Healthy Start Scheme

Kate Green Excerpts

Wednesday 7th September 2022 Westminster Hall

[Christina Rees (in the Chair)]

I will call Kate Green to move the motion, and then the Minister to respond. There will not be an opportunity for the Member in charge of the debate to wind up, as is the convention in 30-minute debates.

[Kate Green (Stretford and Urmston) (Lab)]

I beg to move,

That this House has considered access to the Healthy Start scheme.

It is a pleasure to introduce the debate and to see you in the Chair, Ms Rees. I start by praising Healthy Start. The scheme provides support to expectant mothers who are more than 10 weeks pregnant, and to parents and care-givers who are responsible for at least one child under the age of four. Healthy Start vouchers, which have a value of up to £4.25 a week, or £8.50 a week for those with a child under one, entitle parents in receipt of certain social security benefits to fruit and vegetables, cows’ milk, infant formula and pulses. The vouchers also enable mothers to access vitamins from pregnancy until their child reaches the age of one, and enable children to access them from birth until the age of four. Originally, the scheme used paper vouchers, but since September 2021, families who were already enrolled on the Healthy Start scheme have been moved on to prepaid cards. Since the end of March 2022, prepaid cards have entirely replaced the paper vouchers.

Healthy Start has an important role to play in helping to ensure that mothers and young children have a nutritious diet. It is effective: research has found that participating families increase their spend on fruit and vegetables. The Minister will understand how crucial a healthy diet is for pregnant and new mothers, babies and young children. The British Medical Association has highlighted the effects of poor nutrition during pregnancy: adverse health and social outcomes, premature birth, low birth weight, shorter life expectancy and a higher risk of death in the first year of a child’s life.

[Ian Byrne (Liverpool, West Derby) (Lab)]

I thank my hon. Friend for securing this incredibly important debate; I know the work that she has done on the issue. A report from Feeding Liverpool, published today, has found that thousands in our city who are eligible for Healthy Start are missing out. In 2021, an estimated £758,521 went unclaimed, rather than on giving children and those who are pregnant in Liverpool access to good food, milk and vitamins. That is a huge loss for families who are struggling to cover the rising cost of living in a city where one in three is now food insecure. It will have a huge health impact; we know how important nutrition is for children in the early years. Does my hon. Friend agree that the Government must urgently review and extend the eligibility threshold for Healthy Start, to enable more families to benefit from the scheme, and that the Government must invest in a national Healthy Start communications campaign to increase awareness and uptake?

[Kate Green]

It is a pleasure to respond to my hon. Friend’s question. He has done excellent work as part of his “Right to Food” campaign, and he raises a number of issues, including take-up, the generosity of the scheme and the importance of adequate nutrition, that I will come back to in my speech.

My hon. Friend will know that child food poverty continues to stunt children’s development as they grow up, and that overstretched family budgets, which mean that mothers go without in order to feed their children, are harmful to maternal health, increase maternal stress and are especially dangerous if women are breastfeeding—or, indeed, may prevent them from doing so. The Minister will share our concern that a new YouGov survey commissioned by Kellogg’s, which will be released next week—I appreciate that she has not had a chance to see it yet—has found that 66% of low-income families say that accessing Government benefits is complicated, and 53% are not confident that they are aware of all the benefits available to them. At the same time, 80% of parents on low incomes say that the rising cost of goods has impacted their ability to pay for essential items, and more than one in seven says that their children are worried about the situation.

[Jim Shannon (Strangford) (DUP)]

This is an incredibly important subject. I commend the hon. Lady on the way that she has introduced it. We are moving into what are perceived to be difficult times. Some of the figures for Northern Ireland show that poverty will probably double, which shows the importance of the scheme. Does she agree that the Government and the Minister must look once more at eligibility for the scheme, as working people who are already on the breadline will increasingly find themselves unable to support their family? If the scheme is not able to provide for a family as it did in years gone by, there will be a need to change the money available and the system.

[Kate Green]

The hon. Member draws attention to a very important point about the pressures faced by families—and not just those in which people are out of work, but those where they are working on low incomes. Healthy Start and other forms of social support can play an important part in enabling families to raise their children.

The removal some months ago of the £20 uplift in universal credit and the cost of living crisis will exacerbate the situation for families, as soaring energy, food and fuel bills lead to a further increase in maternal and child poverty. Last month, the Institute for Fiscal Studies reported that the cost of living is expected to be 11.3% higher in financial year 2022-23 than last year; inflation is expected to peak in the last quarter of this year at 13.1%. The impact will fall disproportionately on low-income families. The TUC has suggested that pay rises could fall behind inflation by almost 8% later this year, marking the biggest fall in real wages for 100 years.

