Best Start Foods: evaluation

Executive Summary

Background

The Social Security (Scotland) Act 2018 introduced a range of new benefits devolved to Scotland. Best Start Foods was introduced using these powers, replacing the UK Healthy Start Vouchers in Scotland. Best Start Foods is designed to provide financial support for low income families to access nutritious food at the point of need. It is one of a range of Scottish Government policies set out in the Tackling Child Poverty Delivery Plan[1] which are intended to tackle health inequalities and reduce child poverty in Scotland.

Best Start Foods is delivered via a payment card, which can be used like a normal bank card with contactless or Chip & Pin features. The payment amounts are:

• £4.50 per week for pregnant women and families with children aged 1 and 2
• £9.00 per week for families with children aged under 1, to support both the mother and the child.

The Best Start Foods system went live in August 2019, and the transition period from Healthy Start Vouchers was completed by the end of March 2020. To maximise take-up of the benefit, the application form is part of a joint application for both Best Start Foods and Best Start Grant. People can also choose to apply for Scottish Child Payment using the same form.

This report presents an evaluation of the benefit which is based on progress towards its immediate and short-term policy outcomes. However, it also considers progress towards Best Start Foods' medium-term outcomes, and its contribution to the Scottish Government's long-term aims (e.g. reduced health inequalities). The policy outcomes of Best Start Foods relate to the benefit's impact on people who receive the payments (hereafter referred to as 'recipients'), but the evaluation also considers the experience of Best Start Foods applicants in general.

The evaluation of Best Start Foods is largely based on findings from qualitative research that was commissioned and undertaken by ScotCen, attached in full at Annex B. The qualitative research involved interviews with Best Start Foods recipients, healthcare professionals who support applicants, and retailers who participate in the Best Start Foods scheme. However, it also draws on Official Statistics and a survey of benefits applicants which was undertaken by Social Security Scotland.

Promotion and take-up of Best Start Foods

People find out about the Best Start Foods in a range of ways, including via healthcare professionals, word of mouth and media advertising. However, there is a sense amongst recipients and stakeholders that that there are families, healthcare professionals and retailers with little or no awareness of the benefit, and that more could be done to promote Best Start Foods.

Best Start Foods is claimed by people across Scotland with a diverse range of demographic and equalities characteristics. Over the period April 2020 to June 2021, take-up of Best Start Foods was estimated to be 77%. This means that a majority of eligible people had claimed the benefit, and indicates that early promotional efforts were largely effective. However, it also shows that almost 1 in 4 eligible people had not claimed Best Start Foods, suggesting further steps may still be needed to maximise take-up of the benefit. The next take-up estimate of Best Start Foods is due to be published later this year.

Understanding Best Start Foods

Understanding and knowledge of Best Start Foods is mixed amongst people who apply for the benefit. There are applicants who (upon being made aware of the benefit) conduct their own research on it, and others who are given details by people who support them to make a claim – e.g. healthcare professionals. However, there are people who do not realise that Best Start Foods is part of a joint application form with the Best Start Grant, and therefore do not become aware of Best Start Foods until they receive a decision letter for their claim.

Recipients of Best Start Foods generally understand the purpose of the benefit, and find the guidance letter they receive with the card (and the list of items printed on the side) to be clear and informative. However, some report issues with the guidance, e.g.:

• Having to to rely on others to explain it to them because English is not their first language, and they were not aware it comes in other languages
• That it does not contain a fuller list of retailers where the Best Start Foods card can, and cannot, be used, and information on how to use the card online
• That guidance information is overwhelming and could be more succinct.

There is also some confusion around the recommended list of foods that can be bought with Best Start Foods. For example, some do not realise that it can be used to buy tinned fruit and vegetables, pulses and eggs. Others think it can be used for foods (and non-food items) that are not on the recommended list.

The evaluation also highlights that some recipients do not realise when their Best Start Foods payments will end, and are caught off guard when this happens. While there is information online that indicates that Best Start Foods will stop when a child turns 3, some people are unaware of this, or have forgotten about it.

Applying for Best Start Foods

Most Best Start Foods applicants feel that they are treated well by Social Security Scotland during the application process. The application form is also considered quick and straightforward to complete, and people mostly view the joint application form as positive because it is time-saving. People are also generally satisfied with the process of receiving payments.

