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Healthy Start
Factfile
Healthy Start team – Department of Health
www.healthystart.nhs.uk
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What does it provide?
Vouchers: Vitamins:
Liquid milk For women
Fresh fruit and veg For children
Infant formula milk
AND: Information on breastfeeding and
healthy eating
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The Voucher
• Worth £3.10 each
• Issued 4 weekly to
beneficiaries
• Double vouchers for
under 1’s or babies within
12 months of estimated
due date if born early
• Voucher value is
reviewed annually
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Who for?
Pregnant women and families with children under four getting:
• Income Support, or
• Income Based Jobseekers’ Allowance, or
• Income related Employment and Support Allowance, or
• Child Tax Credit (but not Working Tax Credit –except run-on) with an annual family income of £16,040 or less.
And ALL pregnant under 18 year olds(Once baby is born – entitlement ceases unless they fulfil qualifying criteria)
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Why?
• A statutory scheme
• A nutritional safety net
• Encourages breastfeeding/healthy eating
• A public health tool
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Facts and Figures 1
(England Sept 09)
• Healthy Start supports 558,500 women and children in 439,500 families
• England average take up is 79%
• Healthy Start Issuing Unit (HSIU) issues over 2.6 million vouchers per 4 weeks
• HSIU gets 24,000 applications every 4 weeks
Facts and Figures
West Midlands
• Healthy Start supports over 60,000 women
and children in 47,000 families
• West Midlands average uptake is 80%
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Facts and Figures 2
(England Sept 09)
• 90% of vouchers are used
• 30,000 retail outlets accept vouchers
• Usage breakdown:
• 70% spent in supermarkets
• 16% spent with independent retailers
• 6% spent with milkmen
• 5% spent with chemists
• The rest with box schemes/market traders etc
Healthy Start Retailers
All Healthy Start (HS) retailers must:
• Stock one or more of the HS products
• Sign up to the HS terms and
conditions
Retailer application forms available via
the Healthy Start Reimbursement Unit
(HSRU) 9
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Healthy Start is a
Statutory SchemeHealth Professionals are given
the key tasks of:
• signposting the scheme and
• supporting applications
• PCTs have a duty to make HS vitamin supplements available
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• Start4Life Objectives/Remit– Reduce the proportion of overweight/obese children
– Improve breastfeeding continuation rates at 6 weeks
– Increase average weaning age to 26 weeks
– Start4Life’s remit is Engand for 0-2 year olds
• Healthy Start Objectives/Remit– A statutory scheme, a nutritional safety net, encourages breastfeeding/healthy eating, a
public health tool
– Healthy Start communications revamp (due October 09) will cover broader topics such as post-natal depression, smoking, alcohol and child development.
– Healthy Start is a UK wide scheme for pregnant women and children to 4 years old.
• Links between Start4Life and Healthy Start– Fundamental link is the consistent messaging around nutrition and physical activity
– Start4Life = nationwide (England) campaign aimed at reducing obesity, Healthy Start = ongoing communications to beneficiaries adding value to vouchers and supporting them with broader public health messages
– Sharing message where appropriate e.g ‘No rush to Mush’ and importance of vitamins
Healthy Start / Start4Life
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Hear about Healthy Start
Tax credits helpline
Jobcentre Plus
Leaflets on benefits or tax credits
DirectGov or HS website
Invitation from HSIUMidwife/Health Visitor
Application leaflet in GP surgery
Someone on the scheme
Pregnancy or Birth to Five Book
Poster in children’s centre or clinic
Get application leaflet/FormWebsite
HSIU Helpline
GP Surgery
Health VisitorComplete Form
Get signature from midwife or health visitor
Submit to HSIU
Family becomes eligible
Healthy Start application process
Midwife
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HSIU receives application form
Fully completedWrongly completed
Returned to applicant
(no BDP for wrongly
completed forms)
Clearly do
not qualify
Applicant
Informed by letter
Application for
pregnant
Vouchers Issued
Beneficiaries notify
HSIU with baby details
and start claiming CTC
Application
includes children
Validate against
HMRC and JCP data
Match found
Repeat validation
checks every 2 wks
(HMRC) or 4 wks (JCP)
Vouchers Issued
Match not found
Inform applicant and invite to give
additional information. Repeat 2/4
weekly checks for 3 months
Match found
Voucher Issued
No match found
Vouchers not issued
Letter confirming match not found
Validation
with HMRC
and JCP
Vouchers
continue
Key: HMRC – HM Revenue and Customs; JCP – JobCentre Plus;
BDP – Back Dated Payment; HSIU – Healthy Start Issuing Unit
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Current Priorities
• Vitamins uptake!
