Poverty proofing Rotherham electroconvulsive therapy suite 2026

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 electroconvulsive therapy suite

The Poverty Proofing audit for electroconvulsive therapy suite began in July 2026 to better understand the experiences of families and individuals who are living in poverty.

The work was conducted in partnership with staff, families, and adults to build up a rich picture of the barriers and challenges faced by those referred for electroconvulsive therapy. Due to the nature of the service, it was believed it would be better not to have direct consultation with the patients referred into the service, however a robust consultation was conducted with staff who work in the service, Ward staff where the patients are referred from and also any family or carers.

For the Rotherham, Doncaster and South Humber localities there is one centralised electroconvulsive therapy (ECT) department which is located in Rotherham. This department provides electroconvulsive therapy treatment to patients across these three areas. It is a purpose-built treatment suite and is served by a dedicated team that has received training to work within the department.

Prior to Covid-19 the service used to have patients attend electroconvulsive therapy treatments as outpatients but since covid this has changed as they need to visit the ward first before being escorted to the electroconvulsive therapy by a clinical member of staff. Electroconvulsive therapy (ECT) (TA59) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and, or when the condition is considered to be potentially life threatening in individuals with:

• severe depressive illness
• catatonia
• a prolonged or severe manic episode

The decision whether electroconvulsive therapy is clinically indicated should be based on a documented assessment of risks and potential benefits to the individual including:

• the risks associated with the anaesthetic
• current co-morbidities
• anticipated adverse events particularly cognitive impairment
• the risk of not having treatment

Electroconvulsive therapy is a specialist treatment with important consent, capacity, anaesthetic and cognitive-monitoring requirements. Poverty-proofing should complement, not replace, clinical safety processes. The practical aim is to identify and reduce avoidable financial, travel, communication and coordination burdens while preserving informed choice, dignity and safe treatment.

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

​​Staff were invited to attend the 3- hour training on poverty proofing from July 2026. However, no staff working directly in the service have managed to do so yet at time of writing. We managed to have consultations with 3 staff who work in the service and 2 additional staff who work on wards were patients have been referred from.​

Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management, and a visit to the electroconvulsive therapy suite to observe interactions. and reviewing key areas such as the website policy.

Stage 3: patient and community consultations

It was agreed that no patient consultation would take place due to the nature of the service, however feedback was sought from staff who work on the wards and also some relatives of patients.

Stage 4: feedback session

A feedback session was held with Jack Rowley (Modern Matron) Gillian Thompson and Tracey Houghton (Clinical Leads), where findings were discussed, and changes were collaboratively discussed that could be implemented. We then produced this final report.

Stage 5: review

Around ​twelve​ 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 the Rotherham electroconvulsive therapy suite were:

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

Accessible communication

Patients have information shared with them on possible side effects to look out for after treatment. The use of interpreters in the service though minimal is acknowledged in collaboration with the ward staff where patients are referred from. Where required easy read material can be made available to the patients. Consent is initially discussed and obtained by the ward team before a patient attend the electroconvulsive suite, which helps to prepare patients in advance

“We do use language empire to ensure we can communicate with patients.”

“We have some easy read material that have been provided form MIND.”

“We rely on the ward area obtaining consent in the first instance with the patients to undergo electroconvulsive therapy.”

Barriers and challenges

Accessible communication

While language empire is used for interpreter services for the patient, the service itself indicated that they rarely need to use interpreters as in most cases everything may have been clearly explained to the patient prior to attend the suite. This creates a risk that communication needs are assumed to have been fully addressed rather than checked again at the point of treatment.  Understanding the nature of the service as it was not possible to get feedback from patients, this would be an area for the service further explore where interpreter use has been noted by the ward.

Recommendations for communication

Accessible communication

• Add a brief communication check on arrival, including preferred language, accessible format, understanding of practical arrangements and any need for an interpreter or advocate.
• Audit interpreter use and declined or unmet requests, without treating low use as evidence of low need.

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

Cost to patients

Patient who attend the electroconvulsive suite for treatment don’t not pay for any items or services as part of their healthcare, while there. Food is made available to patients while they are receiving treatment and have a choice to choose from menus shared.

“We provide our patient with food while they are here from our menu.”

Barriers and challenges

Cost to patients

Although those who attend for treatment may not have any cost to them, where a family member or carer chaperones to the treatment these may be indirect cost that need to be explored. Carer meals, parking, telephone or data use, time away from work, childcare, or costs associated with repeat attendance.

Recommendations for health related costs

Health related cost

• Provide clear pre-visit information about available food and drink, nearby low-cost options, and whether any carer expenses can be supported.
• Include carers in the affordability check where their presence is clinically or practically important. Agree a small, proportionate contingency arrangement for carers who cannot afford food during prolonged attendance were identified
• Signpost or refer patients and carers to established money, benefits and debt advice.

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

Appointments

The electroconvulsive therapy dates are coordinated with the Rotherham NHS Foundation Trust (TRFT), whose anaesthesiologist attends on specific days. This support coordination with a specialist clinical resource. Wards staff attendance and escorting provides a route for clinical handover and support before treatment.

“Appointment are set with what we get from Rotherham NHS Foundation Trust while this works well is there any scope to use different locations… as we sometime have patients having to travel from North Lincolnshire to Rotherham to use the service.”

Barriers and challenges

Having the availability of treatment based on dates when anaesthesiology is available from one provider, raises the question of whether other acute hospital location could support treatment, noting that the centralised model can require long-distance travel, including from North Lincolnshire to Rotherham.

Recommendations for navigating and negotiating appointments

Complex health systems

Explore with other acute partners whether additional anaesthetic support or alternative locations are feasible, while retaining clinical governance and safety standards.

Page last updated: November 06, 2026

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