Cost of Living: Healthy Start Scheme

Alison Thewliss Excerpts

Tuesday 23rd May 2023 Westminster Hall

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to see you in the Chair, Mr Twigg. I thank the hon. Member for Stretford and Urmston (Andrew Western) for bringing this important debate to Westminster Hall. As the chair of the all-party parliamentary group on infant feeding and inequalities, I have worked on this issue for many years. The cost of formula is not a new problem; it is a continual problem, and one that the UK Government have completely ignored for many years.

A number of years ago, the all-party group did some research on the cost of formula. Even at that time, it was already a struggle for many families. Despite all the evidence, the Government did nothing about it. I have asked questions about inflation and the cost of infant formula, and the Government have said that they are monitoring it. Monitoring is one thing, but actually doing something about it is quite another.

I was glad to see the hon. Member for Stretford and Urmston introduce the debate. I am also grateful to Sky News, which has done stellar work in exposing the many, multifaceted impacts that the cost of infant formula is having on families up and down these islands. Sky News has been out there listening to people’s heartbreaking stories, and telling them. In 2023, we should not have people foraging on Facebook or stealing from shops to feed their babies. It is absolutely desperate.

As hon. Members have said, there is nothing more distressing than a hungry baby. The Minister needs to be dealing with this issue as a matter of urgency. Quite frankly, the Prime Minister is living in a different world if he suggests that the Healthy Start vouchers are sufficient to meet the needs of families. Not enough people are eligible, not enough people are claiming and the vouchers do not meet the cost of a tub of infant formula. Suggesting that people should somehow fall back on discretionary payments from local councils is not much help to a family with a screaming baby at 3 o’clock in the morning. The Prime Minister does not have a clue.

This issue is vital to the development of babies. Babies’ brain development is crucial to their future health and wellbeing, and not being fed properly at this very young stage can have a significant impact on their development. Families are watering down formula beyond the composition it is supposed to be. If they are adding things to formula, such as flour, rusk or other things, children are not getting the nutrition that they need. If people are buying it on the black market, or buying half tubs off Facebook or from friends, the quality of the milk is not guaranteed. Formula in itself is not sterile and it has to be made up properly. If it has been lying open for a while, it could be unsafe for the baby and cause them health problems.

In addition to that, people are struggling to pay their electricity bills. I am grateful to Mumsnet for providing a briefing for this debate. A person on that website said:

“I used to have a client family, a young couple with a newborn, who were really struggling financially...The poor mum just couldn’t breastfeed her newborn, despite the health visitor’s best efforts...The cost of formula was crippling, even with the healthy start vouchers. To make matters worse, they were being really ripped off for electricity through a coin meter and it cost them about 20p to boil a kettle to make up the formula.”

Families are being hit at all angles.

There is also a risk with bottles of formula that are made up. They should be discarded after a period because they do not remain safe and sterile, but if a family cannot afford the next bottle, they will just keep it and feed it to the baby regardless. In those circumstances, parents will likely feel that some formula is better than no formula at all, despite the risk to the child’s health.

Food price inflation is at 19.2% and general inflation is at 10.4%. I pay tribute to First Steps Nutrition Trust for its long-standing research that tracks the price of formula. It has found that the cheapest own brand, and the only own brand of formula on the market in the UK, has gone up by 45% in the last two years. Other formulas went up by between 17% and 31% in the same period. The market is out of control, and the Government have done nothing to address it.

First Steps Nutrition Trust has pointed out that the situation is much the same for other items people may buy with Healthy Start vouchers, such as fruit, fresh vegetables, bread or milk. The trust says that in 2006 someone could get seven pints of milk with Healthy Start vouchers, whereas in 2023 they can get only 4.7 pints. The money is being stretched in all kinds of ways—not just for babies but for older children too.

Part of the issue is the unregulated nature of the formula market in the UK. According to recent research in The Lancet, formula companies bring in £55 billion annually. They spend £3 billion at least on marketing. That amount adds to the price people pay when they buy a tub at the till. The companies are also spending significant money on developing new products, apparently for specialist needs, but these products can be bought over the counter uniquely in the UK. In many cases, they are not necessarily products the Government have failed to regulate, but desperate families are choosing them as an option.

