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Fourth Standing Committee
on Delegated Legislation
The Committee consisted of the following Members:
Chairman:
Mr. David Marshall
†Blunt, Mr. Crispin (Reigate) (Con)
†Brown, Lyn (West Ham) (Lab)
†Burns, Mr. Simon (West Chelmsford) (Con)
†Flint, Caroline (Parliamentary Under-Secretary of State for Health)
Key, Robert (Salisbury) (Con)
†Lilley, Mr. Peter (Hitchin and Harpenden) (Con)
Maples, Mr. John (Stratford-on-Avon) (Con)
†McCarthy, Kerry (Bristol, East) (Lab)
†Merron, Gillian (Lord Commissioner of Her Majesty’s Treasury)
†Mitchell, Mr. Austin (Great Grimsby) (Lab)
†Mullin, Mr. Chris (Sunderland, South) (Lab)
†Snelgrove, Anne (South Swindon) (Lab)
†Soulsby, Sir Peter (Leicester, South) (Lab)
†Vis, Dr. Rudi (Finchley and Golders Green) (Lab)
Webb, Steve (Northavon) (LD)
†Williams, Stephen (Bristol, West) (LD)
Gordon Clarke, Committee Clerk
† attended the Committee
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Tuesday 15 November 2005
[Mr. David Marshall in the Chair]
Draft Healthy Start Scheme and Welfare Food (Amendment) Regulations 2005
4.30 pm
The Parliamentary Under-Secretary of State for Health (Caroline Flint): I beg to move,
That the Committee has considered the Draft Healthy Start Scheme and Welfare Food (Amendment) Regulations 2005.
I think we have just been joined by a member of the Liberal Democrat party. I am glad he can join us for this important debate on how best to provide a healthy start for babies and mothers in some of the lowest-income families in the early years of a child’s life.
I hope that the Committee will agree to the regulations for the first phase of the new scheme in Devon and Cornwall. Following the first phase, which will be evaluated for six months, we hope to extend the scheme to the rest of the country. I understand that it will apply to Scotland and Wales; Northern Ireland has its own scheme but it will look at how the proposed scheme works out with a view to providing it in Northern Ireland.
Remembrance Sunday this week serves as reminder that the welfare food scheme was first introduced in the second world war as a means of supporting families during periods of food shortages and rationing. It has been giving vital nutritional support to many families since those days, some 65 years ago. It has provided a valuable safety net to more than 560,000 low-income and disadvantaged households through the provision of free milk and vitamins but, as was discussed when we considered the legislation that paved the way for the regulations, it was felt that it needed updating to support more fully the nutritional requirements of present-day families.
The reforms set out in the regulations will improve nutritional choice for families, increasing the range of foods available as part of the scheme and encouraging a balanced diet. Not only will the scheme provide greater flexibility for beneficiaries, but it will go much further, involving the NHS in delivering advice and support to those who most need it. As the Minister with responsibility for public health, I am acutely aware of how important healthy eating is at the very start of children’s lives and when their mothers are pregnant.
Our original proposals to reform the scheme predate the White Paper “Choosing Health”, published in November 2004, but they closely reflect its principles. We want to encourage and support children and their parents in establishing good patterns of behaviour early in life. During previous debates on the Health and Social Care (Community Health and Standards) Act 2003, which introduced the enabling powers for
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this reform, concerns were raised about the impact that the changes might have and who they might apply to.
The Conservative Front Bench spokesman on health, the hon. Member for South Cambridgeshire (Mr. Lansley), who is currently involved in a debate in the Chamber, raised the matter of premature babies and when their access to the scheme should start. I am pleased to say that the regulations include the families of premature babies from the actual date of their arrival.
The regulations will enable us to start phase 1 in Devon and Cornwall. That is a good idea when such a big change is proposed to a scheme that has been around for a number of years. It will enable us to test the regulations in a practical way, to see how they work, and to bring further regulations before the House to extend the scheme nationally.
