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 Diamond Activity and Therapeutic Centre
The Poverty Proofing audit for Diamond Activity and Therapeutic Centre began in April 2025 to better understand the experiences of families and individuals who are living in poverty.
The work was conducted in partnership with staff, families, and adults to build up a rich picture of the barriers and challenges faced by those accessing the trust Diamond Activity and Therapeutic Centre. Due to the nature of the service, it was believed it would be better for the service users to be supported in sharing their experiences with staff and the family and personal assistance who support them. Staff were then provided with the opportunity to share further comments using questionnaires and in part of the scoping.
Diamond Activity and Therapeutic Centre is located on Tickhill Road site, it is part of the larger learning disability service in Doncaster and works closely with the staff in our community learning disability teams. People are referred to the Diamond Centre as necessary following assessment of their care and support need. Services include Snoezelen and sensory services, group activities and access to therapy services including occupational therapy and hydrotherapy. The Diamond Centre is accessible only to people whose needs have been assessed as eligible, either by the Council or the NHS. The majority of people who attend are under the age of 50, with a significant proportion under the age of 30.
Doncaster is ranked 37th most Deprived (from 317) local authorities in England in the 2019 English Indices of Multiple Deprivation (IMD) where one is the most deprived and 317 is the least deprived. This is a rise of five places from forty-two 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 IMDs in 2004, 2007, 2010, 2015 and 2019 with the average rank over those studies being forty. Doncaster is in the top 20% most deprived local authorities in England. Sixty percent 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.
Utilization of activity and therapy centres by individuals with learning disabilities is a crucial aspect of their holistic development and wellbeing. These centres provide structured environments offering a range of specialized interventions designed to enhance cognitive, social, emotional, and physical skills. Activity centres often focus on recreational and skill-building activities, such as art therapy, music therapy, adaptive sports, and vocational training, which can significantly improve motor skills, communication, and social interaction among patients with learning disabilities (Attwood and Atkinson, 2021). Focusing on provision of activity and therapy services in learning disabilities this in turn help to reduce inequalities and improve outcome for those with learning disabilities (Public Health England, 2016) (NHS England, 2019). However, individuals with learning disabilities form lower socioeconomic background often face substantial barriers in accessing these services.
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 on poverty proofing in quarter 1 of 2025 and 2026; however, no staff have been recorded as completing the training. Consultations were completed with 4 staff and there was 10 survey responses captured.
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
38 service user reviews were completed by management answering questions on common themes in next section. Some conversations were manged with 3 personal assistants to service users.
4.4 Stage 4: feedback session
A feedback session was held with Racheal Deakin (Modern Matron) and Morag Mckay-Ellison (Team Manager) where findings were discussed, and changes were collaboratively discussed that could be implemented. We then produced this final report.
4.5 Stage 5: review
Around twelve 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 Diamond Activity and Therapeutic Centre 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 Accessibility of communication
The staff at Diamond Activity and Therapeutic Centre use adapted communication strategies suited to the complex needs of their service users. This is including personalised communication aid, visual notices and pictorial updates.
“All communication is adapted to meet both client and family carer needs.”
“All service users have their communication needs assessed upon referral to the service, and this is communicated across the staff team.”
5.1.1.2 Cultural and language needs
Staff always try to ensure that the cultural and language needs of the service users are met and respected.
“All cultural, religious and, or family preferences regarding care are acknowledged and supported.”
5.1.1.3 The service can identify poverty
Staff who work at Diamond Activity and Therapeutic Centre shared that as a service they can identify if their service user maybe experiencing poverty, as at point of admission. This would be done as part of their admissions assessment and through verbal screening.
“When an assessment is completed; if progressing, case managers submits accepted referral to Joint Funding Panel. When confirmed, mutually agreed placement days or times agreed with an agreed start date.”
5.1.1.4 Feedback
The importance of service feedback, particularly in the context of poverty reduction lies in its ability to ensure that interventions are effective and meet the needs of the target population. The Care Opinion is shared with service user for them to feedback on their experience with the service.
“I enjoy being there.”
“Always very friendly and supportive.”
“It gives her so much independence.”
