Two years ago, when her second child was born, Marsha signed up for the government’s Healthy Start vouchers. The scheme gives those on Universal Credit who are pregnant or have children under four-years-old extra money to buy healthy foods and claim free vitamins. “It really does help,” says Marsha, from south London.
Reductions in the overall spend on the scheme and soaring inflation on things including basic foods means, however, that mothers and children are getting dwindling returns. “Nothing goes far at the moment, to be honest,” Marsha says. “Everything’s gone up – milk and bread has gone up – but the money we’re getting in doesn’t seem to be matching. It’s always a bag less of shopping, every time, because you can’t afford it.”
A freedom of information request, sent by the food alliance Sustain and seen exclusively by Spotlight, reveals that funding for the scheme has declined to less than a third of what it was a decade ago, a loss of over £90m. According to the data in the FOI request, between the 2018-19 and 2019-20 financial years, the spend for the scheme more than halved, from £95m to £44m. A Department of Health and Social Care spokesperson told Spotlight: “The Healthy Start scheme is a demand-led scheme, as such the annual cost of the scheme may vary dependent on how many families apply for and are in receipt of Healthy Start. The figures referenced in the FOI incorporate expenditure on both the Nursery Milk and Healthy Start schemes and a split between the two is not available.” Given that, before 2019-20, the schemes were accounted for with a combined figure, this could explain the shrinking budget of the programme.
Money from the scheme is distributed every four weeks. The amount given to young families and those who are pregnant differs according to circumstances: £4.25 a week is given to pregnant mothers from their tenth week of pregnancy; £8.50 a week is given to those with a child aged one; and families with a child aged between one and four are given £4.25 a week.
The scheme used to be run using paper vouchers that would give discounts on healthy essentials in supermarkets. In October 2021 the government began to digitise the operation. It didn’t go well. According to a briefing for MPs written by the Food Foundation charity in March, the online portal for people to enrol in the scheme had multiple issues, support phone lines were jammed, and anxious parents have been complaining to the scheme’s official Facebook page about delays.
As of 8 September 2022 about 44,500 households who were enrolled on the paper voucher scheme were not on the new digital system, the NHS Business Services Authority (NHSBSA), which oversaw the transition and now the entire programme, told Spotlight.
The government has acknowledged to Sustain that there have been "some issues with the transition". The NHSBSA said that more than 500,000 invitations were sent to encourage people to apply for the digital version, and that it has increased resources at the NHS Healthy Start contact centre by enrolling more support staff and introducing 24-hour automated helpline. It also said that families whose applications were delayed could be entitled to back-payments.
“I found it very difficult,” says Marsha, who missed two months of payments when enrolling on the digital scheme, following administrative issues with support staff. "It’s not fair, [because] you lose out.” She supports calls for those who, like her, had been on the old system and missed payments during the transition period, to receive back-payments. “You calculate that [support] into your [weekly budget] as well, so when you lose it, you are short.”
While the intentions of the Healthy Start scheme are well placed, campaigners are frustrated by its application. “The scheme is very much needed," says Sofia Parente of Sustain, which has helped people to apply for the scheme. “It provides a nutritional safety net for families with young children and pregnant mothers. We only wish more families would benefit.”
Worries persist over awareness of Healthy Start. Last year only 57 per cent of eligible people in England and Wales took up the scheme. More than two million qualifying people missed out, leaving an estimated £69m on the table. “This is an NHS-run, government-funded benefit. It should be something that's easily known about,” Dr Naomi Maynard, programme director of the Feeding Liverpool food alliance, which conducted research into the scheme's uptake, told Spotlight.
Maynard used Healthy Start herself when she unexpectedly became pregnant with her first child while studying for her PhD at university. She attributes the relatively low uptake to a lack of advertising of the scheme (“there isn't a centralised marketing and comms budget for Healthy Start”), a previous lack of information on the programme being available in languages other than English, and the effects of the pandemic, during which face-to-face contact between families, benefits advisers and health professionals fell.
“If you're a family whose budget is tight, and you're a bit overwhelmed – perhaps by having a young child – you need it mentioned more than once, multiple times by different people in different spaces,” Maynard says. “We can't leave it to the voluntary sector to promote it.”
In November 2021, following a legal challenge, the government agreed that families who have permission to live in the UK but have no recourse to public funds will be entitled to enrol on to Healthy Start if they have a British child under four-years-old and are on a low income.
“It's a lengthy back and forth process, which they might still get rejected for,” notes Maynard, whose alliance helps people in such circumstances apply for the scheme.
Healthy Start "needs to work harder to reach more families and children", says Parente. The scheme also “should be expanded to children until the age of five to bridge eligibility gap between free school meals”, she adds, stressing that Healthy Start needs to offer more money to those already enrolled on to the programme to compensate for rising inflation (the amount given to families was last increased in April 2021).
In September Liz Truss announced temporary measures that cap the unit cost of gas and electricity, which will mean the average household's energy bill is equivalent to £2,500 a year, putting some ease on increasing family finances. But soaring inflation for basic essentials including food will see millions continue to struggle with the cost of living.
“No one in that parliament, I don’t think, has any understanding of what is actually going on,” says Marsha. “I am a bit worried and very scared of what's going to happen – if I can actually afford to heat my home as well as eat. That's where Healthy Start and all these charities [offering support] help, but I don't think the government's even thinking or helping enough at all.”
And still, the dwindling amount given out by the scheme, coupled with rising costs, makes it hard for Marsha to cook healthy meals for herself and her family. “I can't think of healthy or non-healthy [meals]," she says, "it’s about what I can afford now. I have to close my eyes and eat it sometimes.”
Correction: This article has been updated to reflect the fact that funding for the Healthy Start Scheme and the Nursery Milk Scheme used to be accounted for under a combined figure, but have not been accounted for together since 19/20. This split could explain the shrinking budget of the scheme. Spotlight has asked the Department of Health and Social Care to provide up-to-date data, but that has not been provided. This article has also been corrected to remove references to the scheme or its budget being cut or slashed.