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 Rotherham inpatient
The Poverty Proofing audit for Rotherham Inpatient Wards (to include Sandpiper, Brambles, Glade, Kingfisher and Osprey) began in January 2025 in order to better understand the experiences of families and individuals who are living in poverty.
The work was carried out in partnership with staff, families and adults to build up a rich picture of the barriers and challenges faced by those accessing Rotherham inpatient services.
2.1 Sandpiper and Osprey
The Sandpiper and Osprey wards are located within the Swallownest court, offering care and treatment through a multi-disciplinary approach that includes medical, nursing, occupational therapy, and psychology services. Both wards provide sectorised beds for patients aged 16 to 65 years old.
2.2 Kingfisher
The Kingfisher psychiatric intensive care unit, situated at Swallownest court, offers intensive care beds for patients facing high-risk acute mental health problems, necessitating temporary and intensive interventions.
The Kingfisher psychiatric intensive care unit also conducts assessments for patients detained under section 136 by the police.
2.3 Glade and Brambles
The older people’s mental health inpatient services cater to adults aged over 65 facing functional mental illnesses.
The Glade ward is focused on assessment and treatment for patients experiencing memory issues or dementia.
The Brambles ward aims to enhance the overall wellbeing of patients accessing the older people’s mental health services at the Woodlands. Since the audit, the Brambles ward is now closed, but the information has been included pending a merger.
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, where 1 is the most income-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 they can’t tap into. 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 inpatient services were:
- communication
- health-related costs
- patient empowerment
- staff awareness and guidance
5.1 Communication
5.1.1 What works
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.
5.1.2 Barriers and challenges
5.1.2.1 The service is welcoming
Those using any of the Rotherham inpatient services said that their communications have always been positive. The staff are always kind and helpful, and they really value the service that they receive.
- “Communication is great.”
- “Whenever I have a question, it is answered quite well.”
5.1.3 Recommendations for communication
5.1.3.1 Translation services are problematic
In some cases, the patients require the use of translation services when discussing their condition and treatment with clinicians. However, it has been noted that the current service is often inaccessible, and often family members have to step in to interpret on behalf of the patient. There are a number of issues with this including; confidentiality and accuracy of translation where medical terms are not easily understood.
- “Family members sometimes have to translate for us.”
5.1.3.2 Telephone calls to the wards
Patients, families and carers have mentioned that contacting the wards via telephone can be particularly difficult, with many calls going unanswered. Relatives and carers often resort to making the trip to the wards as they are unable to find out the condition of their relative via phone call.
- “Sometimes I’ve had to resort to trying several times until someone answers.”
- “I have tried calling the ward at one point and there was no answer for a long time, and I gave up.”
- “If there was an option to leave a message to request a call back that would be great.”
For those patients who do have phones, they have made a number of comments about poor phone reception in ward areas.
- “Sometimes I hardly have signal on my phone which results in missing a lot of call from family, friends.”
5.1.3 Recommendations for communication
5.1.3.1 Translation services
This is a consistent theme across the Poverty Proofing audit, and the trust should consider procuring a more reliable approach which is more appropriate for patients and staff.
5.1.3.2 Message system
The wards should consider a voicemail or messaging system so that relatives and carers can request a call back if telephones cannot be answered by staff.
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
For the most part, patients do not incur many costs in relation to their condition while they are a patient on the Rotherham wards. They are able to access the majority of necessities during their stay, with little need for additional funds.
5.2.2 Barriers and challenges
5.2.2.1 Discrepancies around incontinence pads
Patients have preferences around the types of incontinence pads. If they wish to have pull-up style protection, then this is not available on the NHS. Only the standard pads (of varying sizes) are available on prescription.
- “I like specific pull-up pants.”
5.2.2.2 Flourish café and access to food
There are a number of issues around accessing food and snacks while staying at any of wards in Rotherham. At Woodlands, the only option is Flourish Café which many think is extremely expensive and it does not do hot meals, only sandwiches, snacks, cake and drinks.
Additionally, Flourish is only open Monday to Thursday from 10am until 3pm, so there is no café provision in the evenings or weekends for staff or relatives.
At Swallownest, there is no café provision, but there are vending machines available; however, this is thought to be very expensive also.
- “At Swallownest, the price of items in the vending machines is shocking.”
It has been noted that there is a lot of food waste from the wards and it would be preferable to save food where possible, or give it away for free as opposed to throwing it away.
- “It is painful to be putting food in the bin knowing that there maybe somebody who would have enjoyed having it to eat.”
5.2.2.3 Toiletries and other provisions
When admitted, some patients do not have anything with them apart from the clothes on their body. It is good to see that the ward has some basic supplies which they can utilise (often left-over raffle prizes or things staff bring in from home); however, there is no budget to purchase back up supplies for patients who need them.
