Poverty proofing report children’s neurodevelopment 2024

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 CNE 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: Locally trained team roll out half day workshops to the remainder of the services. Through this approach, services will learn how to work with their patients to identify barriers and to apply the learning and approach to their own services and settings 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 children’s neurodevelopment

The neurodevelopment service is a specialist service for children and adolescents that offers:

• diagnostic assessments for autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD)
• personalised recommendations to support needs and recognise strengths
• psychoeducation for autism spectrum disorder and attention deficit hyperactivity disorder
• signposting to partner agencies and other organisations for additional support
• support for other children and adolescent mental health service pathways if mental health or emotional wellbeing concerns arise

In Rotherham and Doncaster, we offer medication support and behavioural strategies for attention deficit hyperactivity disorder.

In North Lincolnshire, we refer to the Community Paediatric team for medication support and behavioural advice.

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

18 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 patient-facing 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 89 people in total who attended the service. This included adults, parents and carers and young people.

4.4 Stage 4: Feedback session

A feedback session was held with a senior member of the podiatry staff and a senior strategic development manager from the trust, where we discussed our findings and collaboratively considered various changes that could be implemented. We then produced this final report.

4.5 Stage 5: Review

Around 12 months after completion, Children North East will return and 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 children’s neurodevelopment services 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 Clinical jargon is mostly avoided

Staff make a really conscious effort to ensure clinical terminology is avoided, where it can be replaced with more simplified language. This is to ensure there is a shared understanding of assessment, diagnosis and potential care plans.

• “The language that is used in the assessment report is gone through as part of the feedback and, in that session, we explain any clinical jargon and simplify it so it’s understood.”
• “I focus on the language and terminology, and I’d rather it represents them than me. If the language or terminology need changing, I’m quite happy to change it.”
• “We might lose what’s normal in our language like I used the word diagnosis the other day and I got quite blank looks, and I think oh, like, I should rephrase diagnosis even though that’s such a common word for me.”

5.1.1.2 Contact

The service is quite easily accessible via telephone and email, and effort is made to respond to all correspondence within 24 hours of receiving it.

• “The staff will ring me back when I can’t get through the first time.”

5.1.2 Barriers and challenges

5.1.2.1 Interpretation services create barriers

At times, the service and patients require the use of interpreters; however, this process is not straightforward. The interpretation services are unreliable which means that interpreters do not show up on time or at all. In some cases where a language is particularly uncommon, an interpreter has been allocated to a patient who knows them.

• “It is difficult to coordinate the appointment when trying to factor getting an interpreter.”
• “There have been cases where the interpreter is known to the patient (for example, it is someone they know or lives in their area. This isn’t fair on the patient, and it compromises confidentiality.”

5.1.2.2 Avoidance of clinical jargon does not go far enough

Patients praise the service for helping them to understand certain words and terminology; however, this isn’t enough for some of the patient cohort. Some patients still really struggle to understand the communications they receive.

• “The letters and form we have received from the service are well written though sometimes I have to use the dictionary to make sure I understand clearly.”

5.1.3 Recommendations for communication

5.1.3.1 Interpreter services

The trust should review the current contract for interpretation with a view to procuring a more reliable and suitable service for the benefit of both patients and colleagues.

5.1.3.2 Take further steps to embed avoidance of clinical jargon

Review all standardised documents to ensure they are fully understandable and avoiding overly technical language. Consider using online tools to check the readability of letters or communications such as the fog index.

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 Very few health-related costs

For the vast majority of patients within the children’s neurodevelopment service, they encounter very few costs in relation to their care plan, but this is not to say they don’t encounter other hidden costs in their daily lives. Most are able to access the equipment they need as a result of NHS funds, as it is referenced in their care package.

5.2.2 Barriers and challenges

5.2.2.1 Discrepancies around entitlement to sensory or fidget toys

Some patients and staff expressed confusion about whether sensory toys, such as fidget spinners, are available on the NHS. Some areas do give them out, and others don’t, so there doesn’t seem to be consistency. If we do offer them free of charge, we need to make sure people are able to get them without having to ask.

• “We have purchased a few fidget toys for our son, but he soon gets annoyed with them and we have to get a different one. It would be great if there was somewhere we could have a fidget toy exchange.”
• “Sometimes we recommend sensory toys, fidget toys and apps that they can purchase to use.”

5.2.3 Recommendations for health related costs

5.2.3.1 Discrepancies around entitlement to sensory or fidget toys

• To review our offering around fidget or sensory toys, and ensure all patients know where to access. If we give them free of charge, then all patients need to be aware of this so they can access what they need. If patients need to purchase them, please ensure this is a consistent message.
• To consider setting up a sensory or fidget toy exchange where patients can bring in unwanted toys to exchange for something new to them, without cost.

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 Appointment reminders

Some staff remember to send reminders to patients prior to their appointments, people reported that they find this particularly useful when it does happen.

• “I have received a text with an appointment reminder.”
• “Staff tend to call me on the morning of my appointment to confirm attendance and to also send text messages reminder the day before.”

5.3.2 Barriers and challenges

5.3.2.1 Appointment reminders are inconsistent

• “Our appointment system doesn’t send automated reminders, so staff are relied upon to remember to do it themselves.”

5.3.2.2 Appointment times

During patient consultations, it was widely noted that some families really struggle to attend appointments due to being unable to find childcare. They are aware it is not appropriate to bring multiple children to an extensive appointment but equally have nobody to take care of the other children.

• “A lot of appointment cancellation are experienced during summer holidays.”
• “We usually get a lot of did not attends (DNAs) or was not broughts (WNBs) over the Christmas and New year period.”
• “I would struggle for childcare to bring one child to appointment or incur the cost of coming with all three children on the bus.”

