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 North Lincolnshire community psychosis
The North Lincolnshire psychosis pathways is made up of the following services at risk mental state service (ARMS), early intervention in psychosis (EIP), psychosis and assertive outreach.
The Early Intervention in Psychosis team (EIT) in North Lincolnshire early intervention in psychosis and at-risk mental state (ARMS) employ diverse approaches to assist individuals. This includes aiding in:
- understanding their situation
- medication
- individual
- family therapy
- supporting education
- employment
- finances
- engaging in physical or group activities
Psychotic experiences often emerge during crucial developmental stages in young individuals’ lives. Seeking assistance early can significantly reduce the disruption caused by psychosis.
Anyone concerned that an individual may be experiencing psychosis, including the individual themselves, can contact us for advice or referrals. However, before making a referral, the referrer must notify the person in question.
Referrals can be made by phone, in writing, or in person using the provided contact details. Referrals can be made on your behalf by your GP or another health care professional.
The Assertive Outreach team offers assistance to individuals with severe mental health problems.
This service is open to patients aged 18 and above who have experienced difficulties in accessing appropriate mental health support in the past.
We collaborate with patients and carers to recognise and comprehend your individual needs, assisting you in enhancing your strengths and abilities while acknowledging the challenges posed by your disorder.
Additionally, we provide separate assessments and support for carers. Our care and support services are flexible, available in your home or another community setting, tailored to best suit your needs.
Referrals to this service are made through your care coordinator or consultant psychiatrist. We will contact you to arrange a visit to determine if this service is suitable for your needs.
The service is located at Monarch House in North Lincolnshire and operates Monday to Friday, 9am to 5pm and weekends and bank holidays, 8am to 8pm.
In North Lincolnshire, 13.3% of the population was income-deprived in 2019. Of the 316 local authorities in England, North Lincolnshire is ranked 106th most income-deprived, with 1 being the most deprived.
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 psychosis 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
When considering the patient consultations, there is really strong evidence in favour of the welcoming atmosphere staff strive to create. Patients feel like their questions will be answered and nothing is too much trouble.
- “Me and my son where always felt welcome and relaxed.”
- “People I’m under provide a good care service and are spot on.”
- “The staff are really friendly and always take the time to support us with our questions and concerns.”
5.1.2 Barriers and challenges
5.1.2.1 General communication
Over half of the patients who took part in the survey said they would like to see improved communication and outreach. This is a general feeling which includes appointment reminders and follow-up letters.
- “Better communication and outreach.”
5.1.3 Recommendations for communication
5.1.3.1 Improve communication
- Review process for issuing appointment communications and reminders, ensuring patient preferences are taken into account where applicable.
- Review all standardised documents to ensure they are fully understandable and avoiding overly technical language. Consider using online tools to check the readability of letters or communications such as the fog Index.
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
5.1.2.1 Very few health-related costs
For the vast majority of patients within the North Lincolnshire community psychosis service, they encounter very few costs in relation to their care plan, but this is not to say they don’t encounter other hidden costs in their daily lives. Most are able to access the equipment they need as a result of NHS funding.
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 Some patients are very comfortable in asking for help
Out of all the patients who were surveyed as part of this audit, half would feel comfortable to tell their clinician if they were struggling with their healthcare costs.
- “(staff member) wouldn’t want me to miss my appointment and would do everything they could to help.”
5.3.2 Barriers and challenges
5.3.2.1 Some patients are not aware they can ask for help
Further to the above, the other half of the patients surveyed communicated that they were not aware they could discuss their financial situation with their clinician. They were also not sure if the service were able to support if they did.
- “Wasn’t sure if this is something that they are involved in.”
- “I am not clear on what is out there.”
5.3.2.2 Some patients do not know options available to them
If a patient makes a disclosure that they need financial help, staff often don’t know how to help the patient to help themselves. Signposting is sporadic and there is not a structured approach within the service.
- “There is no quick way to support people.”
- “It would be great if we are able to have somewhere or someone who can be able to advise us accordingly on Personal Independence Payment (PIP) or benefits.”
5.3.3 Recommendations for patient empowerment
5.3.3.1 Lack of signposting
Develop a bank of information which patients can use if they need financial support. At the trust, we now have in-house appointment with Citizens Advice, so it is important that staff know about this so they can direct patients and, or make a referral.
5.3.3.2 Making financial conversations routine
All staff should look to attend further training on having financial conversations with patients a routine part of initial and ongoing appointments. This training is available on the learning half days at the trust and is bookable via the staff portal.
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
Some staff do informal assessments of a person’s financial circumstances and are able to make judgements about any potential financial hardship.
5.4.2 Barriers and challenges
5.4.2.1 Staff awareness
Supplementary to the section above were some staff already do informal assessments of financial circumstances; however, this is not consistent. Staff themselves were keen to understand what is available so they could help to support their patients. This is something which would evidently be mutually beneficial for patients and staff.
- “Be able to have a booklet that has information that we can share with then that can provide them with areas that they can contact for support.”
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 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.
- It is also recommended that a booklet of information is created so that staff have easy access to everything available.
5.5 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.
From both staff and patient consultations, this particular theme had the most responses.
5.5.1 Barriers and challenges
5.5.1.1 Cost of travel to appointments
During consultations, patients expressed worries at the cost of getting to their appointments. Some were concerned about the costs of buses or taxis, particularly as they may have to cover a fair distance to reach the clinic. It is also apparent that the costs of transport are not always spoken about between clinician and patient.
It is not just the cost of appointments, many patients feel they miss out on the other support groups available to them as they do not have affordable means of transportation.
- “I worry about fuel to get to clozapine clinic, although this service has joined up with the lithium clinic so only one appointment at this time.”
- “I have to pay for travel to get to the social groups (pool and cooking) but currently I am financially unable to as it could be £15 return trip in a taxi.”
- “I’m able to make medical appointments with family but they aren’t able to take regularly and definitely not twice a week.”
5.5.1.2 Underutilisation of community venues
It is evident that both patients and staff feel a sense of frustration at the lack of appointments made available at community venues. There is a feeling that being able to deliver appointments closer to homes would make it much easier for people to attend without causing severe inconveniences.
- “Access to more community bases, or schedule more appointments in those bases available, to see people closer to their homes to reduce the requirement to travel.”
- “I would like support to attend appointments at a different venue than home address.”
5.5.2 Recommendations for staff awareness and guidance
5.5.2.1 Cost of travel to appointments
Transport and appointment options to be clearly communicated across the trust, so colleagues know where to direct patients.
5.5.2.2 Underutilisation of community venues
- Prioritise the scoping of community venues to provide more flexibility in relation to appointment locations.
- Support staff to help them understand the process for booking community venues and empower them to do so.
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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