Contents
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 planned nursing
The Poverty Proofing audit for Doncaster planned nursing began in October 2024 in order to better understand the experiences of families and individuals who are living in poverty.
The work was carried out in partnership with staff, families and adults to build up a rich picture of the barriers and challenges faced by those accessing or attempting to access the Doncaster planned nursing service.
The Doncaster Planned Nursing Service provides planned, home-based nursing care for adults (aged 18 years and over). The planned team work between the hours of 8:30am to 5pm
The service is central in supporting adults to remain in their own homes, maximise their independence, and improve their health outcomes and quality of life. It provides healthcare, as a single agency or in partnership with other agencies and specialist services, to residents of Doncaster.
The referrals for planned are triaged by sister and charge nurses within the Single Point of Access team who arrange the appropriate treatment depending on the outcome of the assessment
The planned service is managed by 4 districts, North, South, East and Central which all have a base point where the nurses work from. Their supplies and equipment are within these facilities which are normally part of a GP surgery.
According to the Indices of Multiple Deprivation (2019), Doncaster is ranked 48th most income-deprived out of 316 local authorities. Of the 194 neighbourhoods in Doncaster, 68 were among the 20% most income-deprived in England.
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 planned nursing services were:
- communication
- health-related costs
- 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
9 in 10 of those using the service said that their communications with the service have always been positive. The nurses are always kind and helpful, and they really value the service that they receive.
- “Approachable staff who go out their way.”
5.1.1.2 Staff make themselves available
While on visits, staff make themselves available to patients, encouraging them to get in touch if they have any issues. If not, staff are able to direct patients elsewhere to ensure they receive the appropriate help and advice.
- “The nurses might be able to help if I needed it or direct me elsewhere.”
5.1.2 Barriers and challenges
5.1.2.1 Patient cohort has minimal access to the internet
Staff within the service have advised that many of their patients do not have access to the internet or access to a mobile phone, although this doesn’t come through in patient consultations. This can create barriers in making swift contact with patients when necessary, and also presents challenges with two-way communication.
5.1.2.3 Contact must be made via single point of access
During the service scoping, it was found that if patients do wish to speak with someone in the service, to change an appointment or otherwise, they must contact the Single Point of Access team first. Not having direct contact with the service can prevent people from getting in touch if they really need to, especially if they are left in a queue.
5.1.3 Recommendations for communication
5.1.3.1 Patients without internet access
- Continue to use methods of communication which have been identified as the preferred method by the patient. This is typically landline.
- Ensure that, while many healthcare services are adopting digital interventions, the patients within the service are not digitally excluded.
5.1.3.2 Patients without mobile phones
- Continue to use methods of communication which have been identified as the preferred method by the patient. This is typically landline.
- Ensure that, while many healthcare services are adopting digital interventions, the patients within the service are not digitally excluded.
5.1.3.3 Direct access
Consider how the use of single point of access is of benefit to this patient cohort. Can communication be simplified?
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 Doncaster planned nursing service, they encounter very few costs in relation to their health. Most are able to access the equipment they need as a result of NHS funds, as it is referenced in their care package. Additionally, most service-users are entitled to personal independence payment (PIP) or attendance allowance, which supports them to pay for costs relating to their condition.
- “I am housebound and elderly, my prescriptions are free, and my equipment is from the hospital.”
- “The service is free.”
5.2.2 Barriers and challenges
5.2.2.1 Discrepancies around incontinence pads
Some patients expressed issues around having to pay for incontinence pads for use at home and they can be very costly. One patient told us that they spend £30 per week on incontinence pads. Staff within the service offered some clarification around this; patients are referred to the incontinence service if needed. The incontinence team will assess the patient and, if they meet a certain threshold, they will receive their pads on prescription. If they do not meet the threshold, then the patient must fund this themselves.
In addition to this, patients also have preferences around the types of incontinence pads. If they wish to have pull-up style protection, then this is not available on the NHS due to the falls risk. Only the standard pads (of varying sizes) are available on prescription.
- “I have to pay for pads, I get them from the internet very expensive. £30 per week”
- “Sometimes have to buy more incontinence pads if I run out”
5.2.2.2 Chiropractor needs
It was found in the patient feedback, that some patients require a chiropractor to support their physical abilities, but they cannot afford it as often as they would like. Presently, this is not offered as part of a care package and is unlikely to be in the near future.
5.2.3 Recommendations for health related costs
5.2.3.1 Discrepancies around incontinence pads
- To routinely assess for incontinence needs as this may change throughout a person’s time in the service.
- To continue ensuring that there is a shared understanding of what incontinence is. Some patients may not recognise themselves as incontinent when asked, but they are and require appropriate support.
5.2.3.2 Additional needs
- Where patients are requesting referrals for a chiropractor, it would be advisable to look for an appropriate alternative which they might be able to access without a cost to themselves.
5.3 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.
