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Healthy Start Scheme and Welfare Food (Amendment) Regulations 2005

rose to move, That the draft regulations laid before the House on 3 November be approved. [8th Report from the Joint Committee and 14th Report from the Merits Committee] The noble Lord said: My Lords, the Welfare Food Scheme has played a vital role in providing a valuable safety net for pregnant women and families since it was introduced back in 1940. It is currently serving about 560,000 low income and disadvantaged households. But it now needs updating better to meet the nutritional requirements of present day families. In discussions on the enabling powers contained in the Health and Social Care (Community Health and Standards) Act 2003, several concerns were raised about the changes proposed to the Welfare Food Scheme. We have tried to take on board the comments made at that time and have reflected them in the proposals we are now making. For example, we are proposing to introduce the reforms in two stages to test the scheme prior to full implementation across Great Britain. That is taking up very much the points made during the debate on the 2003 Act by the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Barker. We propose to implement Healthy Start in Devon and Cornwall in the first instance. During that first phase, beneficiaries in Devon and Cornwall will receive Healthy Start vouchers, while beneficiaries in the rest of Great Britain will continue to receive Welfare Food Scheme milk tokens. Existing beneficiaries in Devon and Cornwall will be automatically transferred onto the new scheme to ensure seamless provision. Beneficiaries in phase 1 will receive with their vouchers Healthy Start communications providing information about the scheme and useful hints and tips on eating a balanced, healthy diet. Those materials will be part of a larger communications strategy developed to support the introduction of the new scheme. As part of phase 1, we propose to remove provision of low-cost infant formula via the NHS across the whole of Great Britain to families with children under the age of one who receive specified tax credits and have a family income under a certain threshold. NHS clinics in Devon and Cornwall will also cease the provision of all infant formula from the start of phase 1, which will support the department’s commitment to increasing the number of mothers who initiate breastfeeding. It is also our intention to remove the exchange of infant formula, as part of the scheme, from all NHS clinics from the start of phase 2. We expect phase 2 of Healthy Start to be rolled out across the rest of Great Britain later in 2006, taking into account the feedback from the evaluation of phase 1. In the main, beneficiaries currently receiving Welfare Food Scheme milk tokens will also be entitled to Healthy Start vouchers. The scheme will continue to provide, in phase 1, vouchers to all pregnant women and children under five in low-income families on certain benefits—income support, income-based jobseeker’s allowance and child tax credit. But we intend to remove entitlement for those pregnant beneficiaries currently receiving tokens because they are in a family receiving pension credit (guarantee credit)—that applies to fewer than 200 women—from phase 1 because of the greater value of this benefit. We also intend to remove entitlement for the small number of disabled children aged five to 16 years not in relevant education as a result of their disability, but we have made a commitment to provide a one-off goodwill payment to those disabled children. The Committee on Medical Aspects of Food and Nutrition Policy concluded that there was no nutritional justification for continuing that element of the scheme. In contrast, we will provide Healthy Start vouchers to all pregnant under 18 year-olds regardless of their income, because we know that teenagers’ diets are often nutritionally poor. Supporting young pregnant women during such an important time can only improve the health outcomes for both mother and baby. From phase 2, we intend to reduce the age limit for the scheme from age five to age four. We have not reduced the age range during phase 1 as that would create inconsistencies and inequalities between those receiving Healthy Start vouchers in Devon and Cornwall and those receiving milk tokens throughout the rest of Great Britain. As a result, we can increase the support that we give to families with the youngest and most vulnerable children by providing double vouchers to most families with children under the age of one. The new scheme also recognises that premature babies may need extra nutritional support, and so double vouchers will be paid. We propose that the value of each voucher should be £2.80 per week, but regularly reviewed, as was mentioned by the noble Lord, Lord Clement-Jones, in the passage of the 2003 Act. Beneficiaries will receive vouchers in advance in four-weekly cycles, and the vouchers will normally have a four-week expiry date. In circumstances where a backdated payment is made, vouchers may be issued with a longer expiry date. Regulation 8(2) allows for an expiry date of up to six