Poverty proofing report North Lincolnshire health visitors (age 0 to 19) 2024

1 Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Foundation Trust to fulfil its ambitious promise to “poverty proof” all of its services by September 2026. 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 will positively impact the overall health outcomes of everyone.

A locally trained team (LTT) of people have been trained and are being supported by Children North East 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: all other trust services will engage in the Poverty Proofing process during 2025 and 2026. Children North East will deliver training to all staff; the locally trained team will carry out scoping of services and engage people and staff in consultations; and the trust strategy team members will deliver feedback and write reports for each service. Moving forward, services will become more poverty informed, learning how to work with their people to identify barriers, 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 health visitors (age 0 to 19)

The locally trained team engaged with North Lincolnshire health visiting (age 0 to 19) and promotion services during May and June 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 these early years services in Doncaster.

The 0 to 19 children’s service in North Lincolnshire include the following teams:

2.1 Health visiting

the health visitors (age 0 to 5) service is for children, young people, and families. The team of NHS professionals possesses experience and expertise in all aspects of children’s and young people’s health and wellbeing. The health visiting service includes specialist community public health nurses and other professionals. They provide expert information, assessments, and interventions for babies, children, and families, including first-time parents and those with complex needs.

2.2 Nursery nurses

Community nursery nurses to support and work within the 0 to 5 health visiting pathway. They work with health visitors and health promotion practitioners to deliver the Healthy Child Programme, using evidence-based tools to support our children’s’ development. Nursery Nursing works with the 0 to 5 Health Visiting team collaboratively and with other agencies and professionals to help improve the health and wellbeing of the population. They facilitate groups according to identified need. Provide specific and routine stimulus and co-ordinated play activities in the home environment and group settings. They co deliver the healthy child programme through sessions, groups or in the home environment. They participate in health education and promotion particularly in relation to child health and with families where it impacts on children such as smoking cessation and or healthy eating.

2.3 School nursing

The school nursing service works as part of a wider team, including senior school nurses, community staff nurses, and nursery nurses. They are trained to support children and young people in making healthy lifestyle choices, helping them reach their full potential and enjoy life. The services they offer include height and weight measurements, vision and hearing screening, immunisation clinics, bed wetting advice and support, sex and relationship advice, home visits for families in need, health education, advice, and signposting to other agencies, support with behaviour concerns and safeguarding and service coordination.

2.4 Parent infant emotional wellbeing (PIEW)

The North Lincolnshire parent infant emotional wellbeing team is part of the 0 to 19 (25 special educational needs and disabilities (SEND)) health and wellbeing service working in partnership with North Lincolnshire Family. The team provides comprehensive assessment and therapeutic interventions to support mild-moderate parental mental health needs and improve parent-infant relationships and work with parents or any family member who may be caring for an infant, from conception up to 24 months of age. The team accept self-referrals for families living in the North Lincolnshire area.

2.5 Health and wellbeing

The health and wellbeing service, for ages 0 to 19, is a service dedicated to children, young people, and families. The team of NHS professionals brings experience and expertise in all aspects of children’s and young people’s health and wellbeing. The service consists of health visitors for ages 0 to 5, school age nursing for ages 5 to 19, and 25 special education needs and disability (SEND).

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.

Save the Children tell us that:

“All children deserve the best start in life, we must aim to fulfil every child’s right to thrive. The earliest years of a child’s life lay the foundations for their health, wellbeing and future outcomes. What babies and young children experience affects how they learn and develop. Persistent exposure to adverse environments and experiences in the early years, such as poverty, often means that young children don’t have equal access to the conditions that enable them to do well. Relative poverty for households where there is a child under five continues to rise rapidly, though economic disadvantage does not inevitably lead to poor outcomes for children. Key factors play a significant role in mitigating the causes and effects of poverty. Our responsibility is to maximise the chances of good outcomes for babies and children through multi-sector, long-term commitment and proportionate investment so that all families are given fair access to opportunities for their children.”

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

19 staff attended 3-hour training on learning half days in May and June 2025. We also received 26 survey responses from staff and spoke to 9 staff.

4.2 Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management.

4.3 Stage 3: patient and community consultations

We received feedback from 17 people who uses the service.

4.4 Stage 4: feedback session

The report was shared with the Service Manager, Jo Shearman, to consider the findings. We then produced this final report.

