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 comprehensive emotional care
The comprehensive emotional care pathway is made up of the following services:
- complex emotional needs
- therapy
- primary care hub
The Comprehensive Emotional Care team offer a complex emotional need pathway to help people with complex emotional needs or dysregulation to manage their condition and relationships.
People accessing the service may have a diagnosis of personality disorder however you do not need a diagnosis to access the treatment as we focus on what your needs are, not the diagnosis alone.
Personality refers to the way we think, feel and behave. Due to life experiences, difficulties can arise in these areas and someone may develop complex emotional needs and personality difficulties. If the difficulties cause you great distress, are long lasting, and impact on many aspects of your life then you may need help from mental health services.
The complex emotional need pathway works with you to help you:
- understand and accept your difficult feelings
- learn skills to manage your emotions, mood and feelings
- problem solve
- become able to make positive changes in your life
- manage impulsivity (acting without thinking), relationships, self harm and suicidal thoughts
- work with you to increase the skills, and receive treatment, to be able to lead a life outside mental health services
The complex emotional need pathway includes a range of treatment offers including but not limited to psycho-education, structured clinical management (SCM), dialectical behaviour therapy (DBT) and individual therapies. We are working to incorporate more lived experience and peer support into the pathway.
SCM and DBT are treatments that are more likely to work if you are committed to make positive changes in yourself, if you are ready to work hard at treatment and if you are ready to focus mostly on your present and future, not your past.
Therapy team: The primary goal is to enhance and sustain a patient’s functional abilities and independence within their home setting to improve their overall quality of life. This service is provided by allied health professionals, occupational therapy and physiotherapy.
The North Lincolnshire Primary Care Network team operates through three pathways:
- the routine pathway, offers routine and non-urgent specialist mental health assessments, advice, and referrals
- the dementia review pathway, monitors and supports individuals on prescribed dementia medication, conducting yearly medication review appointments post-diagnosis from secondary care
- the severe mental illness (SMI) pathway, provides an annual health and medication review for those diagnosed with severe mental illness, collaborating with GPs to monitor physical health
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 comprehensive emotional care 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.
- “The staff were very helpful and friendly and made me feel welcome, nothing was too much trouble.”
- “Vickie and Louisa are very welcoming.”
- “The trust aims to support each and every person.”
5.1.2 Barriers and challenges
5.1.2.1 Minimal communication about financial assistance
Patients have expressed that while communication with the service is typically good, they don’t tend to receive any communications about financial assistance.
- “Better communication about available support.”
5.1.3 Recommendations for communication
5.1.3.1 Make information about financial assistance available to everyone
- Create a leaflet of all financial assistance available to patients and offer it to all patients.
- Staff to keep an electronic version of this leaflet for use when needed.
- Direct patients to the benefits advice sessions which are now available on-site with Citizens Advice.
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 Very few health-related costs
For the vast majority of patients within the North Lincolnshire comprehensive emotional care 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.
5.2.2 Barriers and challenges
5.2.2.1 Absorbing healthcare costs
Patients expressed that they often have to absorb the cost of Flow headset pads when they run out of their current pads. The average price for the official, compatible pads is £15 from online retailers.
- “The cost of flow headset pads (when I run out of my current supply).”
5.2.2.2 Digital exclusion
One patient has raised an issue around needing a smartphone to be able to partake in a pilot. This creates issues around equity of access, as patients without smartphones are excluded from partaking in pilots.
- “The pilot I have just taken part in required the use of a smartphone which not everyone had.”
5.2.3 Recommendations for health related costs
5.2.3.1 Cost of items related to healthcare
- For any items which are recommended as part of a patients’ healthcare plan, it would be supportive to ensure that these items are not available on prescription. If items are not available on prescription, then the service should look to keep a small supply of items to ensure patients do not go without.
- Ensure patients know where to access help with equipment and support groups.
5.2.3.2 Digital exclusion (pilots)
Ensure that all participants are able to partake in any activity, even if they need a form of technology to be able to take part. Devices can be loaned to patients by local agencies with the trust are connected with. The trust needs to make this information widely available to all staff.
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 are very comfortable in asking for help
Based upon patient consultations, it is very positive to see that most patients feel comfortable in asking staff within the service for help in relation to their finances. They know they could ask for help and would be okay with doing so.
- “(I could ask for help) they are understanding and friendly.”
- “(I could ask for help) the staff are all approachable and friendly.”
- “I feel everyone will listen.”
5.3.2 Barriers and challenges
5.3.2.1 Some patients will not ask for help
A small number of patients reported that they’ve never been asked about their finances, and that it doesn’t feel like an official route to getting constructive, ongoing support.
- “Too unofficial.”
- “It has never come up.”
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 to empower patients
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 Verbal screening
When taking part in the staff consultation phase, over half of staff said they make verbal screening a routine part of a person’s appointment. There is a particular focus on speaking with those who are believed to need help.
- “Verbal screening, asking those we think need help.”
5.4.1.2 Providing support
It is encouraging to see that staff are already really engaged with providing support to patients. There is evidence of staff sourcing food parcels for patients, making referrals to Crosby Community Association and supporting with home visits.
- “We source food parcels, have communicated on their behalf to agencies for support.”
- “I think the team are caring and compassionate and largely will go out of their way to provide whatever support they can to enable patients to access resources that we know about.”
- “We offer home visits if patients are unable to travel, will find other ways to contact or complete assessments if access to technology is not available.”
5.4.2 Barriers and challenges
5.4.2.1 Making financial conversations routine
Supplementary to the section above were some staff already do informal assessments of financial circumstances; however, this is not consistent. Almost all staff suggested they were aware how important financial conversations are, but do not feel empowered to carry them out.
5.4.2.2 Staff awareness
All staff have said they would feel more empowered to have financial conversations if they had more information about what is available to their patients. They would like to know what support is out there in communities and with other agencies.
Staff made the following comments:
- “Have a better understanding of how to access support for people experiencing poverty.”
- “Better understanding, more awareness of support available.”
- “I need more information on available resources in the community.”
- “I would like more information on supporting agencies or access to services.”
5.4.3 Recommendations for staff awareness and guidance
5.4.3.1 Making financial conversations routine
It would be good practice to initiate conversations around affordability and poverty with all patients, not just those the service think might need it. A more routine approach will ensure nobody slips through the net.
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.
5.5.1 What works
None of the patients who took part in the survey reported issues of affording transportation. This could, partly, be due to the service already offering home visits and making various provisions to ensure patients are accommodated.
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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