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 telephone nursing service
The Poverty Proofing audit for Doncaster telephone nursing service began in January 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 adults to build up a rich picture of the barriers and challenges faced by those accessing the trust Doncaster telephone nursing service.
The telephone nursing service consists of a team of qualified nurses who collaborate with specialist teams and primary care within the community nursing services.
Services provided:
- comprehensive care for patients with heart problems, respiratory issues, diabetes, cancer, and various long-term conditions
- support for carers and patients dealing with anxiety and mood-related concerns linked to their conditions
- phone-based assistance for patients with a palliative diagnosis
2.1 How to get help
Referrals are primarily initiated by district nurses and specialist nurses but can also come from other healthcare professionals, patients, or caregivers. These referrals can be made through the single point of access (SPA).
Doncaster is ranked 37th most deprived (from 317) local authorities in England in the 2019 English Indices of Multiple Deprivation (IMD) where 1 is the most deprived and 317 is the least deprived. This is a rise of 5 places from 42 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 IMD’s in 2004, 2007, 2010, 2015 and 2019 with the average rank over those studies being 40. Doncaster is in the top 20% most deprived local authorities in England. 60% 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.
Census 2021 includes an element of deprivation analysis that confirms Doncaster is more deprived than the National average.
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 they can’t tap into. 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
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 telephone nursing service were:
- communication
- health-related costs
- patient empowerment
- staff awareness and guidance
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 reliable
The planning of communication is effective, the next patient appointment is made at the end of the previous appointment. The appointments always take place when agreed. If the patient misses the call from the nursing team, the nurse will always call back or the patient has a contact number to call the nurse themselves.
- “I get calls every three weeks and they tell me when to expect the calls.”
- “I have never had to rearrange an appointment. I have missed calls when my phone is in another room, and she always calls me back.”
5.1.2 Barriers and challenges
5.1.2.1 Age demographic of the patients
The patients detail how they are not very technology savvy and are not frequent uses of mobile phones. Many patients detail how they only use their phones for phoning people. It is evident that they do not use their phone for research, such as finding out the support services available to them and therefore rely on the communication from the telephone nursing service.
- “I am not digitally clued on; I just have a fossil phone to make and receive calls.”
- “I only ever use my phone as a means of communication when I am in hospital.”
5.1.2.2 Text messages
Some patients detail how they received a text confirmation of their next appointment; however, this is not consistent throughout.
- “I don’t get any text messages reminders for when the calls will be as this is agreed in our call, but I guess it won’t hurt to get one.”
- “I do get text messages to let me know when my next appointment is.”
5.1.2.3 Translation services
The service does not use translators, they must refer to the district nurses. It does not appear from the information available that this is an issue, as it is not disclosed by the patients.
5.1.3 Recommendations for communication
5.1.3.1 Confirmation of appointment
There is a lack of consistency on when patients receive a text confirmation of their next appointment. Considering the age demographic of the patients, maybe a letter confirming next appointment may be more suitable.
5.1.3.2 Age demographics
It is clear from the results the demographic of the patients spoken with is of an older generation. Consider how these patients can be made aware of the support available them, without having to access the internet.
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
For the most part, patients do not incur many costs in relation to their condition while they are a patient under this service. They can access many necessities during their treatment, with little need for additional funds.
The patients are complimentary about the nursing team updating their prescription.
In the main, the patients strongly agreed that the service is accessible for everyone, regardless of financial position.
The patients think it is great that they receive the phone all from the team so that they do not incur any costs.
- “I’m 90, so my prescriptions are free to a point, I have been a taxpayer all my life.
- “I have never had to purchase anything for my healthcare.
- “When I came out of Doncaster Royal Infirmary there was a certain cream I needed, and the nurse was able to add this to my prescription.
The colleagues share that they send food first booklets to patients so they are aware of the support available to them, this is not acknowledged in the patient feedback.
5.2.2 Barriers and challenges
Several patients refer to taxi costs being expensive when they need to attend a hospital appointment. In the results, there is a theme of lack of information on support available to help with general travel costs.
There was a lack of awareness of the travel reimbursement scheme.
There was an overwhelming response to patients wanting to know more about the financial support available to them.
- “If we must go the hospital, I need to use a taxi which can be expensive. My pension is not a lot with all the other bills I must pay.”
- “I was not aware of the travel reimbursement scheme.”
- “It would help a lot because the pension we have covers the bills and sometimes there are additional healthcare costs the think about.”
- “It is really important to share what is available.”
5.2.3 Recommendations for health related costs
5.2.3.1 Greater awareness of financial support available
Information on financial support available to me made clear to all patients. Extra consideration given to the age demographic of the patients. Paper leaflets or posting information may be more suitable. Do not rely on signposting to the internet.