Beneficiaries throughout the rest of Great Britain will continue to receive welfare food scheme milk tokens during phase 1. The provision of milk across Great Britain to children under five in day care will remain unchanged during that phase. We will also continue to provide vitamin supplements to pregnant women and young children who are on either the welfare food scheme or healthy start in the first phase in Devon and Cornwall.
To promote breastfeeding, the NHS will stop provision of infant formula when healthy start is rolled out nationally, and will do so in Devon and Cornwall from phase 1. There was a ten-minute Bill on the issue recently. Throughout Great Britain at the start of phase 1, we are therefore also removing entitlement to buy reduced price infant formula from the NHS for families with a family income under a certain threshold who receive specified tax credits. That is not to say that people cannot use their vouchers to buy formula, but for a considerable time it has been felt that the NHS, which should support better breastfeeding, should send out a strong, single message rather than a mixed message on how important breastfeeding is. Rates of breastfeeding are very poor, especially among low-income groups.
Mr. Simon Burns (West Chelmsford) (Con): Why was Devon and Cornwall chosen for the pilot scheme?
Caroline Flint: We were looking for a region that combined urban and rural areas. The area chosen covers the whole of Devon and Cornwall. We wanted a place that had towns and rural areas and communities where we could work with the agencies locally to provide the best start to phase 1 of the scheme. The area chosen gives us that opportunity.
Mr. Burns: As Devon is my home county, I am fairly familiar with it. All regions of the country combine towns and rural areas, so why was Devon and Cornwall chosen?
Caroline Flint: It was felt that the area would be a good starting point. We felt that we could work with the health professionals in the area, and it is as good a place as any. I hope that the hon. Gentleman is not suggesting that we should not start with that area,
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because spearheading the scheme is a good opportunity. The area provides geographical coverage and urban and rural settings so that we can see how the scheme will work. That is particularly relevant when considering how it will impact on retailers and where we might have to expand the number of retailers who are part of the scheme.
The note that I have been passed contains exactly what I have just said. The area is geographically self-contained, with borders that do not cut across large urban communities. It has a mixture of current approaches to the supply of infant formula through the welfare food scheme, using pharmacies as well as clinics for distribution points. As I said, the area chosen includes urban and rural areas. It also has small pockets of deprivation as well as larger identifiable areas. That is also important because sometimes in larger areas of deprivation these schemes are easier to operate and there is more involvement with health professionals. Sometimes it is the smaller pockets of deprivation that we need to attend to so that they get the services that they need. I hope that the hon. Gentleman will watch the scheme closely as it unfolds and that we can learn lessons from the first phase.
We are removing entitlement to buy reduced-price infant formula from the NHS for the reasons that I have outlined. We want to encourage breastfeeding as the first resort when it comes to feeding babies. At present, more than 720,000 beneficiaries are receiving milk tokens. We do not expect that figure to change substantially with the introduction of phase 1. The groups of beneficiaries entitled to healthy start vouchers for phase 1 will be broadly similar to those currently receiving welfare food scheme milk tokens.
Pregnant women and children under five in families receiving certain benefits—income support, income-based jobseeker’s allowance and child tax credit—will continue to be entitled to them. We will provide healthy start vouchers to all pregnant under-18-year-olds because we know that teenagers in general tend to have a poorer diet and those who are pregnant require more nutrients. That will add about 24,500 people to the scheme throughout Great Britain.
We will remove, however, entitlement for the approximately 200 people currently getting pension credit guarantee credit because of the greater value of this benefit. That said, if there is an under-18-year-old in the family, they will have access to the benefits as I have described. Some of the beneficiaries currently receiving milk tokens as a result of family entitlement to pension credit guarantee credit may qualify in other ways.