The situation is especially acute for families with new babies and very young children. Maternity Action points out that the value of the basic rate of maternity, paternity and parental pay, relative to women’s median earnings, has declined from 42% in 2012 to 37% in April 2022. New mothers are expected to survive for up to 33 weeks on not much more than a third of women’s average earnings. That, of course, is at a time when they face the additional costs associated with parenthood.

Against that backdrop, Healthy Start will be more important than ever, but as my hon. Friend the Member for Liverpool, West Derby (Ian Byrne) and the hon. Member for Strangford (Jim Shannon) have pointed out, many mothers on low incomes will not even be eligible for support. To qualify, they have to be on an income of less than £408 per month, so a new mum receiving universal credit plus statutory maternity pay would not qualify for support.

Alongside concerns about the scale of support needed are concerns about the take-up of Healthy Start, as we have heard. In a written answer to the Bishop of Gloucester on 1 August, Lord Kamall stated that up-to-date figures are not held centrally. He promised that work to compile the data was taking place across Government, and that the data would be published as soon as possible, but I find it astonishing that the Government do not have those figures now.

As we have heard, there is widespread concern about low take-up. In Greater Manchester, the combined authority estimates that around 40%, or approximately £5 million-worth, of vouchers go unclaimed. That is borne out by Maternity Action’s survey; fewer than 1% of respondents on low incomes reported receiving Healthy Start, the Sure Start maternity grant, or the Scottish Best Start grant and food vouchers, yet more than half of those very same mothers reported difficulties in buying essentials at least some of the time, and 2% reported using food banks. It is pretty clear that the benefits are not proving effective at reaching all those most in need.

Concerns about take-up are compounded by the suspicion that digitalisation has not improved things; indeed, it may have made them worse. I am not at all against digitalisation—indeed, the National Institute for Health and Care Excellence recommended it back in 2014. There are a number of potential benefits to introducing a payment card system: cards can be used anywhere in the UK; unspent sums can be rolled over from week to week; administration should be simpler and potentially cheaper for retailers; and data collected from card use could be used to improve the supply chain and for system monitoring.

However, it appears that when prepaid cards were finally introduced last year—applications are made by telephone or online—the process had been piloted only on those who already had smartphones and monthly price plans. That may explain some of the problems being experienced, which may be inhibiting take-up. First, the issue of the cost of calls—55p a minute for those on a pay-as-you-go mobile—is compounded by long waiting times to get through on the helpline. Applicants have reported having to wait up to an hour to speak to an adviser, leading to call costs of as much as £33.

One reason for the delay in getting through seems to be that the same line is used for both inquiries and application. A complicated query can lead to long waits for callers down the queue. Meanwhile, those applying online may face data costs. Claimants also report that no reason is given if their application is rejected. They need to reapply if they think the decision is incorrect but, unhelpfully, they will not know what they got wrong. Support takes effect from the date that an application is approved, but there is no backdating for those who had to reapply.

The expectation that a card system would mean improved coverage has not always materialised. The prepaid cards can be used at any outlet that accepts Mastercard. Unfortunately, that means that some outlets that previously accepted the paper vouchers are no longer able to accept the prepaid cards. They include independent local stores, which often supply culturally appropriate foods to minority and marginalised communities, market stalls, and those making direct sales from the farm gate, which is a particular issue in relation to rural poverty. Even some well-known high street names that previously accepted the paper vouchers had the wrong Mastercard merchant code and could not accept the cards, as food retailing is not their main business. I am not sure whether that issue has been resolved; perhaps the Minister could confirm that.

Finally and distressingly, while we may have expected that the use of a prepayment card would reduce stigma, Feeding Britain points to worrying research from Northumbria University; it shows that shoppers need to split their trolley of purchases at the check-out; cards are frequently declined at the check-out, causing anxiety, embarrassment and humiliation; and shop staff are unfamiliar with the new prepaid cards, unable to help or offer conflicting advice. We hope that those are teething problems and will reduce as stores become familiar with the cards, but it is troubling that the new scheme should have compounded poverty with stigma in this way.

Having said all that, I repeat my support for the Healthy Start scheme, but it could be so much more effective at reducing poverty and improving maternal and child nutrition if changes were made. I will conclude with some questions and suggestions for the Minister. First, sort out the helpline. I cannot understand the logic of a service that is intended to support low-income households imposing call charges that exacerbate family poverty. Healthy Start is not alone in that. It is high time that the Government carried out a comprehensive review of the cost of calls to helplines across Government that are specifically designed to enable people on low incomes to reach the services and benefits intended to help them, including Healthy Start. While I am on the subject, a review is needed of the data charges when accessing services online.

Next, deal with the delays—if necessary, by increasing helpline staff numbers to reduce waiting times. Will the Minister review the routing of calls depending on their nature, so that complex queries do not create bottlenecks that lead to long waits for other callers?