5.3.1 What works
5.3.1.1 Comfortable in asking for help
The vast majority of patients feel as though they could ask for help if they needed it.
- “I like the nurses, they help with everything.”
5.3.2 Barriers and challenges
5.3.2.1 Staff awareness
While patients feel comfortable asking for help if they need it, but they weren’t confident that their nurse would know how to support, or if it is their role to do so. Lots of patients said they would like staff to have a better understanding of what is available, so that the information can be shared with them. This is particularly beneficial for those without access to the internet, as information is much less available for them to find themselves.
- “Better training for staff.”
5.3.3 Recommendations for patient empowerment
5.3.3.1 Providing information to patients which they might not otherwise have access to
Patients would like to know what is available to them as they are unable to find out themselves (lack of internet access). This could include charities, food banks and benefits.
5.3.3.2 Staff awareness
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.
5.4 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.
5.4.1 What works
5.4.1.1 Visual assessments
Staff already do visual assessments of a person’s financial circumstances and are able to make judgements about any potential financial hardship as they visit houses and can see surroundings or environment. Some staff will have conversations with patients who they feel are struggling financially.
5.4.1.2 Food provision
The service is very good at identifying where patients need food and, in some cases, purchasing it on their behalf; however, this is reliant on the good nature of the workforce as opposed to being part of policy. Staff may sometimes need to take time out of their day to buy some supplies for a patient and will sometimes purchase it out of their own money.
Some colleagues mentioned that there is a small supply of food and toiletries within the service which they can distribute, and they also create hampers at Christmas for those in need.
- “We already have a supply of clothes, food and toiletries for those in need.”
- “We prepare Christmas hampers with small treats for patients who may not have much over the holiday period.”
5.4.2 Barriers and challenges
5.4.2.1 Staff awareness
Supplementary to the section above were patients expressed a desire for staff to be able to supply information, the staff themselves were also 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 all.
When asked about what the service does to support those facing financial hardship, 40% of staff said they felt “unsure” about what the service does or felt that patients “were not supported”. 32% of staff said they would benefit from some kind of training.
- “Allow staff to learn and have a clear understanding of what services are available to patients and patients’ family and how these can be accessed.”
5.4.3 Recommendations for staff awareness and guidance
5.4.3.1 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.
5.4.3.2 Food provision
It would be ideal to have a trust pantry (much like we do for staff) that colleagues are able to collect from to distribute to patients, particularly for those housebound patients who have minimal support. This would improve appointment times as staff would spend less time going to the shops, and ensure staff are not purchasing supplies out their own money.
5.4.3.3 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.
5.5 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.
5.5.1 What works
In theory, travel should not be a particular issue in this service as it is a community service, and all patients are visited in their homes. There is no need for a patient to travel at all for their appointment with the Doncaster planned nursing service.
5.5.2 Barriers and challenges
5.5.2.1 Travel to other appointments
During patient consultations, some patients expressed a dissatisfaction with the cost of transport to enable them to get to other appointments which relate to their condition. While this doesn’t affect Doncaster Planned Nursing directly, it may have an indirect impact if the patients condition worsens due to missed appointments elsewhere. It is thought that Disability Living Allowance should cover these types of things, but it seems, in many cases, it does not.
- “I can’t afford a taxi if the hospital transport is unavailable so I would just miss the appointment.”
- “The hospital transport only goes to Doncaster Royal Infirmary or Mexborough, if I have (an appointment) at Tickhill Road I would have to get a taxi, and I can’t afford this so would miss the appointment.”
- “I would like to see free hospital transport to Tickhill Road Hospital.”
5.5.2.2 Staff travel
During staff consultations, staff expressed some frustration with the process for claiming mileage. Due to the nature of the community nursing role, full-time staff may have to input hundreds of miles worth of claims per week which can be very time-consuming for them.
The process is not automated, and the current system does not allow for house numbers to be inputted (only postcodes) which is not always a true reflection of the distance travelled.
Additionally, some staff have difficulties when their own car is out of action. It is expected that they will find alternative transport to ensure that they are able to complete their appointments; however, this is not very easy for those without access to a second car or courtesy car.
5.5.3 Recommendations for travel
5.5.3.1 Transport options
Transport options to be really clearly communicated across the trust, so colleagues know where to direct patients.
5.5.3.2 Co-wheels
- All staff to register with co-wheels.
- The trust to look more widely at how co-wheels are used. Those without cars (due to unforeseen circumstances) should be allocated a car, even at short notice.
5.5.3.3 Automated mileage system
The trust to consider an automated mileage system which also builds a colleagues working day, choosing sensible routes with the fewest miles. Autoplanner is currently being piloted in Doncaster Central, but we need to ensure this offers everything we need.
6 References
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- Literacy Trust (2012), Adult Literacy (opens in new window)
- 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 (opens in new window)
Page last reviewed: May 20, 2025
Next review due: May 20, 2026
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