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Poverty proofing Rotherham acute and urgent mental health 2025

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 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 patients 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 patients 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 Rotherham acute and urgent mental health

The locally trained team engaged with Rotherham acute mental health services during July and September 2025, in order to understand the experiences of people and families who are living in poverty.

The work was carried out with staff to build up a rich picture of the challenges and barriers faced by those accessing or attempting to receive mental health services in Rotherham. Staff in the service also looked to get the voice of people who use the service as well.
Acute and urgent mental health services in Rotherham are provided for people across a different range of types and settings. This includes:

  • crisis: crisis service is for an individual or someone they know who is experiencing a mental health crisis, feeling suicidal or in need of urgent support to keep them safe
  • home treatment: home treatment service offers short-term assistance for individuals needing extra support in managing their mental health requirements
  • hospital liaison: offer mental health assessments for individuals aged 16 and above, either in the accident and emergency department or on inpatient wards typically in physical health acute settings
  • safer neighbourhoods and Partnership: the Safer neighbourhood and partnerships worker conducts initial assessments, represents at multi-agency management meetings, provides and receives intelligence

Some services are clinic or hospital based, others are based upon visiting the person in their home.

People can self-refer, and healthcare professionals can also refer into the service.

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

6 Staff attended 3-hour training between July and September 2025. We also received 19 survey responses from 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 did not receive feedback from people who use the service. It was agreed at the start of the audit that we would not ask people who are in crisis. The service did ask other people who use the service, but they did not want to answer questions.

4.4 Stage 4: feedback session

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

4.5 Stage 5: review

Around 6 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward. This will be part of the trust’s poverty proofing community of practice.

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 acute and urgent mental health were:

  • communication
  • health-related costs
  • navigating and negotiating appointments
  • people 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 Barriers and challenges

Through the Rotherham acute and urgent services themselves, we have sought the views and experience of poverty from patients and carers. It was agreed that it would be inappropriate to ask people in crisis when their mental health support was the immediate priority. The service felt that they were best placed to ask other people who use the service that weren’t in crisis, rather than the locally trained team, due to the needs of the people. Unfortunately, we have not been able to do so, despite best efforts. Therefore, the direct voices of the people 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 and further training that will be provided by Children North East. Having financial conversations is important to understanding the quality of life people are experiencing, which can also impact their mental health.

The language we use may mean some people don’t understand what is being asked of them, or what 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. For example, staff said that the written communication might not be appropriate in terms of a person’s reading age or clear for people to understand. It is important to understand a person’s communication needs and ability, so they know what is available and what treatment they will receive.

“We sometimes get older people ringing up saying we’re not sure what it means.”

5.1.1.2 Interpreters

In some cases, people using the service require the use of an 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 and not available.

“We have Language Line… but at night there’s barely anybody around.”

“It’s hard enough with an interpreter because it’s a 3-way conversation… we’ve just not been able to get an interpreter and had to discharge them home.”

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.
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.
5.1.2.3 Interpreting services
  • This is a consistent theme across the poverty proofing audit, 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.

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 Paying for prescription costs can be difficult for people

Staff told us that the costs of prescriptions for patients can be difficult to meet. In addition, due to the nature of the condition of people they may also forget to collect prescriptions as part of their treatment. The trust’s pharmacy does deliver prescriptions when someone is in treatment, but after they are discharged the person needs to arrange this themselves. Whilst staff told us that they had knowledge of help with prescription costs, it was unclear how this was communicated to people.

“Most staff will know about prescription pre-payment certificates, so they should be telling patients that.”

5.2.2 Recommendations for health related costs

5.2.2.1 Paying for prescription costs can be difficult for people
  • 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.
  • Consider including information in discharge letters.
5.2.2.2 People not collecting prescriptions post-discharge

Look to partner with local pharmacies to support those at risk of not collecting medication.

5.3 Navigating and negotiating appointments

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.”

As most people who use these services need to be seen immediately, the service is not delivered in what could be called an “NHS appointments” way as other services are. This is more likely to take place when people are discharged from this service to, for example, community teams for ongoing support.

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 navigating and negotiating appointments

5.3.2.1 Complexity of 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 in the pathway, 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 People 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 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 is available, people may not be aware of this opportunity.

