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Poverty proofing report Rotherham assertive outreach 2024

Contents

  1. Poverty proofing delivery partner model
  2. Poverty proofing Rotherham assertive outreach
  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 Rotherham assertive outreach

The Poverty Proofing audit for Rotherham assertive outreach service began in January 2025 to better understand the experiences of families and individuals who are living in poverty.

The work was conducted in partnership with staff, families, and adults to build up a rich picture of the barriers and challenges faced by those accessing trust Rotherham assertive outreach services. Due to the nature of the Illness, senior staff believed it would be better if staff who worked in the service supported patients and carers to download the quick-response (QR) code which accessed the patients survey, for them to complete the questionnaire, or for staff to support patients carers to fill in the questionnaire.

According to the trust website the assertive outreach service offers support for people who are experiencing a severe mental illness. The service is accessible to people over the age of 18 who had difficulties accessing community mental health teams in the past and a more intense approach is needed. The team will collaborate with patients and carers to recognise and comprehend their individual needs, assisting them to enhance their strengths and abilities while acknowledging the challenges of their illness. Additionally, the service will offer a sperate assessment and support for carers. The support and care delivered is flexible and tailored to people’s needs and staff will meet people in their homes or other community settings, referrals to this service are made through other Community Mental Health Teams.

The service is based at Swallownest Court, Aughton Road, Rotherham, S26 4TH, however the service will deliver care to people across the brough of Rotherham.

In Rotherham, 16.8% of the population was income-deprived in 2019. Of the 316 local authorities in England, Rotherham is ranked 45th 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 Rotherham assertive outreach were:

  • communication
  • health-related costs
  • navigating and negotiating appointments
  • patient empowerment
  • staff awareness and guidance
  • travel and transport

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

For those using Rotherham assertive outreach services people suggested that they strongly agreed or agreed that the service is a welcoming place. Describing the staff as helpful, friendly, and good at team working, describing the service as exemplary.

  • “NHS couldn’t have done any more than what they have done for me.”
  • “Very helpful.”
  • “Friendly staff.”
  • “The Assertive Outreach team all work well together and do there best to keep patient well and at home and in the community.”
  • “Thanks for getting me through difficult times, I feel that the service I receive is exemplary and second to none.”

People using the service suggested that if they could not afford their care, they felt they could talk to staff about this challenge stating the service is friendly and staff are easy to talk too.

  • “Friendly service easy to contact.”
  • “Talking to staff is easy.”
5.1.1.2 The service can identify poverty

Staff who work in Rotherham assertive outreach reported that the service has ways to identify people who maybe experiencing poverty, of those that identified that the service has ways to identified poverty staff reported the following:

  • “Judgement of staff.”
  • “Financial screening tool.”

5.1.2 Barriers and challenges

5.1.2.1 Identify poverty

Although people who use the service suggested they felt they could talk to staff if they could not afford their care, some people suggested they were unsure, this appeared to be for personal reason, but this could be supported by staff asking about poverty.

  • “I’m not the kind of person to be talking or explaining a lot.”
  • “I haven’t asked before.”

Although staff members reported that the service has ways to identify people who maybe experiencing poverty, two staff members suggested the service does not have a way to identity people who are experiencing poverty.

5.1.2.2 Information

When people who use the service were asked how the service could improve its understanding and support for patients facing financial barriers they suggested:

  • “Support with access to digital interventions (device, data).”
  • “Better communication and outreach.”
  • “Give clear communication about available support.”

When staff members were asked what the barriers to communication are, they reported:

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

When staff were asked the one thing, they could change about their practice to make life better for people experiencing poverty they reported:

  • “More information about the help we can offer.”

5.1.3 Recommendations for communication

5.1.3.1 Identifying poverty
  • Ensure staff have the confidence and knowledge to have a discussion with people who use the service about poverty.
  • It would be helpful if staff asked people who use the service the question during initial assessment and regular reviews.
5.1.3.2 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 Rotherham and District 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.
  • Look to create a resource pack.

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 Cost to patients

Those who access Rotherham assertive outreach service, 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. However, there was also a split in people suggesting they neither agreed of disagreed that cost is affordable.

  • “No extra costs.”
  • “Because the service is free for me, I assume it is free for others too.”
5.2.1.2 Appointments

People who use the service said they did not have to delay or miss an appointment due to financial reason (travel, childcare and prescriptions). The service is flexible in how they offer support to people and deliver care, the service will offer support in peoples home and communities, reducing the hidden cost of health care.

5.2.2 Barriers and challenges

5.2.2.1 Cost to patients

Although those who access Rotherham assertive outreach service, in part suggested they did not have to pay for any items or services as part of their healthcare, it was reported by four people that they sometimes had to pay for items or services as part of their healthcare.
When people who access the service was asked what type of financial support would be most helpful to you, they reported:

  • “Reduced treatment costs.”
  • “Help with prescription costs.”
  • “What’s available and what to avoid.”

When staff were asked what more the service could do to support families on low incomes to take up the care on offer, staff reported:

  • “Provide more financial help.”
  • “Offer discounts or free services.”
5.2.2.2 Appointments

Although people who use the service suggested they did not have to delay or miss appointments due to financial reasons it was reported that this challenge did affect some people, this appeared for appointments in a different part of the health system.

