Supporting families better with the NHS Healthy Start scheme

Executive Summary

• Although food price inflation has reduced since the 45-year high in 2023, price levels remain elevated. These higher prices will have a greater impact on lower income households and those with children as they spend a higher proportion of their budget on food.
• The Healthy Start scheme provides eligible families with money towards some healthy foods. However, levels of participation in the scheme have varied over time and across locations, and there is substantial potential to improve the support given to these families by the NHS Healthy Start Scheme. 
• The real terms value of Healthy Start payments has decreased since the standard weekly payment was uplifted to £4.25 in April 2021. The government should up-rate the payments to reflect this, and we estimate that the payments would need to increase by over £1.30 per week to keep their value. There is also a case for extending eligibility for the scheme.
• There is an opportunity for supermarkets to do more to help families by promoting Healthy Start to improve participation or by giving top ups to the scheme, as Sainsbury’s already does, for example.

Disclaimer: The report was originally published in April 2023. It has been revised and updated as of January 2025 to reflect updated information and corrections in the NHS Healthy Start eligibility data. 

Introduction

Food and drink inflation peaked at 19% in March 2023 the highest rate in over 45 years, and while inflation rates have since reduced, price levels remain elevated. Households with children and lower income households face a higher inflationary burden as they spend a higher proportion of their expenditure on food and may still struggle financially due to higher food and drink prices. In our latest tracker data from December 2024, levels of financial difficulty remain elevated compared to before the cost of living crisis, we found 8% of households missed a housing, bill, loan or credit card payment. This is more common among working-age parents and lower income households, with one in seven (13.7%) and one in eight (11.7%) missing a payment. These cost pressures are likely to make eating healthily more difficult for low income families, which would exacerbate existing inequalities in diet quality.   

Financial support for food spending is provided to low-income families with small children through the NHS Healthy Start scheme in England, Wales and Northern Ireland. A comparable scheme, Best Start Foods, is provided in Scotland, but the absence of publicly available regional data on takeup means that we do not include geographic analysis of the scheme in this briefing [1]. 

Healthy Start began in 2006 with the stated aim of providing a nutritional safety net and improving the access to a healthy diet for low-income families. Healthy Start provides pregnant women or families with children under 4 on qualifying benefits or tax credits to receive money towards some healthy foods, including milk, infant formula and fruit and vegetables. Since April 2021 it has been worth £8.50 per week for children aged 0 to 1 and £4.25 for all other recipients.

However, the effectiveness of Healthy Start has two challenges. First, participation in the scheme has varied over time and across locations. Second, the high levels of food price inflation over 2022 and 2023 substantially decreased the value of the payments in real terms. Therefore, the scheme may be failing to provide a nutritional safety net for low income families.

In this briefing note, we analyse these two issues and consider what could be done by both the public sector and the food industry to increase take up and make the scheme more valuable to participants. Which? believes that the supermarket sector is particularly well placed to increase the impact of this scheme by promoting the scheme and providing top ups, if they are not already. Given the record levels of food inflation and the general squeeze on household budgets, it is vital that struggling families are able to afford healthy food.

 Participation in Healthy Start 

Participation in Healthy Start is not automatic and eligible families must apply. As a consequence, not all eligible participants are receiving payments. We know that the rate at which eligible recipients participate in the scheme has varied substantially over time. The participation rate was 73% in 2015, but fell to just 51% in 2020, likely in part due to the falling real value of the payments which had not been increased since 2010. However, participation rose significantly as the scheme moved from paper vouchers to a prepaid card between September 2021 to March 2022. During the rollout period, the participation rate increased from 60% to 72% across England, Wales and Northern Ireland. Unfortunately, it is not possible to say what has happened to the participation rate as there have been data issues since the start of the fully digitalised scheme in March 2022. The number of eligible and active participants is not available between April 2022 and December 2022, and since January 2023 only data on the number of active participants is available [2].

Geographic variation in participation 

In the latest data, as at December 2024, there are around 354,000 participants on the Healthy Start scheme across the UK (excluding Scotland). The number of participants has fallen by 2.3% since the beginning of January 2023. The change however varies across the nations with a 2% decrease for England, 4.9% decrease for Wales and 8.4% decrease for Northern Ireland. The monthly changes over the last two years are shown below in Figure 1. 

Due to the current lack of data available on eligible participants we cannot be sure if this decline in participation is due to more people becoming ineligible for the scheme or fewer people joining the scheme. 

Figure 1: The number of people on the digital scheme has fallen over the last two years

Analysis at the local authority level for England and Wales shows that there is not a decline in participation for all areas, as illustrated in Figure 2. Crawley had the largest decline in the number of participants over the last two years, with an 18% decrease between January 2023 and December 2024. Many coastal areas have seen large decreases including South Tyneside and Torbay, with 17% and 16% respectively. During the same time period, the number of participants has grown significantly in other local authorities such as Pendle, Rushmoor and Forest of Dean with a 20%, 19% and 18% increase respectively.