5.1.2 Barriers and challenges
5.1.2.1 Cultural and Language needs
While accessible cultural and language needs for the service users are considered; translated materials are not routinely made available for non-English speakers.
5.1.2.2 Feedback
Feedback captured via Care Opinion is a bit limited from families and carers and this maybe due to a reliance on staff relaying information on this, using multiple methods of communication ensured that all voices are heard.
“We sometimes struggle to get feedback from service users’ family or carers…”
5.1.3 Recommendations for communication
5.1.3.1 Cultural and language needs
- Develop multi language resources and plain English materials. Also considering easy read option.
- Expand communication to include translated welcome material or signage.
5.1.3.2 Feedback
- Current offer to include face to face feedback requests or phone-based feedback for digitally excluded service users or carers and paper-based surveys.
- Have a dedicated section on the trust website about the service
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 Cost to patients
Those who attend Diamond Activity and Therapeutic Centre don’t have any extra cost to attending imposed on them. Meals, drinks therapies and medications are included in the package. Those who require specialist adaptable equipment this is also available for them.
“Free drinks, and additional food, who had not enough or suitable food.”
“All costs for accessing the service are covered within the funding agreements.”
5.2.2 Barriers and challenges
5.2.2.1 Cost to patients
Although those who attend Diamond Activity and Therapeutic Centre were said not have to pay for any items when they attended the centre as part of their healthcare. When staff were asked on poverty related barriers that apply to the patients that access their service they mentioned:
“Travel and transport (cost of parking, public transport, taxi’s et cetera).”
“Hidden costs of appointments (time of work, childcare, missed free school meals).”
Families under financial pressure often avoid services if they expect hidden costs. Clear, consistent communication about what is free increases engagement and trust.
5.2.3 Recommendations for health related costs
5.2.3.1 Health related cost
Display “no cost to attend” posters in the reception and in the new starter packs.
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 Attendance
The service users that attend Diamond Activity and Therapeutic Centre attend on set days with fixed placement schedules. There is no clinical appointment system, but absences must be reported and captured. The predictable structure benefits the families and carers and this consistency aids routine and allows for staff planning.
5.3.2 Barriers and challenges
5.3.2.1 Attendance
Although the above, when staff were asked which poverty-related barriers apply to patients accessing services one staff members informed:
“Complex Health Systems (difficult to navigate, referrals, appointments et cetera).”
This was voiced in relation to communication issue pertaining to attending the service for session were staff shared that.
“Families or carers may not always notify changes to attendances promptly…”
This was linked to appointments that may have been put in place for the service by another healthcare provider at the time when they need to attend the centre. Families and carers with limited resources or stress from navigating a complex healthcare system may forget to make call to update non-attendance or miss calls to remind. This can also be exacerbated where routines may end up changing for the service user and due to this, thereby affecting continuity of care for the service user as they have set days of attending and may end up missing out on sessions at the centre.
5.3.3 Recommendations for health related costs
5.3.3.1 Attendance
- Provide a communication protocol with simple option via text or call for confirmation of attendance day before.
- Consider trailing reminder texts or calls.
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. For individuals with learning disabilities living in poverty, health literacy is a critical determinant of health outcomes and ensuring understanding of basic health concepts such as medication instruction, appointment scheduling or health diets can help in management of chronic conditions thereby improving overall quality of life.
5.4.1 What works
5.4.1.1 Voice, choice and advocacy
Services users, their families and carers who use the Diamond Activity and Therapeutic Centre are provided with opportunity to share their feedback as noted in the communication section of this report.
“Families are carers are regularly approached for feedback due to service users’ communication constraints. Service users are asked for their feedback where possible and appropriate, and the conversations are adapted to meet the communication needs of the individual service user.”
Where there are any changes noted that need to be made to the care package for the service user these are shared with their case managers to ensure that they are implemented.
“Case managers submits accepted referral to Joint Funding Panel. When confirmed, mutually agreed placement days or times agreed with an agreed start date.”
5.4.1.2 Health literacy
The service provides adaptable communication for service user, their families and carer, to enable participation in their care. However, some service users are unable to fully express their preferences without these adaptable tools.