There are also follow-on milks, which are completely unnecessary. I would say to any families out there spending their precious money on follow-on formulas: do not spend that money. They are simply a tool to market formula. They are not required for children. First-stage formula is perfectly adequate for the first year. Do not waste money. If all first-stage formulas are exactly the same—which they are by regulation—why does one cost £9.39 when a different tub costs £19? The Government have very little curiosity about why there is a variation in these prices if all compositions are essentially the same.

The Government should do an awful lot more to interrogate this industry and make sure there is provision for parents out there. It could be like something of the past—perhaps a plain-labelled Government-branded formula that is accessible to people. The Government should be looking at what they can do. It is very clear that the market left to itself is not able to control the prices. The Government should be stepping in to regulate the price of formula. Formula is unique. Unlike all other food products, it is required by babies; they cannot get nourishment any other way. It is a very different type of food product to everything else.

The hon. Member for Strangford (Jim Shannon) mentioned breastfeeding. As chair of the all-party parliamentary group on infant feeding and inequalities, I am a massive supporter of breastfeeding. It is the best way to feed a baby. For many families, breastfeeding can be very challenging and formula is necessary—if, for instance, the mother has an HIV diagnosis and breastfeeding is contraindicated, they require infant formula. In other families, children may be adopted or there may be childcare issues, so breastfeeding can be difficult. I would always encourage the Government to invest more in infant feeding support, because inconsistency in support, alongside a very rapacious infant formula industry, is undermining breastfeeding in this country. I would like to see full implementation of the international code of marketing of breastmilk substitutes, because that would also help to support families.

I also want to talk about the holes within the system. The Healthy Start vouchers are not keeping up with the pace of things. Families cannot simply rely on food banks or baby banks to provide something as a fall-back option, because, as I have said, infant formula is incredibly expensive and if food banks are trying to feed the most people they can, do they buy a whole load of tins of beans or do they buy one can of infant formula? That is a very difficult position to put food banks in and they should not be the emergency service to make up for where the Government have failed.

I will finish with a point of contrast. As has been mentioned, the Best Start Foods scheme in Scotland, which is a devolved benefit that the Scottish Government have set up, is—importantly—more generous than the Healthy Start scheme. It stands at £9.90 per week in the first year. The Scottish Government have increased that, with inflation, and the UK Government should do likewise with their schemes.

In addition, in Scotland there is the Scottish Child Payment of £25 a week, which makes a massive difference to families; whether they have babies or older children, that is £25 per child per week. And from speaking to people at food banks in my constituency, I know that that is making the difference between families coming in desperate for food or not. That £25 payment is paid up to the age of 16. As I say, it makes a massive difference for families in Scotland and provides a clear contrast with what the UK Government are providing.

In Scotland, we have also looked at increasing the eligibility for that benefit. We are trying to make sure that those who have no recourse to public funds and who would not be eligible ordinarily for Healthy Start vouchers can get the Best Start grant in some circumstances. Of course, if the UK Government would abolish no recourse to public funds, we could give the Best Start grant out to far more people and make sure that all babies are fed, regardless of their parents’ immigration status.

In Scotland, there is also a range of other grants, in addition to Best Start Foods. So, there is a Best Start Pregnancy Payment of £707.25 for someone’s first child and of £353.65 for subsequent children, with no limit on the number of children, unlike the two-child limit for some other schemes. There is also the Best Start Grant Early Learning Payment between the ages of two and three and a half, and a School Age Payment for when a child is old enough to start school.

Those grants are incredibly important in the landscape of benefits available to parents, because families are pressed from all different directions at the moment, whether that is buying school uniforms or putting food on the table. The Scottish Government are making a real difference in this way, by making sure that children are fed and that families are not on the absolute brink of survival. I believe that it is up to the UK Government to meet that challenge, to regulate the infant formula sector and to uprate the payments under the Healthy Start scheme to match—or exceed if possible, which would be nice—what is available in Scotland, because we are doing everything we can.

I thank First Steps Nutrition Trust, Leicester Mammas, Feed UK, the British Pregnancy Advisory Service and the Food Foundation for their work, and I thank the hon. Member for Stretford and Urmston for securing this debate today. There is a lot of work going on and the Government need to meet the challenge that they have been set.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I am grateful to the hon. Member for Stretford and Urmston (Andrew Western) for securing this debate and to the other Members who have participated. The hon. Member for Strangford (Jim Shannon) made a typically compassionate speech.

