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.
Poverty proofing Rotherham and Doncaster adult neurodiversity
The adult autism spectrum disorder (ASD) service is a small specialist community service. It provides assessments, diagnosis, and interventions to adults in Doncaster who are on the autism spectrum.
The Rotherham adult autism diagnostic service (RAADS) offers diagnostic assessments for autism spectrum disorder to residents aged 18 and above in the Rotherham area.
The diagnostic process involves an initial screening by trained staff to identify and diagnose adults with autism.
Upon receiving an autism diagnosis, patients can attend short-term follow-up sessions to receive assistance with the following:
- adjustment to autism diagnosis
- education around diagnosis
- working with employers and services to make reasonable adjustments
- sensory assessment
- signposting to services that offer further support
The service offers advice and support to patients and their families to improve long-term mental and physical wellbeing. This involves developing a better understanding of the diagnosis to help patients manage their emotions upon receiving it in adulthood.
Colleagues provide advice on coping strategies and techniques to help overcome challenges and manage the impact of autism on daily life.
They connect patients to various mainstream services, offer guidance to professionals, and support positive outcomes for people with autism.
These services include phone and email support, home visits, and clinic appointments.
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.
Voice
The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.
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.
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?
Poverty proofing process
Stage 1: training and consultation with staff
0 staff completed a 3-hour training session.
Stage 2: scoping
Time was spent gathering information about the setting and how it works. Verbal consultations were held with 7 staff, and 2 colleagues responded via survey.
Stage 3: patient and community consultations
We spoke to 6 people in total.
Stage 4: feedback session
The feedback is yet to be arranged at the time of writing this report.
Stage 5: review
Around 6 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward.
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 and Doncaster adult neurodiversity were:
- communication
- health-related costs
- staff awareness and guidance
- travel
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.
What works
A welcoming service
Staff communication was described by patients as caring and approachable; the staff are generally welcoming. The setting itself was thought to be quite clinical but not overcrowded, which patients were appreciative of.
“The staff are welcoming. The setting itself is quite clinical, but it needs to be.” (colleague)
“I don’t like going places where there are lots of people and waiting, that’s not usually the case here.” (colleague)
Patient appointments
Colleagues from within the service reported that patients routinely receive appointment reminders via text as standard or telephone call (if necessary). These reminders are very important as they help to reduce missed appointments, minimise the stress on patients and save NHS resources. Many patients miss appointments simply because they forgot the date or time, and evidence suggests that reminders significantly lower did not attend (DNA) and was not brough (WNB) rates.
“Clients get appointment text reminders (at time of booking and day before). If people have struggled with attendance (for example, due to executive functioning difficulties), staff will call them to remind them (pre-arranged with clients).” (colleague)
Report language
Staff report a good awareness amongst the workforce about the need for accessible language both verbally, and within important documents such as diagnostic reports.
A well-written, accessible report supports people with neurodiversity, families, carers and other healthcare professionals clearly understand assessment outcomes and support needs. When reports are difficult to read, overly clinical, or inaccessibly, patients may struggle to use the information to access care, benefit entitlements or workplace adjustments.
Colleagues report having completed a piece of work with peer support workers to get some feedback on what patients would like to see in their reports (language and content). This type of positive, proactive action helps patients to participate in their care.
“We are good with reports, staff try to make them as accessible as possible.” (colleague)
“Reports are neuroaffirmative. If we have to use more jargony words, they include paragraphs to describe meaning.” (colleague)
Barriers and challenges
Automated texts
When you don’t have money, every unnecessary journey or mistake has a cost. When appointments are given, there is often insufficient detail provided. Patients might not know who the appointment is with or where it will take place. At the very least, this means having to contact the service to clarify the missing information, which may prove difficult for some.
“It would be better if reminder texts were automated, this isn’t happening on the new S1 unit and has to be done manually. It’s quite a general message and doesn’t necessarily have the correct number or location details.” (colleague)
Recommendations for communication
Automated texts
- Mandate a minimum‑information standard for all appointment messages, to include: name of worker, address and postcode, room or venue, appointment type (for example, phone, video or in‑person), service name and a contact number for queries.
- Add a clear action line in every message (for example, “If you cannot attend, text or call this number”).
- Ensure all appointment correspondence is written in plain English and is clearly set out, with only essential information included.
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.
What works
It was very positive to note both staff and patients agreed that there are minimal or no healthcare costs related to accessing care within this service. The absence of direct and indirect healthcare costs has major effects on patients and public health generally. No health-related costs can improve access to treatment, reduce inequality and support better long-term health outcomes.
Where staff make suggestions about initiatives or products which may support a person’s treatment, they typically try to find ways around the patient having to spend money. This might include loaning equipment or covering the cost.
