More for less

With just a relatively small outlay the simplest interventions can tackle exclusion where it hurts most, says Liam Knowles.

There’s a lot of talk in drug and alcohol services about complexity. But ask people using services what actually gets in the way of moving on and the answers are often simple – no data or credit on their phone, no ID, no way to get to appointments, no bank account. Things that so many of us would not give a second thought to.

Through partnerships with external organisations, Bridges has been targeting these areas to make demonstrable differences. Not via large-scale programmes or shiny pilots, but by removing practical barriers that quietly block people from accessing support, healthcare and financial safety.

The outcomes show how relatively small interventions can have a huge impact on engagement, wellbeing and risk. This is work that can sit at the intersection of harm reduction, safeguarding and inequality and it can happen one SIM card, bus ticket and birth certificate at a time.

Data poverty

As everything moves further towards ‘digital by default’, the consequences of data poverty are becoming impossible to ignore. Universal Credit journals, GP appointments, e-consult forms, housing portals, appointment reminders – almost all require regular internet access.

Bridges became part of the National Databank for free mobile SIM cards and has distributed more than 350 cards to people experiencing data poverty. For many, this has been the difference between disengagement and continuity.

One person supported by Bridges had repeatedly fallen foul of the Universal Credit system – without data on his phone, he relied on sporadic access to public computers, missing journal updates and deadlines. Once he received a SIM he was able to check messages daily, upload evidence, and respond to requests in real time. His income stabilised and so has his engagement with support.

————-

Bridges has provided 150 bus tickets to support people to attend hospital and medical appointments.

As part of Shelter’s Breaking the Cycle scheme, Bridges supports people to open bank accounts – particularly those blocked by lack of ID, unstable housing or previous financial difficulties.

Receiving a SIM enables people to check messages daily, upload evidence, respond to requests in real time, stabilise income and engage with support.

————-

Health exclusion

Another immediate impact has been in access to primary healthcare. Just about everyone knows how hard it is to get a GP appointment, so imagine getting one without a phone or internet access. Many surgeries require patients to call repeatedly at opening time or submit requests through e-consult systems. Without data, people are effectively excluded before they even start.

Having a working SIM has allowed people to submit online consultations, respond to appointment texts, and manage prescriptions – something that directly affects both physical health and recovery stability. For staff, it also means people can be contacted reliably, safeguarding concerns can be followed up quickly, and missed appointments are reduced. In short, connectivity is no longer a ‘digital issue’. It’s a health and welfare issue.

Basic needs

Health inequalities are often discussed in abstract terms, but for people living on very low incomes they can be as basic as not being able to afford the bus.

Bridges has provided 150 bus tickets (through a health inequalities grant managed locally on behalf of the National Lottery) to support people to attend hospital and medical appointments. The impact has been both practical and deeply human.

One man was supported with a number of ‘day tripper’ bus passes each week, allowing him to travel eight miles to visit his terminally ill partner in hospital. Without the passes, he would not have been able to visit regularly – the support reduced distress, preserved connection at a critical time and removed an impossible financial choice.

Others have used bus tickets to attend outpatient appointments, mental health services, or substance use reviews. Importantly, some people reported feeling more willing to attend A&E when unwell, knowing they would not be stranded there if they were assessed and discharged rather than admitted.

This kind of transport support prevents problems escalating. Missed appointments turn into emergencies; emergencies turn into admissions, and admissions often trigger housing and safeguarding crises. A bus ticket can halt the spiral early, cheaply, and with dignity.

Financial exploitation

For people without a bank account in their own name, everyday financial transactions can carry serious risk. Bridges is part of Shelter’s Breaking the Cycle scheme, which supports people to open bank accounts – particularly those blocked by lack of ID, unstable housing or previous financial difficulties.

The need for this work is stark. Some people supported by Bridges reported that, without an account of their own, they were effectively charged a ‘tax’ of up to 50 per cent to have benefits or wages paid into someone else’s account. This is not a minor inconvenience; it’s exploitation in plain sight.

Having a bank account restores control. It allows people to receive money safely, pay bills, budget, and reduce reliance on others who may misuse or withhold funds. From a safeguarding perspective, it reduces exposure to coercion, debt manipulation and financial abuse. From a recovery perspective, it creates stability and predictability – key foundations for change.

Staff have also noted that once people have an account, other barriers begin to fall. Housing applications move forward, employment becomes viable, and people feel more confident managing their own affairs.

Small documents, big consequences

One of the most underestimated barriers faced by people accessing services is lack of basic identity documentation. Without it, people can be locked out of housing, employment, banking and benefits – often for years.

Birth certificates locally are ‘order online’ only – a further complication for those without data or a bank account. Bridges – through funds from the University Hospitals Tees’ infectious diseases outreach team – has been covering the cost of birth certificates where needed, and the impact has been immediate.

One individual was able to register with a local housing provider for the first time after years of exclusion. Another was able to start work once they could evidence their identity – something that had previously felt out of reach despite motivation and readiness.

For a relatively small financial outlay, the return is significant. A birth certificate can unlock a chain of progress – ID, bank account, housing, employment. It also removes a persistent source of shame and frustration. 

Vital work

None of these interventions are flashy. They don’t come with complex frameworks or long delivery plans. But they work because they address the reality of people’s lives.

When someone can’t get online, can’t travel, can’t prove who they are or safely receive money, expecting consistent engagement with treatment or support is unrealistic. By removing these barriers, Bridges is not only supporting individuals but making the whole system work better.

These interventions support dignity, show people that they’re worth investing in, that their place in society matters, and that recovery does not happen in isolation from poverty, exclusion and inequality.

What Bridges is doing is replicable. It relies on partnerships, modest flexible funding, and a willingness to see ‘practical help’ as a core rather than an add-on.

In a sector under intense pressure, let’s remember that sometimes the most effective intervention is not another form or referral pathway, but a SIM card, a bus ticket, or a piece of paper that proves someone exists. 

Small Spend. Big Change

Liam Knowles is project worker at Bridges Family and Carer Service