Poverty proofing report Doncaster unplanned community nursing 2024

1. Poverty proofing delivery partner model
2. Poverty proofing Doncaster unplanned community nursing
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 unplanned community nursing

The locally trained team engaged with Doncaster unplanned community nursing service during March 2024 and April 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 receive community nursing services in Doncaster. Face-to-face consultations with patients were done by the service themselves.

The Doncaster community nursing service provides planned and unplanned home-based nursing care for adults (aged 18 years and over). The unplanned team operate a 24-hour response service on a reactive basis. Part of the unplanned service also includes a team of Twilight staff which regularly work between 6pm to 11pm daily.

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 and unplanned are triaged by the sister and charge nurses within the single point of access (SPA) Team who arrange the appropriate treatment depending on the outcome of the assessment.

The service receives their referrals from acute hospital, GP, other specialist nursing services (tissue viability and lymphoedema, continence, respiratory) and self-referrals. Referrals are received in the single point of access who add them to triage list for the staff to contact patient and arrange visits to them. Referral can be over the phone or via email.

The service is based at Opal Centre, and this is also where they have their intravenous therapy (IV) clinics.

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.

In research by the Joseph Rowntree Foundation and King’s Fund “The authors describe how patients may struggle to access NHS diagnosis and treatment due to issues such as the cost of travelling, difficulties accessing online services, and paying for NHS charges. They also note that the stigma of poverty can lead to a reluctance to come forward for treatment, or to seek help more broadly, for example by accessing financial advice. Additionally, administrative processes, such as claiming back travel expenses, can be complex.”

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 unplanned community nursing 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

People were complimentary about how they were communicated with
People strongly felt that the service was welcoming, and praised the service on the quality of information that was given to them.

• “Professional and friendly staff introduce themselves and there are no barriers to communication.”
• “I know the staff well and they have been looking after me for a long time. I feel safe with them.”
• “Able to get help for my mum who is housebound and unable to get to the local GP in my area.”

5.1.2 Barriers and challenges

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

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.

5.1.2.2 Interpreter services are problematic

Staff told us that they experience difficulties in accessing interpreter services. However, it has been widely noted that the interpreter service who held the contract up to April 2025 was perceived as particularly unreliable with last-minute cancellations and faulty connections being a regular occurrence.

• “We rely on family and friend to translate for the patient. But it would be great if some of the information we share could be provided in different languages.”
• “I once had to look after a patient who was Polish and requested the use of translation service, but there was a wait time of about 30 minutes. I ended up having to use Google Translate explaining how a syringe driver works.”

5.1.3 Recommendations for communication

5.1.3.1 Translation and Interpretation

• Translate key documents and information into the most frequent community languages spoken in Doncaster, and share with organisations from those communities.
• Ensure staff are familiar with the process and contact details of the provider of translation and interpretation services in Doncaster.
• Report any missed interpreter appointments through Radar as an incident.

5.1.3.2 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.

5.2.1 What works

5.2.1.1 People felt they could talk to staff if they couldn’t afford their care

Most people told us that if they had a problem affording an aspect of their care, they would feel confident to talk to staff about it.

• “I can talk to the staff about all aspects of my care and any worries I have.”
• “I am confident to express how I feel during my care, staff are very approachable, and I am happy to ask questions when I don’t understand.”
• “End of life palliative patients have sometimes asked of support and have seen in patient records where patient have been referred to Macmillan.”

5.2.1.2 People think the service will support them if they can’t afford their care

Most people did feel the service would try to find a way if they had problems affording their care.

• “They listen to me and provide reassurance and solutions to any worries I have.”
• “Approachable and friendly staff.”

5.2.2 Barriers and challenges

5.2.2.1 Costs to access the service

Some people cited that they had petrol and other travel costs to attend clinics other people mentioned prescription costs and other items such as fixings for holding a catheter in place. Whilst those people said they felt the costs were affordable, this might not be in other cases. For example, one person did say they had affordability issues with travel and childcare and wouldn’t discuss this with staff.

• “Feel embarrassed.”

5.2.2.2 Costs of prescriptions

People told us that one of the things they would like, in terms of financial support is the help with the cost of their prescriptions.

