Healthy Start Factfile Healthy Start team – Department of Health [email protected] www.healthystart.nhs.uk 1 What does it provide? Vouchers: Vitamins: Liquid milk Fresh fruit and veg Infant formula milk For women For children AND: Information on breastfeeding and healthy eating 2 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 3 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) 4 Why? • • • • A statutory scheme A nutritional safety net Encourages breastfeeding/healthy eating A public health tool 5 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 6 Facts and Figures West Midlands • Healthy Start supports over 60,000 women and children in 47,000 families • West Midlands average uptake is 80% 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 8 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 Healthy Start is a Statutory Scheme Health Professionals are given the key tasks of: • signposting the scheme and • supporting applications • PCTs have a duty to make HS vitamin supplements available 10 Healthy Start / Start4Life • 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 11 Healthy Start application process Family becomes eligible Midwife/Health Visitor Invitation from HSIU Tax credits helpline Jobcentre Plus Application leaflet in GP surgery Someone on the scheme Hear about Healthy Start Leaflets on benefits or tax credits Pregnancy or Birth to Five Book Poster in children’s centre or clinic DirectGov or HS website Website HSIU Helpline Get application leaflet/Form Complete Form Midwife GP Surgery Health Visitor Get signature from midwife or health visitor Submit to HSIU 12 Key: HMRC – HM Revenue and Customs; JCP – JobCentre Plus; BDP – Back Dated Payment; HSIU – Healthy Start Issuing Unit HSIU receives application form Fully completed Clearly do not qualify Application for pregnant Applicant Informed by letter Vouchers Issued Wrongly completed Application includes children Validate against HMRC and JCP data Beneficiaries notify HSIU with baby details and start claiming CTC Validation with HMRC and JCP Vouchers continue Match found Match not found Inform applicant and invite to give additional information. Repeat 2/4 weekly checks for 3 months Vouchers Issued Match found Repeat validation checks every 2 wks (HMRC) or 4 wks (JCP) Returned to applicant (no BDP for wrongly completed forms) No match found Vouchers not issued Voucher Issued Letter confirming match not found 13 Current Priorities • Vitamins uptake! • • • • • Scheme uptake Communications review Streamlining links with tax credits system Frozen fruit and vegetables? Monitoring/evaluation 14 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 15 Vitamin Uptake (England) • Vitamin take up through HS is less than 1% across the board 16 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 17 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 18 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 19 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? 20 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 21 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 22 Vitamin Facts Women’s Tablets Children’s Drops Code: ABX 073 Code: ABX 072 Cost to PCT: £1.61 Cost to PCT: 70p Cost when selling: £1.77 Cost when selling: 77p Available to: Available to: Children; 6 months – 1 year 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 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: Bayer Manufacturer: SSL International Shelf life: 2 years Shelf life: 10 months 23 Healthy Start Vitamins (Ordering and reimbursement process) PCT contacts NHS Supplychain Order vitamins and make payment PCT records how many vitamins given out to beneficiaries 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 DH send HSVR form to finance contact in each PCT PCT to send DH quarterly invoices along with the HSVR form DH reimburses PCT 24 Key: HSVR – Healthy Start Vitamins Return Vitamin Uptake Success: Key factors • • • • • • Team working across boundaries Training Senior level support Clear Communications Distribution - accessibility Make things simple! 25 More Info? Healthy Start Website www.healthystart.co.uk Including a CPD module 26