Skip to main content

Poverty proofing report North Lincolnshire specialist forensic and community wellbeing 2024

Contents

  1. Poverty proofing delivery partner model
  2. Poverty proofing North Lincolnshire specialist forensic and community wellbeing
  3. Poverty proofing process
  4. Common themes
  5. 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 specialist forensic and community wellbeing service

The locally trained team engaged with North Lincolnshire specialist forensic and community wellbeing service during March 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 received mental health services in Rotherham. Face-to-face consultations with patients were done for this service by locally trained teams.

The specialist forensic and community wellbeing service offers comprehensive care for both the physical and mental health aspects linked with severe mental illness. Additionally, the service delivers supportive psychological assistance, focusing on recovery for individuals transitioning back to primary care.

Some of the service that are delivered by the team include:

  • supporting forensic patients: closely collaborates with patients affected by mental illness or personality disorder, who have either offended or display a potential to offend, posing risks to themselves or others
  • clozapine clinic or Lithium clinic
  • routine health checks for people with a severe mental illness
  • individual placement service, to get and support people in work
  • prescribing medication
  • ensuring compliance with medication

The services are based at different settings in North Lincolnshire.
This service does not accept self-referrals. Referrals are exclusively made by healthcare professionals already involved in a person’s ongoing care.

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.
Key findings of a Mind Report in August 2021 tells us “There’s still a lot of shame about money and mental health. There’s a lot of worry about privacy for people facing poverty and worry that they don’t deserve support. Many feel mental health is a white, middle-class conversation they can’t tap into.”

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 the North Lincolnshire specialist forensic and community wellbeing service 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 Barriers and challenges

5.1.1.1 Getting the patient voice to understand their experiences of poverty

Through the locally trained team, by the specialist forensic and community wellbeing service itself, or a combination of both, we have sought the views and experience of poverty from patients and carers. Unfortunately we have not been able to do so, despite best efforts. Therefore, the voices of the patients from this service are not present in this report. Instead, we have incorporated common recommendations from our other poverty proofing work in the trust for the service to consider. The service may want to consider other ways of engaging with patients and carers on the challenges of the cost of living utilising on the poverty proofing training that staff have received. Having financial conversations is important to understanding the quality of life people experiencing, which can also impact their mental health. Some of this is borne out from what staff told us they think services need to do.

  • “Increase my knowledge around available support systems that can be accessed by our patients.”
  • “Dialogue around poverty and reaching out for help, visible information for patients, for example, social media, leaflets and websites.”
  • “Have an awareness of support I can offer and what questions I can ask to identify a problem.”
  • “Schemes, trainings and support cupboard.”
5.1.1.2 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 Recommendations for communication

5.1.2.1 Staff engaging in financial conversations with people
  • Open up financial conversations routinely as part of someone’s care.
  • Provide a basic level of training for staff, to empower them to have financial conversations.
  • Get information from charities and food banks on what is available in North Lincolnshire and how people can access them.
  • Make sure staff are aware that they can refer people for money and debt advice to Citizens Advice North Lincolnshire (a referral link is at the end of this report) and record this on SystmOne.
5.1.2.2 Communicating with people based upon their needs and ability
  • Make sure people are asked about their communication needs and preferences.
  • 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.

The Institute for Health Equity and World Health Organisation said that “A person’s mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk.”

5.2.1 Barriers and challenges

5.2.1.1 Health cost position cannot be determined

As we have been unable to get the voice of the patient in this audit, it is not clear if there are costs that people have that they may also be entitled to make a claim against. We have found in other audits there are costs that people do need help with.

5.2.2 Recommendations for health related costs

5.2.2.1 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).

5.2.2.2 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 accessing other healthcare needs.

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.
  • 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 medical 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.

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 Barriers and challenges

5.4.1.1 Access to digital devices

A number of staff said one thing could you change in their practice to make life better for people experiencing poverty is access to digital devices. Citizens Advice North Lincolnshire will be running a programme to help with digital literacy, devices, and data: like the barrier on what financial assistance available, that people may not be aware of. There are other such support services for people in North Lincolnshire (a link is at the end of this report).

