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 community mental health
The locally trained team engaged with Rotherham Community Mental Health team during March 2026 and April 2026 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 face by those accessing or attempting to receive mental health services in Rotherham.
The Rotherham Community Mental Health team is split into two locality teams: North Locality team, based at Ferham Clinic and South Locality team, based at Swallownest Court. The team provides assessment, intervention and treatments for people experiencing complex mental health difficulties which significantly impact their daily life. This may include complex emotional needs, anxiety and mood disorders, complex trauma, psychosis and other severe and enduring mental health conditions.
The team includes a skill mix of psychiatrists, psychologists, social workers, nurses, occupational therapists and peer support specialists who work collaboratively to address the mental health needs of the community.
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.
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
9 staff attended poverty proofing training. We received 20 responses from staff.
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
19 people who use the service provided feedback. Patient attending for an appointment were asked to complete at online survey.
Stage 4: feedback session
The report was shared with the Service Manager, Lindsey Watson to 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
The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Rotherham community mental health were:
- communication
- health-related costs
- navigating and negotiating appointments
- patient empowerment
- 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
Through the locally trained team and the locality team administration team we have sought the views and experience of poverty from staff, patients and carers. On the whole patients were very complementary about the service stating that staff were “friendly, polite and helpful”.
Patient’s commented that
“Everyone is willing to help, always friendly and smiling.”
“Made me comfortable to come into practice its way out of my comfort zone.”
“Kind caring gets things done.”
“Everyone is polite and kind making you feel welcome.”
“Cheerful and happy receptionist.”
Barriers and challenges
One patient commented that:
“Sometimes reception isn’t always manned and busy.”
Staff suggested:
“Easy read appointment letters for health appointments.”
“Implemented a proper support service with information of where to signpost.”
Recommendations for communication
Reception
- Review staffing to ensure there is always a member of staff covering reception in both the main building and the annex.
- Prioritise staffing reception areas when patient appointments are scheduled.
- Consider self-check in option to cover when staff numbers are low.
Sharing information with patients
- Review format of letters to ensure easy read format.
- Review access to local services and approach to signposting, is information easily available for staff to share.
- Information can be shared in the waiting area, for example, monitors or leaflets.
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
Most patients stated that there are costs associated with attending for appointments such as travel, time of work, childcare and prescriptions.
Barriers and challenges
While most said they had not missed any appointments due to health-related costs there were four patients who had missed appointments in the past because of petrol, changing work, money stuff and car repairs.
Patients asked for support with travel costs and parking, prescriptions, information about benefits, someone to talk to about money worries.
“Possible a prepaid bus pass if unable to attend by other means.
“More specific debt help. Not just Citizens Advice as they don’t always understand mental health or neuro diversity and money.”
Recommendations for health related costs
Pre-paid bus passes
Agree local process to issue bus passes for patients struggling to attend appointments, for example, information to be provided when first appointment booked and, or during first appointment.
Money and debt advice from people who understand mental health and neurodiversity challenges
Link in with the Citizens Advice to find out what mental health and neurodiversity training their staff receive. Is there an opportunity to enhance this training?
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
Visits from loved ones are vital to the health and wellbeing of people receiving care in care homes, hospitals and hospices. (Visiting in care homes, hospitals and hospices, Department of Health and Social Care, 2023)
Life can be particularly unpredictable when living on a low income. Social problems often accompany poverty, and sometimes life can be chaotic, which makes consistent appointment or visiting 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.”
Barriers and challenges
Staff suggested:
“Easy read appointment letters for health appointments.”
Patient’s suggested:
“Arrange home visit to ease money spent on transportation.”
Recommendations for navigating and negotiating appointments
Appointment times and location
- Can home visits be offered more routinely.
- Can patients be offered a choice of day, time and location so they can plan childcare and work.
Letters
Review format of letters to ensure easy read format.
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.
Barriers and challenges
Patients asked for:
“Information about benefits and someone to talk to about money worries.”
Patients said it would be helpful to:
“Have a member of staff who you could talk to about financial worries and benefits you can claim.”
One patient suggested:
“Maybe more information about available benefits when you first present to the service and check-in throughout your support in case financial circumstances change due to long term sickness.”
“Let patient know what the services they offer.”
Staff also said it would be helpful to have a:
“Support service put in place for patients to access.”
Recommendations for patient empowerment
Support services
- Increased on site presence of Citizens Advice service and information about benefits, how to claim, what entitled to.
- Introduction of peer support workers to provide one-to-one support.
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
Staff said that the service identifies people who may be experiencing poverty with a formal financial screen tool that is routinely carried out. Staff said one thing that could change practice would be:
“To have more resources and time.”
Staff also use verbal screening, asking those they think may need help and having support service put in place for patients to access would make life better for people experiencing poverty.
Barriers and challenges
Patients said they would like:
“Someone to talk to about money worries.”
“Information about food banks and community support.”
Staff suggested a:
“Support service put in place for patients to access.”
“Making sure all staff not just clinicians are aware of poverty proofing.”
Make it clear from the patient front sheet who is identified as at risk so embarrassing questions from admin are avoided and a clear line of escalation where needed for queries relating to identified patients’ concerns with regards to their lack of access to funds.
Recommendations for staff awareness and guidance
Financial discussion
- Appointment to include opportunity to speak to staff about any financial concerns so staff can signpost patients to Citizens Advice or other local support
- Identify local community groups offering financial discussion or advice and support.
Useful local support information
- Provide staff with access to local support information such as food banks, community groups, use Rotherham HIVE.
- Information available in waiting areas as leaflets or visually via televisions.
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.
Barriers and challenges
Patients identified travel as the main cost to accessing their appointments with the following suggestions on how the service could support them to keep these costs to a minimum:
Patients asked for;
“Flexible location for appointments.”
“To be given a free risk ticket for all trips to appointments.”
One patient suggested:
“A telephone appointment for doctor review if needed to prevent spending money on transportation.”
Staff also identified travel and transport as an issue for patient attending appointment.
Staff said:
“Making sure people are given the opportunity to access care by supporting with additional cost, transport, equipment to online services.”
Recommendations for travel
Travel costs
- Ensure all staff aware of the free bus passes available for patients.
- Staff to ask patients at first appointment if they need any support with travel costs? Refer to Citizens Advice and offer free travel pass, issue to patient before leaving appointment.
- Appointment times and location.
- Offer more patient choice with appointment times, location, telephone and home visits.
- Explore other community locations where appointments could take place.
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: June 02, 2026
Next review due: June 02, 2027
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