Improving the Healthy Start Scheme to Enable more Families on Low Incomes to Access Healthy Foods

Centre for Food Policy

Overview

Context: The National Health Service (NHS) Healthy Start scheme was introduced in England by the UK Government in 2006. The scheme aims to subsidise pregnant women and families with young children (under age 4 years) who are living on low incomes to eat better, by giving them a payment card to use each week to buy fruit, vegetables, milk or pulses. The scheme also includes access to free nutritional supplements (vitamins) for pregnant women, babies, and infants. Over recent years take-up of the scheme had been declining and only around 65% of eligible families were accessing it. Health inequalities in England are growing and high numbers of families, especially those with young children, are experiencing food insecurity. Children growing up in the least affluent households are 2-3 times more likely to be overweight or obese than their peers living in the most affluent households by the time they start school. Children from poorer backgrounds are 1.3cm shorter than their affluent peers by the age of 5 years.

Ambition: Our project is an evaluation of the NHS Healthy Start scheme with the aim of increasing uptake amongst eligible people so that more people (including the youngest in our society) can benefit from increased access to healthy foods like fruit, vegetables, milk and pulses at a critical time in the life course.

Alignment with the EAT-Lancet Commission

Improving uptake of the scheme will help increase consumption of fruit and vegetables, and pulses. This contributes to making healthy diets more affordable and accessible, particularly for women and young children in low-income households. While this social protection policy is already in place, it can be further improved to increase efficacy and expand the reach to ensure that everyone who is eligible for the support can access it.

Our collaborators in the three study sites have reported back to us after we have completed work in their areas. For example, in Redbridge we co-produced a short film about Healthy Start. This local film has been translated into five languages across the borough and is shown in key places including health clinics, family hubs, local libraries, and community centres. The community action plan we co-produced through a series of deliberative workshops in Redbridge was instrumental in setting up a Healthy Start Taskforce and is being used to set the agenda for focused work across the local food system.

Key actors

Families who are eligible for Healthy Start are the most important actors
The evaluation is national with three case study sites in England: Southampton, Manchester, and the London Borough of Redbridge
Key stakeholders across the food system - including: health professionals, local authorities, community organisations, faith groups, advocacy and campaigning organisations, food retailers and others
Collaborating partners including the Institute for Fiscal Studies, University of Southampton and the Food Foundation
Department of Health and Social Care (DHSC) who run the Healthy Start scheme

Lessons Learned

We have learnt several lessons about what makes government food subsidy programmes work well or not so well. Many of these lessons are included in this publication based on over 110 qualitative interviews with key stakeholders available to read here.

A key insight has been that many families need a ‘helping hand’ when accessing services like the NHS Healthy Start scheme, and this helping hand is most effective when offered in their own community by someone they trust and relate to. The type of words used to describe the scheme are also important to ensure they avoid stigma and are clear about the benefits of using the scheme.

Next steps

Complete the series of co-creation workshops in Manchester and work with collaborators in the three study sites to implement the co-produced action plans.
Continue to report back to DHSC and NIHR so that improvements can be made to the NHS Healthy Start scheme which will allow more eligible people to access this vital nutritional safety net.
Work with our public participation panel to disseminate and share findings with all stakeholders in a variety of ways including academic publications, blog posts, infographics, case study reports, and short videos.
Continue to champion the NHS Healthy Start scheme and ensure it is strengthened at a time when so many families and children in the UK are living with food insecurity primarily due to problems of affordability and access.

For more information contact: Millie Barrett at millie.barrett@citystgeorges.ac.uk , Dr Sophie Clohessy, Prof Christina Vogel

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