Poverty proofing report community learning disabilities 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 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 community learning disabilities

The Poverty Proofing audit for the trust community learning disabilities services 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 people who have a learning disability, to build up a rich picture of the barriers and challenges faced by those accessing the trust community learning disabilities services.

As discovered when completing the fact-finding activity, the trust community learning disabilities services covers all three localities within the trust which includes Rotherham, Doncaster, and North Lincolnshire. The service offers specialised healthcare to adults aged eighteen and above who have a confirmed learning disability or are transitioning from children’s services.

The work involves collaborating with patients who have a learning disability, their caregivers, families, and the broader health and social care community. The services cater to various people with a learning disability through multiple specialised programs and teams, including:

• Health Action team (HAT)
• Community Nurse team
• learning disability crisis and intense support (CAIS)
• clinical psychology and counselling.
• physiotherapy
• occupational therapy
• speech and language therapy (SALT)
• psychiatry

The services specialise in assessing and supporting patients with complex and challenging needs. Some examples of the support that is offered includes:

• physical health assistance
• addressing communication and swallowing difficulties
• supporting mental health and emotional wellbeing
• managing challenging behaviours
• conducting mental capacity and best interest assessments
• ensuring safety and effective risk management

Referrals are accepted if a patient requires support for a physical or mental health need that cannot be met by mainstream services. Referrals and requests for a single access referral form (SARF) for the service can be made over the phone or via email.

The service working hours are Monday to Friday in the hours of 9am to 5pm and the staff bases are:

• Rotherham: Badsley Moor Lane, Rotherham S65 2QU
• Doncaster: Tickhill Road Hospital, Tickhill Road Site, Balby, Doncaster, DN4 8QN
• North Lincolnshire: Monarch House, Queensway Court, Scunthorpe, North Lincolnshire, DN16 1AD

In Rotherham, 16.8% of the population was income-deprived in 2019. Of the 316 local authorities in England, Rotherham is ranked 45th most income-deprived, with 1 being the most deprived. 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. In Doncaster, 16.6% of the population was income-deprived in 2019. Of the 316 local authorities in England, Doncaster is ranked 48th most income-deprived, with 1 being the most deprived.

Research by Prison Reform Trust in 2019 tells us:

“People with learning disabilities are more likely than their non-disabled peers to be exposed to a range of ‘social determinants’ of poorer health. These include poverty, poor housing conditions, unemployment, social exclusion, violence, and exposure to overt acts of abuse, victimisation, and discrimination.”

People with learning disabilities are more likely to experience poverty, which can result in poorer nutrition, unstable housing, higher stress levels and limited participation in community activities which can have negative impact on health outcomes. By focusing on how to reduce all this aligns with the NHS Long Terms Plans commitment to reducing health inequalities and improve outcome for those with learning disabilities (Public Health England, 2016) (NHS England, 2019).

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

“There’s still a lot of shame about money and mental health. Many feel mental health is a while, middle-class conversation into which they can’t tap. 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

Staff were invited to attend the 3-hour training session on Poverty Proofing, and 42 staff members are recorded on our training system as receiving training.

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 38 people who use the service and family members/carers who supported people who use the service. We spoke to 51 staff who work in the service. The information gathered was a mixture of surveys and face-to-face consultations.

4.4 Stage 4: feedback session

The report will be sent to the matron for the Learning Disabilities Service, Rachel Deakin, where we will share our findings and collaboratively considered 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 the trust community learning disabilities 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 The service is welcoming

Those using the trust community learning disabilities services suggested that they strongly agree or agree that the service was a welcoming place.

“They are very welcoming when they visit me at home.”

“Very welcoming staff.”

“Very polite and welcoming.”

People who use the service described staff as friendly, caring, understanding and supportive.

“Staff are caring.”

“Very friendly staff.”

“Understanding, caring, supportive and give good advice.”

5.1.1.2 Information

Those using the trust community learning disabilities services suggested that access to resources regarding financial support is available and that they feel the team will support people to access support if needed.

“All information and services we require are there.”

“I feel my team will always go the extra mile to recognise people who are struggling and will refer on for further help and support plus offer support themselves.”

