PARLIAMENTARY DEBATE
Healthy Start - 22 May 2024 (Commons/Westminster Hall)

I apologise for missing the first couple of minutes of my hon. Friend’s speech. She is making an excellent speech outlining why the scheme is so needed. She mentions that take-up of the Healthy Start scheme is too low, so proper information about the scheme is needed, along with auto-enrolment. That would cut through the red tape and the hurdles that many families experience. Does she agree that the Government must therefore do more to promote the Healthy Start scheme to families so that people are aware of it, as recommended in the excellent national food strategy?

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South Shields (Mrs Lewell-Buck) on securing this important debate. She has done a considerable amount of work—some with me and some in her own right—over the past few years and has followed in the footsteps of my predecessor as Member of Parliament for Stretford and Urmston in campaigning on auto-enrolment.

This is a hugely important issue. We know that those families who are eligible to receive the Healthy Start allowance are some of the poorest in our country. We know, too, just what an important component of the benefits system it is. It ensures that youngsters at risk of malnutrition because of a lack of finance and of available cash in the family home are able to access things like healthy foods, fruits and vegetables, as well as milk formula and other important things to help with babies’ early development.

There are a number of aspects to this. My hon. Friend has focused largely on her important campaign to secure auto-enrolment, but I want to take a moment to broaden the debate with some comments about the uplifting of the allowance, given the significant increases in inflation in recent years.

I can see that my hon. Friend is going to make an excellent speech; he has made some important points already. Hon. Members may be aware that an event was held yesterday by Diabetes UK that discussed the shocking rise in the prevalence of type 2 diabetes in young people. They mentioned early years nutrition and the important part that that period plays in establishing the lifelong health of an individual. Does my hon. Friend agree that that very early food system and what food children consume in those very early years is so important, and that schemes such as the Healthy Start scheme should be thought to be central to a good public health mission?

My hon. Friend is correct to make that point and to link diabetes and other negative health experiences that can happen as a result of poor nutrition in early years. She has spent many years campaigning for children and their health in this place, not least during her time as the shadow Minister, and I know that many families up and down the country will be grateful to her for that.

I turn back to the issue of inflationary pressures and the lack of uplift in the Healthy Start allowance since 2021, when it was uplifted for the first and only time since the Government came to power in 2010. We all know the inflationary pressures that we have seen since then; food, in particular, has outstripped other parts of our economy, with an average 30% increase in food prices. That pressure has been especially acute in the price of milk formula.

My hon. Friend the Member for South Shields mentioned our last Westminster Hall debate. I called that debate a year ago yesterday, and things have worsened since then. As my hon. Friend said, uptake has decreased, as prices—although they are not growing as quickly—have continued to rise. Twelve months ago, we were at the point at which there was not a single milk formula product on the market that could be afforded under the Healthy Start allowance. That is a terrible situation to be in, not least because of the other pressures we have seen on family finances in recent years.

I turn to auto-enrolment. Uptake is problematic: it has decreased over the past two months. As I said, these are the poorest families and those in the most need. Families are not deciding that they do not require that money. Families are looking, as my hon. Friend the Member for South Shields so ably outlined, at an opaque and challenging system to navigate. That, as well as a lack of knowledge that this allowance even exists for families, is one of the primary causes, if not the only cause, of this damagingly low uptake.

I am interested to hear the Government’s thoughts on the thorny issue of auto-enrolment, although I am not sure why it is so thorny. I also wish to broaden out my hon. Friend’s comments about the interim proposal that she and I put forward to Government of writing to those families who are eligible for the Healthy Start allowance but who are not taking it up. We have had a number of excuses from the Government over the past 12 months, similar to those that my hon. Friend outlined on data sharing and a financial agreement through a card system, which have since been quashed by Mastercard.

I have submitted a number of written questions about where we are with the data, given previous undertakings from Ministers that they would draw the data together to write to those families. In September 2023 I was told that that data was being brought forward. In November I asked again, in pursuance of the previous question, and we were told that the data would be available in early 2024. My hon. Friend the Member for South Shields and I seem to dovetail on this issue a lot: she then submitted a question in March this year. There was still no sign, despite previous suggestions that the data would be available in early 2024 for that work to happen.

