Transcript nhfshare.heartforum.org.uk

Healthy Start
London Region: Workshop 2
7th March 2011
Anna Kitt
[email protected]
1
Agenda
Time
Item
9.30am
Refreshments
9.45am
Welcome & overview
10am
Case Studies – Sharing best practice
Ealing PCT
Westminster PCT
Lead
Anna Kitt
Eula Green
Eva Hbronova &
Anna Varela
Raynes
11am
Coffee
11.15am
Healthy Start Update - London
Anna Kitt
12pm
Update from the Healthy Start Policy
team
Moragh Loose
12.30pm
Lunch
2
•
•
•
•
Replaced Welfare Food Scheme in 2006
A statutory scheme for PCTs
A nutritional safety net
A public health tool
3
What does Healthy Start provide?
Vouchers:
Vitamins:
Liquid milk
Fresh fruit and vegetables
Infant formula milk
For women
For children
Eligible families are able to get these from
10wks pregnant to their child’s 4th birthday
AND: Information on breastfeeding and
healthy eating through the Healthy Start
magazine sent with the vouchers
4
Why give Vitamins?
• Sufficient evidence to convince COMA and
SACN to recommend supplementation
• NICE report on Maternal and child nutrition
(March 2008) places the onus on PCTs to
ensure supplementation happens
Source:
COMA – Committee on Medical Aspects of Food and Nutrition Policy
SACN – Scientific Advisory Committee on Nutrition
NICE – National Institute for Clinical Excellence
5
Healthy Start eligibility is based on patient’s
financial status i.e. Whether they are on
benefits or under 18 yrs of age
The following groups are at risk of Vitamin D
deficiency:
• all pregnant & breastfeeding women
• all infants & children (6mths to 5yrs) unless fed
500mls infant formula
• People whom lack exposure to the skin
• People from BME groups with darker skin
6
Vitamin Facts
Children’s Drops
Women’s Tablets
Code:
ABX 072
Code:
ABX 073
Cost to PCT:
£1.61
Cost to PCT:
82p
Cost when
selling:
£1.77
Cost when
selling:
90p
Available to:
Children; 6 months –
3 years
Available to:
Women; pregnant and
until child is 1 yr old
Contains:
233mcg Vitamin A
20mg Vitamin C
7.5mcg Vitamin D
Contains:
70 mg Vitamin C
10 mcg Vitamin D
400 mcg Folic Acid
One bottle:
10 mls (8 week
supply)
One bottle:
56 tablets (8 week
supply)
Daily Dose:
5 drops
Daily Dose:
1 tablet
Classification:
General Sales List
Medicine
Classification:
Multivitamin Food
Supplement
Manufacturer:
SSL International
Manufacturer:
Bayer
7
Vitamin D Supplement
Recommendation
People at risk of vitamin D deficiency
Daily vitamin
D supplement
• All pregnant and breastfeeding women
10µg/day
• All infants and children from 6 months to 5years, unless they
are drinking 500mls (a pint) of infant formula a day at any time
during this age range
6 months to 5
years - 7µg/day
(If there is any doubt about the mother’s use of vitamin
supplements during pregnancy and/or breastfeeding, breastfed
infants will benefit from vitamin D supplements from 1 month)
• People whom lack exposure to the sun e.g. people confined
indoors for long periods and those who cover their skin for
cultural reasons
10µg/day
• People from ethnic minorities who have darker skin, because
their bodies are not able to produce as much vitamin D. Clinical
deficiency has been most reported among children of AfricanCaribbean and South Asian origin.
10µg/day
8
Can a healthy diet provide adequate vitamin D?
Food
Vitamin D
content
(mcg)
100g canned sardines
in tomato sauce
7.5
1 boiled egg
1.1
30g Fruit n’ Fibre
0.6
1tbsp low fat spread
0.4
100g Salmon
4.5
Simple Answer NO!
9
Vitamin D deficiency is
Sunlight Deficiency
• UK :13-28% of women of childbearing age
have low plasma vitamin D levels
• 2 hours/week sunlight exposure if face only, 30
minutes face, arms and hands is sufficient for
Vitamin D synthesis. (SPF 8+prevents)
• Darker skin blocks some of the UV rays, so
need more exposure to make Vit D
• In UK the wavelength of sunlight received in
winter (November to March) is not effective at
making vitamin D
Univ Westminster
Carol Williams, 2009
10
There is no funding to provide universal Healthy
Start vitamins free at my PCT
• Implement Healthy Start pathway with distribution
points where the vitamins can be sold & locally
advertise this
• Signpost women to their local pharmacy e.g. Boots,
Tesco, Holland & Barrett to buy vitamin D and folic
acid supplements
• Check there is Healthy Start information at the
booking appt (10wks) maternity pack
11
Vitamin D
Supplements
• Boots
• 12.5mcg (90 tablets)
£2.79
• Holland & Barrett
• 10mcg (100 tablets)
£3.19
• ASDA
• 10mcg (60 tablets)
£2.23
• Healthy Start (DH)
• 10mcg (56 tablets)
• 90p
Prices correct Nov 2010
12
What is the role for Public Health?
