Healthy Start

[Peter Dowd in the Chair]

I beg to move,

That this House has considered the Healthy Start scheme.

It is a pleasure to see you in the Chair, Mr Dowd. What is not a pleasure is that I am here yet again, still trying to get the Government to do something very simple and impactful to help those who need it the most. Auto-enrolment with an opt-out, as opposed to the current opt-in system, would ensure that the Healthy Start scheme operates as it should, so that every single child gets the best start in life.

The last Labour Government introduced the Healthy Start scheme, which provides financial assistance in the form of a prepaid card to all under-18s who are pregnant, families with young children or pregnant women claiming certain benefits. This is to help with the ever-increasing costs of fruit and vegetables, milk, formula milk and vitamins. The scheme is available in pregnancy and until the child’s fourth birthday, yet the scheme is beset with problems—problems that were caused by this Government and can be easily fixed by this Government.

The child of the north all-party parliamentary group has heard evidence that children in the north are more likely to die before reaching their first birthday than those elsewhere in the country. We have heard about desperate mothers who are seeking an abortion because they simply do not know how they will feed their baby. When I raised that with the Prime Minister only two weeks ago, his response was to advise me that he was

“proud that…the Government have overseen a significant fall in poverty, particularly child poverty.”—[Official Report, 8 May 2024; Vol. 749, c. 570.]

Child poverty has not significantly fallen: it stands at more than 4 million. When expectant mothers have had to make these heartbreaking decisions, bragging about the support put in is crass, to say the least. It was followed up with an equally tone-deaf letter from the Secretary of State for Work and Pensions.

It has been widely reported that some parents, in desperation, have resorted to theft of baby milk and formula or are having to water it down, which is not surprising considering that prices of baby formula are at historically high levels and the current Healthy Start payments do not even cover the cost of formula for one week. Despite this, Healthy Start take-up is dropping. The Government’s 75% target—given to the NHS Business Services Authority, which runs the scheme—was missed last year, and take-up continues to decrease: it stands at just 62.5% across England, Wales and Northern Ireland. The comparable scheme in Scotland, however, has reached 92% take-up. Some local councils and organisations have made a dedicated investment to promote the scheme; not only does this create a postcode lottery, but they were left feeling utterly demoralised after the Government provided false, inflated take-up figures and were then unable to provide accurate uptake data.

An opt-out system would ensure proper data and free up organisations to support families instead of having to try to locate them—a point that is supported by research published earlier this month and funded by the Minister’s own Department. In some areas, the take-up is as low as 44%. About 220,000 babies, young children and pregnant women are missing out on the scheme, and Sustain estimates that that leaves £58 million unclaimed.

Despite the Chancellor’s crowing on this morning’s news, low inflation still means rising prices on top of previous high rises. In short, this is just stemming the pain for families. Only last year, UNICEF found that the UK had the worst rise in child poverty, leaving us bottom among 39 of the world’s richest countries. That is why admissions for malnutrition have increased in children and there has been a resurgence of Victorian diseases such as rickets and scurvy. It is no wonder that the Government blocked the United Nations special rapporteur on the right to food from visiting the UK and investigating poverty. When the previous UN special rapporteur on extreme poverty visited the UK, he was very clear that the rise in poverty was the direct result of Government policies.

Food banks, baby banks, faith groups and charities have now become embedded parts of our welfare state. The Key to Life food bank in my constituency reported a 300% increase in demand last year, coupled with a decrease in donations. It is therefore highly unlikely that the £58 million that is going unclaimed is unclaimed because people do not need it. There is a very clear need for the scheme but, as I have been told time and again, awareness is low among the public and professionals. That is why in 2021 the national food strategy recommended that the Government implement a communications plan related to Healthy Start, but they did not.

