Best Start Foods - evaluation: annex B - qualitative research

1. Introduction

1.1. Policy background

Making Scotland the best place in the world to grow up and allowing every child to have the best start in life has been a longstanding commitment from successive Scottish governments. Working towards these goals has seen significant developments across a wide range of policy areas in the last decade; from maternal and child health, with the introduction of the Baby Box, to education, with policies such as the expansion of Early Learning and Childcare. Supporting healthy weight in childhood and improving children's diets have been key features of this policy development through the introduction, and recent extension^[1], of nutritious free school meals and regular access to healthy food during school holidays. A comprehensive commitment to a range of actions in this sphere was set out in the Scottish Government's 2018 diet and healthy weight delivery plan^[2]. Amongst other things, the plan commits to supporting mothers to have good nutrition and a healthy weight before and during pregnancy, improving the provision of healthier food in early learning and childcare (ELC) settings and supporting low income families to access a healthy diet.

Policies to improve diet and eating behaviours in early life are predicated on considerable evidence which suggests that both eating habits and weight in early childhood are predictive of positive health and wellbeing in later childhood and beyond. For example, analysis of longitudinal data from the Growing Up in Scotland study (GUS) has shown that factors present very early in children's lives, such as maternal smoking and early introduction of solid foods, are predictive of obesity at age 12. More broadly, evidence gathered by the World Health Organisation^[3] demonstrates that poor maternal nutrition at the earliest stages of the life-course, including during pregnancy and early life, can induce both short and longer term effects.

Seeking to impact both maternal and infant dietary patterns and health behaviours would therefore appear to be beneficial for children's short and longer-term health outcomes. However, evidence from a range of sources identifies persistent inequalities in healthy weight, good diet, food security and positive health behaviours amongst Scottish children and their mothers. For example, the 2019 Scottish Health Survey^[4] showed that food insecurity (as defined by being worried during the past 12 months that they would run out of food due to lack of money or resources) was significantly higher amongst single parent households than other household groups. Furthermore, results from the 2017 Scottish Maternal and Infant Nutrition Survey^[5] showed that women from more deprived areas were less likely to have taken folic acid and more likely to be at risk of obesity during pregnancy than those in less deprived areas. Together, this evidence demonstrates the greater risk of poorer health and dietary outcomes for children and mothers living in poverty and deprivation and the need to ensure that such families are supported to access healthier food.

Given the inequalities in health and dietary outcomes for lower income families, providing specific support to those families will be necessary to achieve the goal of giving every child the best start in life. The Scottish Poverty and Inequality Commission^[6], an independent advisory body established to provide independent advice and scrutiny to Scottish Ministers on poverty and inequality, advised that action to reduce poverty should focus on three areas: boosting incomes through work, reducing housing costs and using social security. The introduction of the Best Start Foods (BSFs) payments represents one of several actions taken within the last of these areas, utilising Scotland's newly devolved social security powers.

1.2. About Best Start Foods

Under the terms of the Scotland Act 2016, 11 benefits were devolved to the Scottish Government. These include many which are already being administered by the new agency Social Security Scotland such as the Carer's Allowance Supplement, Scottish Child Payment, Funeral Support Payment, Young Carer Grant and the Job Start Payment. Section 27 of the Scotland Act 2016 devolved powers in relation to Welfare Foods, which included Healthy Start Vouchers (HSVs), Healthy Start Vitamins and Nursery milk. The Welfare Foods (Best Start Foods) (Scotland) Regulations 2019 were laid out in Parliament in May 2019, and the BSFs system went live in August 2019, replacing the UK Government administered HSVs in Scotland. In early 2020, there was a final push to encourage any remaining Scottish HSVs recipients who had yet to apply for BSFs to do so. The UK Government's Department of Health and Social Care continued to deliver HSVs to Scottish recipients until they transitioned onto the BSFs scheme, up until 31 March 2020 when the UK scheme was revoked in Scotland. Anyone who was getting HSVs in Scotland (but who had not applied for BSFs) did not get HSVs after 31 March 2020.

BSFs provides eligible pregnant women, parents and carers with a weekly payment which can be used to buy selected nutritious food and drink items from certain retailers^[7]. The amount paid varies: pregnant women and families with children aged 1 and 2 receive £4.50 a week whilst families with children aged under 1 receive a double weekly payment of £9.00 to support both the mother and the child. BSFs payments are loaded onto and then used via a debit card. The card can then be used in any shop which accepts Mastercard that sells the relevant items with an eligible merchant code. Someone can apply for BSFs from when they become pregnant up until their child turns 3. Under 18s are automatically entitled to BSG and BSFs, without the need for a qualifying benefit. Recipients of BSFs that are under 18 will continue to be eligible for BSFs once they turn 18 during pregnancy and up until their child turns one. In all other cases, eligibility for BSFs is based upon being in receipt of a qualifying benefit. For some of these qualifying benefits, income thresholds also apply^[8].

1.3. Rationale for the research

The aim of BSFs is to provide financial support for low income families to meet the cost of nutritious food during pregnancy and early years. However, the benefit has the potential to contribute to a range of medium and longer term outcomes for lower income families, such as: a healthier diet and food choices throughout childhood (supported by linked policies such as nutritious, universal free school meal entitlement through ELC and school settings); contributing to sustained healthy weight, better general health and wellbeing; and reduced health inequalities. The benefit also has the potential to contribute to reduced poverty through freeing up household resources to use for other purposes.

The evaluation of HSVs^[9] in England found that mothers reported eating a greater amount and wider range of fruit and vegetables, that the quality of family diets had improved and that good eating habits had been established for the future. Given the positive evidence from evaluation of HSVs in England, it is logical that the Scottish Government would wish to have early sight of the difference BSFs is making and any ways in which delivery of the benefit may be improved.

The Scottish Government commissioned ScotCen Social Research in late October 2021 to conduct qualitative research to inform the overall evaluation of BSFs. Findings from the qualitative research will be used by the Scottish Government alongside quantitative data from Management Information and Social Security Scotland surveys to conduct an interim policy evaluation of BSFs. The Scottish Government has already demonstrated its eagerness to adapt BSFs in order to achieve the greatest benefit to eligible families. For example, adaptations introduced to date include increasing the value of the payments from £4.25 to £4.50 per week in August 2021.