There is a lack of transparency and accessibility in the application process. The Government are not helping to disavail people of that view when they refuse to let even those who are eligible for the scheme know that that is the case. The impact on our communities is significant. In my constituency of Stretford and Urmston, one child in five lives in poverty. My local food bank in Stretford told me recently that 40% of the people it serves are first-time users, such is the enormous increase in demand that it has seen of late. Most damningly of all, in my community they also tell me that there has been an 80% increase over the past 12 months in the number of families with children that they are supporting.

We are in crisis. Families are struggling. The allowance is targeted at those in the greatest need, yet just this weekend, in Old Trafford in my constituency, residents were having a real-time WhatsApp conversation about the fact that milk formula and milk itself are security-tagged in some—not all—supermarkets up and down this country. There was a debate going on: if they were a retail worker, would they stop somebody who was clearly in need from taking milk or baby formula?

I said 12 months ago that people were watering down formula, and my hon. Friend the Member for South Shields mentioned it today. Worse still, as Sky News covered at the time, in some cases there were suggestions that mothers were adding flour and other such substances into milk formula to pad it out further. The impact that that can have on a baby’s digestion is significant and risks long-term health problems. This is the scale of the challenge that we face.

I would be incredibly grateful for an update on the Government’s thinking about whether they should be uprating the Healthy Start allowance in line with inflation, given the significant pressures on the price of food and especially on milk formula since the allowance was last uprated in 2021. Are the Government serious about the issue of auto-enrolment? If not, why on earth is more not being done to bring together the data that is required? That would at least let families know whether they can embark on this admittedly opaque process to try to bolster their family budgets and try to ensure that their babies, their children under the age of four or they themselves, if they are more than 10 weeks pregnant, can access healthy things such as fruit, vegetables or milk for their baby.

This is a crisis. The need is there. We all see it in our communities. The time to act is now, and I beg the Minister to do it urgently.

It is an honour to serve under your chairship, Mr Dowd. I thank the hon. Member for South Shields (Mrs Lewell-Buck) for securing this important debate. By the time children start school, one in five is living with obesity. Recent research has shown that children who are severely obese by the age of four have their life expectancy cut by nearly half if they do not lose weight. Type 2 diabetes is being diagnosed in children, while a national NHS survey found that nearly 30% of children under the age of five are experiencing enamel and dental decay.

All the while, one in four UK households with children under four experiences food insecurity. That is defined as when households reduce the quality, variety and desirability in their diets. It is concerning that demand for emergency food parcels distributed by the Trussell Trust food bank network has nearly doubled over the past 12 months, and 65% of that support went to families with children. In Somerset, 18,000 food parcels have been distributed in the past year. When the household support fund closes in September, we could see pressures increase even further. In addition, Food Foundation polling from January 2024 found that food-insecure households were more likely to cut back on purchasing healthy foods such as fruit, veg, fish, dairy and eggs by up to 60%.

The Healthy Start scheme provides pregnant women or pre-school-age children from low-income households with a weekly payment to be spent on healthy food. That is welcome, but the Government have failed to roll out the scheme effectively or give it the attention that it deserves. The Government set an uptake target of 75% by March 2023, yet the latest figures for April 2024 show that only 62% have taken it up and we do not know the uptake data between July 2023 and February 2024, due to a major data error. That just amplifies how neglected the scheme is.

The scheme needs to move faster to reach more people and must not be left to stagnate against the backdrop of considerable food price rises. The scheme does not give people enough money to afford healthy foods in the light of inflation and the increased cost of food. The poorest 10% of UK households would need to spend between 34% and 52% of one person’s weekly food budget to afford one week’s worth of a five-a-day diet.

If the scheme is to be used as a tool to fight food insecurity, it must not be used in isolation. However, I do not believe that the Government are willing to take the necessary measures to change our food system for the better. They should accept the national food strategy’s recommendations by extending the scheme’s eligibility criteria and committing to a properly funded promotional campaign. The Government must also focus on the lack of access to healthy, nutritious food by incorporating household food security, including people’s ability to access healthy food, into a yearly assessment of UK food security.

At last week’s Farm to Fork summit, the Prime Minister had the chance to focus on primary food producers being squeezed by tight retailer-supplier contracts, but he did not, leaving potentially more farmers on the brink of closing their farm gates for the final time because of the associated financial pressures and anxiety. The Government have failed to grasp that we have a broken food system, which leaves farmers on a cliff edge and families reliant on unhealthy, ultra-processed foods and unable to afford the food necessary for their children’s healthy development. It should be a national embarrassment that so many children under five are beginning their lives with serious health issues because of poor nutrition, but the neglect that the Healthy Start scheme has experienced from this Government is symptomatic of the neglect that they have paid to our food system.

