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Poverty proofing report North Lincolnshire community older adults mental health 2024

Contents

  1. Poverty proofing delivery partner model
  2. Poverty proofing North Lincolnshire community older adults mental health
  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 North Lincolnshire community older adults mental health

The Poverty Proofing audit for North Lincolnshire (NL) community older people’s mental health 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 older adults to build up a rich picture of the barriers and challenges faced by those accessing  North Lincolnshire community older people’s mental health service.

As stated on the website community older people’s mental health service in North Lincolnshire offers assistance to older people facing mental health issues. The team provides assessment, treatment, and care management for patients over the age of 65. The service supports older adults with mental health concerns, both at home and in clinical settings, enabling people to manage challenges and remain at home.

The service also supports people who may be experiencing concerns with memory and will provide an assessment, diagnosis, and treatment if appropriate and regular reviews of treatment. In North Lincolnshire, a pilot commenced in January 2025 to deliver a rapid assessment diagnostic service for peoples who may be experiencing problems with their memory.

The North Lincolnshire community older adults service is made up of the following teams: memory, diagnostic and assessment, primary care memory annual medication review, older adult community mental health teams, occupational therapy and Psychological therapy.

Referrals to this service are received through local general practice, the staff bases are at Bernard Court Health Centre, Old Courts Road, Brigg, DN20 8JH and Ironstone Centre, West Street, Scunthorpe, DN15 6HX. The service opening is Monday-Friday in the hours of 9am to 5pm. The team is supported by a receptionist and an admin team, people who use the service can ring the team and there is always someone on duty to support people with their queries. The team have a voicemail service and people can leave messages out of hours and a member of the team will get back to people the next day.

In North Lincolnshire, 13.3% of the population was income-deprived in 2019. Of the 316 local authorities in England, Rotherham is ranked 106th most income-deprived, with 1 being the most deprived.

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 into which they can’t tap. 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 North Lincolnshire community older adults mental health 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 The service is welcoming

Those using North Lincolnshire community older adults mental Health services said their communication and their contact with staff had been positive, describing staff as friendly, welcoming, approachable and that the service had been supportive.

  • “The staff have been friendly.”
  • “Staff are spot-on and have been welcoming and approachable.”
  • “Staff who completed home visits was friendly.”
  • “Staff in the service have been kind and approachable and the support in the service has been good.”

When people who use the service were asked if they felt able to open-up about financial difficulties and discuss this with staff they reported they felt comfortable to do this.

5.1.1.2 Information

Staff members reported that translators are available for people who need the support, and that this is discussed with patients when the appointment is booked in. if needed leaflets in different languages can be used.

  • “Patients are informed when the appointment is booked in that interpreting is available.”

However, this is dependent on people informing the service of this.
Appointment letters of the service are noticeably clear, give good instruction, expectations of the appointment and what to bring to the appointment. It advises on the two hours free parking at the venues, however on observation not all letters discuss parking options.

5.1.2 Barriers and challenges

5.1.2.1 Interpreters

In some cases, people using the service require the use of interpreting service to be able to discuss their needs and treatment. However, it has been noted that the current service is often inaccessible in terms of appointment been offered virtually.

  • “A translator can be arranged to attend; however, the meetings are held virtually, and this could be a problem for some patients.”

It was also observed that there was no information about access to interpreting services in the clinic settings.

Although there is flexibility in how appointments are offered, when staff were asked what a barrier for patients may be experiencing poverty and access to their service they suggested “Digital.”

When staff were asked in your experience, which of the following poverty-related barriers apply to patients accessing your service the following was reported:

  • “Communication (no data or access to credit Wi-Fi).”
  • “Health Literacy (understanding of written materials or verbal communication).”

5.1.3 Recommendations for communication

5.1.3.1 Interpreting services

This is a consistent theme across the Poverty Proofing audit, and the trust should make sure the new provider of the service has a reliable approach which is more appropriate for patients and staff.

Report any missed interpreter appointments through Radar as an incident.