In 2021, I and others raised concerns about plans to fully digitalise the scheme by 2022, meaning that paper applications and vouchers would no longer be accepted. The result was that, as of October 2023, more than 20,500 households that were previously in receipt of the vouchers were no longer receiving them, 19 months after digitisation. The NHS Business Services Authority then admitted that technical issues meant that applications were being declined, resulting in parents and pregnant women struggling to get through to the helpline and having their payment cards rejected.

As it stands, the application routes are overly complex and varied. When an application is made online, an automated message claims that a response will be given in two days. This very rarely happens. Some mothers report that they have never heard back and that, after multiple attempts, they have given up.

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?

I thank my hon. Friend for that intervention and for all the work that she does in this space. She has tirelessly championed children for as long as I have known her and for as long as she has been in this place. Charities, organisations and local authorities are using what little money they have to promote a Government scheme, and then when they go to the Government for data about how it is working, they get either false figures or no figures at all, so I could not agree more with my hon. Friend.

The Healthy Start phone number is not freephone, and it is fully automated. There is no option at all for callers to speak to anyone unless they need an interpreter or have inquiries relating to their card. The absurdity of an automated system asking whether callers have problems with cards that they do not yet have is not lost on any of us, I am sure. Worse still, if the application is refused, the parent is not told why and is directed to the phone line: again, they cannot speak to anyone. Research by Manchester Central food bank highlights the fact that those on legacy benefits or with no recourse to public funds have to apply via paper or telephone, but that is completely at odds with the Healthy Start phone line and website, which state very clearly that applications must always be made online. The confusion is completely unnecessary.

Repeated questions to the Secretary of State for Health and Social Care about funding for the scheme and future take-up have been equally frustrating. The Government refuse to say how much money they allocate to the scheme each year. They claim it is allocated on a forecast for take-up, but will not say what that forecast is. A cynic would conclude that if the Government forecast low uptake, it is against their interest to do anything to boost it, as they will not have budgeted for that, or that if they forecast higher uptake but do not reach it, millions of pounds that could have been spent on feeding children will be spent elsewhere. Either way, hungry babies and children are once again the ones losing out.

Back in May 2023, a similar debate was held in which the Government were made fully aware of the problems with Healthy Start. The following month, I introduced my Bill on auto-enrolment, the Healthy Start Scheme (Take-Up) (No. 2) Bill. Over the past two years, I have sent the Health Secretary two cross-party letters, signed by MPs and a multitude of outside organisations. This was followed by more questions and speeches in the Chamber and a full report to the Chancellor in advance of the previous Budget. Forty-eight written questions and two well-supported early-day motions later, here we are again.

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.

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.

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.

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?

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.

As the Minister heard in my opening comments, Mastercard completely refutes that argument. It and Allpay, which administers the scheme, have been clear that it is entirely possible to do auto-enrolment; they just need the Department for Health and the DWP to talk to them about it. It is not a difficult thing to do. They have outlined it to me in a letter, and I am happy to share that with her Department, yet again.

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.

I thank all hon. Members who have spoken today, in particular my hon. Friend the Member for Stretford and Urmston (Andrew Western), who has long championed a reduction in the price of baby formula. He rightly pointed out that auto-enrolment is not the only issue with Healthy Start; there is also the value of payments and the eligibility criteria. I thank my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill) for her kind words and support.

I also thank the Minister for her comments. However, it will come as no surprise that I completely disagree with her analysis of the entire situation. The one thing I will take from her speech is that at least she has reiterated the promise to once again write to all eligible households missing out on the scheme. We have been promised that for some time now and it has not yet been delivered.

If the rumours about an imminent general election are true, I must tell the Minister to please get a move on, because we do not have long left. In the interim, before we have a new Government, I will, as I have always done, use my time in this place to try anything at all that the Government might accept. I will keep pushing for them to at least explore trying a pilot for auto-enrolment for Healthy Start.

People should not have to put up with the daily grind and struggle. Eradicating child poverty was a central plank of the last Labour Government, and I know for a fact that it will be a key plank of the next one. I just cannot wait until we get there.

That this House has considered the Healthy Start Scheme.