Healthy Start

Emma Lewell-Buck Excerpts

Wednesday 22nd May 2024 Westminster Hall

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I beg to move,

That this House has considered the Healthy Start scheme.

It is a pleasure to see you in the Chair, Mr Dowd. What is not a pleasure is that I am here yet again, still trying to get the Government to do something very simple and impactful to help those who need it the most. Auto-enrolment with an opt-out, as opposed to the current opt-in system, would ensure that the Healthy Start scheme operates as it should, so that every single child gets the best start in life.

The last Labour Government introduced the Healthy Start scheme, which provides financial assistance in the form of a prepaid card to all under-18s who are pregnant, families with young children or pregnant women claiming certain benefits. This is to help with the ever-increasing costs of fruit and vegetables, milk, formula milk and vitamins. The scheme is available in pregnancy and until the child’s fourth birthday, yet the scheme is beset with problems—problems that were caused by this Government and can be easily fixed by this Government.

The child of the north all-party parliamentary group has heard evidence that children in the north are more likely to die before reaching their first birthday than those elsewhere in the country. We have heard about desperate mothers who are seeking an abortion because they simply do not know how they will feed their baby. When I raised that with the Prime Minister only two weeks ago, his response was to advise me that he was

“proud that…the Government have overseen a significant fall in poverty, particularly child poverty.”—[Official Report, 8 May 2024; Vol. 749, c. 570.]

Child poverty has not significantly fallen: it stands at more than 4 million. When expectant mothers have had to make these heartbreaking decisions, bragging about the support put in is crass, to say the least. It was followed up with an equally tone-deaf letter from the Secretary of State for Work and Pensions.

It has been widely reported that some parents, in desperation, have resorted to theft of baby milk and formula or are having to water it down, which is not surprising considering that prices of baby formula are at historically high levels and the current Healthy Start payments do not even cover the cost of formula for one week. Despite this, Healthy Start take-up is dropping. The Government’s 75% target—given to the NHS Business Services Authority, which runs the scheme—was missed last year, and take-up continues to decrease: it stands at just 62.5% across England, Wales and Northern Ireland. The comparable scheme in Scotland, however, has reached 92% take-up. Some local councils and organisations have made a dedicated investment to promote the scheme; not only does this create a postcode lottery, but they were left feeling utterly demoralised after the Government provided false, inflated take-up figures and were then unable to provide accurate uptake data.

An opt-out system would ensure proper data and free up organisations to support families instead of having to try to locate them—a point that is supported by research published earlier this month and funded by the Minister’s own Department. In some areas, the take-up is as low as 44%. About 220,000 babies, young children and pregnant women are missing out on the scheme, and Sustain estimates that that leaves £58 million unclaimed.

Despite the Chancellor’s crowing on this morning’s news, low inflation still means rising prices on top of previous high rises. In short, this is just stemming the pain for families. Only last year, UNICEF found that the UK had the worst rise in child poverty, leaving us bottom among 39 of the world’s richest countries. That is why admissions for malnutrition have increased in children and there has been a resurgence of Victorian diseases such as rickets and scurvy. It is no wonder that the Government blocked the United Nations special rapporteur on the right to food from visiting the UK and investigating poverty. When the previous UN special rapporteur on extreme poverty visited the UK, he was very clear that the rise in poverty was the direct result of Government policies.

Food banks, baby banks, faith groups and charities have now become embedded parts of our welfare state. The Key to Life food bank in my constituency reported a 300% increase in demand last year, coupled with a decrease in donations. It is therefore highly unlikely that the £58 million that is going unclaimed is unclaimed because people do not need it. There is a very clear need for the scheme but, as I have been told time and again, awareness is low among the public and professionals. That is why in 2021 the national food strategy recommended that the Government implement a communications plan related to Healthy Start, but they did not.