5.4.1.2 People’s access to advocacy services

Staff told us that one of the barriers to people accessing services is the availability of advocacy services.

5.4.2 Recommendations for patient empowerment

5.4.2.1 Helping people with their digital needs
  • Ask people about their digital needs and barriers.
  • Refer people to Citizens Advice North Lincolnshire digital support programme, or other locally run support (a link is at the end of this report).
5.4.2.3 Support for carers

Make sure if the person is a carer, or they have a carer, they are referred to the council for a carer’s assessment, as part of promise 2 (a link is at the end of this report).

5.4.2.4 Advocacy
  • Identify advocacy services in North Lincolnshire that can provide support for patients or carers.
  • Make sure staff and people know about them.
  • Look at how peer support could play a role in supporting people.

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 Some good examples where staff support people

Some staff told us that support for people that may be experiencing poverty does take place. This means that the service has its own good examples to build upon.

  • “We always ask people as part of our assessment process how are people managing financially, have they got food, any debt. We support by referring to food banks, referrals to Citizens Advice and provide support with appointments if required. We also discuss low cost meal planning including batch cooking.”
  • “In my experience my colleagues routinely ask the question about budgeting and debt.”
  • “The current food cupboards in the kitchens are very handy and staff have been using them when needed.”
5.5.1.2 There is a commitment to improve processes to understand barriers people face

We were provided with ideas and suggestions by staff on actions that could be taken to understand financial barriers people face. These revolved mainly around changes to systems and processes.

  • “For these issues to be added to the patients notes so staff are aware.”
  • “Collaborate with social services.”
  • “Offer knowledge of services which help with poverty proofing, add the question ‘Are you coping financially’ and a follow-up flowchart to identify ways they can access extra support to all assessments”

5.5.2 Barriers and challenges

The response to supporting people experiencing poverty is mixed and not consistent.

Some staff cited examples of where the service supports people experiencing poverty, but this is dependent upon judgements of individual staff. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.

  • “In the severe mental illness health check we would ask questions around finance, however the template has changed, and these questions are no longer asked. We still refer to social prescribing team who can signpost and support.”

The response to supporting people experiencing poverty is mixed and not consistent.

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Making staff aware of financial support available
  • 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 budgets
  • Make sure this is communicated to people and their peer support
    Learning of what works already in the service.
  • Use the examples colleagues reference for supporting people, such as financial screening, and spread this to all colleagues. For example, in team meetings.

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 Barriers and challenges

5.6.1.1 Help with travel costs

Staff told us that the cost of travel has been a barrier to people accessing the service. This includes some of the staff who said the service supports people well in poverty.

5.6.2 Recommendations for staff awareness and guidance

5.6.2.1 Promote Healthcare Travel Cost Scheme
  • Promote the claiming back of travel costs and make this normal in staff roles.
  • As a trust, develop a process to claim back travel costs that isn’t stigmatising and is easy to use.
  • Advertise it to patients, ensure staff know about it, and how it works.
  •  Look to introduce pre-loaded travel cards or similar for people who don’t have the money up front.
5.6.2.3 Volunteer drivers
  • Look to create a pool of volunteer drivers to help people attend appointments.
  • Identify people who would benefit from such a scheme.
  • Trial and test, before learning and rollout.
5.6.2.4 Re-imbursing travel costs for people on low incomes

Where people have to attend clinics, and are at risk of did not attend (DNA) due to the affordability of travel, use the process being developed as part of the 2025 and 2026 Investment Fund.

5.6.2.5 Home visits

Identify people for home visits, where cost and affordability of travel is a problem.

5.6.2.6 Community appointments

Look to hold appointments in community settings, which are closer to where people live and help avoid unnecessary travel.

5.6.2.7 Digital appointments

Look at there, clinically, an appointment can be undertaken digitally that will reduce the travel need of the person and staff alike.

6 References

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

Problem with this page?

Please tell us about any problems you have found with this web page.

Report a problem