As I have said, eligibility for Healthy Start starts from the 10th week of pregnancy. In practice, however, the support takes effect from the date of a successful application, so an expectant or new mother who has only belatedly discovered that she is entitled to support will lose out. Does the Minister agree that support should take place from the 10th week of pregnancy in all cases, and be backdated if necessary? That would help those whose initial applications are rejected and who successfully reapply. Will the Minister look at what can be done to ensure that applicants are clear about the reason for refusal if their application is rejected?

As I have said, Healthy Start is available until a child is four, which leaves a gap of several months before children start school and may become eligible for free school meals. Will the Minister consider extending coverage until a child starts school? Will she look at the value of Healthy Start, at extending it further up the income scale—many claimants in receipt of universal credit are ineligible—and at automatic uprating, so that the value of the benefit keeps pace with inflation? The Co-operative Group topped up the value of the vouchers as families struggled during the pandemic. With the cost of living now rising so sharply, there is a need for the Government to act urgently.

Crucially, will the Minister urgently launch a vigorous and comprehensive national take-up campaign, working with local and regional government; retailers and industry bodies such as the Co-op and the Association of Convenience Stores, which work hard to promote the scheme among their members; charities, foodbanks and pantries such as the Bread and Butter Thing and Community Fridge; the advice sector; schools and family hubs; registrars in NHS settings; and organisations that provide support to new mums and pregnant women? There is good practice on which to build—for example, Kellogg’s is partnering with the Greater Manchester Poverty Action Group to run a pilot in four schools and colleges that gives parents access to a financial inclusion officer, who will be available in informal settings such as school breakfast clubs in order to offer parents advice on how to access benefits, including Healthy Start.

Finally, a more accessible application process would also help take-up, so will the Minister work with the Department for Work and Pensions to introduce a tick box as part of the universal credit application process, and with local authorities to introduce a similar tick box on applications for council tax support? Better still would be to introduce a system of automatic enrolment, as Feeding Britain has proposed—perhaps with the option to opt out—to replace the system that we have now, which requires parents to opt in. Is that something the Minister would consider?

I know the Minister takes the health and welfare of pregnant women and children very seriously. Healthy Start has an important role to play, and I hope she will find the suggestions that I have made this morning helpful. I look forward to her reply, and to hearing how she intends to take action to ensure the scheme does all that it has the potential to do to help children to thrive.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

It is a pleasure to serve under your chairmanship again, Ms Rees, and I am grateful to the hon. Member for Stretford and Urmston (Kate Green) for securing the debate. I know that she is passionate about the Healthy Start scheme and the wider issue of children and young people. I also thank the other hon. Members who contributed this morning.

The Government welcome the opportunity to discuss the Healthy Start scheme and how it is benefiting hundreds of thousands of families across the country. Eating a healthy and balanced diet in line with the “Eatwell Guide” can help prevent diet-related disease, ensuring that we get the energy and nutrients needed for good health and for maintaining a healthy weight throughout life. As the hon. Lady outlined, the Healthy Start scheme is one of the ways that the Government continue to target nutritional support at the families most in need, which is increasingly important in view of current pressures on the cost of living. The scheme helps to encourage a healthy diet for pregnant women, babies and children under four from low-income households. It offers support to buy fresh, frozen or tinned fruit and vegetables, fresh, dried or tinned pulses, plain cow’s milk, and infant formula. Beneficiaries are also eligible for free Healthy Start vitamins.

Healthy Start is a passported benefit, with eligibility based on the receipt of welfare benefits and tax credits under certain earnings thresholds. Women who are at least 10 weeks pregnant and families with a child under four years of age are eligible for the scheme if they claim income support, income-based jobseeker’s allowance, child tax credit with an annual family income of £16,190 or less, universal credit with family take-home pay of £408 or less per month, or pension credit. Pregnant women on income-related employment and support allowance are also eligible for the scheme. In addition, anyone aged under 18 who is pregnant is eligible for Healthy Start, regardless of whether they receive benefits. Once they have given birth, they must meet the benefit criteria to continue receiving Healthy Start. Pregnant women and children aged over one and under four each receive £4.25 every week, and children aged under one receive £8.50 every week, as well as free Healthy Start vitamins.

Our commitment to the Healthy Start scheme is demonstrated in both the voucher value increase of over 37% in April 2021, and the strategic move from a paper-based service to a digital one. I am extremely pleased that there have been over 400,000 successful applications to the Healthy Start digital service since its launch. Of those, 37% are households brand new to the scheme. The figures show that by providing a modern and efficient digital Healthy Start service, we have addressed the barriers created by the legacy paper-based service and have encouraged more eligible families to join.

Following user research and testing, we have replaced the paper application form with an online application that provides an instant decision for many families. We have also swapped paper vouchers, which beneficiaries told us could be lost, damaged, inconvenient or stigmatised to use, with a prepaid card. I take on board the hon. Lady’s point that cards can be stigmatising when they go wrong, but a prepaid card that is loaded with Healthy Start benefit payments is an improvement. I am aware that there have been teething issues, which is to be expected when transitioning from a legacy service to a new digital service. However, we have been working to address those issues with the NHS Business Services Authority that operates the Healthy Start scheme on behalf of the Department.