5.4.1.2 Access to food

A number of staff told us that people being able to afford to pay for food was a real challenge. Whilst staff might make arrangements for people to get food, this still remained a problem which can impact upon a person’s recovery.

“Funds to support with food parcels.”

“Help with food banks…”

5.4.1.3 Access to housing

A number of staff told us that a barrier people faced was housing or being homeless. Links between health and having somewhere to live is an important part of a person’s recovery. People who accessed the service often had problems with housing or somewhere to live, and support was limited (especially out of hours).

“We have that pretty much every day. Most of our client base is struggling with accommodation.”

“Out of hours, it’s the homelessness team… but we are very limited in what we can signpost to.”

“Older people are often referred through to the Integrated Discharge team.”

5.4.2 Recommendations for people empowerment

5.4.2.1 Access to digital devices
  • 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 Access to housing
  • Look at the current arrangements for working with housing providers for people who are homeless or have other housing problems.
  • Plan to improve or address any gaps in arrangements.
5.4.2.3 Access to food
  • Work with other organisations to establish referrals to foodbanks.
  • Look to develop food cupboards, to support people who may be struggling with paying for food.
  • Refer people to Citizens Advice Rotherham and District for support (a link is at the end of this report).

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 There are some clear examples how services support people experiencing poverty

Staff told us of a range of ways their service identified people who may be experiencing poverty. This then led to action being taken to support people. Here are some of the examples.

“Offer access to food parcels and drinks.”

“Support from the wards to provide emergency food.”

“Support worker to help patients with benefits et cetera…”

“We offer food parcels and drop off. We offer taxis to and from appointments when required. We liaise with other services if required.”

“Formal financial screening tools that are routinely carried out.”

5.5.2 Barriers and challenges

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

Whilst the above paragraph shows structured ways to support people, with staff citing examples of where the service supports people experiencing poverty, this can be dependent upon judgements of other individual staff or verbal screening. The response to the staff survey is also mixed: around half the staff think there is a way their service can identify someone in poverty, whereas the other half don’t think there is. This means the support people receive may depend upon the member of staff the person sees, rather than a consistent offer being made.

“More awareness of how that could affect people living in care homes.”

“I would like a better understanding of the interplay between poverty and the social care system in supporting people who live with dementia.”

5.5.2.2 Staff awareness of what is available in the community

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. The person who responded to the consultation was also unsure what we could do.

“Greater awareness and increased provisions in Rotherham. Organisations that provide support, for example, Aspire, floating support and council.”

5.5.2.3 Staff awareness of what is available in the trust

In April 2025, the trust introduced a referral process so that people can get money and debt advice from Citizens Advice Rotherham and District. Staff were not aware that this service was in place, and that they could refer directly rather than have to ‘signpost’ people to such advice.

“More access to services that can support patients.”

“Allow direct referrals to Citizens Advice Bureau or financial services instead of relying on self-referral.”

“We can only signpost.”

“We can only signpost to people that have disclosed financial difficulties… it’s different for every assessment.”

“At the minute the Citizens Advice Bureau is just self-referral, you have to self-contact.”

“If we had someone in A&E who could advise on finance or housing, that would be helpful.”

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
      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 foodbanks on what is available in Rotherham and how people can access them.
5.5.3.2 Access to benefits and debt advice
  • Refer people to Citizens Advice Rotherham and district Doncaster for an income or benefits check, a link is provided at the end of this report.
  • Hold an awareness session with staff on how to access this service for people.

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 Cost of travel

We were told by many staff that the cost of travel has been a barrier to people accessing the service. Staff also told us access to transport would be a help for people as well. People struggled to pay the bus fare, petrol or taxis. Staff weren’t aware of travel re-imbursement schemes. In some cases, staff paid for travel themselves out of goodwill.

“Quite often we’ll pay for the taxi.”

“We normally pay for people… if they can’t get themselves home and have no means to do so.”

“I know there is an NHS travel reimbursement scheme… but quite a lot of people within the trust weren’t even aware that we had that.”

“Me personally, no, I’m not sure about everybody else.” (staff response on travel reimbursement)

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 agreed 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 Community appointments

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

5.6.2.6 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: December 11, 2025
Next review due: December 11, 2026

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