the impact off digital poverty on engagement (offering appointments without the need of a telephone appointments).”

5.5.2 Barriers and challenges

5.5.2.1 The response to supporting people experiencing poverty is mixed and not consistent

Whilst the above paragraph shows structured ways to support people, with staff citing examples of where the service supports people experiencing poverty, this can be dependent upon judgements of other individual staff or verbal screening. The response to the staff survey is also mixed: around half the staff think there is a way their service can identify someone in poverty, whereas the other half don’t think there is. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.

“Some people will naturally flow into conversations around how things at home are… some people don’t really want to discuss it.”

“Optional screening, it’s a question on a pre-registration form.” (in hospital liaison)

5.5.2.2 Staff awareness of what is available in the community

A number of staff said they or their colleagues may be unaware of what is available or how they can help someone experiencing poverty. This means that people may be losing out to support that they need or are entitled to.

“Use more proactive signposting with good links to support services rather than generic information.”

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Making staff aware of financial support available
  • Communicate with staff the nationally publicised help that is available for people which is published on the trust website (a link is at the end of this report):
    • help with transport costs
    • NHS Low Income Scheme
    • help with health costs for people on Universal Credit
    • help when you need to pay for NHS care (prescriptions, dental care, eye care wigs and fabric supports)
    • personal health budgets
  • Make sure this is communicated to people and their peer support.
5.5.3.2 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.
  • Get information from charities and foodbanks on what is available in North Lincolnshire and how people can access them.
5.5.3.3 Access to benefits and debt advice
  • Refer people to Citizens Advice North Lincolnshire for an income or benefits check, a link is provided at the end of this report.
  • Hold an awareness session with staff on how to access this service for people.
5.5.3.4 Access to other support
  • Work with the council and voluntary and community sector to create a list of information of support available to families (such as access to white goods).
  • Make that list accessible to staff.
  • Communicate to staff via team meetings, email, et cetera.

5.6 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.

5.6.1 Barriers and challenges

5.6.1.1 Cost of travel

We were told by many staff that the cost of travel has been a barrier to people accessing the service. Staff also told us access to transport would be a help for people as well. People struggled to pay for the bus fare, petrol or taxis. Where possible, people wanted home visits due to travel costs. Staff weren’t aware of travel re-imbursement schemes.

“There are people that we meet that do struggle financially and don’t have the means to travel.”

“I don’t think it’s common knowledge to a lot of us, about reimbursement schemes.”

5.6.2 Recommendations for travel

5.6.2.1 Promote Healthcare Travel Cost Scheme
  • Promote the claiming back of travel costs and make this normal in staff roles.
  • As a trust, develop a process to claim back travel costs that isn’t stigmatising and is easy to use.
  • Advertise it to patients, ensure staff know about it, and how it works.
  • Look to introduce pre-loaded travel cards or similar for people who don’t have the money up front.
5.6.2.2 Volunteer drivers
  • Look to create a pool of volunteer drivers to help people attend appointments.
  • Identify people who would benefit from such a scheme.
  • Trial and test, before learning and rollout.
5.6.2.3 Re-imbursing travel costs for people on low incomes

Where people have to attend clinics, and are at risk of did not attend (DNA) due to the affordability of travel, use the process agreed as part of the 2025 and 2026 Investment Fund.

5.6.2.4 Home visits

Identify people for home visits, where cost and affordability of travel is a problem.

5.6.2.5 Community appointments

Look to hold appointments in community settings, which are closer to where people live and help avoid unnecessary travel.

5.6.2.6 Digital appointments

Look at there, clinically, an appointment can be undertaken digitally that will reduce the travel need of the person and staff alike.

6 References

Page last reviewed: December 11, 2025
Next review due: December 11, 2026

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