5.3.3 Recommendations for navigating and negotiating appointments

5.3.3.1 Inconsistent appointment reminders

Set up a reliable system (possibly within SystmOne) to ensure reminders are targeted and consistent, to ensure patients know when and where their appointment is taking place, what to expect from the appointment and how long it will take.

5.3.3.2 Links with schools

Form links with Directors of SEND and SENCo roles within schools and Trusts across the patch to improve did not attends (DNAs) or was not broughts (WNBs) and collectively find ways to deliver appointments within schools.

5.3.3.3 Appointment times

• Consider if appointment times are meeting the needs of the whole family and if there are any caring responsibilities that create a barrier to accessing appointments.
• Identify which appointment times are suitable with patients during assessments or treatment sessions.
• Explore the possibility of providing more out of hours appointments so that those with zero hours contracts or the self-employed have more choice when booking appointments reducing the potential loss of earnings.

5.4 Patient 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 What works

5.4.1.1 Comfortable in asking for help

The vast majority of patients feel as though they could ask for help if they needed it.

• “If I needed help I would mention it, but others might not.”

5.4.2 Barriers and challenges

5.4.2.1 Paperwork support

Patients report that there are often forms to complete prior to their child’s appointment; but there are varying opinions about how straightforward this is to complete.

• “The form that I was provided to complete were a bit long and I had to get help to complete them.”
• “I wasn’t offered any support.”

5.4.2.2 Lack of signposting

If the parent or carers of the young person make a disclosure that they need financial help, staff often don’t know how to help the patient to help themselves. Signposting is really sporadic and there is not a structured approach within the service.

• “I wouldn’t have a list of you need to ring that person or that team in my head.”
• “It would be great to have some information at hand to share.”

5.4.3 Recommendations for patient empowerment

5.4.3.1 Paperwork support

Ensure that support is made available to all patients in regard to forms which need to be completed. If the forms are a mandatory precursor to the appointment, the service need to ensure a patient feels confident in completing, without making assumptions.

5.4.3.2 Lack of signposting

Develop a bank of information which patients can use if they need financial support. At the trust, we now have in-house appointment with Citizens Advice, so it is important that staff know about this so they can direct patients and, or make a referral.

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 Visual assessments

Some staff do informal assessments of a person’s financial circumstances and are able to make judgements about any potential financial hardship.

5.5.2 Barriers and challenges

5.5.2.1 Staff awareness

Supplementary to the section above were some staff already do informal assessments of financial circumstances; however, this is not consistent. Staff themselves were keen to engage with additional learning about how they might better be able to support those in their care. This is something which would evidently be mutually beneficial for patients and staff.

• “It would be good to know what’s out there.”
• “I would like patients to feel like we are in it alongside them.”

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Visual assessments

• Where staff rely solely on visual assessments, it would be good practice to make conversations around poverty more routine to ensure nobody slips through the net.
• It would be ideal to initiate conversations around financial difficulty with those living in our “Core20Plus5” areas. This information can be found on our SHAPE app, or on RePortal.

5.5.3.2 Staff awareness

As recommended above, staff expressed an interest in knowing more about how to support patients. It is recommended that more staff attend the Poverty Proofing training delivered within the trust, with a view to more bespoke training delivered by Citizens Advice.

5.6 Travel

Healthwatch UK (2019) showed that travel is a key issue for patients, 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 patients 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 What works

5.6.1.1 Free parking

Patients and staff are very appreciative of the free parking on offer as it helps to keep appointment costs to a minimum.

• “It’s great that there is a parking space that offer free parking”

5.6.2 Barriers and challenges

5.6.2.1 Cost of travel to appointments

During consultations, some parents or carers expressed concerns at the cost of getting to their child’s appointments. Some were concerned about the costs of buses or taxis, particularly as they may have to cover a fair distance to reach the clinic. It is also apparent that the costs of transport are not spoken about between clinician and parent or carer.

• “I don’t think the service understand the cost implications that people face even just to attend an appointment.”
• “If they were able to do more home visit it would be great.”

5.6.2.2 Underutilisation of community venues

It is evident that both parents or carers and staff feel a sense of frustration at the lack of appointments made available at community venues. There is a feeling that being able to deliver appointments closer to homes and schools would make it much easier for people to attend without causing severe inconveniences.

Within staff consultations, staff expressed a real struggle with knowing how to book community venues, which venues are “allowed” and how to pay for them.

• “Some parents have pointed out they have to travel 1 hour 30 minutes for the appointment.”
• “It would be great if we had other areas in the community, we could base ourselves maybe GP surgeries especially when we need to do assessments.”

5.6.2.3 Lack of awareness around potential travel reimbursement

There are opportunities for some parents or carers to apply for travel reimbursement via an approved scheme. However, knowledge of this scheme was particularly low across the service, for both patients and staff.

• “As a staff member, I would not know how to direct patients to be able to get travel reimbursement or provide them information on how to access this.”
• “I wasn’t aware I could get travel reimbursement to come for my appointments.”

5.6.3 Recommendations for travel

5.6.2.1 Cost of travel to appointments

Transport and appointment options to be clearly communicated across the trust, so colleagues know where to direct patients.

5.6.2.2 Underutilisation of community venues

• Prioritise the scoping of community venues to provide more flexibility in relation to appointment locations.
• Support staff to help them understand the process for booking community venues and empower them to do so.

5.6.2.3 Lack of awareness around potential travel reimbursement

Promote the claiming back of travel expenses and normalise this across all staff roles.

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: June 19, 2025
Next review due: June 19, 2026

Problem with this page?

Please tell us about any problems you have found with this web page.

Report a problem