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 (Mulberry and Laurel)
Mulberry and Laurel mental health units are based at Great Oaks and cater to patients experiencing acute mental health issues. Our service accommodates patients detained under the Mental Health Act, as well as those who voluntarily seek our services.
When a patient needs acute care, they are often in crisis, anxious, and vulnerable, requiring a high level of attention. Acute wards offer a secure and stabilizing environment for individuals who cannot safely receive treatment in the community.
Mulberry Ward offers services to adults in mental health crisis. It is a 19-bed ward within the grounds of the Great Oaks site and offers an inpatient facility for predominantly aged 18 to 65 adults experiencing functional mental health issues. We do aid in the management of combined mental illness and frailty, also accommodating an all-age approach within a frailty framework.
Laurel ward offers service to older adults over 65 years experiencing acute mental health issues, providing a safe and stabilising environment for those in crisis, whether detained under the mental health act or voluntarily seeking care. These acute wards cater to patients requiring a high level of care and support when the community setting is not suitable for treatment. Laurel ward is a 13-bed ward at Great Oaks for both male and female patients. It is an acute ward designed for patients who require a short stay in hospital to recover from a significant period of mental illness. It supports patients with functional mental health problems and also patients living with dementia.
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 member of staff has 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 13 people who use the service, which is a good proportion of the overall patient cohort. We also spoke to 8 staff who work in the service.
4.4 Stage 4: feedback session
A feedback session will be held with Natasha Jarrett where we will discuss our findings and collaboratively consider various changes that could be implemented.
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 North Lincolnshire acute (Mulberry and Laurel) were:
- health-related costs
- people empowerment
- staff awareness and guidance
- travel and transport
5.1 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.
5.1.1 What works
5.1.1.1 Prescription costs
All patients who were consulted with were eligible for free prescriptions.
5.1.2 Barriers and challenges
5.1.2.1 Energy costs
Some patients described having difficulties with energy costs when they are not staying at the unit. For those staying on Laurel Ward, many were left without the government’s Winter Fuel Allowance last year, and were grateful that those allowances have now been reinstated for this year.
“I do worry about energy costs sometimes.”
“The cost of having the heating on has risen a lot recently.”
5.1.2.2 Food costs
There was a significant number of patients on Mulberry Ward who expressed a concern about having to buy their own food, due to the quality and variety of the offerings on the ward being so poor. Patients felt that the same meals are served on repeat, and it can become very monotonous. It is problematic when patients do not receive good quality, varied, nutritious food as it can have an impact on their overall health. Patients are now resorting to leave site, and going to purchase their own meals, this is happening at least once a day.
“We’ve asked for a salad bar before, but we’ve been told there aren’t enough staff to have one.”
“The sandwiches are terrible, dry and stale.”
“Stop serving stews in summer.”
“I can’t eat another stew.”
5.1.3 Recommendations for health related costs
5.1.3.1 Energy costs
All staff should be redirecting patients to our dedicated Citizens Advice partner to discuss any issues they have with affording necessities. Staff can make appointments for patients on the intranet; and Citizens Advice can visit the patient on-site.
5.1.3.2 Food costs
The trust should carry out an urgent review of the food on offer for patients. There needs to be more variety, and more nutritional options available. The same meals should not be repeated too frequently. Food should also be more seasonable; not only for preference but also for the trust to become more sustainable. Seasonal food often carries fewer carbon emissions.
5.2 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.
5.2.1 What works
5.2.1.1 Most patients are very comfortable in asking for help
Based upon patient consultations, it is very positive to see that most patients feel comfortable in asking staff within the service for help in relation to their finances. They know they could ask for help and would be okay with doing so.
“I know who to ask.”
“Yes I would feel fine talking about money.”
“I am confident that I would be listened to.”
5.2.2 Barriers and challenges
5.2.2.1 Lack of funding for activities
Patients are not empowered to create their own routines while they reside on the ward, as they feel there is so little available to them. Most patients expressed feelings of intense boredom and felt that most of the activities were not appropriate to their needs (more suited to children). When staff were asked about the potential for differing activities, 3 staff confirmed that:
“There’s no funding for anything else.”
One member of staff also commented that:
“If we do anything different, the staff have to pay out of their own money.”
And:
“I organised iced coffee making last week, but I had to pay for the ingredients myself.”
It is worth noting that these consultations were carried out prior to the trust revamping the ward activities, so things may have changed since then (see recommendations).
“There’s nothing to do.”
“The staff always tell me off for watching too much TV, but there’s nothing else to do here.”
“There are lots of colouring books, but they’re very boring.”
“The gym equipment outside is okay, but not much fun in winter.”
“An Xbox or tablet would be welcomed.”