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 Most patients speak to the same contact
The patients detail how they regularly speak to the same contact, making them feel at ease during the appointment. This creates a rapport with the patient and allows them to speak more freely.
- “More than likely to get calls from the same person.”
5.3.1.2 Building a rapport with patients
The nurses are regularly referred to as “friendly” and a common theme throughout the reports are that patients feel comfortable in opening up to the nurses.
There is overwhelming positivity regarding the nurses listening to the patients and making them feel valued and supported.
- “The nurse I speak to is very easy to talk to and listens.”
- “Always helpful, giving advice.”
- “Brilliant service. I was terrified about going to the GP, having someone to talk to on the phone is great for me.”
- “I feel I can talk to them and raise my concerns.”
- “the nurse I have is very invested in my care.”
Colleagues within the team acknowledge the rapport with patients:
- “We feel that most of our patients would be comfortable to tell us if they were struggling because we have longer time to speak with them in comparison to other services.”
5.3.2 Barriers and challenges
5.3.2.1 Staff awareness
When asked about what the service does to support those facing financial hardship, some staff said they felt “unsure” about what the service does.
They felt this was not down to lack of knowledge, but that it was not applicable to them therefore the information was not shared.
“I think it just needs to be highlighted a bit more than this service exists, especially in the winter months.”
Patients also shared a lack of wider awareness about the telephone nursing service, and by having this service communicated more widely it can support people with financial difficulties as they are not having to travel to the GP, or hospital.
- “The nurse from the GP suggested the telephone service and I did not know they existed so it would be great if everyone knew about this service.”
- “It is great to share what is on offer, to help everyone, especially financially.”
- “I think there needs to be more funding on what services are available.”
5.3.2.2 Technology
Throughout the survey responses, there is an overwhelming theme of technology being a barrier. Some positives being that the telephone calls are helpful as they require little or no experience.
- “I am a person on my own. I am 88 and I have nobody. I have difficulty with a lot of things, I would appreciate help on how to find things on the internet.”
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 not always able to find out themselves. 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.
5.3.3.3 Technology awareness
Greater knowledge and ability to signpost patient for support with internet, Wi-Fi and technology support.
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 Additional provisions
The service is very good at identifying where patients need provisions and, in some cases, loaning equipment such as blood pressure machines, weighing scales, pulse oximeter.
Some patients will say if they are incontinent, and they are happy to buy their own pads.
- “In some cases, our continence team will send out some incontinence-pads for patients to use.”
5.4.1.2 Guidance
Often, the nursing team talk to the patient’s family members who are looking after the patient. It is clear the nursing team also recognise the importance of rapport building.
- “We have case loads so we get to know the patients well enough and can pick up on when things might not be well even if they do not verbalise it.”
5.4.2 Barriers and challenges
5.4.2.1 Staff awareness
In the questionnaire results, the nursing team refer to services and support available that are not mentioned by the patient’s interview. This might be that these services were not applicable to the patients interviewed. For example, financial support from MacMillan, hampers at Christmas time.
5.4.2.2 Understanding the service
Colleagues share that some patients think they have a direct line to the GP services and will call to access this link. There could be a greater awareness from the outset on what the service offers.
When asking patients about their financial situation, for example if the house is privately owned when they are suggesting using carers, or mobility aids installed, the nursing team get resistance from patients.
- “Why should I use my money for carers, when others get it for free.”
5.4.2.3 Contacting the service
The patient feedback on contacting the service is positive. The colleagues highlight that there may be some learning for the single point of access team to use greater initiative and questioning when filtering calls. They recognise they may need to spend time with single point of access to upskill their knowledge on the telephone nursing service.
5.4.3 Recommendations for staff awareness and guidance
5.4.3.1 Awareness leaflets
It would be ideal to have a trust leaflet posted to the patients detailing the nature of the service being provided and all the support available.
5.4.3.2 Staff awareness
As recommended above, staff expressed an interest in knowing more about how to support patients. It is recommended that more staff attend the Poverty Proofing training delivered within the trust, with a view to more bespoke training delivered by Citizens Advice.
5.4.3.3 Quick-response (QR) code for feedback
It is detailed in the colleague feedback how quick-response (QR) codes are used for feedback. It is apparent through the information available that these are an older demographic with some patients not having smartphones, Wi-Fi or access to a computer. Consider alternative ways of feeding back.
6 References
- O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
- Literacy Trust (2012), Adult Literacy
- Sheehy-Skeffington and Rea (2017) How poverty affects people’s decision-making processes.
- Healthwatch UK (2019) There and back, People’s experiences of patient transport.
- Disability Living Allowance (DLA) for adults
Page last reviewed: May 29, 2025
Next review due: May 29, 2026
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