Review of the Distribution of Healthy Start Vitamins Through Community Pharmacies

8. Improving up-take of Health Start Vitamin tablets and drops

Although many of the factors affecting distribution identified by the review were identified by both Health Start Leads and Community Pharmacies, there were no clear solutions to many of the factors identified. However, a number of suggestions were made about how some aspects of distribution might be improved;

• NHS Boards are looking at a variety of alternative distribution and associated funding models to achieve higher uptake (for example redirecting local funds to ensure all eligible women receive vitamins or funding all pregnant women to receive them).
• Consider alternatives to making vitamins to be easily accessible; targeting areas of deprivation, working with wide range of services for distribution (see example box below).
• Make vitamins and drops available to all pregnant women and children under 4. Universal provision removes the requirement for a complex system of application, receipt and exchanging of coupons for eligible families and also removes many other barriers to access. This would need careful planning and monitoring to avoid waste and associated costs.

Early Years Collaborative tests of change on Healthy Start includes improvements to the distribution of vitamins (see Appendix 4 for the Early Years Collaborative Driver Diagram which identifies actions for improving uptake of Health Start scheme), these include;

• Distributing vitamins to all women as part of their first booking appointment
• Distributing vitamin tablets and drops to eligible women and families through a range of associated children and families health and wider services.

Example: Distribution of children's drops through Early Learning and Child Care settings in NHS Fife

NHS Fife are currently testing the distribution of Healthy Start children's drops through local authority Early Learning and Child Care settings in areas of deprivation to parents of children aged from 2-yrs. The test started in Oct 2013 with one centre and due to its success is now being testing across 13 centres. NHS Fife agreed additional funding from Fife Local Authority for a dedicated post to work with centres to develop distribution processes using continuous improvement data to inform service development change. This helps to integrate and sustain changes within the nurseries (rather than expect nurseries to implement change unsupported). The work has resulted in positive engagement with parents and improved uptake of children's drops (moving from 5 to 10% uptake). Distribution through nurseries underlines the aim that the Healthy Start drops as part of wider health and wellbeing (emphasis on drops as a food supplement to support improve child development) rather than presenting the drops in terms of a health prescription. Distribution also enables wider engagement by parents who may feel stigmatised though accessing means tested benefits and those who are not engaged with health services.

A number of suggestions were raised by community pharmacies and Healthy Start Leads to improve awareness and understanding of health start vitamin tablets and drops. These included;

• Promotion and awareness raising of the importance of vitamin tablets and drops.
• Wider/early access to information, especially for women who are thinking about becoming pregnant.
• Engaging a wider range of services in communicating consistent messages about healthy diets and nutritional supplements, including vitamins.
• Engaging vulnerable groups and their support networks about healthy diets and vitamins and how distribution might be improved