Review of the Distribution of Healthy Start Vitamins Through Community Pharmacies

Appendix 3 Wider Healthy Start Scheme Challenges

During the review of the distribution of vitamins and drops, both community pharmacies and Health Start Leads raised issues concerning the Health start scheme as a whole. These included:

• Entitlement to the Healthy Start Scheme depends on whether women are receiving benefits or tax credits. Women and children who are asylum seekers may not be eligible for benefits and therefore will not be eligible to apply for health start. Also, women who have had their benefits sanctioned will not be able to receive the coupons.
• Women who may not be eligible for benefits when they become pregnant may not be aware of the need to take vitamins and may not be aware they are eligible to receive the coupons once their circumstances change. Eligibility may also change post birth, due to entitlement to certain Tax Credits or due to the family income leading to entitlement to benefits.
• A health visitor or midwife is not essential for accessing the scheme (the application can be signed by any health professional) however women may not know to ask about the scheme and would not necessarily have the opportunity for prompts that would be afforded by regular contact with a health visitor.
• As the Healthy Start scheme is linked to benefits and low income there may be stigma attached healthy start which may influence whether women are comfortable applying and using the coupons.
• Applying for coupons requires women to complete an application form correctly and include information for the health professional both of which may not have the required information readily available (national insurance numbers, expected date of delivery). The application process may take time to compete (particularly if women are not aware of the scheme or require additional information or support to complete the application) and therefore they may not receive the coupon earlier enough in their pregnancy to be most effective. New mothers may also not be aware they are required to contact the scheme to confirm the birth of their child in order to continue to receive the coupons and may leave it too late so that they will need to reapply.
• Due to the time taken to process a Healthy Start application, the women may not have received her first coupons for vitamins until after the time at which some of the vitamins are most effective (especially for folic acid).

Recent research of a wider implementation of the Healthy Start scheme in London Yorkshire and the Humber raised issues about the constraints of a targeted approach in addressing vitamin deficiencies in certain geographical areas and also identified key areas of concerns with regard to the current scheme^[7].