5.1.3.2 Digital (ensure communication with people is based on their needs)
  • Identified as a trust Issue, work is starting as a trust to look at this challenge.
  •  Ensure people are asked about their communication needs and preferences, and this is recorded on SystmOne.
  • Refer people to Citizens Advice North Lincolnshire to access a digital support programme.
5.1.3.3 Information
  • People mentioned they would benefit from more information around tackling their financial issues. It would be helpful for staff to ensure this information is available in appointments.
  • Refer people for money or debt advice to Citizens Advice North Lincolnshire (a link to the form is at the end of this report) and make sure this is recorded on SystmOne.

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

Those who access North Lincolnshire community older people’s services, in part suggested they did not have to pay for any items or services as part of their healthcare and agreed that the service was accessible and affordable for everyone, regardless of their financial situation.

  • “No costs for any treatment, no medication.”
  • “Patient care comes first.”
  • “No financial support has been needed to support access to appointments.”

Staff also reported that if people are facing healthcare cost challenges, they will be flexible with how they deliver their appointments for example: visits at home wherever possible and using digital appointments if appropriate.

  • “There are home visits that are arranged.”
  • “Getting the most out of remote consultations.”
5.2.1.1 Parking costs

It was reported by both people who use the service and staff who work in the service that there are free two hours car parks at both destinations where patients may visit, this will help reduce the risk of hidden healthcare costs.

  • “Two-hour appointments that fit in well with the two hours free parking; the car park is directly outside Barnard Court.”

5.2.2 Barriers and challenges

5.2.2.1 Cost to family

Although some patients discussed that the service was flexible and offered alternative appointments and worked with their preferences, some people preferred to meet face to face, and some appointments are only offered face to face. Of these people some suggested that family members supported them to attend appointments, when people who use the service were asked about hidden cost they suggested:

  • “Family having to support travel” and “Cost to family.”
5.2.2.2 Knowledge of support schemes

There are several support schemes to support people who access our services with additional health costs, however both staff who work in our services and patients who use our services suggested they were unaware of these schemes. Our patients reported:

  • “The biggest challenge currently was knowing what support was available.”
  • “Not aware of the Health Care Travel cost scheme but said would be unlikely to bother applying for reimbursed costs as thought it would be more difficult than it would be worth.”
5.2.2.3 People unable to attend appointments

Although much of the evidence would suggest that the impact of extra health cost is low for these services, staff members did report some challenges around people been able to attend appointments were due to financial worries.

  • “Patients or family have on occasion rung to change appointments due to not having the funds for bus fare and wanting to rearrange appointments for after payday.”

5.2.3 Recommendations for health related costs

5.2.3.1 Cost to families
  • To continue to offer flexibility in appointment for example: home visits and digital where appropriate.
  • To continue to offer appointments that are flexible around work around families, to ensure no further extra cost is incurred.
  • Ensure information about free care parking is indicated in all appointment letters.
5.2.3.2 Knowledge of support schemes
  • 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, Health Care Travel scheme and prescription support)
5.2.3.3 Financial support
  • This is a trust wide area of focus; work will be developed in May for people to access travel cost to attend healthcare appointments if appropriate. This may involve pre-loaded travel cards or similar for people who do not have the money up front.
  • 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)
5.2.3.4 Personal health budget

The trust have recently gone into partnership with Citizen’s Advice Bureau, ensure staff are aware of this service and refer people who may benefit from the service.

5.2.3.5 Appointment times
  • Consider if appointment times are meeting the needs of the whole family and if there are any caring responsibilities that create a barrier to accessing appointments.
  • Identify which appointment times are suitable with patients during assessments or treatment sessions.
  • Explore the possibility of providing more out of hours appointments so that those with zero hours contracts or the self-employed have more choice when booking appointments reducing the potential loss of earnings.

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.”

5.3.1 What works

Staff who work in the service suggested that the access to a variety of methods to complete their appointment was helpful.