• Scheme uptake
• Communications review
• Streamlining links with tax credits system
• Frozen fruit and vegetables?
• Monitoring/evaluation
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Priority Vitamin
Uptake!
• PCTs should make HS vitamin
supplements available
• Health Professionals have the key task of:
- alerting pregnant women to the
vitamin supplement scheme
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Vitamin Uptake
(England)
• Vitamin take up through HS is less than
1% across the board
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HS Vitamin products
• Children’s vitamin drops contain vitamins A, C and D
• Women’s tablets contain vitamins C and D, and folic acid
• The importance of both products has been highlighted by NICE
• PCTs are responsible for supplying them
• Local promotion to clients is important
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Why Vitamins?
• Enough evidence to convince COMA and SACN to recommend supplementation and
• NICE report on Maternal and child nutrition (March 2008) places the onus on PCTs to ensure supplementation happens
Key: COMA – Committee on Medical Aspects of
Food and Nutrition Policy
SACN – Scientific Advisory Committee on
Nutrition
NICE – National Institute for Clinical Excellence
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Why Vitamins?
Folic acid – role well understood in
preventing neural tube defects
• Supplement readily taken, preferably in
early pregnancy; often acts as a ‘build up’
for the next pregnancy
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Why Vitamins?
• Understanding of vitamin D role in mediating many illnesses much better understood
• Especially role in 3 trimester in foetal bone mineralisation
• Knock on effect in later life?
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Why Vitamins?
• Most vitamins are available easily through a balanced diet
• Like folic acid vitamin D is not, obtained mainly from sunlight, main food source is oily fish.
• Geographical latitude (above 52° N) available from sunlight April – September only,
• Skin type, clothing, sunscreen all effect uptake
• Rising levels of insufficiency/ deficiency being recorded with rising levels of admission for Vitamin D deficiency as a primary diagnosis
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Cost
• Children’s drops 6months – 4th birthday: £37.03
• Women’s tablets pregnancy to child’s 1st
birthday: Less than £9.00
• Treatment of deficiency for 1 year: £2600
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Children’s Drops
Code: ABX 072
Cost to PCT: £1.61
Cost when
selling:
£1.77
Available to: Children; 6 months –
1 year
Contains: 233mcg Vitamin A
20mg Vitamin C
7.5mcg Vitamin D
One bottle: 10 mls (8 week
supply)
Daily Dose: 5 drops
Classification: General Sales List
Medicine
Manufacturer:
Shelf life:
SSL International
10 months
Women’s Tablets
Code: ABX 073
Cost to PCT: 70p
Cost when selling: 77p
Available to: Women; pregnant and until
child is 1 yr old
Contains: 70 mg Vitamin C
10 mcg Vitamin D
400 mcg Folic Acid
One bottle: 56 tablets (8 week supply)
Daily Dose: 1 tablet
Classification: Multivitamin Food
Supplement
Manufacturer:
Shelf life:
Bayer
2 years
Vitamin Facts
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PCT contacts
NHS Supplychain
Order vitamins
and make
payment
NHS Supplychain
delivers
vitamins to
designated NHS
location – PCT
to arrange
PCT gives out vitamins or passes
onto children’s
centres/clinics according
to local arrangements
PCT records how
many vitamins
given out to beneficiaries
PCT to send DH quarterly invoices
along with the HSVR form
DH reimburses PCT
Healthy Start Vitamins
(Ordering and reimbursement process)
DH send HSVR form to finance
contact in each PCT
Key: HSVR – Healthy Start Vitamins Return
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Vitamin Uptake Success:
Key factors
• Team working across boundaries
• Training
• Senior level support
• Clear Communications
• Distribution - accessibility
• Make things simple!
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More Info?
Healthy Start Website
www.healthystart.co.uk
Including a CPD module