“Some of us take advantage of the local gym who offer 1 free hour each day between 10 am and 11 am.”
5.2.2.2 Patients arriving with no spare clothes and toiletries
Some patients are admitted onto the ward with no clothes other than those they have with them at the time. The same goes for toiletries. Patients on Laurel often find that they cannot access their money easily and, therefore, they will often have to ask staff for items, which they can find embarrassing. Staff understand that there is no funding to buy basics for patients.
“Staff will bring toiletries in from home.”
“I will go to Primark on a weekend to buy basic clothing for patients, but this is our of my own pocket.”
5.2.3 Recommendations for people empowerment
5.2.3.1 Lack of funding for activities
The trust has recently reviewed activities on the ward, and activities will now be more frequent and varied. Staff on Mulberry and Laurel should consult with patients in January and February 2026 to understand whether the new activity routine is appropriate and entertaining.
5.2.3.2 No basics available (clothing and toiletries)
The service need to organise a stock of basics, which is funded by the trust (or charitable funds) to ensure that patients are catered for.
5.3 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.
5.3.1 What works
5.3.1.1 Providing support
While carrying out consultations on the ward, it was observed that many staff are aware of the financial challenges faced by patients. There are lots of opportunities for patients and staff to have financial conversations; either in one-to-one discussions or in wider patient groups.
5.3.2 Barriers and challenges
5.3.2.1 Staff training
The uptake across the North Lincolnshire wards (Mulberry and Laurel) for the poverty proofing training has been very poor so far. One person has attended the training. In order to better understand and support those with experiences of poverty, all staff should look to attend the training as soon as realistically possible.
5.3.2.2 Staff funding key elements
A number of staff raised concerns about having to personally fund essentials on the wards. These essentials might be things like clothes, toiletries and activities for the patients. When the locally trained team probed about why this was happening, there were mixed responses; some staff felt that was the:
“Right thing for them to do as a person in a caring role.”
And others felt that it was:
“Expected of them by senior leadership.”
Staff support patients to attend appointments whilst inpatients using the ward vehicle, this however does not qualify for a blue badge. This means staff are expected to pay any tolls and parking charges incurred as a result of the appointment and are required to claim this back via petty cash.
“Lots of things are paid for out of our pocket.”
“I always buy things for the ward when I’m doing my weekly shop.”
“Senior leadership will tell us to buy things, but won’t offer reimbursement.”
“At times, staff are expected to buy things with no process on how to claim costs back.”
5.3.3 Recommendations for staff awareness and guidance
5.3.3.1 Staff funding key elements
The service leads need to put in a proper process for buying things for the ward. For things that are required routinely, there needs to be a stock of them on the ward (purchased via usual channels). For ad-hoc items, staff can purchase these if they are willing, but there should be no expectation. If a member of staff does purchase something (with prior approval), there needs to be a clear, speedy process for them to claim their money back. Equally, staff should not purchase things without first checking that it is essential.
5.3.3.2 Staff training
All staff need to have been on the poverty proofing training which is held on trust learning half days. This training will help them with their knowledge of poverty, as well as how to support patients who are experiencing financial difficulties. Staff can book onto this training via the staff portal (free of charge).
5.4 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.
5.4.1 What works
5.4.1.1 Transport of patients
The transporting of patients is often supported by staff in the dedicated ward car. Both staff and patients agreed that this worked well.
“If a patient needs to go somewhere, we take them in the ward car.”
5.4.2 Barriers and challenges
5.4.2.1 Friends and family visits
Some patients advised that family members have to travel significant distances to visit them while they reside on the wards. This can be very costly and upsetting for the families, and also limits the amount of visits a patient may receive.
One patient stated that her:
“Husband makes a return journey from Epworth to Great Oaks every day, which has a financial implication.”
“My family can’t visit me often because of the cost.”
Patients rely on family or friends to attend appointments
Once discharged, many patients rely on friends or relatives to attend their healthcare appointments. Many do not have their own vehicle and are dependent on the people around them for support.
“If I can’t get a lift, I’ll get a taxi.”
“My mate picks me up and drops me off.”
5.4.3 Recommendations for travel
5.4.3.1 Friends and family visits
The service should explore ways to make friends or family visits more possible. Where a person is unable to receive any visits due to cost, this should be discussed with the service and the service should explore options with Citizens Advice and, or their leadership team.
5.4.3.2 Patients rely on family or friends to attend appointments
During routine conversations, all trust staff should enquire about a person’s ability to attend their appointment. If a patient expresses a difficulty in attending an appointment due to financial reasons, the service may offer a free bus pass where appropriate. These are available to all services.
6 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.
- Disability Living Allowance (DLA) for adults
Page last reviewed: December 24, 2025
Next review due: December 24, 2026
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