  • “Where a patient is unable to attend the appointment in person, home visits are arranged.”
5.3.1.1 Appointments

People that access the service suggested they have not missed appointments due to financial reasons and that the flexibility they have been offered or granted when requested had been helpful. This has included flexibility in the method, day, and time of the appointment. The people who use the service also suggested they did not have to complete a referral form for the service and that this was completed by the GP.

  • “Some patients will ring to say that they can’t afford to get a taxi to attend the appointment and ask for a home visit to be arranged as an alternative.”
  • “The appointment was arranged through the doctor.”
  • “Neither patient nor family member had to complete any referral forms prior to their first appointment.”

5.3.2 Barriers and challenges

When staff were asked in your experience, which of the following poverty-related barriers apply to patients accessing your service staff suggested:

  • “Complex Health Systems (difficult to navigate, referrals appointments).”

5.3.3 Recommendations for health related costs

5.3.3.1 Complex mental health systems
  • This is a trust initiative and work has commenced to look our complex referrals into our service and within our services.
  • 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 Comfortable in asking for help

People who access the service reported that they felt the service would support them if they were unable to afford their care.

Staff were able to recognise people in poverty and when they have recognised this, they would act to support people using the service.

  • “During home visits I also like to check in with patients and ask about whether they have managed to pay their bills this week or month. If they are struggling, I arrange for a voucher code to be shared that can then be given to the patient for the food banks.
  • “Personal Independence Payment (PIP) and Disability Living Allowance (DLA) signposting.”
  • “Our trust has access to meal vouchers to allow families or individuals to obtain food parcels.”

When staff were asked if their service have a way to identify people who may be experiencing poverty they answered yes and suggested they did this by:

  • “Judgements of staff.”
  • “Verbal screening.”
  • “I feel the service is good at identifying issues and making relevant referrals.”
5.4.1.2 Environment

On observation of the environment, it was noted that there are posters and advertisements for a staff member for Citizen’s Advice based in the Atrium at the Ironstone Centre and is available daily when the Centre is open 10am to 3pm. There is also a poster for access to community connectors three days a week when people can attend to seek advice for transport and travel, housing, health and wellbeing and free phone SIM card and unlimited texts offered for 6 months.

5.4.2 Barriers and challenges

5.4.2.1 Technology

People who work in the North Lincolnshire community older people’s mental health service reported that the use of digital technology may be a barrier for some people who access the service and that they may rely on family members and friends to support them to access the service.

  • “Some people need support with arranging appointments and transport etc and wouldn’t be able to manage without family support. For example, use of technology.”
5.4.2.2 Environment

On observation of the environment and the waiting room where our patients may wait for their appointment there was no information regarding support with financial challenges, (except for the leaflet from Community Connectors in the Atrium). There was a poster stating that the booth is booked out every Thursday for Citizen’s Advice about money and debt advice, however, there was no one in attendance today.

5.4.2.3 Staff confidence

Although people who access community older peoples mental health Service suggested they felt the service would support them and staff were able to recognise people in poverty and act on this, some staff still reported they were unsure if the service supported their patients around poverty and that they did not have the knowledge.

  • “How well do you feel your service supports patients and families in poverty? Not sure.”
  • “Unaware of the support with financial help booklet, therefore not offered to patients.”

5.4.3 Recommendations for patient empowerment

5.4.3.1 Financial support (staff confidence)

The trust have recently gone into partnership with Citizen’s Advice Bureau, ensure staff are aware of this service and refer people who may benefit from the service. A link to refer people is at the end of this report. Make sure this is recorded on SystmOne

5.4.3.2 Digital
  • Identified as a trust Issue, work is starting as a trust to look at this challenge.
  • Ensure people are asked about their communication needs and preferences, and this is recorded on SystmOne.
  • Refer people to Citizens Advice North Lincolnshire to access digital support programmes.
5.4.3.3 Knowledge (environment)
  • Provide information or training to staff about having conversations with people about poverty.
  • Ensure staff are aware what is available for people, in terms of entitlement, where there is a cost to accessing care (for example, personal health budgets, Health Care Travel scheme and prescription support)
  • Gather resources on finical support (leaflets) and display in clinic or take on visits if needed.

