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Poverty proofing report Doncaster older adults mental health services 2024

Contents

  1. Poverty proofing delivery partner model
  2. Poverty proofing Doncaster older adults mental health services
  3. Poverty proofing ethos
  4. Poverty proofing process
  5. Common themes
  6. References

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 Doncaster older adults mental health services

The locally trained team engaged with Doncaster older people’s mental health services during December 2024 and January 2025, in order to understand the experiences of People and families who are living in poverty.

The work was carried out with people and staff to build up a rich picture of the challenges and barriers faced by those accessing or attempting to received older people’s mental health services in Doncaster. No face-to-face consultation were done for this service, the data captured was reliant on the survey that staff who work in the service encouraged and or supported people to complete during their appointments. This was because staff had existing relationships with the people and their families, so it was felt they were better placed to undertake the work.

The older people’s community mental health teams in Doncaster aid people facing mental health issues. This is offered as assessment, treatment and care management for people who are 65 years and over. They also support under 65’s with a dementia diagnosis. The service is provided in the community at clinic bases, or the staff also visit to provide care in people homes. The service has clinic bases that cover Central Doncaster at Forest Gate Centre on Tickhill Road site, In the North of Doncaster this is available at the Jade Centre in Bently and in the East of Doncaster this is at the Heathfield Centre in Hatfield.

Referrals into the service are mainly from GP surgeries and other healthcare professionals. People can also self-refer into the service, but this is usually in crisis situations. Some of the referral into the service are received via the single point of access are expedited to the relevant services for triage and for allocation for clinicians to follow up with people.

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.

Key findings of a Mind Report in August 2021 tells us “There’s still a lot of shame about money and mental health. There’s a lot of worry about privacy for people facing poverty and worry that they don’t deserve support. Many feel mental health is a white, middle-class conversation they can’t tap into.”

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 Doncaster older adults mental health 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 People were complimentary about how they were communicated with

People were complimentary about how the staff communicated with and treated them as individuals. There are a lot of comments about how friendly staff are. From a poverty perspective, this is important given that older adults may sometimes feel to be a ‘burden’ on the system and being treated well makes them feel valued.

  • “At first was unsure but are at present we are happy.”
  • “All so friendly helpful answer questions needed also we know we can get in contact with the service anytime.”

5.1.2 Barriers and challenges

The language we use may mean some people don’t understand what is being asked of them, or is available

A number of staff said that the way we communicate with people might be a barrier to them understanding what is on offer to mitigate poverty. It is important to understand a person’s communication needs and ability, so they know what is available and what treatment they will receive.

  • “Health Literacy (understanding of written materials or verbal communication).”
  • “People Advocacy (unable to ask for and get help).”

5.1.3 Recommendations for communication

5.1.3.1 Communicating with people based upon their needs and ability
  • Make sure people are asked about their communication needs and preferences, and this is recorded on SystmOne.
  • Make sure communication needs and preferences are recorded in SystmOne.
  • Check with people that they understand what is being communicated to them. Get them to explain what is being said.

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.

The Institute for Health Equity said that “Health and social care services will be under increasing strain due to rising numbers of older people with poor mental health, mild cognitive impairment and dementia. This is particularly significant for older people in lower socioeconomic groups, who are more at risk of experiencing the drivers of poor mental health, mild cognitive impairment and dementia over the life course and in older age, and will likely lack the social and economic resources to secure appropriate care.”

5.2.1 What works

Most people who responded to this question did not stipulate that they had additional costs of care. There were a few exceptions, however.

5.2.2 Barriers and challenges

5.2.2.1 Cost of transport and daycare

People who did have costs to care mainly had costs associated with day care (not delivered by the trust). None agreed that these costs were affordable.

  • “Having to pay to cost of transport and also day centres.”
5.2.2.2 Cost of transport to other parts of the health system

A couple of people referenced the travel cost to attend GP and hospital appointments.

5.2.2.3 Help with prescription costs

A number of people said they would like to see more financial support to help with their prescription costs.

5.2.3 Recommendations for health related costs

5.2.3.1 See if people are entitled to support with transport
  • Make all staff aware that the NHS Travel Costs Scheme exists. Provide clear information on who can apply and what they are entitled to claim for (this may not only be people who are on benefits, others can be eligible through the NHS Low Income and Healthcare Travel Costs Schemes).
  • Refer people to Citizens Advice to see if they are entitled to support with transport costs and attending day centres.
5.2.3.2 See if people are entitled to help with prescription costs
  • Advise patients about the HC2 form and how to fill it in effectively.
  • Advise that patients who are paying for prescriptions whilst their HC2 form is being processed, should keep their receipts to be reimbursed.