Staff working in the service also believe they are excellent at supporting and signposting people to other services and providing information if needed. Staff will also adapt this information to make it is more accessible and aligned to people’s needs. Examples include using easy read and translation services.

“In my opinion, our staff offer excellent support and signposting to helpful services.”

“Using easy read information and using translation services to be able to understand and meet needs more effectively.”

5.1.2 Barriers and challenges

5.1.2.1 Information

When staff were asked in your experience, which of the following poverty-related barriers apply to patients accessing your service the following was reported:

• communication (no data or access to credit Wi-Fi et cetera)
• health Literacy (understanding of written materials or verbal communication)
• patient advocacy (unable to ask for and get help)

“It would be great to get some letters in easy read.”

“Sometimes it would be helpful to contact the family members or carer to arrange the appointment.”

When staff were asked if they could change one thing in their practice to make life better for people experiencing poverty, they suggested having access to information that is appropriate for individual people’s needs who use the service.

“The patients that we look after need to have materials in easy read, it would be ideal to have a suite of material readily available to share.”

When people who use the service were asked if it would help if more information was received on community resources or financial help for healthcare, majority of people suggested yes.

“More information on other services that can help, more information on community resources would be helpful.”

5.1.2.2 Communication

When people who use the trust community learning disabilities services were asked what support would help them if they were experiencing poverty, people reported support to access digital’s interventions and better communication regarding support available regarding financial support.

“Better communication and outreach.”

“Give clear communication about available support.”

“Providing more financial help, discounts or free services and giving clear communication on this support.”

5.1.3 Recommendations for communication

5.1.3.1 Information

People mentioned they would benefit from more information around tackling their financial issues. It would be helpful for staff to ensure this information is available in appointments and in easy read format if needed.

5.1.3.2 Digital (Ensure communication with people is based on their needs)

• Identified as a trust issue, work is starting as a trust to look at this challenge.
• It would be helpful if people are asked about their communication needs and preferences, and this is recorded on SystmOne.
• Refer people to Citizens Advice in Rotherham Doncaster and North Lincolnshire digital support programme.

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

Those who access trust community learning disabilities services, in part suggested they did not have to pay for any items or services as part of their healthcare. When staff were asked about unintended healthcare cost, they suggested that staff supported people who use their services if experiencing unattended healthcare cost, for example the offer of flexible appointment and support to access other resources if needed.

“We always support in bus pass applications, we engage in home visits, I am a food bank referrer, and I support with Personal Independence Payment (PIP) applications”

“We will arrange home visits or Microsoft Teams calls.”

“Your service accommodates us if we are not able to get to you by coming to us.”

People who use the service reported that they believed that the service is accessible and affordable for everyone regardless of their financial situation, and the service will be flexible if people need more support with accessibility and are experiencing poverty.

“The service should be available to everyone regardless of their financial situation.”

“I have never had to pay for anything.”

“This is because it is the NHS, and I have never had to pay before.”

“Staff support patient to access the community services and aim to help with budgeting and spending.”

“I think you do go out to see anyone if they can’t afford to come in which is appreciated, the service is flexible and helpful.”

5.2.2 Barriers and challenges

Although much of the evidence would suggest that the impact of extra health cost is low for these services some people who use the service did suggest that they had to pay for items or services as part of their healthcare. This included items needed to support mobility, maintaining hygiene and cost related to travel.

“I have to pay for my walking frame.”

“I have to buy gloves, hygiene wipes, aprons for incontinence.”

“Petrol money for face-to-face visits which also increase in staffing cost to escort.”

When staff were asked if people who use their service would incur intended healthcare cost related to their service, they did identify the need to pay for travel to attend appointments.

“Sometimes our service users have to pay for taxis to attend appointments.”

When staff were asked in their experience did people using their service experience issues accessing their services that is related to poverty, staff reported poverty-related barriers that people may experience is: hidden cost or appointments (time to work, childcare, missed free school meals). However, if poverty-related barriers are identified staff will support people using the service to access the support they need.