“We make recommendations for sensory tools but no obligations to buy (have loaned them occasionally).” (colleague)
“We have sensory equipment that clients can try and we talk to clients about ways of getting equipment cheaper.” (colleague)
Barriers and challenges
Loss of income to attend appointments
One patient described the loss of income to attend groups and appointments, due to being self-employed. The financial burden of engaging with treatment, attending appointments, and participating in recovery activities is significant, especially for those struggling financially. What might be small, practical issues for others, are major obstacles when money is scarce.
“I’m self-employed and have to take time off work to attend appointments.” (patient)
Recommendations for health related costs
Loss of income to attend appointments
- Expand scheduling to put on appointments early mornings, lunchtimes, evenings and weekends, for those unable to miss work to attend.
- Offer more remote or hybrid attendance options (phone or video) where clinically appropriate, to reduce need for unpaid leave. This might also include exploring the option of utilising community venues (lists are available on trust intranet with varying costs).
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.
What works
Support offered by colleagues
Some staff do ask questions around clients’ financial and benefit needs. While this is not consistent across the service, where it is happening, it will really make a difference for people in poverty.
“Conversations about finances aren’t explicit, but staff do ask about patient’s current situations, for example, housing or unemployment. Autistic clients may need more explicit questions.” (colleague)
Signposting knowledge
The majority of colleagues within the service do know what is available, but there are some who do not (see below). Staff are aware they can signpost to Citizen’s Advice, Speak Up, Clover Leaf Advocacy, Absolute Advocacy. Colleagues are keen to know of other local services that can assist with finances.
Barriers and challenges
Inconsistent financial support
The stigma and shame of poverty means that people experiencing it are unlikely to ask for help. Instead, they will often cover it up, so as not to let anyone know they are struggling. Therefore, it is crucial that services create a safe trusting space to be able to initiate conversations with clients about their circumstances and any difficulties they may have in being able to access the care and support they need.
“We don’t routinely ask about financial situations, but we can work with people on this.” (colleague)
It is important to recognise that while very few staff members will have comprehensive knowledge of financial support and benefit advice, the questions should still be asked, universally and routinely of everyone, to identify where extra support is required. Those with the expertise can then work alongside the identified client to support and guide them.
“I’m unsure where to signpost other than the council.” (colleague)
Services need to provide fair, consistent, proactive support, otherwise the result will be some clients accessing entitlements and others being left behind, which reinforces inequalities.
Recommendations for staff awareness and guidance
Inconsistent financial support
- Normalise financial conversations for all patients at initial assessment.
- Embed Citizens Advice within the service and ensure it is being fully utilised.
- Consider creating a support checklist, to ensure all clients get access to the same support.
- Continue having financial conversations with clients at various touchpoints along their journey.
- Develop clear, mapped referral pathways so staff know exactly where to direct patients.
- Use warm handovers (for example, introducing the patient directly to a partner service) rather than just signposting.
- Ensure follow-up so patients don’t fall through gaps between services.
- Ensure conversations are logged on SystmOne.
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.
What works
Staff have built relationships with alternative venues
Travel is undoubtedly a substantial barrier for people in poverty being able to access treatment and support in the service. What shines through however, is that staff have built relationships with local GPs to be able to access spare rooms for free. This is not based on a fixed contract or any type of permanent arrangement and relies solely on the goodwill of the surgeries to offer this.
Barriers and challenges
Unaffordable travel costs
The cost of travelling to appointments is prohibitive for many, with potentially devastating results. This barrier typically affects people on low incomes, those with disabilities, rural communities, and those requiring frequent hospital visits.
“One client walked to the appointment for 45 minutes in the snow because she had no money.” (colleague)
“Staff have noticed that some clients have struggled to get to appointments in the last couple of weeks before they get paid, due to not being able to afford the travel.” (colleague)
The trust have implemented a travel scheme, whereby patients can access a bus pass free of charge. There is no criteria for accessing these passes, but colleagues will need to be aware to ensure the bus passes are received by the patient in good time in the lead up to their appointment.
The challenges of using public transport
Some clients described the challenge of needing to get the train and, or multiple buses. Public transport is particularly unreliable for those living in rural areas. Travelling far distances requires money, time, and emotional and physical energy. These resources are lowest in people experiencing poverty, and in those who are in the early stages of recovery. In addition, multiple bus changes add cost, risk, and complexity, especially for those with the least financial resource.
“Doncaster base is not in town so some patients have to get two buses to get there.” (colleague)
Recommendations for travel
Unaffordable travel costs
- Ensure patients who are struggling to attend their appointments due to travel costs receive an trust bus pass free of charge. Information on how to process these requests can be found on the intranet.
- Explore partnerships with community transport schemes or voluntary sector organisations
The challenges of using public transport
- Continue to build partnerships in local areas so that more community venues can be found.
- Meet more patients nearer to their houses using community venues.
- Consider any barriers or risks to providing home visits, and how these can be effectively mitigated.
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.
Page last reviewed: June 02, 2026
Next review due: June 02, 2027
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