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

5.2.3.3 See what organisations provide prescription deliveries

• Get a list of organisations that serve Doncaster who provide free prescription delivery services.
• Add to trust website, and make staff and patients aware of this.

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.”

5.4 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 Having financial conversations

Some staff do engage positively in financial conversations with people.

• “Planned nursing who some of our patients end up getting referred to have more in depth conversation where some issues around finances are covered. The unplanned team tend to go in and then if regular visit is required for the patients, these are then referred to planned nursing.”

5.4.2 Barriers and challenges

5.4.2.1 Access to digital devices

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

5.4.2.2 Cost of heating homes

Staff told us about experiences where people were finding it difficult to heat their homes properly. This could be a sign that people are experiencing fuel poverty.

• “Cold in the house, some people might only heat that room where the patient is occupying.”
• “Use of a lot of portable heaters in some of the houses that we visit.”
• “Asking questions to patients to make sure they are warm and comfortable and have healthy diet.”

5.4.2.3 People’s access to advocacy services

Staff told us that one of the barriers to people accessing services is the availability of advocacy services.

5.4.2.4 Not knowing what support is available

People did not necessarily know of the various schemes that are available to help with health costs.

• “Patient said they would be interested to know what help and support is available for if their financial situation were to change.”
• “None specifically for myself but getting the word out there could help me help others by having the knowledge.”

5.4.3 Recommendations for patient empowerment

5.4.3.1 Helping people with their digital needs

• Ask people about their digital needs and barriers.
• Refer people to Citizens Advice Doncaster digital support programme (a link is at the end of this report).

5.4.3.2 Help with heating

Refer people to Citizens Advice Doncaster for an income or benefits check, so that any grants they are entitled to for heating are made available.

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 (a link is at the end of this report).

5.4.3.4 Advocacy

• Identify advocacy services in Doncaster that can provide support for patients or carers.
• Make sure staff and people know about them.
• Look at how peer support could play a role in supporting people.

5.5 Staff awareness and guidance

5.5.1 Barriers and challenges

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

Some staff cited examples of where the service supports people experiencing poverty, but this is dependent upon judgements of individual staff and some verbal screening. Other staff said there wasn’t anything in place to identify if a person has financial challenges. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.

5.5.1.2 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. People also told us that communication and outreach work, more staff training, more financial assistance programmes would be helpful.

People also said we should provide more financial help, discounts and offers, and give clear communication about support.

• “It would be great for staff be to be able to get the information to be able to share with patients on what is available that can help them financially. If there was a kind of one-stop shop booklet that has this information that would be great to leave with patients but also as a reference for staff.”
• “A system or process that recognises patient who are in poverty, and education for staff to know services or benefits patients can claim.”
• “Knowing about more services out there which can help patients.”
• “Having the confidence to start having the conversation of why people are not able to attend clinic or refusing equipment.”

5.5.1.3 Staff unsure how well the service supports people experiencing poverty

We asked staff in the survey how well the service supported people experiencing poverty. Whilst some said well or not well, most were not sure either way.

• “Be able to hand out information packs with resources for people to get assistance, for example, charities, food banks, Age UK events.”
• “I could ask if they require any help or if they are experiencing difficulty or give a questionnaire with relevant questions to find out if any help can be given.”

5.5.1.4 Staff experiencing poverty

Staff generally told us that they were unsure what was available for them if they were experiencing financial challenges themselves.

• “Unsure on services or provisions available for staff who are experiencing poverty.”
• “District nurses or health professionals struggling with fuel for vehicles and unable to reserve a works co wheels.”

5.5.2 Recommendations for staff awareness and guidance

5.5.2.1 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 (a link is at the end of this report):
  • 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.

5.5.2.2 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.

5.5.2.3 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. For example, in team meetings.

5.5.2.4 Support for staff

• Make staff aware that they can refer themselves for money or debt advice to Citizens Advice, through the staff app.
• Look at a prioritisation process for staff to access Co-Wheels.

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.

6 References

• O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
• Fenney, D. and Buck, D. (2021), The King’s Fund, The NHS’s role in tackling poverty: Awareness, action and advocacy.
• 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
• Help with health cost
• Doncaster carers offer
• Citizens Advice Doncaster support