Despite these positives, the evaluation highlights some issues with the application process:

• Some peopleneed support when filling out an application e.g. due to difficulties understanding English, a lack of access to technology, or issues with literacy skills.
• Application processing times have increased each year since the benefit was introduced. This includes time spent waiting to receive copies of documents or evidence requested from clients. Lengthy waits for application outcomes can make applicants feel anxious. However, those who are told there might be delays feel reassured and are more understanding about long waiting times.
• There can be long waiting times when calling the Social Security Scotland helpline to enquire about the progress of claims.
• Some people report receiving multiple requests from Social Security Scotland for the same supporting information after submitting an application form.
• Some feel that the decision letter does not explain the reason for their application outcome clearly, in cases where claims are denied.

The Best Start Foods card system

Overall, recipients prefer Best Start Foods to the previous Healthy Start Vouchers system, because they feel the payment card is more discreet. They feel less embarrassed and stigmatised using the card in shops. Recipients also report that the card is easier to use and more convenient than vouchers – e.g. because it facilitates contactless payments and the ability to self-checkout in shops. People who do not speak English also prefer it because the format is familiar to them, and they do not need to speak or read English to use it.

However, some experience difficulties using the card for the first time. This is because, for example, they have not read, or could not read, the guidance on how to use the card when making an initial transaction. Also, some recipients say that they always have to use Chip & Pin in stores because their contactless payments do not work.

Recipients report that Best Start Foods can be used in more shops than Healthy Start Vouchers. This enables recipients to shop around and find the lowest prices. However, there are mixed views on the range of recommended foods available with Best Start Foods. While some feel it is appropriate for their needs, others feel some healthy foods are not on the list – e.g. wholegrains and fish. While healthcare professionals are generally positive about the range of foods, some also feel it could be restrictive for young recipients in particular who do not have the skills or confidence to cook healthy meals from scratch.

Retailers report that the Best Start Foods card is an improvement on the Healthy Start Vouchers scheme. They say it is more convenient because they receive payments immediately, as opposed to submitting vouchers to receive payments. However, they find it challenging not having data on how their customers use the card, and feel this information would enable them to make informed choices on stock and in store promotions.

The impact of Best Start Foods

Progress towards short-term policy outcomes

Best Start Foods helps people to buy a greater quantity (and quality) of healthy foods. The qualitative evidence suggests that people use it to mainly buy cow's milk, baby formula, fresh fruit and vegetables. Some also use it for other recommended items (e.g. eggs, pulses, and frozen or tinned fruit and vegetables). In addition, recipients report using the card to buy items not on the recommended list (e.g. bread, pasta, fish, poultry and meat), and even non-food items (e.g. nappies, baby toiletries and clothes).

The evaluation also shows that Best Start Foods has supported healthier shopping habits and meal planning, and has enabled mothers and children to eat more healthy foods. For example, recipients purchase healthier snacks for their children, instead of processed foods like crisps, and some use payments to experiment with new healthy recipes. Recipients also say the benefit gives them more freedom to let their children try a greater range of healthy foods without worrying about wasting money or food. Healthcare professionals also report that families are excited about trying different healthy foods as a result of receiving Best Start Foods.

Best Start Foods has also helped to reduce financial pressure on households. For some recipients it is a 'lifesaver', because it guarantees they can afford essential foods for their children even when finances are difficult. For others the payments have freed up money for costs such as household bills or items (e.g. clothes) for their children. Healthcare professionals also report that their clients seem less burdened with money worries as a result of having Best Start Foods.

Despite these positive outcomes, some recipients find it difficult to afford the same amount of healthy foods when their children turn 1, and they return to the lower rate of Best Start Foods. Healthcare professionals also raise concerns about reducing payments when children turn 1, and the impact it will have on healthy food shopping. Also, while recipients appreciate the financial support offered by Best Start Foods, they feel the impact would be greater if eligibility was extended until their child starts school. Some recipients share that they would find it difficult to cover the costs of nutritious food after Best Start Foods comes to an end.

Contribution to medium-term policy outcomes

A full assessment of progress towards Best Start Foods' medium-term outcomes would require: (a) more time to have passed since the benefit was implemented, and (b) access to more robust quantitative data. However, the findings summarised above indicate that the benefit has led to reduced incidence of food insecurity and increased healthy eating behaviours.

There is also evidence that Best Start Foods has contributed to better health and wellbeing for children and their mothers. As mentioned above, Best Start Foods recipients feel reassured that they can buy essential foods for their children, and this helps to reduce financial stress and anxiety. Recipients also mentioned other positive health and wellbeing impacts of Best Start Foods, including:

• Observing their children eating more fruit and vegetables, which they feel is good for them nutritionally and supports their development
• Feeling positive about being able to provide their children with more nutritious food
• Feeling less anxious or self-conscious about using the Best Start Foods in shops compared to when they received Healthy Start Vouchers
• In cases where they experienced mental health problems, feeling more comfortable being able to use the card online.

