Welfare Foods: consultation

3. Phase 1 of Welfare Foods: a new approach for Scotland: Best Start Foods

3.1 Current UK Healthy Start Vouchers

The current UK Healthy Start Scheme provides vouchers to purchase healthy foods for all pregnant teenagers under the age of 18 plus pregnant women and families with children under the age of four who qualify for the following benefits:

• Income Support, or
• Income-based Jobseeker's Allowance, or
• Income-related Employment and Support Allowance,
• Child Tax Credit (with a family income of £16,190 or less per year),
• Universal Credit (with monthly income below £408 per month).

The UK Healthy Start Vouchers can be used to purchase; plain cow's milk, infant formula milk, fresh or frozen fruit and vegetables from registered supermarkets and grocers. Those qualifying are entitled to receive one £3.10 voucher per week or two vouchers per week worth a total of £6.20 for babies under one. The weekly vouchers amount to nearly £900 per child over the duration of entitlement, from pregnancy to four years old. We estimate that current uptake of Healthy Start Vouchers is around 70 per cent [3] . The recently published Scottish Maternal and Infant Nutrition Survey 2017 provides information about awareness of the Healthy Start Scheme and the use of Healthy Start vouchers, as reported by women who responded to the antenatal and 8-12 month survey [4] .

3.2 A new Best Start Foods payment

Our 2016-17 Programme for Government set out our intention, on devolution, to integrate the systems for Healthy Start Vouchers and the Sure Start Maternity Grant, which is also being devolved to Scotland. Our new combined system Best Start Grant ( BSG) will replace the former Sure Start Maternity Grant and will form part of a Scottish social security system that is based on dignity, fairness and respect, helping to support those who need it, when they need it.

The BSG aims to improve children's wellbeing and life chances by mitigating the effects of child poverty and material deprivation. The BSG will provide eligible families [5] with £600 on the birth of their first child and £300 on the birth of any subsequent children. It will also give families two further payments of £250 around the time their child's early learning and childcare ( ELC) entitlement starts and around the time a child starts school, to recognise the costs parents face in supporting their children during these years. A consultation on the Best Start Grant Regulations was launched on 26 March 2018.

The Best Start Grant will also include a system for Best Start Foods payment, formerly known as the UK Healthy Start Vouchers. This will be delivered by the new Social Security Agency.

Best Start Foods will continue to provide targeted financial support for low income pregnant women and families to purchase healthier foods.

Best Start Foods will be a sub-set of BSG, which means that some, but not all, BSG recipients will also be entitled to Best Start Foods. Section 3.4 sets out who will be eligible. This is Phase 1 of our transition to the new Welfare Foods policy for Scotland. We will launch the BSG and the Best Start Foods in Summer 2019 and will communicate the processes and practicalities for transitioning into the new system in due course.

As part of our new Best Start Foods payment we will increase the weekly value from £3.10 to £4.25 to ensure this covers the value of providing fruit, vegetables and milk.

We know that the current UK Healthy Start Voucher of £3.10 a week has been static for many years and is too low to provide sufficient fruit and vegetables for pregnant women and breastfeeding mothers. It is also insufficient to cover the weekly cost of providing the recommended daily portion of fruit/vegetables (five portions) and milk (½ pint) for a child per day [6] . The additional £1.15 will ensure families on lower incomes can buy nutritious food and milk for their children throughout their early years.

3.3 Designing a new system for Scotland

We want to ensure we provide the best offer for parents and families through the BSG system that is as efficient and accessible as possible. The Scottish Government's BSG Service Design Team has been working with a range of people, including parents and practitioners, to design a new system for Scotland. We have been using a wide range of research and engagement techniques including focus groups, interviews and co-design workshops, to understand people's experiences and what they need, want and hope for from our new system. This includes designing and testing the business processes needed to allow people to access and receive the BSG, including the application form.

Parents have told us that they would prefer a single application process for the new Best Start Foods and BSG. This will reduce the number of different applications parents need to make and keep track of. The branding of the payments will be linked, making entitlements clearer from pregnancy through to children starting school. On-going contact will allow us to prompt people to apply for what they are entitled to and ensure they are accessing the benefits to which they are entitled.