We will also remove the entitlement from disabled children aged five to 16 not in relevant education because of their disability. There has been a great deal of discussion about that. We have, however, made a commitment to make a one-off good-will payment to the very small number of families affected—fewer than 20, I understand. The Scientific Advisory Committee on Nutrition, which was known as COMA, looked into the scheme, the nutritional benefits and reform and concluded that for that age group there was no nutritional justification for continuing that element of
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the scheme. As I have said, however, despite the small numbers affected, we recognise that we need to make a one-off payment to compensate and we will do that.
Mr. Burns: It is interesting that the Minister says that she thinks that about 20 families are affected. That gives rise to two questions. First, if it is so few, why go through the pain and grief of making this change? Secondly, what level of one-off payment does she expect to be made?
Caroline Flint: To answer the hon. Gentleman’s second question first, the level of benefit is still being discussed in the Department. We should remind ourselves that the reason for the scheme in the first place was to consider issues relating to nutrition and, over the years, a much larger number of children have found themselves in mainstream education. COMA looked at the nutritional issues, because that is the basis on which the scheme is founded, and found that there was no nutritional justification for that benefit. The clinical needs of that group—a small number—are very varied and it was felt that their nutritional needs could be better served by other means—for instance with the assistance of their NHS consultant and other support. I know that it is a small number, but it is a bit of an anomaly in the system. The easy choice might be to let that anomaly continue, but in terms of good practice and regulation, and despite the small numbers, I think it is right to sort it out now, when we are revising the scheme as a whole. We are, however, still discussing what would be a one-off payment. I assure the Committee that we do not want to take something away from that very small group of people if that could in any way be viewed as detrimental to them as families.
Consultation showed that we should focus on the youngest children and, to that end, we will be doubling vouchers for all eligible families with children under one year of age. We mentioned in the Government response to the consultation exercise published in February 2004 that we proposed in phase 2 to reduce the upper age limit for children to receive healthy start vouchers from their fifth to their fourth birthday.
The double vouchers will broadly cover the cost of one tin of infant formula per week, or provide extra help to buy foods for weaning. Families in which mothers breastfeed will receive the double vouchers as well as those in which mothers bottle-feed. That is important, because for a considerable time, well meaning though it was, the welfare food scheme actively discriminated against breastfeeding mothers in terms of how they could use the vouchers, both for their own intake of nutrients and in other ways.
We are therefore having to make choices about where we think that the vouchers will be most valuable. After considerable discussion and consultation, we have reached the view that, certainly in phase 2, we should seek to ensure that the double vouchers are available for the youngest children, although that means that we bring down the age from the fifth to the fourth birthday. We have to make those choices about how to ensure the best and healthiest start in life. However, I am pleased to say that
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considerable work is going on at the Department for Education and Skills to improve school meals. Again, some of those different programmes will fit nicely together in the long term.
As I said, there is an improvement in the scheme for breastfeeding mothers. Under the current scheme, breastfeeding mothers can exchange tokens for only seven pints of milk, which is worth much less than a tin of infant formula. There will also be better support for families with babies born early, as they will get double vouchers for a year after the child’s expected date of delivery, not just for a year following the birth. That is also important.
Vouchers will be issued to beneficiaries for each week in which they are entitled. In practice, that normally means a four-weekly mailing of vouchers that have a four-week expiry date. Sometimes a voucher may have a longer expiry date—for example, when a beneficiary is entitled to vouchers for a backdated period.
The front of each healthy start voucher will show its value, which has currently been set at £2.80 per week, the types of food available and the period for which it is valid. There are means by which, if there are problems with the vouchers, a cheque could be issued. I think that that would occur only in unusual circumstances, but there is always the possibility that something might go wrong with any scheme. We therefore have safeguards to back the process up.
