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 perinatal mental health
The perinatal mental health service extends specialised assessment and treatment to mothers, birthing parents, and their families.
The service operates in partnership between the trust and Light, a local perinatal peer support charity.
It is estimated that 1 in 5 women will experience a diagnosable mental health issue before, during and after pregnancy, which is also known as the perinatal period. That’s where the trust can help.
The trust offers confidential and non-judgmental care and treatment to women and birthing parents experiencing mental health challenges. This includes those planning to have a baby, currently pregnant, or who have given birth within the past 12 months.
Everyone the service sees is unique and experiences different things. That’s why what the trust offers is tailored to meet each person’s individual needs.
Some of the services the service offer include:
Pre-conception advice
If a person is managing an ongoing mental health problem and thinking about having a baby, the service can offer a range of advice. At this one-off appointment, the team will discuss current care, risks, treatment and medication.
Specialist mental health assessment
Specialists have a detailed conversation about all aspects of current needs and previous history. The appointment will take place in a place where the patient feels most comfortable, whether that’s at home, in one of our clinics or anywhere else they choose.
Interventions and treatments
The service offers a range of interventions and treatments including, mental health birth care planning, baby massage and other parent infant interventions, video interaction guidance, psychology, medication management, diagnostic review and emotional support.
Peer support
The trust attends and support peer support groups, with LIGHT, which gives people the opportunity to meet other parents and babies, share stories and support each other through your recovery. LIGHT offers a range of support so if a group setting isn’t suitable, they can still help.
Access to a team of specialists
To help during recovery, a person can access care from a variety of specialists, including psychologists, psychiatrists, nurses, social workers, occupational therapists, parent infant specialists, nursery nurses and support workers.
General advice and signposting
The trust offers advice for referrers and to anyone seeking support. They work closely with GPs, maternity services, health visitors, mother and baby units, family hubs and other mental health services. They can signpost a person to relevant services who might be better placed to offer help.
Non-urgent advice: how to get help
To access services, a referral must be made by a health or social care professional working in Rotherham or Doncaster. This referral could come from a GP, community mental health team, midwife, or health visitor.
The service is available to women and birthing parents who:
- are planning to try and have a baby
- are pregnant
- have a child less than 12 months old
And who also:
- have previously been diagnosed with a moderate to severe mental health problem
- might be developing a moderate to severe mental health problem
- have experienced previous trauma
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
7 staff completed a three-hour training session. 33 staff were consulted with via a survey.
Stage 2: scoping
Time was spent by members of the locally trained team gathering information about the setting and how it works. This stage included conversations with staff and management, observing interactions and reviewing key areas such as the website and communications.
Stage 3: patient and community consultations
We spoke to 11 people in total.
There has been good engagement from staff and patients within the service during the poverty proofing audit, which means the report and recommendations truly represent the position of the service when it comes to dealing with financial concerns.
Stage 4: feedback session
A feedback session will be offered, where we will discuss our findings and collaboratively consider various changes that could be implemented. These findings will be fed into the bigger piece of work across the whole trust. This report is based on our findings.
Stage 5: review
Around 12 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
We have also taken some feedback from Care Opinion to support the service in their continuous improvement:
“I have felt supported and looked after in more than just my mental health and not just me but they have both shown interest in my children and interacting with them.”
“I felt genuinely listened to and understood.”
“The service isn’t mentioned to expecting mums so I had no idea it existed until I was really struggling.”
“The service should be offered to mums until they feel ready and confident, the 12-month cap isn’t helpful if you are just getting into the swing of things it disrupts all the progress made.”
The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Rotherham and Doncaster perinatal mental health were:
- health-related costs
- navigating and negotiating appointments
- staff awareness and guidance
- travel
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
Health-related costs
During consultations, patients praised the service for being readily available and free of charge. In fact, 100% of patients involved in consultations were unable to list any healthcare-related costs at all which is a fantastic result for all involved. Having no healthcare-related costs reduces financial stress and allows patients to focus on their well-being rather than worrying about medical bills. This makes preventative care more possible as patients are less likely to delay or avoid appointments because of financial concerns.
“The service they provided is free of charge. The help and support they offer is all strictly free!” (patient)
Patients were also very complimentary towards the staff when it comes to financial support:
“They don’t judge, they listen and offer help and support to benefit yourself.” (patient)
Recommendations for health related costs
There are no recommendations for this theme for perinatal mental health across both Rotherham and Doncaster.
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.”
What works
Accommodating patients with parental responsibilities
Given the nature of the service, the patient cohort have parental responsibilities which means it is not always easy for them to attend face-to-face appointments. Patients may struggle to take their children to appointments, find alternative childcare or work around school times and it is imperative that the service acknowledges these barriers to access.
Thankfully, the service is able to offer a wide range of different appointments to cater to the needs of the patients. Colleagues will offer home visits or virtual appointments which means that patients are not faced with difficult juggling decisions and “did not attend” rates should theoretically be lower than services which do not or cannot offer these adjustments.
“Staff visit patients at their home address.” (patient)
“Face to face appointments or over teams or they can come to you instead.” (patient)
Barriers and challenges
Communication around appointment flexibility
During the audit process, it was evident that there is good flexibility around appointments for patients, with various appointment options for them to select from if needed. However, it seems that not all patients are aware of these:
“Having the option of video and telephone appointments would be more beneficial to fit around work commitments.” (patient)
Some patients were asking for more options during consultations, which means that there likely needs to be improved communication around what options are available to them from of the onset.
