Best Start Foods: evaluation

Conclusion

The purpose of the interim evaluation was to:

1. Evaluate the extent to which Best Start Foods has met its policy outcomes.

2. Assess the likely contribution of Best Start Foods to wider long-term government outcomes for children and their families.

3. Discuss implications for future policy development.

The first two of these has been achieved by reviewing the available evidence on Best Start Foods, drawn from different sources (primarily bespoke commissioned research carried out by ScotCen, Official Statistics, and Social Security Scotland research). As discussed above, Best Start Foods has made good progress towards some of its immediate and short-term, and medium-term outcomes. Based on this progress, it is reasonable to assume that the policy is also contributing towards the government's long-term aims of reduced health inequalities and reduced child poverty.

Despite these positive developments, the evaluation has also highlighted some areas where Best Start Foods could be improved to achieve better outcomes for recipients. These are outlined below.

Policy implications for Best Start Foods

Please note that these implications have been drawn from the commissioned research report by ScotCen, which is available in the full in Annex B. However, they also take into account the wider evidence from Official Statistics and Social Security Scotland research which has been presented throughout this report. They are as follows:

1. There could be a need to (a) undertake further promotional work for Best Start Foods, and (b) maximise take-up of the benefit amongst eligible people.

The evaluation indicates that the majority of people who were eligible for Best Start Foods applied for the benefit. However, recipients and stakeholders feel that further efforts could be made to promote Best Start Foods amongst families, healthcare professionals, and retailers – some of whom they feel do know about the benefit. Indeed, the most recent estimate indicates around 1 in 4 eligible people did not claim Best Start Foods as of June 2021. Therefore, it may be necessary to undertake further promotions of the benefit, and maximise take-up amongst eligible people.

2. There could be a need to (a) improve knowledge of Best Start Foods amongst applicants, and (b) make it clearer when Best Start Foods payments will end.

On becoming aware of Best Start Foods (e.g. via advertising or word of mouth) some people do their own research on the benefit, or are told more about it by someone supporting them to make a claim (e.g. a healthcare professional). However, there are cases where people only become aware of the Best Start Foods when they receive an application decision letter, and not all applicants realise it is part of a joint application with other benefits. Additionally, some do not realise that payments will stop when their child turns 3. As such, it may be necessary to improve knowledge of Best Start Foods amongst applicants, and communicate more clearly to recipients when payments will stop.

3. There could be a need to review the guidance given to recipients, and make alterations where necessary.

The guidance letter given to Best Start Foods recipients is generally considered to be clear and informative, and the list of recommended items printed on the card is also felt to be a helpful reminder for recipients when they are shopping. However, the evaluation highlights some issues with the guidance, as reported by recipients – e.g. that it is not clear that it comes in other languages, does not contain a comprehensive list of shops where the card can be used, or that the information is overwhelming and could be more succinct. There is also some confusion amongst recipients on what is on the recommended list of items, and a general lack of awareness that the card can be used for online shopping. As such, it may be necessary to review the content of the guidance given to recipients of Best Start Foods, to determine whether clarifications and improvements can be made.

4. There could be a need to review specific aspects of the application process to make it easier for applicants.

In general, the Best Start Foods application form is considered easy and quick to complete. Being able to use different formats (i.e. online, phone, and paper) is appreciated by applicants, and people generally view the joint application as being positive because it saves them completing multiple forms. However, the evaluation also highlights that some people need support when filling out the Best Start Foods application – e.g. due to difficulties understanding English and issues with literacy skills. More issues are highlighted in the commissioned research report at Annex B. It should be noted that it is not clear how widespread these issues are amongst applicants. However, the application process could be reviewed to see if changes are necessary or possible. For example, while the application process does have a range of accessibility features (e.g. the digital application process is compatible with assistive technologies, and clients can request phone calls and letters in a variety of formats e.g. in over 100 different languages) the evaluation findings suggest that more could be done to signpost users towards these features.

5. Where possible, steps could be taken to (a) review application processing times and the process of collecting supporting evidence from applicants, and (b) improve communications and helpline waiting times after applications are submitted.