Conclusion and policy implications

The evaluation shows that Best Start Foods has largely achieved its immediate and short-term policy outcomes, and has made progress towards its medium-term policy outcomes. It is therefore likely to have contributed positively to the Scottish Government's long-term aims (e.g. reduced health inequalities and reduced child poverty). However, the evaluation also highlights some issues with Best Start Foods. These issues and their implications are as following:

1. Recipients and stakeholders feel that more could be done to raise awareness of Best Start Foods amongst families, healthcare professionals, and retailers. Regarding take-up, the most recent estimate suggests that 23% of eligible people over the period April 2020 to June 2021 had not claimed Best Start Foods. While this figure may have changed since then (a new estimate will be published later this year), steps may be needed to maximise take-up of Best Start Foods, including further promotional work.

2. There is mixed awareness that Best Start Foods is part of a joint application with Best Start Grant, and some people only become aware of Best Start Foods when they receive an application decision letter. Additionally, there is evidence that some recipients do not realise payments will stop when their child turns 3. It may therefore be necessary to improve awareness of Best Start Foods amongst those who apply, and communicate clearly to recipients the cut-off date for payments.

3. The Best Start Foods guidance letter (given to recipients when they receive their Best Start Foods card) is generally considered to be informative and clear. However, some recipients experience issues with the guidance, e.g. some are not aware that it comes in other languages and need help to read it, and others report that it does not contain a comprehensive list of participating retailers. There is also some confusion about the recommended list of foods, and a general lack of awareness that the card can be used for online shopping. As such, the guidance may need to be reviewed, and steps taken to improve or clarify the content where possible.

4. The evaluation highlights that some people need support when filling out the Best Start Foods application form – e.g. due to difficulties understanding English and issues with literacy skills. It is not clear how widespread these experiences are amongst applicants. However, the application process could be reviewed to see if changes are necessary or possible. This might involve increasing awareness of existing accessibility features in Social Security Scotland's application forms, which includes translation services.

5. While Best Start Foods helps people to buy more (and better quality) healthy foods, some recipients feel that the recommended list of foods should contain other items they view as being healthy (e.g. wholegrains or fish), and cater more to children with special dietary needs. Healthcare professionals also raise concerns that the range of foods does not reflect their clients' eating habits in cases where they lack the skills or confidence to cook healthy meals from scratch. It may therefore be necessary to review the Best Start Foods range and extend it if necessary.

6. Some recipients experience difficulties using the Best Start Foods card for the first time e.g. because it is not yet activated. Some also report that contactless payments do not work on their card, meaning they have to use Chip & Pin. As such, there may be a need to provide clearer guidance to recipients on how to use the card for the first time. Additionally, while it is not clear how widepsread issues are with contactless payments, there may be a need to investigate possible technical problems with this feature of the card.

7. Retailers feel that Best Start Foods is more convenient than the Healthy Start Vouchers system. However, they also say they would like more information about how recipients use the card in their shops, to help them make informed choices on stock and in store promotions. As such, it might be necessary to explore whether retailers can be given data on how people use the Best Start Foods card.

8. Best Start Foods is generally considered a helpful contribution towards costs, and reassures recipients that they can afford essential foods for their children if money becomes tight. However, recipients and stakeholders raise concerns about the rate of payment dropping when children turn 1, and some recipients feel that they will not be able to afford nutritious foods when payments end. As such, it is important that recipients' perceptions of impact should continue to be monitored over time, and the rate of Best Start Foods kept under review.

9. Application processing times have increased each year since Best Start Foods was introduced, and some recipients report long waiting times on the Social Security Scotland helpline when calling about claims. There are also cases where applicants are asked on multiple occassions for the same supporting evidence. As such, it may be necessary to review the application process to determine whether (a) decision making can be expedited, and (b) the evidence gathering process can be improved. Steps may also be needed to ensure that applicants are kept better informed about the progress of applications, and to reduce helpline waiting times for applicants who enquire about their claims.

10. While the evaluation indicates that progress has been made to longer-term outcomes associated with Best Start Foods, it is not possible with the information available to make objective assessments in these areas. As such, more data should be sought and made available for future evaluations.