4.5 Stage 5: review

Around 12 months after completion, the trust will 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 health visitors (age 0 to 19) 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

People who used the service overall felt that the service is welcoming. Most people agreed or strongly agreed when asked this question.

“The health visitor in the south team… really great.”

“The school nursing team are very approachable.”

“Nice staff at babies first friends.”

“All staff are very friendly and approachable and make you feel listened to when talking about any problems.”

5.1.1.2 People value the staff and the service provided

People provided good feedback about the service overall. For example of 62 stories told by people on Care Opinion about the health visiting service, 62 people would recommend it. Likewise, for 6 of the 6 people would recommend the school nursing service.

“We have had a tricky time with our new son, who was struggling to put on weight. Despite the stressful time, we felt supported throughout by our health visitor Kate. She has been a great source of information, and has gone out of her way to help us where ever she can. She made us feel heard and helped us access further support where needed.”

“The doctor referred me to the local bed wetting team, who were great very caring and knowledgeable. Kept in contact and all round provided a great service.”

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

A number of 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 Interpreters

In some cases, people using the service require the use of interpreting service to be able to discuss their needs and treatment. Staff reported that the main issue that they experience is with interpreters, and that the service can be unreliable.

“A couple came to see me, they were Arabic,  a real language barrier, a lack of understanding of the service, no support, had nothing for the baby even though she was 30 weeks. I used a telephone interpreter, but the line kept cutting out about 3 times. They hadn’t been attending their appointments, because they just didn’t understand they needed to.”

“We could be better at language, especially patient medication, have stickers in different languages available to go on medicine boxes.”

5.1.3 Recommendations for communication

5.1.3.1 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.

5.1.3.2 Interpreting services

• This is a consistent theme across the Poverty Proofing audits, 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.
• The service has identified some innovations that could help with interpreting. The service should be supported into looking how this could be used so that people can get a better service. This could be used for wider learning in the trust.

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.

In 2025, Moneyhelper said about a child’s early years:

“You’re already nearly £600 down in the first month but add in the costs from the other eleven months and even with very basic costs of £95 a month (based on product data from price comparison site idealo), you’re looking at £1,645. But in reality it could be much more, as LV estimates parents spend a whopping £12,400, per year on raising a child. With many having taken maternity leave and therefore a cut in their pay it’s likely to be putting a strain on your budget. It’s estimated that in years one to four parents are typically spending on average £63,224 in childcare fees.”

This would be before any affordability is taken into account, where families may be experiencing poverty and low income.

5.2.1 What works

5.2.1.1 Staff do try and find ways to support families with the costs of bringing up children

Staff recognize the financial challenges that families face, and do go out of their way to support people with items that may be beyond direct health costs. This is a reflection of their care for the families they support.

“We have a family bank that we can refer to for children’s clothing, nappies and a children’s centre. We refer a lot of families to the food bank and Crosby 1.”

“Offer food bank vouchers, baby basket, home visit clients we know can’t access clinic appointments.”

5.2.2 Barriers and challenges

There are some instances where people will need prescriptions after pregnancy or 12 months after giving birth (when prescriptions are free). They may be above or below income thresholds to receive free prescriptions. It may be that these people are entitled to Universal Credit or another benefit and should be referred to Citizens Advice for a money check. People told us that help with the cost of prescriptions would be a good thing to introduce. In some instances, it is also the case that the prescription given doesn’t adequately meet the need.

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 Doncaster to see if they are entitled to support with transport costs and attending day centres (link at the end of this report).

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.

5.3 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 Barriers and challenges

5.3.1.1 Complexity of health systems

A number of staff said that the health system itself can make it difficult for people to get the support and treatment they are entitled to. Not only does this mean it can delay a person’s treatment, it can also mean that it can prevent people from accessing other healthcare.

5.3.1.2 Hidden costs of accessing services

Staff told us that there were indirect costs to people, such as childcare or time off work, that could make attending appointments difficult.

5.3.2 Recommendations for health related costs

5.3.2.1 Help create simpler health systems

• 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.

5.3.2.2 Home visits

• Consider offering home appointments to people identified as being on low-income or with increased health risk, where this isn’t currently offered.
• Consider offering home appointments where possible, especially during the initial period of accessing the service. This could allow people to feel more comfortable and open up more than in a clinical setting.

5.3.2.3 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.

Page last reviewed: August 12, 2025
Next review due: August 12, 2026

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