Transcript Slide 1

Healthy Start
and
Early Years
Anna Kitt
[email protected]
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What is Healthy Start?
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Replaced Welfare Food Scheme in 2006
A statutory scheme
A nutritional safety net
A public health tool
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Healthy Start
Introducing Solid Food
Breastfeeding
Inter related
infant
health
initiatives
Start4Life
Baby Life check
Active play
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What does it 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
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Who is it for?
Pregnant women and families with children
under four getting:
• Income Support, or
• Income Based Jobseekers’ Allowance, or
• Income related Employment and Support
Allowance, or
• Child Tax Credit (but not Working Tax Credit) with
an annual family income of £16,190 or less.
And ALL pregnant under 18 year olds
NOTE: There are no back payments for missed
5
time periods
The Voucher
• £3.10 each week
• Issued 4 weekly to
beneficiaries
• Double vouchers for under 1’s
(£6.20/week)
• Voucher value reviewed
annually
• Over the course of a
pregnancy this equates to £93
food vouchers
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Role of Health Care
Professionals
The way the parents
find out about the
scheme effects their
relationship with the
scheme.
Health professionals can make a huge difference!
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Healthy Start is a
Statutory Scheme
Health Professionals are
given the key tasks of:
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Signposting to the scheme
Supporting applications
Signing application forms
PCTs have a duty to make
Healthy Start vitamin
supplements available
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Healthy Start application process
Family becomes eligible
Midwife/Health Visitor
Invitation from HSIU
Application form in GP
surgery
Tax credits helpline
Jobcentre Plus
Potential beneficiary hears about
Healthy Start
Internet
Website
HSIU Helpline
Pregnancy or Birth to Five
Book
Poster in children’s centre
Get application leaflet/Form
GP Surgery
Complete Form
Health Visitor
Get signature from midwife or health visitor
Submit to HSIU
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HSIU receives application form
Fully completed
Clearly do
not qualify
Application for
pregnant
Wrongly completed
Application
includes children
Returned to applicant
Applicant
informed
Vouchers Issued
Validate against
HMRC and JCP data
Validation
checks later
Match found
Match not found
Inform applicant and invite to give
additional information. Repeat 2/4
weekly checks for 3 months
Vouchers Issued
Match found
Repeat validation
checks every 2 wks
(HMRC) or 4 wks (JCP)
No match found
Vouchers not issued
Voucher Issued
Letter confirming match not found
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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
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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
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Vitamin Collection
Points
• Local Vitamin
Collection Points
(marketing)
• Collection of
vitamin coupons
(administration)
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Arrow points towards either the
women’s or children’s vitamins
depending on which product they
should be picking up.
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Synthesis of Vitamin D
Our main source
of vitamin D is
that made by our
own bodies. 90%
of our vitamin D
is made in the
skin with the
help of sunlight
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Dietary Sources of
vitamin D
• Oily fish including trout,
salmon, mackerel, herring,
sardines, anchovies,
pilchards, and fresh tuna
• Amount will depend on
preparation, with smoked
herring containing
approximately 4μg per 100 g
and raw herring 40μg per
100g
• Cod liver oil and other fish
oils
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90% of the UK
lies above the
latitude that
permits
exposure to the
ultraviolet B
wavelengths
necessary for
vitamin D
synthesis
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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
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Who gets vitamin
D deficiency?
• Pregnant or breast-feeding women. Vitamin D
deficiency is even more likely to develop in
women who have had several full-term
pregnancies with short gaps between them.
• In the last three months of pregnancy, babies
are growing at their fastest and mothers often
become short of vitamin D especially if these
months occur during winter or early spring.
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Who gets Vit D Deficiency?
• Breast-fed babies whose mothers are
lacking in vitamin D, or with prolonged
breast-feeding
• Bottle-fed babies do not need vitamin D
supplements as formula milk is fortified
with vitamin D
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Explanations provided for low sun
exposure and low vitamin D intake by
mothers
(Outpatient survey, West London)
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Little time outside: busy indoors or at work
Going “out” often includes shopping in malls
Use of sun block
Dislike or fear of sunlight for themselves and
their infants
Use of skin lightening creams regularly
No Healthy Start vitamins
No mention of vitamin D in antenatal care
No knowledge of vitamin D
How to improve knowledge and healthy
behaviour relating to vitamin D
(Michie C. London Journal of Primary Care, 2010)
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Rickets
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Vitamin D insufficiency is
common in the UK population
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Vitamin D deficiency typically
presents with bony deformity
(rickets) or hypocalcaemia in
infancy and childhood, and with
musculoskeletal pain and
weakness in adults
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Currently there is a lack of
coding of vitamin D deficiency in
primary care and secondary care
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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 African-Caribbean and South
Asian origin.
10µg/day
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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 (56
tablets)
• 10mcg
90p
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Prices correct Nov 2010
Vitamin D in
the Headlines
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