In 2021, I and others raised concerns about plans to fully digitalise the scheme by 2022, meaning that paper applications and vouchers would no longer be accepted. The result was that, as of October 2023, more than 20,500 households that were previously in receipt of the vouchers were no longer receiving them, 19 months after digitisation. The NHS Business Services Authority then admitted that technical issues meant that applications were being declined, resulting in parents and pregnant women struggling to get through to the helpline and having their payment cards rejected.

As it stands, the application routes are overly complex and varied. When an application is made online, an automated message claims that a response will be given in two days. This very rarely happens. Some mothers report that they have never heard back and that, after multiple attempts, they have given up.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I apologise for missing the first couple of minutes of my hon. Friend’s speech. She is making an excellent speech outlining why the scheme is so needed. She mentions that take-up of the Healthy Start scheme is too low, so proper information about the scheme is needed, along with auto-enrolment. That would cut through the red tape and the hurdles that many families experience. Does she agree that the Government must therefore do more to promote the Healthy Start scheme to families so that people are aware of it, as recommended in the excellent national food strategy?

[Mrs Lewell-Buck]

I thank my hon. Friend for that intervention and for all the work that she does in this space. She has tirelessly championed children for as long as I have known her and for as long as she has been in this place. Charities, organisations and local authorities are using what little money they have to promote a Government scheme, and then when they go to the Government for data about how it is working, they get either false figures or no figures at all, so I could not agree more with my hon. Friend.

The Healthy Start phone number is not freephone, and it is fully automated. There is no option at all for callers to speak to anyone unless they need an interpreter or have inquiries relating to their card. The absurdity of an automated system asking whether callers have problems with cards that they do not yet have is not lost on any of us, I am sure. Worse still, if the application is refused, the parent is not told why and is directed to the phone line: again, they cannot speak to anyone. Research by Manchester Central food bank highlights the fact that those on legacy benefits or with no recourse to public funds have to apply via paper or telephone, but that is completely at odds with the Healthy Start phone line and website, which state very clearly that applications must always be made online. The confusion is completely unnecessary.

Repeated questions to the Secretary of State for Health and Social Care about funding for the scheme and future take-up have been equally frustrating. The Government refuse to say how much money they allocate to the scheme each year. They claim it is allocated on a forecast for take-up, but will not say what that forecast is. A cynic would conclude that if the Government forecast low uptake, it is against their interest to do anything to boost it, as they will not have budgeted for that, or that if they forecast higher uptake but do not reach it, millions of pounds that could have been spent on feeding children will be spent elsewhere. Either way, hungry babies and children are once again the ones losing out.

Back in May 2023, a similar debate was held in which the Government were made fully aware of the problems with Healthy Start. The following month, I introduced my Bill on auto-enrolment, the Healthy Start Scheme (Take-Up) (No. 2) Bill. Over the past two years, I have sent the Health Secretary two cross-party letters, signed by MPs and a multitude of outside organisations. This was followed by more questions and speeches in the Chamber and a full report to the Chancellor in advance of the previous Budget. Forty-eight written questions and two well-supported early-day motions later, here we are again.

I am sure that in her response the Minister will reiterate the excuses her colleagues have given for refusing auto-enrolment: that it is not possible because the prepaid card is a financial product that is therefore subject to financial regulations. However, Mastercard has written to me explaining that it is possible, if only the Minister’s Department and the Department for Work and Pensions will work with it. I have been here long enough to know that the Minister will not be able to commit to auto-enrolment today, but at the very least can she give a commitment to working with her colleagues and other organisations to look at piloting auto-enrolment?

Can the Minister assure us that her Department’s uptake data is now accurate and advise us on the progress of her Department’s promise to me to write to all eligible households that are missing out on the scheme? As we debate this today, there will be mothers and fathers who, instead of excitedly preparing for their newborn or enjoying those early years with their little ones, are worried and distressed about how on earth they are going to provide for them.