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 Most people have not missed appointments due to financial reasons

The vast majority of people who responded had never missed an appointment due to financial circumstances. One person did say however that they missed an appointment due to the cost of a taxi (more about transport will be covered later in this report).

5.3.1.2 Most people felt confident that they could talk to the service if they couldn’t afford their care

Most respondents said they were confident that they could talk to the service if they couldn’t afford their care it. From a poverty perspective, this is important as talking about affordability can be a stigma to many people.

  • “They are very easy and approachable.”
  • “Very empathetic staff.”
  • “Friendly staff, understanding.”
  • “They would listen and help me.”

5.3.2 Barriers and challenges

5.3.2.1 Some people said that they would not be comfortable talking about ability to afford for their care

Whilst most were confident in talking about issues regarding affordability of their care, a few weren’t sure. This was mainly as they didn’t know who to ask or if they could be trusted.

  • “Not sure about the trust aspect.”
  • “Not sure whom to contact.”
5.3.2.2 Complexity of health systems

A number of staff said that the health system itself can make it difficult for people to get the support and treatment they are entitled to. Not only does this mean it can delay a person’s treatment, it can also mean that it can prevent people from accessing healthcare.

  • “Complex Health Systems (difficult to navigate, referrals, appointments etc).”
  • “To have a pool where all organisation can identify people referred who need access as some of them have barriers such as literacy or technology. So if there is a pool that these professionals can notice and help people in need.”

5.3.3 Recommendations for navigating and negotiating appointments

5.3.3.1 Having conversations with people about affordability
  • Provide information or training to staff about having conversations with people about poverty.
  • Make sure staff know what is available for people, in terms of entitlement, where there is a cost to accessing care (for example, personal health budgets).
  • Provide information to people on correspondence (for example, letters, texts) about contacting the service if they have problems with affordability.
5.3.3.2 Help create simpler health systems
  • Identify on the patient pathway where people come into contact with other health and care services.
  • Look to work with those organisations to make the process as simple as possible.
  • Make sure people understand what the steps are, either being taken by the service or that they need to do themselves.
  • Access peer support for the person to help them navigate the system where it is needed.

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 People feel supported

There was overall positive feedback that people felt supported by the service. People said they would feel that the service would help if they struggled with costs of their care, with the way they feel treated creating confidence.

  • “Very knowledgeable staff.”
  • “Mum has not accessed any services as yet but it feels like the offer will be there.”
5.4.1.2 The service is easy to contact

People said that the service is easy to contact and responsive when they need support or help.

  • “They are easy to contact and are there if there are any problems.”
  • “Because there is always someone to help.”

5.4.2 Barriers and challenges

5.4.2.1 Better communication and outreach

To help people the service improve its understanding and support for people facing financial barriers, a number of people suggested better communication and outreach.

  • “Working with older clients often pride can impact on some ones willingness to discuss poverty difficulties. Mental health problems also impact on an individual’s willingness to share information.”
5.4.2.2 Lack of financial assistance and programmes

A number of people suggested the service should have financial and assistance programmes in place and provide more financial help. Staff also wanted more awareness of what is available. The trust has recently invested in money and debt advice for people with Citizens Advice, and starting to offer and refer people to this new service offer would help to address this suggestion.

Also, making people aware of help with NHS costs such as prescriptions and travel:

  • “Everyone should receive support, especially low-income households.”
  • “When you’re on the basic pension you don’t have the finances to afford the appropriate care.”
  • “Keeping up to date with services we can signpost to.”
  • “Better benefit advice, so people are claiming the benefits they are entitled to, this will also support fuel poverty.”
5.4.2.3 Access to digital devices

A number of staff said one thing could you change in your practice to make life better for people experiencing poverty is access to digital devices. Citizens Advice Doncaster run a programme on behalf of the integrated care board (ICB) to help with digital literacy, devices, and data: like the barrier on what financial assistance available, that people may not be aware of.

  • “They could have a laptop to access remote appointments, so they did not need to travel.”
  • “Improve digital poverty.”