• Provide strategic leadership for Healthy
Start
• Work alongside Commissioners to ensure
the specification for Maternity and Early
Years provider services includes the
Healthy Start pathway
• Identify local needs in the local population
and incorporate this into the Joint
Strategic Needs Assessment (Healthy
Start quarterly report, DH) e.g. Are vitamin
distribution points in areas of deprivation
in the borough?
13
Effective Distribution
• Healthy Start pathway development &
implementation
• Key distribution points identified &
advertised to increase consumer demand
• Administrative staff are trained to issue
vitamins
• Each location is responsible for ordering
vitamins, ensuring that stocks are
maintained & take-up is monitored
14
Working with Health Professionals
• Ongoing training for health professionals
• Midwives promote the scheme at booking
appointments, health visitors follow this up
with guidance at home visits and GPs are
aware of the scheme
15
Raising Awareness
• Promotional materials developed to
supplement those available nationally
• Healthy Start application form available at
all GP surgeries, Children Centres and is
within the booking appointment pack
• Vitamin distribution points are published
on Healthy Start (DH) website
16
Have you identified training needs in
your local area?
• All health professionals
including Midwives, Health
Visitors, GPs need to discuss
the importance of vitamin D for
pregnancy and breastfeeding.
• Particularly important for those
BME groups with darker skin as
their vitamin D requirements
will be higher
• Are there administration
training needs?
17
Discussion points
• Has anyone identified distribution points at
pharmacies or other outlets?
• What are the barriers to the work in
providing effective distribution of vitamins?
• How could these barriers be overcome?
18
Healthy Start uptake
Healthy Start eligibility is based on
snapshot data comparing data on the
scheme against eligibility according to
HRMC tax credits and Job CentrePlus
***England’s uptake 78.9%***
London’s uptake 78.1%
19
All regions Healthy Start scheme uptake December 2010
86%
84.4%
84%
81.7%
81.2%
82%
80.4%
79.6%
% uptake
80%
78.9%
78.1%
77.3%
78%
76%
74.4%
74.0%
74%
72%
70%
68%
North East
North West
Yorkshire &
Humber
East Midlands
West Midlands East of England
London
South East
South West
England
Regions
20
in
g
an
d
Da
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nh
a
Ba m P
rn C
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an n w PC
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ll i
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in
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gt
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Healthy Start scheme uptake London- December 2010
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
21
Vitamin Uptake
Vitamin uptake for both children’s and women’s
tablets.
• In the last year…
• PCT with highest children’s drop uptake is
Islington with 6.9% (Sept 10/11)
• PCT with highest women’s tablets uptake is
Islington with 7.0% (Sept 10/11)
• PCT with highest Healthy Start uptake is
Westminster with 85.1%
22
ar
ki
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B
Vitamin uptake- London June 2010
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Children's drops uptake
Women's tablets uptake
23
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Vitamin D uptake- London December 2010
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Children's drops uptake
Women's tablets uptake
24
ar
k
in
g
an
d
Da
ge
nh
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ar P
B
n C
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PC
T
B
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Vitamin D uptake- London December 2010
Children's drops uptake
Women's tablets uptake
25
Number of women’s vitamins ordered compared
with the potential number eligible 09/10
Westm inster PCT
Wandsw orth PCT
Waltham Forest PCT
Tow er Ham lets PCT
Sutton and Merton PCT
Southw ark PCT
Redbridge PCT
Richm ond and Tw ickenham PCT
New ham PCT
Lew isham PCT
Lam beth PCT
Kingston PCT
Kensington and Chelsea PCT
Islington PCT
Hounslow PCT
Hillingdon PCT
Havering PCT
Harrow PCT
Haringey Teaching PCT
Ham m ersm ith and Fulham PCT
Greenw ich Teaching PCT
Enfield PCT
Ealing PCT
Croydon PCT
City and Hackney Teaching PCT
Cam den PCT
Brom ley PCT
Brent Teaching PCT
Bexley Care Trust
Barnet PCT
Barking and Dagenham PCT
0
NHS Supply Chain
2000
4000
Potential Claim
6000
8000
26
Number of children’s vitamin drops ordered
compared with the potential number eligible 09/10
Westm inster
Wandsw orth
Waltham Forest
Tow er Ham lets
Sutton and Merton
Southw ark
Redbridge
Richm ond and Tw ickenham
PCT
PCT
PCT
PCT
PCT
PCT
PCT
PCT
New ham PCT
Lew isham PCT
Lam beth PCT
Kingston PCT
Kensington and Chelsea PCT
Islington PCT
Hounslow PCT
Hillingdon PCT
Havering PCT
Harrow PCT
Haringey Teaching PCT
Ham m ersm ith and Fulham PCT
Greenw ich Teaching PCT
Enfield PCT
Ealing PCT
Croydon PCT
City and Hackney Teaching PCT
Cam den PCT
Brom ley PCT
Brent Teaching PCT
Bexley Care Trust
Barnet PCT
Barking and Dagenham PCT
0
5000
10000
NHS Supply Chain
15000
20000
25000
Potential Claim
30000
27