I know that auto-enrolment is not a panacea. I know that life will continue to be a hard struggle for so many people. But as I did when I presented my Bill, I want to thank all the parents who have shared with me their stories and their pain. They should always be at the forefront of our mind, because nobody should feel such desperation and hopelessness that they can see no other way than stealing to feed their baby or seeking to terminate their pregnancy. I sincerely hope that the Minister agrees with me about that.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Dowd, and to respond to the debate on behalf of the Under-Secretary of State for Public Health, Start for Life and Primary Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). I am grateful to the hon. Member for South Shields (Mrs Lewell-Buck) for raising this important debate about the Healthy Start scheme, and to other hon. Members who have contributed.

The Government are committed to supporting the next generation of children, who are, of course, our future, and their own will obviously depend on this as well. A child’s early life is critical to their health later in life. We want every family to receive the right support to care for their children. Growing up with a healthy diet and weight is strongly protective against ill health in childhood and adulthood. Eating a healthier diet, as set out in “The Eatwell Guide”, could increase population life expectancy by up to eight years.

We know that fruit and vegetable consumption is lower among more deprived children, and that those children may be at risk of not getting enough micronutrients. More than one in five children start primary school overweight or obese, and the numbers are higher in more deprived areas. That is a major risk factor for long-term diseases including heart disease, type 2 diabetes and many types of cancer.

Against that backdrop, the support for children to eat healthily through the Healthy Start scheme and our provision of free school meals is crucial. The Healthy Start scheme benefits hundreds of thousands of families across the country. The statutory scheme encourages a healthy diet for pregnant women, babies and young children under four from low-income households. Eligibility criteria for the scheme ensure that we target nutritional support on families who need it most.

In April 2021, we increased the value of Healthy Start by 37%, from £3.10 to £4.25 a week, therefore helping families with the increased cost of living. I welcome the support demonstrated by colleagues today for this important scheme and the emphasis placed on its uptake. I fully agree that we need to ensure that eligible families are aware of and able to access Healthy Start. I now turn to how we are doing that.

Healthy Start is delivered by the NHS Business Services Authority, on behalf of the Department. Following user research and testing by both the Department and the NHSBSA, the scheme switched from being paper based to a digitised service in 2021. An online application and prepaid card replaced the previous paper form and vouchers. The number of families being supported by Healthy Start has grown following the introduction of the prepaid card. Since September 2021, of the more than 600,000 successful applications, 45% have come from new families and the scheme now supports more than 360,000 beneficiaries on lower incomes. The uptake is 62% of people who are eligible, which is higher than in the previous paper scheme and shows the benefits of the transition to a digital scheme.

Hon. Members have raised the question of auto-enrolling eligible families on Healthy Start. Moving to auto-enrolment would require a substantial redesign of the scheme. In contrast to what I heard the hon. Member for South Shields say, such a move, unfortunately, is not a simple thing to do. I am told that the prepaid card would need to be removed because it is a financial product that, under financial services legislation, requires applicants to accept the terms and conditions on an opt-in basis, so we cannot have it as an opt-out. Creating a new delivery method and process is therefore far from straightforward and would come at an additional cost to Government, with disruption for the beneficiaries.

[Mrs Lewell-Buck]

As the Minister heard in my opening comments, Mastercard completely refutes that argument. It and Allpay, which administers the scheme, have been clear that it is entirely possible to do auto-enrolment; they just need the Department for Health and the DWP to talk to them about it. It is not a difficult thing to do. They have outlined it to me in a letter, and I am happy to share that with her Department, yet again.

[Helen Whately]

I hear the hon. Member’s point, but as I set out clearly, I understand that this is not a simple thing to do, and not straightforward. As she has offered, however, I suggest that she writes to the Under-Secretary of State for Public Health, Start for Life and Primary Care with that suggestion and the proposal from Mastercard. I have no doubt that my right hon. Friend will look into it and respond to the hon. Member.

I have been saying that it is complicated to shift to an auto-enrolment scheme under existing legislation. By contrast, the current scheme has seen increased take-up, with the switch to the prepayment card. We would not want to jeopardise that progress of increasing numbers of families enrolling on what is an important scheme. That is why the Government’s focus is on increasing the uptake and effectiveness of the existing scheme, so that more children can benefit from Healthy Start. I also assure the hon. Member for South Shields that the substantial level of investment in the scheme is in the order of £78 million per annum.