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 Knowledge

As discussed previously staff who work in the service appear to have a good understanding on poverty and have stated in the consultations that the Poverty Proofing training has supported this.

  • “Majority of staff understand about the impact of poverty.”
  • “It’s on everyone’s radar to get the help that they need.”

It is clear from the evidence that the staff go above beyond to support people who use the service when experiencing poverty and show a non-judgmental attitude and are compassionate to people who use the service.

  • “We have free biscuits that we can give out to people, but some staff also share their own food or snacks with them.”

5.5.2 Barriers and challenges

5.5.2.1 Staff awareness

Although staff are good at identifying people’s need in relation to poverty, they also suggested it would be beneficial to have more knowledge and support around what support is available, suggesting this would give staff confidence.

When staff were asked what one thing you could change in your practice to make life better for people experiencing poverty they suggested:

  • “More understanding, access to types of service to support people in gaining access to the right support at the right time.”
  • “More awareness of what services are available, to understand better what is out there to help our patients who are experiencing poverty.”
  • “Enabling staff to support people to complete forms, and use of work IT to do so if required.”

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Additional provision

Having information as standard to give to all patients about poverty and support available.

5.5.3.2 Staff awareness
  • Staff expressed an interest in knowing more about how to support patients. It is recommended that staff attend the Poverty Proofing training delivered within the trust, with a view to more bespoke training delivered by Citizens Advice.
  • Ensure all staff are aware of the financial wellbeing guidance available.
  • Ensure 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, Health Care Travel scheme and prescription support). A link to a number of these is at the end of this report.

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.

5.6.1 What works

The North Lincolnshire community older adults mental health services have bases in two locations in the North Lincolnshire area and also offer home visits, people who use the service have suggested that the flexibility helps them to access the appointments.

  • “I only have to drive 5 to 10 minutes to attend the appointment, were aware of the Car Park and are using their disabled badge.”
  • “Driven about 8 miles (Local to Brigg) and took about 15 minutes and is easy to get to.”

Staff who work in the service reported that they are aware of how they can be flexible with appointments and how to support people who are experiencing poverty and need to access their services.

  • “More home visits will be offered to vulnerable patients where travel to site is considered a barrier.”
  • “The ambulance service do bring patients and some people can apply for a council pass for the bus if they have a disability.”

5.6.2 Barriers and challenges

5.6.2.1 Family reliance

Although the service is flexible and offer a range of face-to-face clinic appointments and home visits, people who use the service and family members raised concerns about how their relative would access the service if it were not for their support.

  • “Family member 1 did not feel they would have been able to attend if family member 2 had not been able to transport them.”
5.6.2.2 Help with travel costs

When staff were asked what poverty-related barriers apply to patients accessing your service all reported:

  • “Travel and transport costs (cost of parking, public transport and taxi’s)”

When staff were asked: what one thing could you change in your practice to make life better for people experiencing poverty they suggested more community hubs to deliver care for people nearer to their homes with the hope of reducing travel cost.

  • “Access to community hubs and to engage the communities where they live rather than having to go to Ironstone or Barnard House”

People who access the service also reported some challenges with public transport for example with the service and the cost of having to use public transport.”

  • “Family member was concerned how they would have attended the appointment if they could not drive as there is not a bus which goes from Massingham to Brigg, they would have had to take two buses to get here and then a further two buses back.”

5.6.3 Recommendations for staff awareness and guidance

5.6.3.1 Travel cost
  • This is a trust wide area of focus; work will be developed in May for people to access travel cost to attend healthcare appointments if appropriate. This may involve pre-loaded travel cards or similar for people who do not have the money up front.
  • 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 budget
  • The trust have recently gone into partnership with Citizen’s Advice Bureau, ensure staff are aware of this service and refer people who may benefit from the service.

6 References

Page last reviewed: May 29, 2025
Next review due: May 29, 2026

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