  • “Didn’t have a bus pass plus didn’t have much money for taxi so I missed my 8am appointment for an eye test.”

When staff were asked what they believed were the barriers to patient accessing services their services who maybe experiencing poverty, they reported:

  • “Costs of appointments (time of work, childcare, missed free school meals).”

5.2.3 Recommendations for health related costs

5.2.3.1 Cost of appointments
  • 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.
5.2.3.2 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 (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. A link to the referral form is at the end of this report. Make sure referrals are recorded on SystmOne.

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

5.3.1.1 Appointments

The service offers care and support in peoples home and communities, enabling for a more flexible approach, people using the service will also be nominated a care coordinator or lead person that support people to navigate and negotiate the service. Due to this approach people who use the service should have less challenge with navigating and negotiating appointments.

5.3.2 Barriers and challenges

Although the above, when staff were asked which poverty-related barriers apply to patients accessing your service five staff members suggested:

  • “Complex health systems (difficult to navigate, referrals and appointments).”

It was also reported by people who use the service when asked what could the service improve its understanding and support for patients facing financial barriers?

  • “Easier access to services.”

5.3.3 Recommendations for health related costs

5.3.3.1 Complex 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 use Rotherham assertive outreach service feel that the service will support them if they cannot afford their care.

  • “I feel the team will support me if I needed support with my finances.”
5.4.1.2 Supporting people experiencing poverty

It is evident from the feedback that staff can recognise if patients are experiencing poverty and go above and beyond to support people experiencing poverty challenges.

When staff were asked how well they feel their service supports patients and families in poverty, staff reported:

  • “Really well or well.”

When staff were asked if they feel if there is anything the service does well for patients and families who need additional support due to their income staff answered yes.

  • “We go that extra mile with our patients that have no money for food and heating, sometimes supporting patients from our own pockets.”
  • “Help with accessing food banks.”
  • “Food parcels are available for service users.”
  • “Provide financial support.”

5.4.2 Barriers and challenges

5.4.2.1 Financial support

When patients were asked how the service could improve its understanding and support for patients facing financial barriers, they suggested:

  • “More financial assistance programmes and points of information.”

When staff were asked how the service could improve its understanding and support for patients facing financial barriers they reported:

  • “Improved access to food parcels, support to liaise and contact allied services, support to get a bus pass.”

5.4.3 Recommendations for patient empowerment

5.4.3.1 Financial support
  • 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 the referral form is at the end of this report. Make sure referrals are recorded on SystmOne.
  • Look to see what support can be provided to people where they have little means to pay for food.
  • 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
  • It would be helpful for staff to ensure this information is available in appointments.
  • It would be helpful if the team had a resource pack of information for both staff and patients regarding finance support.

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

5.5.5.1 Staff awareness

There is evidence from the feedback that staff can recognise if patients are experiencing poverty and go above and beyond to support patient experiencing poverty challenges. The evidence suggests that staff will support patients by using their own monies, help people access food banks, providing food parcels and giving financial support.

  • “We go that extra mile with our patients that have no money for food and heating, sometimes supporting patients from our own pockets.”
  • “Help with accessing food banks.”
  • “Food parcels are available for service users.”
  • “Provide financial support.”

5.5.2 Barriers and challenges

When staff were asked if people accessing the service would experience any poverty-related barriers, staff reported:

  • “Health Literacy (understanding of written materials or verbal communication).”

When staff were asked what could better support them to support people accessing their services and experiencing poverty, they reported:

  • “Easier access to what is available in the community.”
  • “Being aware, prioritize and share our information or communication.”
5.5.2.1 Staff poverty

When staff were asked if they believe there is support in their service or trust to support staff experiencing poverty and what may support staff, they suggested:

  • “Better relationships with partner agencies or signposting.”
  • “Easier access to benefits advice or appointments.”

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Additional provision
  • It would be helpful for staff to ensure that they are aware of the information available and have access to this in appointments if needed.
  • It would be helpful if the team had a resource pack of information for both staff and patients regarding finance support.
  • It would be helpful if a member of the team is nominated to gain the information that will support people in poverty, from national and local agencies and community support.
5.5.3.2 Staff awareness

There are several staff initiatives to support staff who may be experiencing poverty, ensure the team are aware of these initiatives and how to access the support.

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 service offers care and support in peoples home and communities, enabling for a more flexible approach, therefore travel cost to access the service should be low.

5.6.2 Barriers and challenges

Although the service offer care and support in people’s homes and communities’ people under the care of the assertive outreach service still reported some difficulties in travel cost.

  • “I can’t get out very far, so I rely on taxi.”
  • “I have had to pay for taxi.”

When people who access Rotherham assertive outreach service were asked what financial support would be most helpful, they suggested:

  • “Help with travel expenses.”

When staff were asked what a barrier maybe for people experiencing poverty and access to their service seven members of staff suggested travel is a barrier.

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.
  • 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 the referral form is at the end of this report. Make sure this is recorded on SystmOne.
  • 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

6 References

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

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