[Kate Green]

I am grateful for the tone of the Minister’s response. In relation to addressing the teething problems with NHS digital and business services, I understand that work with local steering groups has now ceased and there are no longer regional co-ordinators to feed back problems. Will the Minister look at ensuring that those on the frontline are able to continue to feed intelligence to the NHS, and receive intelligence back about improvements that are being made?

[Maggie Throup]

Yes, we always need to make sure that we know what is happening on the frontline so that we can keep improving services.

Since 1 April this year, over 1.5 million calls have been made to the automated Healthy Start helpline. The helpline supports beneficiaries to self-serve on topics such as activating their cards, reporting lost or stolen cards, and checking their balance without needing to speak to an agent. The NHS BSA analysed the issues that applicants and beneficiaries may experience when applying for and using the Healthy Start scheme, and it has acted on the findings. In particular, it has invested more resources so that agents are handling calls and resolving them first time—an issue that was brought up early in the scheme. Currently, the average call wait time is down to just 31 seconds, which is a vast improvement. I am grateful to the NHS BSA for its work on harnessing the power of social media by engaging with over 15,000 messages since April this year. I also extend my thanks to Iceland—the supermarket, not the country—which continues to find novel ways to support and promote the scheme. The hon. Lady mentioned other supermarkets that we would be delighted to engage with.

At a time when families are increasingly aware of the cost of living and the need to provide their children with a healthy diet, the Government are committed to helping the most vulnerable. I will try to get through a few of the other questions in the time that we have. The hon. Member for Liverpool, West Derby (Ian Byrne) wanted to make sure that no one was missed in the transition. Since September 2021, the NHS BSA has directly contacted all households receiving Healthy Start vouchers to invite them to apply for a prepaid card, including three invite letters, two leaflets, emails and text messages. The Government continue to look at ways to support households to ensure that they are aware they can take up the offer, and the NHS BSA recently provided training to staff at the Department for Work and Pensions to raise awareness of the Healthy Start scheme. The hon. Member for Stretford and Urmston mentioned DWP and I think it is important that everybody is working together on these issues.

Healthy Start eligibility is kept under continuous review and aligns closely with other passported benefits across Government. There are no current plans to expand eligibility for the scheme with regard to the onus threshold or the qualifying age range but, as I said, we always keep such schemes under review. We have talked about the current cost of living and food inflation, and the Healthy Start scheme is kept under review from this point of view as well. The voucher value rose from £3.10 to £4.25 in April 2021—an increase of 37%. We have no current plans to increase the value of the Healthy Start scheme.

The hon. Member for Stretford and Urmston raised the cost of calls to the helpline. In line with national and other Government agencies, the NHS BSA transferred from 0845 numbers to 0300 or 01 or 02 numbers as part of the fair telecoms campaign. Telephone companies include calls to 0300 numbers in the free minutes of some call plans. Any call charges outside of a plan are charged at a local rate, which is set by the caller’s provider, so calls to the NHS Healthy Start telephone helpline are charged at a local rate if they are not part of an inclusive package. We now have a separate automated telephone helpline that is available 24 hours a day, which will help people with a lost or damaged card or to check their balance—as the hon. Lady said, issues that are not complex but much easier to resolve through an automated system.

Of course, people can apply via email and through the NHS Healthy Start Facebook and Twitter social media channels, so there are ways to access the service without paying for the phone call. We recognised some of the teething problems that were seen on the telephone lines, and hopefully the hon. Lady will see that we have now made vast improvements.

The hon. Lady talked about automatic enrolment through universal credit or local authorities. However, the Healthy Start card is a financial services product, which means that the person using it has to take on certain responsibilities. There therefore needs to be that acceptance of authorisation. The hon. Lady is looking confused—I will write to her with more details, rather than try to explain it in the short time I have left.

The hon. Lady also talked about cost of living pressures potentially increasing existing disparities. The Government are committed to levelling up health across the country and will continue to work to close the gap in health outcomes between different places and communities so that people’s backgrounds do not dictate their prospects for a healthy life. I know that that is very close to the hon. Lady’s heart; it is very close to mine as well.

I have hopefully covered many of the issues that have been raised by the hon. Members for Stretford and Urmston and for Liverpool, West Derby. As I say, I will write to the hon. Lady about the financial services product. If there are any other outstanding issues, I am happy to have further correspondence with her. I close by thanking the hon. Lady for raising this important issue and other hon. Members for their contributions. As always, we will keep the Healthy Start scheme under review to ensure it provides support for those families who need it the most.

Question put and agreed to.