Health professionals also advise us that a single administrative process will provide opportunities for combining promotion of these schemes and will help increase uptake and reduce duplication.

Q1. How can we increase the uptake and awareness of the Best Start Grant and Best Start Foods?

3.4 Eligibility and links to Early Learning and Childcare

3.4.1 Support in Early Learning and Childcare

We want to create a cohesive package of nutrition for young children through Best Start Foods that complements our ELC expansion. Our ambitious ELC expansion programme includes healthy eating choices with near universal uptake of the existing 600 hours funded entitlement by three and four year olds [7] . Some children who attend full-time ELC will receive as much as 90 per cent of their daily food within the ELC setting and as much as 40 per cent when in a part-time setting [8] .

Our support in ELC will be strengthened further from 2020 when all children in funded ELC will receive a free meal during their session [9] . This means that all children, including those from low income families, will be able to access nutritious food from the ages of three and four in ELC settings through a free meal. Section 4 of this consultation proposes that from 2020 all children in ELC funded places will receive a drink of milk and healthy snack as part of their day to further improve our offer in funded ELC provision. Section 4 also asks how we can deliver the same offer of milk and a healthy snack for children outwith funded ELC provision.

3.4.2 Support at home through Best Start Foods

For those children under the age of three, we will focus our support for low income families at home through Best Start Foods. This targeted support aims to make it easier for low income families to access healthy food for their children at home in the earliest years up to the age of three.

As set out in Section 3.2, we will increase the weekly value of the Best Start Foods payment from £3.10 to £4.25 to ensure this covers the value of providing fruit, vegetables and milk for a child. Across the duration of the Best Start Foods payment the amount recipients will receive for each child will increase by £112 - from £899 to £1,011.

3.4.3 Eligibility for Best Start Foods

We want to create consistency across the benefits available in early years. There are currently different sets of eligibility criteria for the UK Healthy Start Scheme and ELC places for eligible two years olds [10] . This makes it difficult for families to understand their entitlement. We will more closely align the eligibility for the Best Start Foods with the eligibility criteria for two-year old places in ELC. This will help simplify entitlement, create opportunities for sign-posting families across benefits, and reduce the administrative burden. The Best Start Foods payment is a sub-set of BSG, which means that some, but not all, BSG recipients will also be entitled to Best Start Foods.

To summarise, all pregnant women under the age of 18 and pregnant women and families who receive the following benefits will be eligible for the new Best Start Foods payment of £4.25 per week, per child, up to when that child turns three:

• Income support
• Income-based Job seekers allowance
• Income-related Employment and support allowance
• Child tax credit up to a maximum income of £16,190 per annum
• Universal credit with an income limit of £610/month

In addition, we will also include those receiving:

• Both maximum Child Tax Credit and maximum Working Tax Credit and income under £6,420, or the 4 week run on
• Pension credit
• Housing Benefit – for those on a maximum income of £16,190 per annum

Entitlement will start from confirmation of the pregnancy instead of from 10 weeks of the pregnancy. We will continue to provide two vouchers for babies under one worth £8.50 per week

3.4.4 Eligible foods

We will expand the range of foods available under the Best Start Foods payment

Currently Healthy Start Vouchers can be used to purchase the following:

• Cow's milk
• Infant formula milk (first milk only)
• Fresh or frozen fruit and vegetables

We want to offer families more choice and to maximise the usefulness of the scheme. We are therefore expanding the foods families can purchase through Best Start Foods to include the following:

Tinned fruit and vegetables: to help those who have limited freezer space or limited access to fresh fruit and vegetables in their area. For example, this may help those who live in remote rural communities or areas where there are a limited number of shops. Tinned fruit and vegetables have a long shelf life and are a good source of vitamins, minerals and dietary fibre and we want to provide choice in the scheme.

Dried or tinned pulses: as these are considered to be good inexpensive source of protein - they can also count as one of your 5-a-day - and can be used to make nutritious meals, such as soups and stews.

Eggs: as they are a reasonably cheap, versatile, nutritious form of protein, they can be easily stored and easily turned into a variety of meals.

