Increasing the uptake of healthy start food vouchers

Amy McDonald, Research and Learning Officer at Small Steps Big Changes in Nottingham, describes how the programme is supporting local families to make healthy food part of their diets.

Amy McDonald

Food poverty - defined as “the inability to obtain healthy affordable food”(1) - is high in the UK.

Prior to the Covid-19 pandemic, it was estimated that 8.4 million people in the UK struggle to get enough to eat(2). Unhealthy foods that are high in saturated fats, salt and sugars are often cheaper and more readily available. Poor diet can have a significant impact upon an individual’s health and life chances and is associated with considerable costs to the NHS and UK economy.

To counter this, the means-tested Healthy Start scheme provides young pregnant women and low-income families with children under the age of four in England, Wales and Northern Ireland with free vitamins and food vouchers to purchase vegetables, fruit, pulses, cow’s milk and infant milks.

However, in order to benefit from the scheme, eligible families need to be aware of it and register to receive the vouchers.

When we entered the spring lockdown, only 67% of eligible families across Nottingham were accessing the scheme, meaning one third of eligible families were missing out.

Disparities in uptake existed too. Across families where English is not the main language spoken at home, only 23% were accessing the scheme.

Throughout the initial spring lockdown, we worked to increase awareness of the scheme by developing new graphics to appeal to our communities.

During this time, families were following government advice to stay at home, so the usual community channels for engagement were closed, so we promoted the offer via social media and linked up with existing and new partners, such as food banks and voluntary sector organisations, to distribute printed flyers by including them in activity and food packs being delivered to families.

Since the spring lockdown, 214 additional eligible families are now accessing the Healthy Start Scheme. On the surface this is really encouraging. However, whilst we have seen the number of eligible families increase from 4498 to 5003, we know there is a continued need for on-going promotion of the scheme.

In response to barriers for families where English is not the main language spoken at home, we are currently exploring options to translate the flyers and offer support to families in making their application. This support will be time limited as towards the end of 2021, the Healthy Start application process will have language support.

To support awareness-raising and promotion, we recognised the value in increasing knowledge of the scheme amongst the local workforces who interact with families. We have therefore developed some brief online training to enable the workforce to speak confidently about the scheme and signpost eligible families to it. We’ve taken a proactive approach, targeting training at both our obvious workforces - such as our Family Mentors, Health Visitors and Early Help - but also others including nursery managers, the interpreting service, and food bank staff.

The training also provides an opportunity to update the workforce around some important changes:

  • A health professional signature is no longer needed to complete the application.
  • The vouchers can now in addition be spent on tinned fruit and vegetables and pulses and legumes (lentils, chickpeas, kidney beans etc.)
  • From April 2021, the voucher value will increase to £4.25
  • The vouchers are also set to be replaced later in the year with a pre-paid card.

The introduction of the prepaid card was welcomed by one local parent, Anita* who previously as a single Mum, relied on the Healthy Start Scheme as an essential part of her weekly food budget. Despite this, she reported shame in having to use them, perceiving “dirty looks” from others in a queue, and feeling judged for receiving benefits. The prepaid cards should allow families to access the benefits of the scheme without concern or judgement.

Some of our learning from developing this work: alongside fresh fruit, vegetables and cow’s milk, healthy start vouchers can also be spent on infant formula. Any promotional material would benefit from being sensitive to this (we changed our original artwork from a milk bottle to milk carton, for instance), to ensure it can be displayed in settings which are Baby Friendly accredited.

*Anita – name changed to protect identity


  2. Cafiero, C., Nord, M., Viviani, S., Del Grossi, E., Ballard, T., Kepple, A., Miller, M. and Nwosu, C., 2016. Voices of the Hungry. Methods for Estimating Comparable Prevalence Rates of Food Insecurity Experienced by Adults throughout the World. Online available at

Further Reading

First Steps Nutrition (2018) The UK Healthy Start Scheme

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK. Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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