Recommendations for navigating and negotiating appointments
Communication around appointment flexibility
The service should look to improve communications about what appointment options are available to patients, right from the point of referral into the pathway. The options are already there, but it seems not all patients are aware, and many may not feel empowered enough to ask for adaptations.
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
Some colleagues are having financial discussions with patients
Generally, most staff try to enquire about a person’s financial wellbeing when they initially enter the service.
“Optional screening, it’s a question on a pre-registration form.” (colleague)
“We undertake an assessment on entry into the service” (colleague)
While there are evidently some gaps, there are some good foundations around having financial conversations for colleagues to build upon. If some staff are already doing this as part of their routine, it is likely possible for all colleagues to be engaging in this dialogue with the patients on their caseload.
Barriers and challenges
Financial questions not asked routinely and universally
While some colleagues do make a conscious effort to speak to patients, this is not a routine and universal offer. This means that some patients may slip through the net and, therefore, are not made aware of additional support available to them. From a poverty perspective, asking everyone about their financial circumstances or difficulties in a tactful and sensitive way, will help to remove the stigma or the feeling of being singled out. A person experiencing the stigma and shame of poverty is highly unlikely to ask for help, so it falls on the service to create a “safe space” and ask the right questions in order to help ensure that support is given where it is needed.
About 65% of patients said that they have been asked about their financial wellbeing during their time in the perinatal mental health service.
During staff consultations, only 1 colleague felt that the service had a robust method of screening patients for markers of poverty.
A need for improved staff awareness about support available
During staff consultations, it was evident that there are a number of colleagues who feel unequipped to support patients facing financial difficulties. Around 40% of colleagues indicated that they would like to know more about what is available.
While it is positive that colleagues are aware of the gaps within the service, there are already initiatives across the trust which the perinatal mental health service is potentially not utilising. At the time of writing this report, uptake for Citizens Advice across Doncaster Mental Health Care Group is lower than other care groups within the trust. This offering can provide support to patients where colleagues cannot.
“Support with ensuring in receipt of benefits and accessing all available.” (colleague)
“Supporting with applying for benefits or bill exemptions.” (colleague)
Recommendations for staff awareness and guidance
Financial questions not asked routinely and universally
- Develop a “script” for engaging all patients in a conversation about their financial circumstances. Tailor this to the context of rehabilitation and going home.
- Embed financial wellbeing questions into routine assessments, so conversations happen consistently rather than opportunistically.
- Normalise financial conversations, framing them as a standard part of holistic care to reduce stigma for patients.
- Empower staff with poverty proofing training, which is bookable via the staff portal.
- Empower staff to attend the new “Having Financial Conversations” training which will be delivered by Children North East on learning half days starting this summer. These sessions will be bookable via the staff portal.
A need for improved staff awareness about support available
- Colleagues do not need to have the answer to everything, but they do need to be able to signpost appropriately.
- Colleagues should look to utilise the trust Citizens Advice scheme for any patient who has expressed concerns about money, food, transport or bills. Referrals can be made via the staff intranet page.
- Colleagues should familiarise themselves with the trust Travel Scheme process, which patients can access free bus passes to attend their appointment.
- The service should develop a bank of resources which are specific to their service, and they can quickly refer to if needed.
Travel
For inpatients on the wards, travel difficulties are generally related to the ability of their friends and family to visit, rather than the patient themselves travelling. Any travel required by the patient will be arranged by the hospital, for example, to and from 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. The costs incurred through travel can mean the difference between receiving regular visitors or none at all.
What works
Home visits
The services visits patients in their homes and, due to this, many patients do not incur travel cost. It is clear that many colleagues are proud of this offering, and are very keen for it to be expanded as much as possible.
“Visiting patients or close to there home to reduce costs.” (colleague)
“I think as a service we do make an effort to be inclusive we offer home appointments and are constantly trying to access communities in which we might not typically see.” (colleague)
Barriers and challenges
A need for improved staff awareness about transport support available
During staff consultations, there were some very specific points raised by colleagues about how it would be useful to have more transport options available to their patient cohort. Staff would like to see more free transport for patients, and possibly funding made available for bus fares. This is something which has repeatedly been raised during poverty proofing audits in other services across the trust which means that it has been brought to the attention of senior colleagues as a consistent barrier to access of services.
“Free transport to and from appointments.” (colleague)
“We should offer a transport service.” (colleague)
“Funding for bus fares.” (colleague)
The points raised by colleagues have now been addressed by the trust at a trust-wide level, so there is no need for any additional interventions at this time (unless the service can specify otherwise). There is an trust Travel Scheme process which is open to all patients (more details about this on the staff intranet) and an trust Citizens Advice service which colleagues can refer patients to. Citizens Advice have dedicated days in Doncaster to be able to support patients with any queries they may have.
Recommendations for travel
A need for improved staff awareness about transport support available
- Colleagues should look to utilise the trust Citizens Advice scheme for any patient who has expressed concerns about money, food, transport or bills. Referrals can be made via the staff intranet page.
- Colleagues should familiarise themselves with the trust Travel Scheme process, which patients can access free bus passes to attend their appointment.
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.
- Disability Living Allowance (DLA) for adults
Page last reviewed: May 29, 2026
Next review due: May 29, 2027
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