The application process is obviously very new. One of the recent changes to the current welfare food scheme was the introduction of an application form for pregnant women. We want to expand that application process under the healthy start scheme to all beneficiaries. The reason for that is not to introduce a bureaucratic exercise—some sort of gateway process—but is to provide opportunities for health professionals to engage with mums and dads and their babies about a healthy start in life. Someone like a health visitor will sign off the application, which will give them the opportunity to engage with the family about the benefits of good diet and nutrition. I asked what had been the result of that application process since November 2004, under the current welfare food scheme. I am pleased to say that in the past six months the numbers have gone up considerably from about 19,500 in the six months before March of this year to more than 23,500 in the past six months. I can provide the exact figures, but that shows that the numbers are going up. We believe that it will allow us to forge closer links between the scheme and the NHS, aiming to improve the health outcomes for pregnant women and young children through focused nutritional advice.
Once a potential beneficiary completes an application form they must get it signed by a health professional. We do not expect that to be time consuming or burdensome. It is not the job of the health profession to gate-keep the process in any way, but to establish a window of opportunity for the sort of conversations that are really important, for questions to be asked and for help and support to be
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given. We simply want to build on the processes that are already in place to advise pregnant women and families about their diet and to encourage beneficiaries to access their local health professionals. We know that the less well-off often do not access the care they need when they need it most. There are wonderful opportunities of which we should take advantage.
To support health professionals we intend to develop awareness training sessions providing information about healthy start in the context of the wider public health agenda. As with the healthy start scheme, the training will be evaluated. We have also developed specific communications materials to help health professionals deliver the scheme. They need to be able to answer the mum’s questions about where the retailers in the local community will be and so on. The materials will contain information about the scheme and health and nutrition issues relevant to such families.
We will support beneficiaries as they are transferred on to the new scheme, or apply for it, by giving them all the information and advice they need. For example, included in their first mailing of healthy start vouchers will be a beneficiaries magazine and a user guide, providing information about how the scheme works as well as hints and tips on eating a healthy diet. Those materials, and those for health professionals, are part of a broader healthy start communications strategy that also involve retailers and the development of a new website.
One criticism of the current scheme is the inflexible nature of the tokens, as seven pints of milk, in many instances, have to be taken in one transaction. Some people do not have adequate cooling facilities, and obtaining seven pints of milk in one go simply means that the milk goes off before it is used, although obtaining milk daily from a milkman can sometimes combat that problem. Under healthy start, people will be able to exchange their vouchers for fresh fruit and vegetables as well as liquid cow’s milk and infant formula. They can choose to use a voucher for, for example, two pints of milk, some fresh vegetables and some fresh fruit. Of course, those who want to continue to receive just milk can do that. We intend to review the range of foods when we prepare to extend the scheme across the rest of Great Britain and will explore in the future the potential to link healthy start to the five-a-day initiative and, where appropriate, to include frozen foods.
A number of concerns have been raised by retailers and milkmen about how the scheme will affect their businesses. We think that there are opportunities in many areas, but we recognise that the scheme will change. There is no point in my trying to disguise that. Many milkmen already provide a variety of goods to the doorstep—not just milk, but orange juice, vegetables, eggs and other things as well.
Mr. Burns: Can the Minister clarify that point? She has mentioned eggs and orange juice. If we look at schedule 3 to the regulations, which lists what such families are able to purchase, eggs and orange juice are not mentioned.
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Caroline Flint: The reason I mentioned that was to show that milkmen provide a variety of goods on a daily basis. The hon. Gentleman is absolutely correct—eggs and orange juice are not in the schedule. I was trying to illustrate the fact that, in a number of ways, the milk service to our doorsteps already provides a range of goods. We hope that there will be opportunities for them to include the foods on the scheme as well.
We want to recruit as many local retailers as possible. Those already participating include the milkmen and local corner shops as well as larger retail outlets. They will all be automatically invited to supply. We will also target other similar food outlets to increase coverage. For the first time, the scheme will be open to other retailers, such as those who sell through farmers markets, food co-operatives and box schemes.
We know, as I have said, that there are concerns about the expansion of the scheme, particularly among milkmen, and we are doing what we can to retain their continued support and involvement in the scheme, but we must balance those considerations against the rights of individuals in the scheme to have access to other goods and a wide range of local retailers, particularly in rural and remote areas.
