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.”