“Identify when a social care assessment maybe required as health needs are not being met due to financial barriers”

“Support to liaise with services who can support benefits”
When people who use the trust community learning disabilities services were asked what support would help them if they were experiencing poverty, people reported support with cost for equipment or travel, flexible appointments to reduce travel and having more information on financial services.”

“Support with item when doing incontinence care that can be purchased cheaper.”

“Having more information on financial service that staff can use would be helpful.”

“Any information on cost saving would be really helpful, for instance on taxis are so expensive.”

“More financial assistance programs.”

5.2.3 Recommendations for health related costs

5.2.3.1 Cost for equipment

It would be helpful if staff are aware of any schemes or benefits that people can access to support with cost of equipment (for example, personal health budgets, Health Care Travel Cost Scheme and prescription support)

5.2.3.2 Knowledge of support schemes

• Provide information or training to staff about having conversations with people about poverty.
• Support staff to understand what is available for people, in terms of entitlement, where there is a cost to accessing care (for example, personal health budgets, Health Care Travel Cost Scheme and prescription support).

5.2.3.3 Support with travel costs

• To continue to offer flexibility in appointment for example: home visits, in people communities and digital where appropriate.
• This is a trust wide area of focus; work will be developed in May for people to access travel cost to attend healthcare appointments if appropriate. This may involve pre-loaded travel cards or similar for people who do not have the money up front.
• Communicate with staff the nationally publicised help that is available for people which is published on the Trust website:
  • 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 budget
• The trust have recently gone into partnership with Citizen’s Advice Bureau, ensure staff are aware of this service and refer people who may benefit from the service. A link to the referral forms are at the end of this report.

5.3 Navigating and negotiating appointment

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 Appointments

People that access the service suggested they have not had to delay or miss appointments due to financial reasons and that the flexibility they have been offered or granted when requested had been helpful.
Staff working in the service reported that if people using the service had any difficulties navigation and negotiating appointments, they would offer alternative methods and apply reasonable adjustments to ensure people can attend their appointment, the service will also contact people if they miss their appointments.

“Contacting via telephone if someone missed their appointment to find out why.”

“Reasonable adjustments, home visits or visit in GP surgery as close to home.”

“Home visits as some of the patients we look after rely on carers or family to bring them to appointments.”

“Flexibility with appointments.”

5.3.2 Barriers and challenges

5.3.2.1 Appointments

Although the evidence suggested that people had not had to delay or miss appointments due to financial reason two people suggested that they had experienced this.

“Mum can’t take me due to financial issues and carers can’t always do it.”

“If having to travel further from home, cost of travel.”

Staff who work in the service reported that information to accessible information regarding appointments is not always available and that digital exclusion may also be a barrier to people navigating and negotiating appointments, however staff will support people to access appointments by offering easy read appointments letters and are flexible with appointments for example the location and the time of the appointments.

“It would be great to have easy read information for appointments.”

“At times you don’t have credit on phone to cancel appointment, so have to rely on someone calling to follow up if appointment is missed.”

“It would be helpful to have appointment offered at home instead.”

When staff were asked in your experience, which of the following poverty-related barriers apply to patients accessing your service staff suggested:

“Complex Health Systems (difficult to navigate, referrals appointments et cetera).”

When staff were asked if they could change one thing in their practice to make life better for people experiencing poverty, they reported a consideration of appointment times, flexibility on location and the consideration of home visits.

“Consideration of appointment times to help people to attend outside of work or school hours.”

“Making reasonable adjustments for appointments, visiting at home or closer to the person’s home if there are any difficulties with travel.”

“Ability to access clinic rooms local to service users and used by other services within the organisation to facilitate access to appointment.”

5.3.3 Recommendations for health related costs

5.3.3.1 Flexible appointments

• To continue to offer flexibility in appointment for example home visit, video, or telephone if appropriate.
• To continue to offer appointments that are flexible around work arrangements, families, carers to ensure no extra cost is incurred.
  Accessible information for appointment.
• It would be helpful is staff have accessible information available for appointment information.
• Provide information to people on correspondence (for example, letters, texts) about contacting the service if they have problems with affordability.

Page last reviewed: August 13, 2025
Next review due: August 13, 2026

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