The bungled digitisation of Healthy Start is hampering low income families' access to healthy food – The BMJ

Intended for healthcare professionals
For months, families have reported problems with the digital transition of Healthy Start, a government funded programme to support families on low incomes. As the cost of living crisis worsens, this is leading to avoidable hardship, write Margaret Anne Defeyter and colleagues
The UK’s Healthy Start scheme helps low income families access healthy food and vitamins. It was introduced in response to rising levels of child food poverty and has become even more of a lifeline for families during the recent cost of living crisis. However, the recent digitisation of the scheme has caused a significant number of teething problems that have resulted in families not being able to access the scheme and use it to buy food in grocery stores. Despite these failings first being raised several months ago, they have still not been properly resolved.1
The scheme is designed for expectant mothers who are more than 10 weeks pregnant and for parents and care givers who are responsible for at least one child under the age of 4. Originally, the scheme used paper vouchers, and these were critically important as they entitled parents in receipt of particular social security benefits to access fruit and vegetables, cow’s milk, infant formula, and pulses, all with a value of up to £4.25 a week (or two vouchers collectively worth £8.50 if they have a child under 1). The vouchers also enabled mothers to access vitamins from pregnancy until their child reaches the age of 1, and for children from birth until the age of 4. Research has found that participating families increase their spend on fresh fruit and vegetables,2 with a concomitant improvement in the nutritional composition of their shopping basket. In particular, the Healthy Start scheme increases the purchase of foods that are rich in nutrients known to promote healthy child development.2
Since September 2021, families who were already enrolled on the Healthy Start scheme have been moved onto “prepaid cards” rather than paper vouchers, and since the end of March 2022, prepaid cards have entirely replaced paper vouchers.
The purported benefits of these cards are that they can, in theory, be used anywhere that sells Healthy Start food items and which also accepts Mastercard. Any unspent money on the card can be rolled over for future purchases. Participants in the scheme can check their balance at any time at a cashpoint. Cards should reduce the time consuming task of processing paper vouchers and should be more efficient for administrators and shops. We hope and expect that such benefits will be delivered and that changes to this vital scheme will ultimately prove effective.
Unfortunately, many of these potential benefits have not been realised so far. In the early phase of the transition away from vouchers, families reported experiencing difficulties using the cards, leading to hardship and humiliation. Problems with prepaid card use include: needing to “split” your trolley of purchases at the checkout to be able to use the card; cards frequently being declined at tills, causing anxiety and embarrassment; shop staff being unfamiliar with the new prepaid cards and unable to help, or offering conflicting advice; children missing out on fruit and vegetables and families reverting to food banks because of difficulties using the cards. Moreover, in January 2022, the Healthy Start helpline failed to answer one fifth of the 370 254 calls made by worried families, meaning many of those experiencing frustrations with the cards struggled to find help.3
The numbers show how this rocky transition has frustrated families’ ability to make use of the scheme, with around 52 000 families who previously used the vouchers not successfully signed up to the cards by May 2022.4 This is on top of the number of eligible families who have never accessed the scheme. Take-up of the Healthy Start scheme in England had reached only 60% by September 2021, on the eve of the transition to cards, meaning that 200 957 eligible beneficiaries were missing out on their entitlement.5 In March 2022—likely to be a high headcount given that both vouchers and cards were included in the figures—28% (more than 150 000) of eligible beneficiaries across England, Wales, and Northern Ireland had not registered for their entitlement. With a growing number of children living in poverty in the UK, and increases in the cost of living, it is crucial that schemes such as this are easily accessible. The problems identified above need to be resolved as a matter of urgency, using a rights based approach to maximise uptake, ease the administrative burden, and improve data monitoring.
One way of maximising uptake is to shift from an “opt in” to an “opt out” registration system through an automated process. Government bodies already hold the data they need to enact this change. To enable this process, all we need is greater clarity, potentially through legislation, around where the responsibility for automatic registration should sit within different layers of central and local government, as well as the handling or sharing of accompanying data. A clear precedent has been set on this front, with the UK government planning later this year to use a process of automatic registration to enrol those eligible for the Warm Home Discount entitlement. The Scottish government is, likewise, seeking to use its devolved powers to initiate an automatic registration process for several schemes.
We fear that, without rapid reforms like automatic registration and the ironing out of problems with the transition to cards, even fewer eligible recipients will use the scheme, leading to adverse consequences for children’s dietary intake, further entrenching the need for charitable food aid on an industrial scale, and increasing health inequalities.6
Competing interests: None declared.
Provenance and peer review: Not commissioned; not peer reviewed.
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