I do not believe it is too late. The Government should urgently revisit the national food strategy recommendations set out by Henry Dimbleby and act on them. The Liberal Democrats would fight to ensure that our children’s health is treated as a priority by guaranteeing free school meals for all primary-aged children and all those whose families are in receipt of universal credit. We would also boost the farming budget by £1 billion to help our farmers thrive, and to help them produce more home-grown, healthy food to improve the health of the nation’s children.

It is pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for South Shields (Mrs Lewell-Buck) for securing this debate. She has been a tireless campaigner on behalf of the 200,000 eligible pregnant women, babies and young children missing out on support via the scheme.

I will start by praising the Healthy Start scheme, which was set up by the last Labour Government in 2006. It provides support to expectant mothers who are more than 10 weeks pregnant, and to parents and caregivers who are responsible for at least one child under the age of four. Healthy Start vouchers have a value of up to £4.25 a week or £8.50 for those with a child under one. The vouchers entitle parents in receipt of certain social security benefits to fruit, vegetables, cow’s milk, infant formula and pulses. They also enable mothers to access vitamins from pregnancy until their child reaches the age of one.

Adequate nutrition in the first months and years of a child’s life is critical to supporting their healthy development. In recent years, the health of children under five has stalled or declined across various measures, including infant mortality, childhood obesity, tooth decay and mental health. Declining health outcomes are linked to a rise in poverty, with children from disadvantaged areas significantly more likely to face a range of poor health outcomes compared with those in more affluent areas.

Healthy Start has an important role to play in helping to take pressure off family finances and ensure that mothers and young children get a nutritious diet. It is effective. Research has found that participating families increase their spend on fruit and vegetables, and the Minister will understand how crucial a healthy diet is for pregnant women, new mothers, babies and young children. The British Medical Association has highlighted the effects of poor nutrition during pregnancy: adverse health and social outcomes, premature birth, low birth weight, shorter life expectancy and a higher risk of death in the first year of a child’s life.

As hon. Members have mentioned, child food poverty continues to stunt children’s development as they grow up, and overstretched family budgets mean that mothers go without in order to feed their children. I and other hon. Members present have raised concerns about Healthy Start for a number of years; I remember writing to the then Minister about it in 2021. However, as we have heard from my hon. Friend the Member for South Shields, three years later, after the cost of food essentials has rocketed, the value of the vouchers is the same as it was then and uptake has not significantly improved.

Since 2021, infant formula prices have risen by about 25%. Almost one in four households with at least one child under four reported being food insecure this year. Some 17% of single-adult households with children reported not eating for a whole day because they could not afford or get access to food. Food insecure households were more likely to cut back on purchasing healthy foods such as fruit, vegetables, fish, dairy and eggs. Those statistics are shocking. As we have heard, there has to be a call to action. The importance of good nutrition during pregnancy, breastfeeding and early life is indisputable. As the National Institute for Health and Care Excellence guideline on maternal and child nutrition states, it forms the foundation for the long and short-term health of both mother and baby.

The incidence of severe malnutrition in the United Kingdom has doubled in the past 10 years, with over 10,000 people hospitalised in 2022, among them 312 children. Can the Minister please tell us—[Interruption.]

The incidence of severe malnutrition in the United Kingdom has doubled in the past 10 years, with over 10,000 people hospitalised in 2022, among them 312 children. Can the Minister please tell us what the Government are doing to urgently get a grip on the issue?

An issue that Members have raised is the poor uptake of the Healthy Start scheme. For years now, the Government’s target has been an uptake rate of 75%, yet the latest data, for April 2024, shows that not a single local authority anywhere in the country is hitting that target. However, when Ministers have been asked about take-up, they have routinely given boilerplate responses highlighting that the NHS Business Services Authority operates the scheme on the Government’s behalf, with no meaningful engagement on how the Government intend to improve that.

I also ask the Minister what assessments she has made of the merits of launching a national take-up campaign. Has she encouraged take-up by signposting through family hubs or early years provision? Likewise, has she made an assessment of the merits of including a tick box as part of the universal credit application process or as part of applications for council tax support?