5.4.2 Barriers and challenges
5.4.2.1 Voice, choice and advocacy
In the previous section on communication recommendation have been suggested on how to increase the level of receiving feedback from the service users and their families. Further consideration may need to be made on how to capture the voice of the patients by adapting their prefeed method of communication.
5.4.2.2 Health literacy
Although those who attend Diamond Activity and Therapeutic Centre are supported to through adaptable communication methods. When staff were asked on poverty related barriers that apply to the patients that access their service they mentioned:
“Health literacy (understanding of written materials or verbal communication).”
5.4.3 Recommendations for patient empowerment
5.4.3.1 Voice, choice and advocacy
- Continue to expand feedback capturing to make it more personalised which could be using, for example, smiley face boards (easy read).
- Display “you said, we did” boards to encourage input.
5.4.3.2 Health literacy
Incorporating multisensory learning for experiences with regular repetition to ensure long term retention.
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 Staff awareness
There is evidence from the feedback that staff can recognise if patients are experiencing poverty and go above and beyond to support patient experiencing poverty challenges. Staff informed that their service does have ways to identify if a patient is experiencing poverty through:
“Verbal screening, asking those we think need help.”
“Judgements of staff.”
Due to the type of service user that attends the centre safeguarding is an important aspect to ensure that the patient’s safety is maintained.
“All staff have service specific safeguarding training and are familiar with service users to identify potential safeguarding concerns.”
5.5.2 Barriers and challenges
While awareness is recognised from the staff who were consulted and responded to surveys, there has been no uptake of poverty awareness training by staff in the service. The service continues to be encouraged to get staff to attend the training on poverty proofing to ensure sustainability of the process which would be beneficial when dealing with the implementation of the recommendations shared.
5.5.3 Recommendations for staff awareness and guidance
5.5.3.1 Staff awareness
- Get more staff in the service to complete the Poverty Proofing training presently on offer.
- Integrate poverty awareness into staff induction.
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 What works
Diamond Activity and Therapeutic Centre is located where there are good transport links to be able to get to it with various bus routes that connect to Doncaster city Centre and wider areas. Located at Tickhill Road Hospital Site this location has ample parking available for staff and visitors. The centre is in a standalone building on the ground floor and fully accessible with wide doors for mobility aids and adaptation to support service users’ abilities. The service users who attend the centre have fully funded transport which is ideal as it removes direct cost barrier to attend the centre. There is secure drop of area to enhance the safety and accessibility to the centre.
“Parking is free with dedicated spaces at service.”
“Case managers apply for funding for travel and the clients can use their own vehicle driven by a nominated driver, for example, family member or carer. Some will attend using contracted taxis, taxis with registered escort or use community transport with Leger Bus.”
“The service also has a designated drop-off zone for service users that is away from the main road past the service.”
5.6.2 Barriers and challenges
Some of the challenges relating to travel for the service users and the staff include occasional delays or early arrivals by the transport provider before session have finished which can cause disruption to routine for the service users.
“There have been occasions when private taxis have arrived early or late which impacts on service user routines.”
Where some family members take on the role to provide transport their family members to the centre, some have not been aware of mileage reimbursement or other support they can have to support with travel cost.
“There are a small number of service users who are dropped off or collected by families or carers.”
5.6.3 Recommendations for staff awareness and guidance
5.6.3.1 Travel cost
- Improve reliability of contracted transport by sharing schedules daily after dropping off.
- Offer travel cost information proactively to families and carers induction materials.
- Develop a transport charter outlining what families can expect and how to report issues.
6 References
- Attwood, S, and Atkinson, C (2021) Therapeutic support for young people with learning difficultiies: what enables effective practice? Journal of Research in Special Education Needs, 254 to 267
- Fenney, D and Buck, D (2021), The Kings Fund, The NHS’s role in tackling poverty: Awareness, action and advocacy
- Healthwatch UK (2019) There and back, People’s experiences of patient transport (Care Quality Commission)
- 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
- Disability Living Allowance (DLA) for adults
Page last reviewed: August 13, 2025
Next review due: August 13, 2026
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