Figure 2: The percentage change in the number of participants on the scheme varies widely across local authorities 

The causes of this geographical variation are not certain but place based factors are relevant since the variation is persistent over time. Absent available eligibility data, we compared the percentage change in active participants over the last two years with the percentage change in the latest local authority population data for children aged 4 and under [3], and found little correlation between the two, indicating that the change in active participants is likely not due to population change.

Instead, the differences in the number of active participants is more likely due to other factors. Healthcare professionals are a key mechanism to increase awareness of the scheme and so differences in local training or processes might be one factor leading to these wide differences in takeup. A recent qualitative evaluation of the scheme found that many of those eligible needed help with their application process, particularly non-English speakers, and that the eligibility criteria is too complex.

The value of Healthy Start in real terms

The value of Healthy Start payments was last increased in April 2021 to £4.25 per week for the majority of participants. Since then food inflation reached a 45-year high so that it is now worth considerably less in real terms. 

By matching the healthy foods that can be bought with Healthy Start payments to ONS inflation data for categories of food, we estimate that the average prices of recommended Healthy Start foods have increased by an estimated 31.3% between April 2021 to November 2024. 

This means that Healthy Start payments would need to be uplifted from £4.25 to £5.58 per week to keep their value. This is a difference of £1.33 per week or over £69 over a year. For recipients eligible for the higher value scheme of £8.50 per week, i.e. those with children aged between 0 and 1, the payments would need to be uplifted to £11.16, a difference of over £138 per year.

Improving the effectiveness of Healthy Start 

The considerable decline in the real value of payments makes it clear that at a time when many families are still struggling financially, the Healthy Start scheme could be a more effective tool for supporting low-income families to have a healthy diet.

The role for the government

The declining real value of Healthy Start payments is clearly a concern and can only be addressed by the government. We believe that the payments should be uplifted to take into account the high levels of food price inflation since April 2021. 

However, the government can go further than this. Now that the scheme has moved away from the use of paper vouchers, we see no reason why the payment should not be automatically uprated in line with inflation as happens to other welfare payments. For the comparable Scottish scheme, Best Start Foods, the value was uplifted again in April 2024 from £4.95 per week to £5.30.

The government has announced plans for a national food strategy. It is essential that health and affordability are at the heart of this. But our analysis shows that there is an urgent need for the government to expand eligibility to all families on Universal Credit and equivalent benefits with children under five years old. Increasing the age limit by one year would bridge the gap between the end of Healthy Start eligibility and Free School Meals eligibility, helping to avoid children going hungry. This would also support the government’s missions relating to health and to breaking down barriers to opportunity.

The role for supermarkets

While the government has a role to play, and there is an important role for public authorities and public interest groups in promoting the scheme, Which? also believes that the food industry can help to improve the effectiveness of Healthy Start and that the scheme offers a particular opportunity for supermarkets to help low-income families eat healthily. Supermarkets could do this firstly by promoting the scheme and making it easy for people to use their card and secondly by providing additional support by topping up the value of the payment. 

There are some examples of good practice that can be built upon. Iceland has for example promoted the scheme on milk bottles with its “Could you get this milk for free?” campaign It has also promoted the Healthy Start scheme with special QR coded delivery vans and has more recently partnered with Del Monte to promote Healthy Start on Del Monte frozen fruit products.  

In 2022, Social Security Scotland partnered with Asda to host in-store events at 7 supermarkets to boost awareness and engagement of the Best Start Foods Scheme. This was impactful, the increase in takeup from 2020-21 to 2021-22 by 14 percentage points has been partially attributed to the partnership work between Social Security Scotland and supermarkets.  A similar approach could be implemented in the other three nations for the Healthy Start Scheme by promoting takeup especially in those local authorities with significant capacity for improving takeup. 

Several supermarkets have previously provided additional support - including through additional vouchers or in Iceland’s case, free frozen vegetables. However, the majority of the major retailers have faced difficulties topping up the new prepaid card scheme compared to the previous paper voucher scheme, reducing the prevalence of these initiatives. Sainsbury’s has however still been able to commit to providing additional top ups for people eligible for the Healthy Start scheme across England, Wales and Northern Ireland.

It is important that other supermarkets follow these examples and provide this much needed additional support. The switch to the prepaid card was intended to bring a number of benefits, including being more discreet, payments being added automatically and the ability to retain money on the card, rather than having to spend it in one transaction. 

Supermarkets need to work with the government to work around the technical challenges that are preventing some of them from providing top ups. Our analysis shows that more generally, there is still a lot more that they can be doing to help raise awareness of the scheme within store and online, building on innovative initiatives that have already been tried, and also to make it easy for people to seamlessly use their cards in store by ensuring that staff are aware of the scheme and trained in how to support people who are using the card.  

Footnotes

[1] Best Start Foods has some differences to the NHS Healthy Start scheme. These differences include a higher standard payment of £5.30 per week and £10.60 for children aged 0 to 1, and that the scheme ends earlier as it is only applicable for children under 3. There are also differences between the nations in terms of a wider system of welfare payments that are available to families and young children.

[2] Further details on the underlying data issues can be found here https://www.healthystart.nhs.uk/healthcare-professionals/

[3] The latest local authority population datasets are as-at mid-2022 and mid-2023.