5.4.3 Recommendations for patient empowerment

5.4.3.1 Making staff aware of financial support available
  • 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 budgets
  • Make sure this is communicated to people and their peer support.
5.4.3.2 Helping people with their digital needs
  • Ask people about their digital needs and barriers.
  • Refer people to Citizens Advice Doncaster’s digital support programme.
5.4.3.3 Support for carers

Make sure if the person is a carer, or they have a carer, they are referred to the council for a carer’s assessment, as part of promise 2.

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 Some staff said the service had a way of identifying people who are experiencing poverty

Most of the staff responding to the survey said the service had a way of identifying people who are experiencing poverty. A consistent number of methods were cited, and these are show in the quotes below.

  • “Formal financial screening tools that are routinely carried out.”
  • “Verbal screening, asking those we think need help.”
  • “Judgements of staff.”
5.5.1.2 Some staff have trialled or implemented something to support people in poverty

There are a number of examples where staff have done something to support someone experiencing poverty. This shows that there is good practice in the service to build upon and a willingness of staff to support people beyond treating them for their condition.

  • “I have offered multiple People vouchers for transport and food etcetera.”
  • “Food vouchers were applied for and issued due to one of our nurses asking the relevant questions to the People and making sure he had food.”

5.5.2 Barriers and challenges

5.5.2.1 The response to supporting people experiencing poverty is mixed and not consistent

Some staff cited examples of where the service supports people experiencing poverty, whereas other staff cited similar examples where the services don’t do this well. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.

  • “Travel and transport (cost of parking, public transport, taxi’s etc).”
  • “Communication (no data or access to credit Wi-Fi etc).”
  • “Hidden costs of appointments (time of work, childcare, missed free school meals).”
  • “We lack a social worker or someone who may be well equipped to deal with social issues. Unsure of what I could offer or where to signpost people to or how to prompt poverty related questions.”
5.5.2.2 Staff awareness of what is available or what to do

A number of staff said they or their colleagues may be unaware of what is available or how they can help someone experiencing poverty. This means that people may be losing out to support that they need or are entitled to.

  • “Staff Awareness (staff unaware or unequipped to help).”
  • “Need to have open conversations with clients to establish if poverty is impacting them.”

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Staff engaging in financial conversations with people
  • Open up financial conversations routinely as part of someone’s care.
  • Provide a basic level of training for staff, to empower them to have financial conversations.
  • Get information from charities and food banks on what is available in Doncaster and how people can access them.
5.5.3.2 Learning of what works already in the service

Use the examples colleagues reference for supporting people, such as financial screening, and spread this to all colleagues.

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 People value home visits

People who receive home visits were complimentary of the service’s offering to support their care. From a poverty proofing perspective, this is good as it means that people who may struggle to pay for transport costs don’t have to do so.

  • “Seen in my home and not having to travel.”
  • “Every one is very supporting, goes the extra mile and will come out my home also contact me by telephone.”

5.6.2 Barriers and challenges

5.6.2.1 Help with travel costs

About a quarter of the people who responded said they would like more financial support with travel costs. The lack of support is putting pressure on them in other ways (that is affording other basic necessities).

5.6.2.2 Help with transport

Staff felt that there were opportunities to provide assistance for people to attend appointments.

  • “Transport for people having to attend psychology appointments, computed tomography (CT) scans, electrocardiogram (ECGs), bloods”
  • “Offer transport to key appointments for example, to forest gate.”
5.6.2.3 Home visits

A number of staff felt that the service could offer more home visits to people. This would help mitigate travel costs to people

  • “Offering more home visits rather than asking them to travel into the service.”

5.6.3 Recommendations for travel

5.6.3.1 Promote Healthcare Travel Cost Scheme
  • Promote the claiming back of travel costs and make this normal in staff roles.
  • As a trust, develop a process to claim back travel costs that isn’t stigmatising and is easy to use.
  • Advertise it to patients, ensure staff know about it, and how it works.
  • Look to introduce pre-loaded travel cards or similar for people who don’t have the money up front.
5.6.3.2 Volunteer drivers
  • Look to create a pool of volunteer drivers to help people attend appointments.
  • Identify people who would benefit from such a scheme.
  • Trial and test, before learning and rollout.
5.6.3.3 Home visits

Identify people for home visits, where cost and affordability of travel is a problem.

5.6.3.4 Community appointments

Look to hold appointments in community settings, which are closer to where people live and help avoid unnecessary travel.

5.6.3.5 Digital appointments

Look at there, clinically, an appointment can be undertaken digitally that will reduce the travel need of the person and staff alike.

6 References

Page last reviewed: May 20, 2025
Next review due: May 20, 2026

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