There is also the very real concern that Members raised about the value of the food vouchers, particularly in the context of the rising cost of living. The few policies that the Government have introduced on healthy food in recent years have done little about affordability. I was momentarily excited last week when the Government launched their new food security index—it sounded promising. However, I looked into it and it appears that the index is comprised of metrics entirely of the Government’s own making, rather than internationally accepted definitions and indices of food security.

Can the Minister explain why the Government have eschewed internationally agreed definitions of food security in terms of availability and access—basically, that the food is there and people can afford it—in favour of their own definitions that do not cover those important points? In other words, why does the Government’s index give zero consideration to the impact on UK food consumers apart from a measure on confidence that their food is safe?

I note that the Government have previously commented that they keep the value of Healthy Start under continuous review. Can the Minister update us on whether there have been any recent discussions regarding the value of the scheme and whether it is still her Department’s position that no increase in value is forthcoming? If that is the case, what assessment have the Government made of the impact of inflationary price rises on low-income households, and what reassurances can she provide to Members that she is taking action to stop families from being priced out of essential goods on the Government’s watch?

One of the most egregious issues facing families with young babies is that they are being priced out of infant formula to feed their children. While breastfeeding will always be the gold-standard healthiest option, and we must do more to promote it, the Minister will know that it is not suitable for everyone, and some women simply cannot. All families should be able to feed their babies, and it is already hard for so many to afford to do so in this cost of living crisis. Does the Minister share my concern that regulations that prevent families from using food bank vouchers to buy infant formula are no longer fit for purpose? Labour will make it so that retailers will be able to accept loyalty cards and vouchers as payments for infant formula to help families feed their children. Labour will urgently review existing legislation on infant formula, ensuring that regulation is protecting families and their babies, not making life more difficult for them.

Healthy Start was a valuable scheme to improve nutrition among mothers and very young children at a critical stage in their development, but the impact of the scheme is being progressively eroded by Government inaction, poor take-up and the rocketing cost of living crisis. Labour has committed to a child health action plan to ensure that every child gets a healthy start in life. That includes our commitment to establish fully funded healthy breakfast clubs across England. We will also reform universal credit and set up Great British Energy to boost Britain’s energy security and cut bills.

Over the last 14 years, the UK’s progress on infant and child health has stalled. I urge the Minister to engage with campaigners on the issue and work proactively with Members on both sides of the House to ensure that the Healthy Start scheme is fit for purpose.

It is a pleasure to serve under your chairmanship, Mr Dowd, and to respond to the debate on behalf of the Under-Secretary of State for Public Health, Start for Life and Primary Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). I am grateful to the hon. Member for South Shields (Mrs Lewell-Buck) for raising this important debate about the Healthy Start scheme, and to other hon. Members who have contributed.

The Government are committed to supporting the next generation of children, who are, of course, our future, and their own will obviously depend on this as well. A child’s early life is critical to their health later in life. We want every family to receive the right support to care for their children. Growing up with a healthy diet and weight is strongly protective against ill health in childhood and adulthood. Eating a healthier diet, as set out in “The Eatwell Guide”, could increase population life expectancy by up to eight years.

We know that fruit and vegetable consumption is lower among more deprived children, and that those children may be at risk of not getting enough micronutrients. More than one in five children start primary school overweight or obese, and the numbers are higher in more deprived areas. That is a major risk factor for long-term diseases including heart disease, type 2 diabetes and many types of cancer.

Against that backdrop, the support for children to eat healthily through the Healthy Start scheme and our provision of free school meals is crucial. The Healthy Start scheme benefits hundreds of thousands of families across the country. The statutory scheme encourages a healthy diet for pregnant women, babies and young children under four from low-income households. Eligibility criteria for the scheme ensure that we target nutritional support on families who need it most.

In April 2021, we increased the value of Healthy Start by 37%, from £3.10 to £4.25 a week, therefore helping families with the increased cost of living. I welcome the support demonstrated by colleagues today for this important scheme and the emphasis placed on its uptake. I fully agree that we need to ensure that eligible families are aware of and able to access Healthy Start. I now turn to how we are doing that.

Healthy Start is delivered by the NHS Business Services Authority, on behalf of the Department. Following user research and testing by both the Department and the NHSBSA, the scheme switched from being paper based to a digitised service in 2021. An online application and prepaid card replaced the previous paper form and vouchers. The number of families being supported by Healthy Start has grown following the introduction of the prepaid card. Since September 2021, of the more than 600,000 successful applications, 45% have come from new families and the scheme now supports more than 360,000 beneficiaries on lower incomes. The uptake is 62% of people who are eligible, which is higher than in the previous paper scheme and shows the benefits of the transition to a digital scheme.