months. During previous debates on the changes, concerns were expressed, by the noble Baroness, Lady Noakes, and the noble Lords, Lord Clement-Jones and Lord Chan, about the introduction of an application process. Those concerns have been considered but we still regard the application process as an important aspect of the scheme, as it forges closer links with the NHS and the very people who are likely to need the most support. The contact will be between beneficiaries and health professionals, which I think was also supported by a number of speakers in debate on the 2003 Act. The application process will create opportunities for health professionals to provide information and advice about healthy eating as an integral part of the scheme. Only new beneficiaries will need to complete an application form, to be signed by a health professional, as existing beneficiaries will be automatically transferred to the new scheme. Under the current scheme, pregnant women already complete an application form, so this is an extension of that existing process. We would expect the application form to be signed by either a midwife or a health visitor, as they are most likely to be in regular contact with the beneficiary. That process very much fits in with the current role of midwives and health visitors, as they currently sign applications for the Sure Start maternity grant. We have consulted the Royal College of Midwives and the Community Practitioners’ and Health Visitors’ Association in establishing the requirements. We intend to develop and deliver a package of health professional training sessions, as well as other supporting materials, to set Healthy Start in the context of wider health advice and guidance. But I should make it clear that we certainly do not expect health professionals to establish whether a potential beneficiary is entitled to vouchers in any way. To help and support beneficiaries in making the right dietary choices, we want to make the scheme more flexible by increasing the range of foods under the scheme and providing a fixed-value voucher. Although we intend to expand the range of foods under the scheme, we have kept it relatively simple at this stage, including fresh fruit and fresh vegetables as well as liquid cows’ milk and infant formula. That is to avoid confusion at the point of sale—particularly, for example, with frozen vegetables, which could include items such as frozen chips that for obvious reasons we would not want to promote through the scheme. We will consider the range of foods and the ““5 a day”” initiative as part of the evaluation of phase 1. We will actively target retailers currently registered with the Welfare Food Scheme, and will seek to recruit further retailers to participate in Healthy Start to ensure that beneficiaries have the widest access possible to a variety of local retailers, including initiatives such as box schemes and farmers’ markets. To participate in the scheme, retailers need to supply only at least one of the food types under the scheme—for example, milkmen who stock only milk for their rounds. Retailers will be required to complete and sign a simple application form, which includes a declaration as an anti-fraud measure highlighting to retailers their responsibilities under the scheme. Once registered, retailers will receive a registration pack containing a handy window sticker and a retailer quick reference guide, as well as their first claim form. The process for reimbursing retailers is designed to be straightforward to ensure unnecessary burdens are not imposed, particularly on smaller businesses. Vouchers will be reimbursed at full face value, so the current and unpopular retailer deduction will cease. That means that, for every £2.80 voucher exchanged by a retailer, £2.80 is received back. Every scheme is vulnerable to fraud but we have considered carefully the concerns expressed previously by, in particular, the noble Baroness, Lady Finlay of Llandaff, about the potential for abuse of the scheme. We are working with NHS counter-fraud specialists to minimise fraudulent activity, including the establishment of a common Healthy Start contractor database. Concerns have been previously raised by the dairy industry about expanding the range of foods. We have met several key stakeholders to discuss the changes we are proposing and have agreed to review the scheme and its processes as part of the phase 1 evaluation. But we must reform the scheme if we are more fully to meet the nutritional requirements of those pregnant women and young children who most need it. Beneficiaries may prefer to continue getting just milk with the new vouchers, rather than using the vouchers for fruit and vegetables—that is their choice. We will undertake a rapid evaluation of the impact and processes for phase 1 before the scheme is rolled out nationwide. I think that that was recommended by the noble Baronesses, Lady Barker and Lady Howarth of Breckland, in debates in 2003. I commend the regulations to the House, and beg to move. Moved, That the draft regulations laid before the House on 3 November be approved [8th Report from the Joint Committee and 14th Report from the Merits Committee].—(Lord Warner.)