Poverty proofing report Rotherham primary care mental health 2024

1. Poverty proofing delivery partner model
2. Poverty proofing Rotherham primary care mental health
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 primary care mental health

The locally trained team engaged with Rotherham Health and wellbeing service during March 2024 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. Limited face-to-face consultations with patients were done for this service by locally trained teams.

The Primary Care Mental Health team delivers mental health support to adults, supporting GPs in addressing mental health concerns within primary care. The service offers support to patients over 18 years of age, with moderate to severe mental health needs.

The focus is on fostering a person-centred approach to both physical and mental health, encompassing consideration of a person’s social care needs.

Assessments of mental health are conducted either face-to-face or by phone. Outcomes may involve:

• guiding and referring a person to other services or organisations
• providing treatment advice
• conducting physical health checks
• offering brief interventions to help manage mental health challenges

The Rotherham primary care integrated mental health hubs, the hubs are aligned to the primary care networks across Rotherham. Referral is primarily done via the primary care mental health practitioners working within Rotherham GP surgeries. Other mental health support services can help with referrals.

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 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 Rotherham primary care mental health 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 primary care mental health service, 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. The patient who did respond to consultation told us they were unsure if they would be willing to tell the service if they were struggling with finances. And, that there should be better training for staff. Some of this is also borne out from what staff told us they think services need to do.

• “People often find it hard to ask for help. Making it easier to access help.”

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. Health Literacy (understanding of written materials or verbal communication) was seen as a barrier by staff. It is important to understand a person’s communication needs and ability, so they know what’s 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 Rotherham and how people can access them.
• Make sure staff are aware that they can refer people for money and debt advice to Citizens Advice Rotherham and District (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, 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.

5.2 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

Whilst the voice of the patient in this audit is limited, the one patient who did respond told us that there should be clear communication about what financial support is available. Overall, we can’t say clearly if there are costs that people have that they may also be entitled to make a claim against but we do know from other audits that this is the case. We were also told by staff more knowledge was needed.

• “Access to transport for patients struggling to attend for appointments. Medications costs, not all get free prescriptions. Better understanding, easier access to support.”

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).
• Refer people to Citizens Advice to see if they are entitled to support with transport costs and attending day centres.

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.”

5.4 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 that to make life better for people experiencing poverty is access to digital devices. Citizens Advice Rotherham and District run a programme on behalf of the integrated care board to help with digital literacy, devices, and data: like the barrier on what financial assistance available, that people may not be aware of. This can also be an opportunity

• “Can do online appointments, reduce time off work or travel costs.”

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 Rotherham and District digital support programme (a link is at the end of this report).

5.4.2.2 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).

5.4.2.3 Advocacy

• Identify advocacy services in Rotherham 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.
• 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 Barriers and challenges

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

Some staff cited examples of where the service supports people experiencing poverty.

• “Training is provided to staff via Teams.”
• “Optional screening, it’s a question on a pre-registration form.”

For others, this is dependent upon judgements of individual staff and wasn’t something that was in place recognised by most. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.

5.5.1.2 Staff awareness of what is available or what to do

A number of staff said they or their colleagues may be unaware of what is available or how they can help someone experiencing poverty. This means that people may be losing out to support that they need or are entitled to.

• “Ask at initial screening questions in first appointments to establish if they need any support pr have any financial barriers which may impact engagement with service, so we can have context in mind throughout their care.”
• “More clear guidance on appropriate signposting or what’s available.”

5.5.2 Recommendations for staff awareness and guidance

5.5.2.1 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.

5.5.2.2 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 Rotherham and how people can access them.

5.5.2.3 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.

5.6.1 Barriers and challenges

5.6.1.1 Help with travel costs

Staff told us that the cost of travel and transport (costs of travel and parking) have been a barrier to people accessing the service. The patient also told us something they would like to see is:

• “Help with travel expenses.”
• “Free transport, more locations for patients to access hubs, or sites.” (staff)

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.

5.6.2.2 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.

5.6.2.3 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.

5.6.2.4 Home visits

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

5.6.2.5 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

• O’Dowd, A. (2020) Poverty status is linked to worse quality of care.
• Fenney, D. and Buck, D. (2021), The King’s Fund, The NHS’s role in tackling poverty: Awareness, action and advocacy.
• 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.
• Help with health cost
• Citizens Advice Rotherham digital inclusion support
• Rotherham carers offer
• Citizens Advice Rotherham referral form