A Healthy Start for All

:

and the City a new scheme for Hackney 17

th

July 2012

Why is Vitamin D important?

Classical function:

   regulates calcium levels in the body Vital for healthy tooth and bone development Deficiency in children can lead to bone deformities and rickets and in adults can lead to osteomalacia (bone pain, muscle ache and weakness) and increased risk of bone fracture

Non-classical function:

 Low levels have been associated with increased overall and cardiovascular mortality, cancer incidence and mortality, autoimmune diseases such as multiple sclerosis.  Vitamin D may modify risk for cardiometabolic outcomes (type 2 diabetes, hypertension, or cardiovascular disease), multiple sclerosis, Crohn’s disease, and certain cancers such as colon, breast, and prostate.

Sources of vitamin D

    Synthesised through the skin through the action of UV light on cholesterol Seasonal variation in individual Vit D levels due to levels of sunlight (primarily takes place April – Sept in UK) Longer exposure required in people with darker skin Small quantity from diet – oily fish, meat, eggs, soya products, fortified foods e.g. margarine, some cereals and fortified infant formula.

Who is at increased risk of deficiency?

      Pregnant, postnatal and breastfeeding women Young children People with little sun exposure People with darker skin People over 65 People with restrictive diets e.g. vegetarian/vegan  People with some chronic conditions

Background to the new local scheme

     High costs and inconsistency relating to prescription of vitamin D and folic acid Anecdotal reports of increased cases presenting with symptoms linked to vitamin D deficiency, including increased rickets cases Local screening identified a high proportion (70%) of the population were insufficient or deficient National Healthy Start programme is means tested and therefore not available to all Low uptake of national Healthy Start vitamin programme

Who is eligible for the new scheme?

    All women who are pregnant All women who have had a baby in the last year or who are breastfeeding All children under four years old (from birth if breastfed; from 6 months if formula fed) Can be recommended to buy OTC to:   Women intending to conceive People in at risk groups who do not fall in previous categories

How does the new scheme operate?

      Registration forms in a range of venues e.g. children’s centres, GP practices, Hackney Service Centre, midwives, health visitors, pharmacies Form authorised by GP, midwife, health visitor or other health care professional Form presented at pharmacy and woman/child(ren) registered on SONAR system Vitamins collected every 8 weeks and logged on SONAR – from any participating pharmacy Vitamins delivered direct to pharmacies by NHS Supply Chain – arranged by Public Health Pharmacy to ask whether families are receiving food vouchers and log – to enable PCT to reclaim costs

Pharmacy role and agreement

       Hold stocks of children’s vitamin drops and women’s vitamin tablets Register child(ren) and women on SONAR when presenting Record in SONAR all vitamins issued Record in SONAR when women/child eligible for national Healthy Start scheme Opportunistic promotion of Healthy Start for All and national Healthy Start schemes SONAR will identify immunisation schedule for each child to prompt discussion Opportunistic promotion of other key health messages e.g. immunisation, breastfeeding, early booking for maternity

Additional information

 Vitamins are Vegetarian Society approved  For Orthodox Jewish community: both women’s and children’s vitamins are considered parev/parve (neutral)  On Kosher product search ( www.kosher.org.uk

For further information contact:

Sarah Rees

Public Health Strategist NHS East London and City Email: [email protected]

Tel: 020 7683 4557

Suman Barhaya

Specialist Pharmacy Lead NHS East London and the City Email: [email protected]

Tel: 020 7683 4007