Poverty proofing report Amber Lodge 2024

1 Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Foundation Trust to fulfil its ambitious promise to “poverty proof” all of its services by September 2026. 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 will positively impact the overall health outcomes of everyone.

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 Amber Lodge

The Poverty Proofing audit for Amber Lodge began in April 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 Amber Lodge.

The forensic low secure unit, Amber Lodge is a 13-bed inpatient service for adults with learning disabilities providing specialist assessment, treatment, and rehabilitation for adult males detained under the Mental Health Act (1983). The patients looked after may have highly complex clinical or risk presentation in addition to a learning disability and or autism.

Service is based on the Tickhill Road Hospital site, is well maintained, and supports patients from both the South Yorkshire catchment area, as well as out-of-area patients requiring specialist inpatient care.

The site has good public transport links to Doncaster City Centre, and bus stops are a short walk away from the service.

There is ample free parking on site for staff and for visitors.
Doncaster is ranked 37th most Deprived (from 317) local authorities in England in the 2019 English Indices of Multiple Deprivation (IMD) where 1 is the most deprived and 317 is the least deprived. This is a rise of 5 places from 42 in the previous IMD of 2015. The overall rank of Doncaster in the Indices has remained much the same over a 15-year period following IMD’s in 2004, 2007, 2010, 2015 and 2019 with the average rank over those studies being 40. Doncaster is in the top 20% most deprived local authorities in England. 60% of Doncaster population live in areas ranked in the “most” deprived or “worse than average” quintiles. The data collected in 2024 is due to be released in late 2025.

Census 2021 includes an element of deprivation analysis that confirms Doncaster is more deprived than the National average.

Key findings from a Mind report of August 2021 tell us:

“There is still a lot of shame about money and mental health. Many feel mental health is a while, middle-class conversation they can’t tap into. Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health.” (Poverty and Mental Health, Mental Health Foundation, August 2016).

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

4 members of staff completed a three-hour training session. This is low when compared with the total number of staff within the services.

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 and communications.

4.3 Stage 3: patient and community consultations

We spoke to 4 people who use the service. We spoke to 6 staff who work in the service. No carer consultations were undertaken. All consultations were undertaken face to face.

4.4 Stage 4: feedback session

A feedback session will be held with Angela Gaylor 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 Amber Lodge were:

• communication
• health-related costs
• patient empowerment
• staff awareness and guidance

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 Support from staff

All patients reported that staff communicates in ways that are easy to understand and suit their communication needs.

Patients are asked about their communication preferences as part of their care planning, and adaptations made accordingly. The ward has the support of occupational therapy and speech and language therapy for this.

“I know staff would listen.”

5.1.1.2 Information is accessible and easy to understand

All leaflets are free, and it is advertised that if an individual needs information in a different format, then to speak to staff.

All patient related literature has been written using clear and concise language and is readily available in easy-read format to suit the needs of patients.

The visitors room has additional information that is displayed in a prominent position and is easily accessible.

5.1.1.3 Information for visitors or carers

Information about the service is available online, and families and carers are provided with contact details upon admission.

5.1.1.4 The ward manager is quick to respond to enquiries

There are always staff available and visible on the unit, who are happy to support visitors and carers where required.

5.1.1.5 Translation services

There are no current requirements for translation services within the unit, but staff are aware of how to access interpreter service.

All information can be translated if required, and there is information available on how to request this.

5.1.2 Barriers and challenges

5.1.2.1 Support from staff

“I can only talk to some staff.”

“Health literacy (understanding of written materials or verbal communication) can sometimes be a barrier.”

5.1.2.2 Constraints around digital access

Security of the unit is key, and therefore information is delivered following guidelines to ensure patients, staff and the service as a whole are not compromised.

One staff member commented that due to the nature of the service, the promotion of some of the service’s achievements were sometimes left out of trust wide newsletters and articles.

There is no free Wi-Fi in the service due to the nature of the patient cohort. There are however information technology (IT) facilities on site that are accessible with support of staff, as per care planned access.

There are TVs throughout the ward area that are easily accessible and have access to regular channels and digital optical disc (DVD) facilities.

“I am not aware of support provided by the service or what they can help you access support for it would be great to know this.”

“More information to be available in leaflet form.”

“More information available for services in the community.”

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 Medication costs and support

All medication is provided to patients at no cost to them.
Service has a named GP, and access to additional healthcare services (opticians, dental) so not additional costs are incurred.

For any other health-related costs patients are supported to make decisions and receive budgeting support.

“I am aware that the service supports with prescription costs.”

5.2.1.2 Transport costs

Patient transport is funded, and the unit have their own dedicated secure vehicle to support with this.

If taxis are required to get to an appointment, the cost is covered by the service. For personal visits (section 17 leave) patients are supported with budgeting for taxi or bus fares via the Occupational Therapy team and ward support staff.

5.2.2 Barriers and challenges

5.2.2.1 Transport costs

“Travel and transport (cost of parking, public transport, taxi’s et cetera) can be a poverty-related barrier for patients.”

“There should be more support available for relatives in poverty to be able to visit patients at Amber Lodge.”

“We always do our very best to support patients needs whether financial or otherwise. If we don’t know the answers we will source the information we need to able us to help.”

5.2.2.2 Call costs

Patients can be contacted via “0300” number at a charge of up to 10 pence per minute from a landline, and 3 pence to 40 pence per minute from a mobile.

“Financial support for access to digital interventions, for example, device, data would be helpful.”

“More information for financial assistance programs.”

“Offer discounts and free services for families and carers, particularly around travel.”

“Costs for data can be a poverty-related barrier for patients.”

5.2.3 Recommendations for health related costs

5.2.3.1 Call costs

The service to explore appropriate packages and plans that reduce the costs of telephone calls for friends and families contacting patients. Explore whether there is a no-cost alternative.