Hon. Members have raised the question of auto-enrolling eligible families on Healthy Start. Moving to auto-enrolment would require a substantial redesign of the scheme. In contrast to what I heard the hon. Member for South Shields say, such a move, unfortunately, is not a simple thing to do. I am told that the prepaid card would need to be removed because it is a financial product that, under financial services legislation, requires applicants to accept the terms and conditions on an opt-in basis, so we cannot have it as an opt-out. Creating a new delivery method and process is therefore far from straightforward and would come at an additional cost to Government, with disruption for the beneficiaries.

I hear the hon. Member’s point, but as I set out clearly, I understand that this is not a simple thing to do, and not straightforward. As she has offered, however, I suggest that she writes to the Under-Secretary of State for Public Health, Start for Life and Primary Care with that suggestion and the proposal from Mastercard. I have no doubt that my right hon. Friend will look into it and respond to the hon. Member.

I have been saying that it is complicated to shift to an auto-enrolment scheme under existing legislation. By contrast, the current scheme has seen increased take-up, with the switch to the prepayment card. We would not want to jeopardise that progress of increasing numbers of families enrolling on what is an important scheme. That is why the Government’s focus is on increasing the uptake and effectiveness of the existing scheme, so that more children can benefit from Healthy Start. I also assure the hon. Member for South Shields that the substantial level of investment in the scheme is in the order of £78 million per annum.

I was sorry to hear about the problems in getting access and responses to phone calls for people calling up for help with access to the scheme. It is clearly important for people to be able to get help, if needed, to access Healthy Start. I understand that the average speed of answer for calls between 1 April and 10 May was 19 seconds, but I have asked officials to look further into the problems raised by the hon. Member for Stretford and Urmston (Andrew Western) regarding accessing the phoneline and accessing help.

Multiple channels of communication are used to raise awareness and encourage take-up of Healthy Start. NHSBSA actively promotes Healthy Start through its digital channels and has created free toolkits for use by healthcare professionals, local authorities and public health teams. NHSBSA uses a range of communications to raise awareness among parents and pregnant women. For example, it has attended maternity and midwifery forum events and placed advertisements in You and Your Pregnancy magazine, which is given to pregnant women in the first trimester, and the Bounty and Badger Notes apps. As officials confirmed to the House of Lords Food, Diet and Obesity Committee on 7 May, we also have plans to write to everyone eligible for Healthy Start to ensure they are aware of the scheme and to encourage them to apply.

As I said before, the Government are committed to promoting a healthy diet for our children. Healthy Start is an important part of the support provided by Government but it is only one aspect of how we are doing that. For our youngest children, the Government are investing £50 million in infant feeding support as part of the family hubs and the Start for Life programme. We support childcare providers with the cost of milk through the nursery milk scheme. We are also working with industry to improve the healthiness, marketing and labelling of commercially available baby food and drink aimed at those aged up to 36 months. Children of all ages also benefit from restrictions on the placement of less healthy products in key selling locations, calorie labelling on menus and upcoming landmark restrictions on multi-buy offers and the advertising of less healthy products on TV and online.

For school-aged children, we have the school fruit and vegetable scheme and free school meals. The Government have expanded free school meals to more groups of children than any Government over the past 50 years. We have introduced universal infant free school meals for all children in reception, year 1 and year 2. Under the benefits-based criteria, more than 2 million of the most disadvantaged pupils are provided with free school meals; in fact, the greatest ever proportion of children are receiving free school meals, with more than a third receiving free lunches compared with one in six in 2010. Furthermore, a crucial backdrop to this debate is the latest fall in inflation—because we know that the best way to help people with the cost of living is to bring inflation down.

Infancy and early childhood is a crucial time for establishing food preferences and dietary patterns. Giving children a healthy start in life is critical to health outcomes throughout childhood and adulthood. The Healthy Start scheme is one of the essential ways in which the Government support our most vulnerable families to give their children the best start for a healthy life. I welcome colleagues’ interest in the Healthy Start scheme and assure them that although our approach may be different from the one that the hon. Member for South Shields argues for, we are committed to making sure that the children who most need help get it.