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Healthy Start and Early Years. Anna Kitt What is Healthy Start?. Replaced Welfare Food Scheme in 2006 A statutory scheme A nutritional safety net A public health tool. Inter related infant health initiatives. What does it provide?. Vouchers: Vitamins:

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healthy start and early years

Healthy Start and Early Years

Anna Kitt

what is healthy start
What is Healthy Start?
  • Replaced Welfare Food Scheme in 2006
  • A statutory scheme
  • A nutritional safety net
  • A public health tool
what does it provide
What does it provide?


Liquid milk For women

Fresh fruit and vegetables For children

Infant formula milk

Eligible families are able to get these from 10wks pregnant to their child’s 4th birthday

AND: Information on breastfeeding and healthy eating through the Healthy Start magazine sent with the vouchers


who is it for
Who is it 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) with an annual family income of £16,190 or less.

And ALL pregnant under 18 year olds

NOTE: There are no back payments for missed time periods

the voucher
The Voucher

£3.10 each week

Issued 4 weekly to beneficiaries

Double vouchers for under 1’s (£6.20/week)

Voucher value reviewed annually

Over the course of a pregnancy this equates to £93 food vouchers


health professionals can make a huge difference
Health professionals can make a huge difference!

Role of Health Care Professionals

The way the parents find out about the scheme effects their relationship with the scheme.

healthy start is a statutory scheme

Healthy Start is a Statutory Scheme

Health Professionals are given the key tasks of:

Signposting to the scheme

Supporting applications

Signing application forms

PCTs have a duty to make Healthy Start vitamin supplements available


Healthy Start application process

Family becomes eligible

Midwife/Health Visitor

Invitation from HSIU

Application form in GP surgery

Tax credits helpline

Potential beneficiary hears about

Healthy Start

Pregnancy or Birth to Five Book

Jobcentre Plus


Poster in children’s centre

Get application leaflet/Form


GP Surgery

HSIU Helpline

Complete Form

Health Visitor

Get signature from midwife or health visitor

Submit to HSIU


HSIU receives application form

Fully completed

Wrongly completed

Clearly do

not qualify

Application for



includes children

Returned to applicant



Vouchers Issued

Validate against

HMRC and JCP data


checks later

Match not found

Match found

Inform applicant and invite to give

additional information. Repeat 2/4

weekly checks for 3 months

Vouchers Issued

No match found

Match found

Vouchers not issued

Repeat validation

checks every 2 wks

(HMRC) or 4 wks (JCP)

Voucher Issued

Letter confirming match not found

why give vitamins
Why give Vitamins?
  • Sufficient evidence to convince COMA and SACN to recommend supplementation
  • NICE report on Maternal and child nutrition (March 2008) places the onus on PCTs to ensure supplementation happens


COMA – Committee on Medical Aspects of Food and Nutrition Policy

SACN – Scientific Advisory Committee on Nutrition

NICE – National Institute for Clinical Excellence


Vitamin Facts

Children’s Drops

Women’s Tablets

vitamin collection points
Vitamin Collection Points
  • Local Vitamin Collection Points (marketing)
  • Collection of vitamin coupons (administration)
Arrow points towards either the women’s or children’s vitamins depending on which product they should be picking up.
synthesis of vitamin d
Synthesis of Vitamin D

Our main source of vitamin D is that made by our own bodies. 90% of our vitamin D is made in the skin with the help of sunlight

dietary sources of vitamin d
Dietary Sources of vitamin D
  • Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards, and fresh tuna
  • Amount will depend on preparation, with smoked herring containing approximately 4μg per 100 g and raw herring 40μg per 100g
  • Cod liver oil and other fish oils
90% of the UK lies above the latitude that permits exposure to the ultraviolet B wavelengths necessary for vitamin D synthesis
vitamin d deficiency is sunlight deficiency
Vitamin D deficiency is Sunlight Deficiency

UK :13-28% of women of childbearing age have low plasma vitamin D levels

2 hours/week sunlight exposure if face only, 30 minutes face, arms and hands is sufficient for Vitamin D synthesis. (SPF 8+prevents)

Darker skin blocks some of the UV rays, so need more exposure to make Vit D

In UK the wavelength of sunlight received in winter (November to March) is not effective at making vitamin D.

Univ Westminster

Carol Williams, 2009

who gets vitamin d deficiency
Who gets vitamin D deficiency?
  • Pregnant or breast-feeding women. Vitamin D deficiency is even more likely to develop in women who have had several full-term pregnancies with short gaps between them.
  • In the last three months of pregnancy, babies are growing at their fastest and mothers often become short of vitamin D especially if these months occur during winter or early spring.
who gets vit d deficiency
Who gets Vit D Deficiency?
  • Breast-fed babies whose mothers are lacking in vitamin D, or with prolonged breast-feeding
  • Bottle-fed babies do not need vitamin D supplements as formula milk is fortified with vitamin D
Explanations provided for low sun exposure and low vitamin D intake by mothers (Outpatient survey, West London)
  • Little time outside: busy indoors or at work
  • Going “out” often includes shopping in malls
  • Use of sun block
  • Dislike or fear of sunlight for themselves and their infants
  • Use of skin lightening creams regularly
  • No Healthy Start vitamins
  • No mention of vitamin D in antenatal care
  • No knowledge of vitamin D
  • How to improve knowledge and healthy behaviour relating to vitamin D

(Michie C. London Journal of Primary Care, 2010)

  • Vitamin D insufficiency is common in the UK population
  • Vitamin D deficiency typically presents with bony deformity (rickets) or hypocalcaemia in infancy and childhood, and with musculoskeletal pain and weakness in adults
  • Currently there is a lack of coding of vitamin D deficiency in primary care and secondary care
vitamin d supplements
Vitamin D Supplements

Prices correct Nov 2010

Holland & Barrett

10mcg (100 tablets)


Healthy Start (56 tablets)



  • Boots
  • 12.5mcg (90 tablets) £2.79
  • ASDA
  • 10mcg (60 tablets)