The Russian invasion of Ukraine has had a global impact. We have seen a rise in inflation, with increased food costs and higher energy prices, and that has impacted on the cost of living. The challenge of the increase in the cost of living is felt by everyone across the country. The Government understand and recognise the challenges that many face as a result of the huge increase in inflation.

The Government have taken, and will continue to take, decisive action to support people with the cost of living. In response to higher food costs, the Department for Environment, Food and Rural Affairs continues to work with food retailers and producers on ways to ensure the availability of affordable food—for example, by maintaining value ranges, price matching and price freezing measures.

In response to higher energy prices, the Department for Business, Energy and Industrial Strategy put in place the energy price guarantee to shield households from the unprecedented rises in energy prices. The guarantee will run until April 2024, and the Government are working with consumer groups and industry to explore the best approach to consumer protections from April 2024 onwards, as part of wider retail market reforms. As set out in the energy security plan, we intend to consult on those options this summer.

In response to the higher cost of living more generally, the Department for Work and Pensions is providing up to £900 in three lump sums for households on eligible means-tested benefits, a separate £300 payment for pensioner households and a £150 payment for individuals in receipt of eligible disability benefits. From this April, the Government have uprated benefit rates and state pensions by 10.1%. In order to increase the number of households who can benefit from those uprating decisions, the benefit cap levels were also increased by the same amount.

Also from this April, the national living wage that this Government introduced increased by 9.7% to £10.42 an hour for workers aged 23 and over. That is the largest ever cash increase for the national living wage. For those who require extra support, the Government are providing an additional £1 billion of funding, including Barnett impact, to enable the extension of the household support fund in England this financial year. That is on top of what we have provided since October 2021, bringing the total funding up to £2.6 billion. This is used by local authorities to help households with the cost of essentials.

[Alison Thewliss]

It is interesting to hear about all the things that were uprated with inflation. Will the Minister explain why Healthy Start was excluded from that?

[Neil O'Brien]

If I can just complete the thought, the total cost of living support that the Government have provided is worth more than £94 billion across 2022-23 and 2023-24. That is, on average, more than £3,300 per UK household. It is one of the most generous support packages for the cost of living anywhere in Europe.

I turn to the critical role that the Healthy Start scheme plays in supporting hundreds of thousands of lower-income families across the country. Eating a healthy, balanced diet, in line with “The Eatwell Guide”, can help to prevent diet-related disease. It ensures that we get the right energy and nutrients needed for good health and to maintain a healthy weight throughout life. The Healthy Start scheme is one way that the Government continue to target nutritional support at the families who need it most, which is increasingly important in view of the cost of living.

Healthy Start is a passported benefit, one of a range of additional sources of help and support that the Government provide to families on benefits and tax credits. It is a statutory scheme that helps to encourage a healthy diet for pregnant women, babies and young children under four from lower-income households. Women who are at least 10 weeks pregnant and families with a child under four years old are eligible for the scheme if they claim: income support; income-based jobseeker’s allowance; child tax credit, if they have an annual family income of £16,190 or less; universal credit, if they have a family take-home pay of £408 or less a month; or pension credit. Pregnant women on income-related employment and support allowance are also eligible for the scheme.

Anyone under 18 who is pregnant is eligible for Healthy Start, regardless of whether they receive benefits. Following the birth of their child, they must meet the benefit criteria to continue receiving Healthy Start. The scheme offers financial support towards buying fresh, frozen or tinned fruit and vegetables, fresh, dried and tinned pulses, plain cow’s milk and infant formula. Beneficiaries are also eligible for free Healthy Start vitamins.

In April 2021, as has been mentioned, we increased the value of Healthy Start by 37%, from £3.10 per week to £4.25 per week. Unlike the Scottish Government’s scheme, which is for the under-threes, Healthy Start is for the under-fours. Pregnant women and children aged over one and under four each receive £4.25 a week, and children aged under one each receive £8.50 a week—twice as much. For a family with a six-month-old and a three-year-old, that is £12.75 a week to help towards buying nutritious foods. That comes on top of the benefits and all the other measures, such as the increase in the national living wage, that I mentioned.