The evaluation has shown that Best Start Foods application processing times have increased each year since the benefit was introduced, and that lengthy waiting times can make applicants feel anxious if they are not informed about possible delays. Other issues with the application process reported by recipients include:

• There can be long waiting times when calling the Social Security Scotland helpline to enquire about application progress.
• There are cases where people are asked on multiple occasions by Social Security Scotland staff for the same supporting evidence.
• Application outcome letters do not clearly explain reasons for decisions in cases where applications are denied.

As such, it may be necessary to review the application process to determine whether (a) decision making can be expedited and the evidence gathering process improved, and (b) communications can be improved to keep people better informed about the progress of claims - including reduced helpline waiting times, and clearer application outcome letters.

6. There could be a need to review the recommended list of food items which can be bought with Best Start Foods.

Best Start Foods has helped recipients to purchase a greater quantity (and quality) of healthy foods. However, there are mixed views about the scope of the recommended food items that can be purchased with Best Start Foods. While there are recipients and healthcare professionals who view the range positively, others feel it is too restrictive because it does not contain foods they feel are also healthy (e.g. fish and wholegrains), or may not cater for children with special dietary needs. Healthcare professionals also raised concerns that the items do not reflect the eating habits of their clients – who may lack the skills or confidence to cook healthy meals from scratch. As such, it may be necessary to review the range of food items recommended to people who receive Best Start Foods, and extend it if appropriate.

7. It may be necessary to (a) clarify guidance on using the Best Start Foods card for the first time, and (b) investigate technical issues with contactless payments.

Best Start Foods card reduces stigma amongst recipients when compared with the previous Healthy Start Vouchers system. It is also considered easy and convenient to use e.g. due to there being no expiry date on payments, and the availability of contactless payments. However, some recpients have experienced challenges using the card. For example, there can be confusion when using the card for the first time if it has not been activated, or if the recipient attempts to make a contactless payment (Chip & Pin must be used for the first transaction). Additionally, some recipients report always having to use Chip & Pin in shops, due to issues with contactless payments. As such, there may be a need to provide clearer guidance on how to use the card for the first time, and to investigate technical issues with contactless payments.

8. Steps could be taken to explore whether is possible to provide retailers with more information about how Best Start Foods is used in their store.

Retailers consider Best Start Foods to be an improvement on the Healthy Start Vouchers scheme e.g. because they receive Best Start Foods payments automatically, instead of having to keep and submit vouchers to obtain payment. However, they also find it challenging not having any information on the use of Best Start Foods in their shop(s). They said this data would enable them to make informed choices on stock and in store promotions. As such, steps could be taken to provide retailers with more information on how people use Best Start Foods, if possible.

9. The impact of Best Start Foods on recipients' financial situation should continue to be monitored, and the rate of payment kept under review.

Best Start Foods is generally considered a helpful contribution towards the cost of healthy foods. It helps to reduce the financial pressure on households and for some it is a lifeline that ensures they can afford essential food for their children when they experience financial difficulties. However, some recipients find it difficult to to afford the same quantity of healthy foods when payments reduce (i.e. when their child turns 1). It is therefore important that recipients' perceptions of impact should continue to be monitored to ensure the benefit remains a helpful contribution to costs. The rate of Best Start Foods should also kept under review.

10. More data is required to fully evaluate progress towards Best Start Foods outcomes.

It has been touched on throughout this report that there is currently a lack of data to fully evaluate the medium-term outcomes of Best Start Foods, and assess its contribution to longer-term government aims (e.g. reduced health inequalities). For example, the evaluation provides some evidence that Best Start Foods reduces food insecurity. However, the true impact of Best Start Foods on food insecurity amongst people on low incomes cannot be objectively assessed with the available evidence. This is similar for other policy outcomes, such as the benefit's impact on health and wellbeing, and increased healthy eating behaviours. Continued efforts should therefore be made to obtain data to fully evaluate the progress of Best Start Foods towards its stated outcomes.