I was sorry to hear about the problems in getting access and responses to phone calls for people calling up for help with access to the scheme. It is clearly important for people to be able to get help, if needed, to access Healthy Start. I understand that the average speed of answer for calls between 1 April and 10 May was 19 seconds, but I have asked officials to look further into the problems raised by the hon. Member for Stretford and Urmston (Andrew Western) regarding accessing the phoneline and accessing help.

Multiple channels of communication are used to raise awareness and encourage take-up of Healthy Start. NHSBSA actively promotes Healthy Start through its digital channels and has created free toolkits for use by healthcare professionals, local authorities and public health teams. NHSBSA uses a range of communications to raise awareness among parents and pregnant women. For example, it has attended maternity and midwifery forum events and placed advertisements in You and Your Pregnancy magazine, which is given to pregnant women in the first trimester, and the Bounty and Badger Notes apps. As officials confirmed to the House of Lords Food, Diet and Obesity Committee on 7 May, we also have plans to write to everyone eligible for Healthy Start to ensure they are aware of the scheme and to encourage them to apply.

As I said before, the Government are committed to promoting a healthy diet for our children. Healthy Start is an important part of the support provided by Government but it is only one aspect of how we are doing that. For our youngest children, the Government are investing £50 million in infant feeding support as part of the family hubs and the Start for Life programme. We support childcare providers with the cost of milk through the nursery milk scheme. We are also working with industry to improve the healthiness, marketing and labelling of commercially available baby food and drink aimed at those aged up to 36 months. Children of all ages also benefit from restrictions on the placement of less healthy products in key selling locations, calorie labelling on menus and upcoming landmark restrictions on multi-buy offers and the advertising of less healthy products on TV and online.

For school-aged children, we have the school fruit and vegetable scheme and free school meals. The Government have expanded free school meals to more groups of children than any Government over the past 50 years. We have introduced universal infant free school meals for all children in reception, year 1 and year 2. Under the benefits-based criteria, more than 2 million of the most disadvantaged pupils are provided with free school meals; in fact, the greatest ever proportion of children are receiving free school meals, with more than a third receiving free lunches compared with one in six in 2010. Furthermore, a crucial backdrop to this debate is the latest fall in inflation—because we know that the best way to help people with the cost of living is to bring inflation down.

Infancy and early childhood is a crucial time for establishing food preferences and dietary patterns. Giving children a healthy start in life is critical to health outcomes throughout childhood and adulthood. The Healthy Start scheme is one of the essential ways in which the Government support our most vulnerable families to give their children the best start for a healthy life. I welcome colleagues’ interest in the Healthy Start scheme and assure them that although our approach may be different from the one that the hon. Member for South Shields argues for, we are committed to making sure that the children who most need help get it.

[Mrs Lewell-Buck]

I thank all hon. Members who have spoken today, in particular my hon. Friend the Member for Stretford and Urmston (Andrew Western), who has long championed a reduction in the price of baby formula. He rightly pointed out that auto-enrolment is not the only issue with Healthy Start; there is also the value of payments and the eligibility criteria. I thank my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill) for her kind words and support.

I also thank the Minister for her comments. However, it will come as no surprise that I completely disagree with her analysis of the entire situation. The one thing I will take from her speech is that at least she has reiterated the promise to once again write to all eligible households missing out on the scheme. We have been promised that for some time now and it has not yet been delivered.

If the rumours about an imminent general election are true, I must tell the Minister to please get a move on, because we do not have long left. In the interim, before we have a new Government, I will, as I have always done, use my time in this place to try anything at all that the Government might accept. I will keep pushing for them to at least explore trying a pilot for auto-enrolment for Healthy Start.

People should not have to put up with the daily grind and struggle. Eradicating child poverty was a central plank of the last Labour Government, and I know for a fact that it will be a key plank of the next one. I just cannot wait until we get there.

Question put and agreed to.

Resolved,

That this House has considered the Healthy Start Scheme.