[Neil O'Brien]

We have chosen to spend over £3,300 per UK household, on average, on the cost of living support. Putting that into the schemes that are available and targeted at people with low incomes, and indeed at the entire population, is the choice that we have made. To reiterate my earlier point, and since the hon. Member says that I am rattling off the figures, it is worth stressing that we have invested £3,300 per household—a colossal sum of money. That is unprecedented. There has never been a cost of living intervention anywhere of that magnitude, so that must be an important part of the discussion about Healthy Start.

[Alison Thewliss]

Will the Minister give way?

[Neil O'Brien]

I will continue with my points and perhaps come back to the hon. Lady in a moment.

Healthy Start is delivered by the NHS Business Services Authority on behalf of the Department. Following user research and testing by the Department and NHSBSA, the scheme, as various Members have mentioned, was switched from being paper-based to a digitised service to increase uptake and usability. We have introduced an online application to replace the previous paper-based application form and a prepaid card to replace paper vouchers. The digitised scheme opened to the public for the first time in September 2021. The online application provides an instant decision for many families. The prepaid card can be used in any retailer that sells Healthy Start foods and accepts Mastercard.

I am pleased to see that the number of new families joining the scheme continues to grow following the introduction of the prepaid card. Since September 2021, there have been more than 500,000 successful applications, with 48% coming from new families. The scheme now supports more than 375,000 families on lower incomes, and that continues to grow month on month. The current uptake is 64.6%, which is higher than the paper scheme, which had a 59.9% uptake in August 2021.

The hon. Member for Stretford and Urmston asked whether we published the figures on eligibility. Yes, the total number of eligible and entitled beneficiaries are published on the NHS Healthy Start website and are broken down by local authority.

[Alison Thewliss]

Will the Minister give way?

[Neil O'Brien]

If this is on the point about data.

[Alison Thewliss]

The Minister is making an interesting point about the uptake, but can he account for why things are so much better in Scotland, where the uptake of Best Start Foods sits at 88%?

[Neil O'Brien]

The schemes are not completely comparable because the Healthy Start scheme covers a wider base of people, as I mentioned. It goes up to age four rather than age three, so it has a wider field of benefit than the Scottish scheme. That may be part of the story, but there could be other reasons, and there may be important things that we can learn from the Scottish scheme. I am always keen to have those discussions.

To increase take-up, NHSBSA actively promotes Healthy Start through its digital channels and has created free toolkits to support stakeholders to do so. NHSBSA uses a range of communications activities to engage parents, pregnant women and healthcare professionals to help to raise awareness of the scheme. NHSBSA has attended Maternity & Midwifery Forum events and placed advertisements in the Bounty packs, which many people receive when they have children, and the “You and your pregnancy” magazine, which is given to pregnant women in the first trimester.

We constantly review the materials produced for the Healthy Start scheme to ensure that communications reach those who need support the most. That is why, following user research by NHSBSA, promotional material was translated into the top five languages spoken by Healthy Start families, to reach a wider demographic. NHSBSA continues to engage with national and local stakeholders to improve the delivery of the scheme and increase the uptake.

Healthy Start is an important part of the support provided by the Government, but it is only one aspect of the support available for families. We are funding 75 English local authorities with high levels of deprivation to ensure that parents and carers can access Start for Life services locally. The healthy child programme is a universal offer across all 150 local authority areas—led by health visitors and school nurses—that supports families from the antenatal period up to school entry. The nursery milk scheme provides reimbursement to childcare providers for a daily third of a pint portion of milk to children and babies. The school fruit and vegetable scheme provides around 2.2 million children in key stage 1 with a portion of fresh fruit or vegetables each day at school, and 419 million pieces of fruit and vegetables were distributed to children in 2022-23.

The Government have extended free school meals eligibility several times and to more groups of children than any other Government over the past half a century, including the introduction of universal infant free school meals and further education free meals. Under the benefits-based criteria, 1.9 million of the most disadvantaged pupils are eligible for and are claiming a free school meal. That saves families around £400 per year. To make it easier for families to find support, the Government also created an online resource so that families can easily check what help is available to them.

At a time when families need support, and with the cost of living increasing, the Government are committed to helping as many families as possible to access the Healthy Start scheme, as well as all those other schemes, to help those most in need.