- “It would be great to offer patients an admission wellbeing pack with some basic supplies to tide them over until family can bring things in for them.”
- “Having new underwear and clean pyjamas would make a huge difference.
- “Sometimes it can take a few days for staff to be available to get the chance to go out to the shops to get some treats for ourselves or even something as crucial as sanitary pads.”
- “They do supply sanitary products on the wards but have often run out and waiting for a delivery.”
5.2.2.4 Parking
For the Woodlands site, many visitors and staff are particularly concerned at the lack of parking and this means that some families and carers feel nervous about visiting. Visitors also comment on the absence of electric charging points.
- “Parking is a nightmare.”
- “I have to drive around for ages until I find a parking space, and sometimes I worry about getting a ticket when I’ve left my car in an inconvenient place.”
5.2.3 Recommendations for health related costs
5.2.3.1 Discrepancies around incontinence pads
Information around incontinence pads to be made clear, including why pull-ups are not advised. Patients to continue to have their incontinence needs routinely reviewed, including for those who have not been deemed incontinent in the recent past.
5.2.3.2 Parking
Electric charging points to be installed to ensure those with electric vehicles are able to charge when needed without worry.
5.2.3.3 Toiletries and other provisions
It would be ideal to have a trust pantry (much like we do for staff) that colleagues are able to collect from to distribute to patients, particularly for those patients who have minimal external support. This would mean speedier access to necessities and ensure staff are not purchasing supplies out their own money.
5.2.3.4 Café and food provision
As part of a wider piece of work, the trust needs to think about food provision which offers value for money to patients, staff and visitors. There should be a warm, nutritious offering which is available beyond current café opening hours.
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
Comfortable in asking for help.
The vast majority of patients feel as though they could ask staff for a discussion around finances if they needed it, and some have been successful in getting help from trust colleagues.
- “Occupational therapist have been great in making sure that adjustments had been put in place to my home prior to discharge which was for a shower chair and handrail.”
5.3.2 Barriers and challenges
5.3.2.1 Food deliveries
The wards in Rotherham have seen a rapid increase in patients ordering food deliveries to the wards in and out of hours. It is suspected that there are a number of reasons for this:
- Ward food is not a modern menu, it’s not what patients are used to eating and they do not enjoy the meals.
- The portion sizes are too small, many patients are on medication which increases their appetite.
- Patients expect to be able to order food in when they want to, and it is their right to do so.
- “Sometimes you can use Deliveroo, but this is not always reliable as the deliveries are left at reception and if you do not have anyone to take you to go collect it you get your food and it’s cold.”
- “If there was a way that reception could communicate with the wards to let them know our deliveries have arrived.”
- “It’s unfair to patients who cannot afford to order food in to supplement the ward menu.”
5.3.2.1 Staff awareness
Patients are keen for the services to engage with additional learning about how they might better be able to support those in their care. This is something which would evidently be mutually beneficial for all.
When asked about what the service does to support those facing financial hardship, some staff said they felt “unsure” about what the service does, and some staff said they would benefit from some kind of training. Better staff awareness would empower patients to better support themselves.
- “I would like to know more about what is available, particularly ready for when we discharge patients.”
5.3.3 Recommendations for patient empowerment
5.3.3.1 Providing information to patients which they might not otherwise have access to
Patients would like to know what is available to them as they are not always able to find out themselves. This could include charities, food banks and benefits.
5.3.3.2 Food provision
As mentioned previously, the trust must urgently review the food provision in the wards to ensure healthy, filling meals for patients which are modern and enjoyable. The trust should engage with patients to ensure any new menus are suitable and patients can look forward to their meals without relying on fast food deliveries.
5.3.3.3 Staff awareness
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.
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 Additional provisions
The service is very good at identifying where patients need provisions and, in some cases, purchasing it on their behalf; however, this is reliant on the good nature of the workforce as opposed to being part of policy. Staff may sometimes need to take time out of their day to buy some supplies for a patient and will sometimes purchase it out of their own money.
- “We bring items from home for patients.”
5.4.2 Barriers and challenges
5.4.2.1 Staff awareness
Supplementary to the section above were patients expressed a desire for staff to be able to supply information, the staff themselves were also keen to engage with additional learning about how they might better be able to support those in their care. This is something which would evidently be mutually beneficial for all.
- “Patients are often discharged with worries about money, and it would be great to know how to help them.”
5.4.3 Recommendations for staff awareness and guidance
5.4.3.1 Food provision
It would be ideal to have a trust pantry (much like we do for staff) that colleagues are able to collect from to distribute to patients, particularly for those housebound patients who have minimal support.
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.
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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