This means the items the Best Start Foods will be able to buy include the following:

• Cow's milk
• First infant formula milk (suitable from birth)
• Fresh, frozen or tinned fruit and vegetables
• Fresh or tinned pulses (including lentils, peas, barley, beans)
• Eggs

3.5 A new smartcard

Service users have told us they would prefer a smartcard system to reduce the stigma associated with using paper vouchers to purchase foods and to make the system as easy as possible to access.

We will move from a paper voucher system to a smartcard system. The smartcard will be pre-loaded for use, every four weeks, with users having more control over the value they spend.

Retailers have advised that they support this proposal. They will be automatically reimbursed for the purchase at the point of sale and will no longer have to send the used paper vouchers to a Reimbursement Unit for processing. This will also reduce the administration and postage costs associated with the current UK Healthy Start Scheme. Retailers will no longer be required to register to accept Best Start Foods payments. The smartcard will be restricted to use in food shops/supermarkets that accept card payments.

Q2. What can we do to make the smartcard system as easy to use as possible?

Q3. How do we gather feedback to make improvements as the system evolves?

3.6 Wider support for improving diet and nutrition

Nutrition plays a crucial role in the early months and years of a child's life and is important in achieving optimal health. The Improving Maternal and Infant Nutrition: A Framework for Action (2011) outlines the measures that should be taken by all organisations working with families to ensure that every parent is supported to give their baby the very best nutritional start in life.

Our consultation A Healthier Future: Action and Ambitions on Diet, Activity and Healthy Weight also sets out our aim to establish good overall food behaviours, including healthy food and healthy eating patterns from the earliest years, which will become part and parcel of Scottish family life. Best Start Foods aim to support access to healthier foods and to empower families to make healthy choices in their nutrition. We want to work with retailers and others to think creatively about how we can make Best Start Foods better, for example, recipes for healthy snacks and meals.

Q4. How can we work creatively with retailers and others to make it easier for families to use Best Start Foods to improve their diet and nutrition?

There is strong and growing evidence of the impact of diet in early years on longer term outcomes [11] including educational attainment. Eating habits developed in the early years frequently last into adulthood. We therefore want to maximise our opportunities for providing broader support to service users as part of these changes.

We want to develop an innovative programme of support around Best Start Foods to help families in establishing healthy eating patterns from the earliest of years that will last a lifetime.

Q5. What could an innovative programme that will support families to establish healthy eating patterns look like?

Q6. What evidence could we gather about the impact?

3.7 Healthy Start Vitamins

Healthy Start Vitamins form part of the UK Healthy Start Scheme. The current UK Scheme provides vitamins for women (in pregnancy and after birth) and families with children under the age of four. People who qualify for this scheme include all pregnant women under the age of 18, plus those who receive:

• Income Support, or
• Income-based Jobseeker's Allowance, or
• Income-related Employment and Support Allowance,
• Child Tax Credit (with a family income of £16,190 or less per year),
• Universal Credit (with monthly income below £408 per month).

However, in Scotland, we also offer free vitamins to all pregnant women throughout their pregnancy, as part of our commitment to giving children the best start in life. These vitamins are the same as those offered through the current UK Healthy Start scheme. This includes women who would have been eligible for these vitamins by virtue of entitlement to the current UK Healthy Start Scheme.

The new vitamin scheme was introduced because there is strong evidence of the benefits of taking specific vitamins during pregnancy which improves the health of both the mother and baby. The current Healthy Start vitamins contain:

• 70 milligrams of vitamin C
• 10 micrograms of vitamin D
• 400 micrograms of folic acid

The main distribution method for women's vitamins is directly through their midwifery services and some community pharmacies and dispensing practices.

A liquid vitamin product is currently provided for children under the UK HS scheme. The daily dose of five drops contains:

• 233 micrograms of vitamin A
• 20 milligrams of vitamin C
• 7.5 micrograms of vitamin D3

The Department of Health and Social Care is currently reformulating children's vitamins to ensure that the optimal dose of Vitamin D (10 micrograms), as per the most recent UK Chief Medical Officer's advice, is included. This is likely to be introduced in Spring 2019.

Q7. Should the provision of children's vitamins be linked to eligibility for the new Best Start Foods ( i.e. up to age of three)?