We will monitor retailer participation by both numbers and types when evaluating phase 1. A helpline number will be provided to beneficiaries to assist them in locating local food outlets. The website that we intend to develop will offer a search function for anyone wanting to find a local healthy start food outlet. That will be backed up by the health professionals who will clearly sign off the application form in the first place.
Retailers in the scheme will be provided with a healthy start window sticker so that it can clearly be seen that they accept healthy start vouchers. Food outlets wanting to take part will need to complete a simple registration process that will include signing a declaration that forms part of our fraud prevention measures. A retailer who subsequently fails to act in accordance with the rules may be liable to withdrawal from the scheme.
We also intend to commission our contractors to develop a database for collecting and reporting information that may indicate fraud on the part of retailers and beneficiaries. However, having read the various notes and briefings on the matter that I have received, I consider that the system that we are introducing has more safeguards, in some respects, than the old one, under which seven pints of milk could be collected on a voucher, but the price could be higher than the cost of seven pints of milk. The voucher states clearly the value of the goods for which it can be used. Of course we will continue to work with NHS counter-fraud colleagues to refer suspected fraud for further investigation.
We have developed a simple reimbursement process for healthy start food outlets to ensure that unnecessary burdens are not placed on small businesses. Retailers will be required to claim reimbursement for vouchers taken within six months of their expiry date. They will be reimbursed in full for
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the vouchers that they accept, and the unpopular retailer deduction currently made under the welfare food scheme will be removed. However, as I have said, the operation of phase 1 in Devon and Cornwall will enable us to see how the regulations work in practice.
In short, the package of reforms that we are proposing will provide new opportunities to support some of the most vulnerable families and children in the country. It is more flexible, and more in keeping with what people want and expect of such a scheme. It complements the other measures that we are taking to encourage healthy eating among children, which we hope will extend through their school life into adulthood.
4.53 pm
Mr. Burns: I am grateful to the Minister for her elaborate description of what the Government intend to achieve through the regulations for the revised scheme. As the Minister said, there was considerable discussion of the issue when the Health and Social Care (Community Health and Standards) Act 2003 was in Committee, because some of my hon. Friends and I raised concerns about possible abuse. I do not want to go over the arguments again, or repeat what the Minister has said in her introduction. However, I should like to put some questions to the Minister, to enable us to get a clear view of what the scheme entails.
In passing, I want to say that I am always suspicious of any politician, regardless of political colour, who says that they are bringing in a bureaucratic scheme in which the paperwork is very simple to fill out—in the present case, the forms to be completed by retailers who sign up to the scheme. From my experience and that of most small business men, things that Ministers might think simple are, in reality, not necessarily so.
We want the scheme to be effective and to achieve the aims set out for it. We want it to be free from fraud and abuse. I should like some answers from the Minister—preferably today, but, if that is not possible, I shall appreciate her writing to me. As she says, the scheme is primarily, albeit not exclusively, aimed at the most vulnerable in society who are also, for various reasons, the most vulnerable to abuse. That being the case, how do the Government account for the price variation around the country, and that which often occurs between urban and rural areas?
Secondly, how will the vouchers reflect the rises and falls in prices, particularly rises? What might be helpful and beneficial in a pilot scheme in 2005 might not be by 2007 or 2008. Can the Minister confirm which foods and liquids the voucher will be able to buy? Schedule 3 of the regulations seems all embracing and not open to abuse, contradiction or confusion. However, could she spell that out exactly, as it would be extremely unfortunate if abuses were to occur—for instance parents might use the vouchers to purchase foods that were not necessarily the most healthy and advantageous for their children. What safeguards are there to prevent that sort of abuse, and to ensure that the vouchers are used only for the items that the Government specify, and that unscrupulous retailers
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are not able to collude with parents to allow them to use them for products that the regulations do not intend?
How will the system work? I assume, but the Minister might like to confirm, that the holders of the vouchers—the parents—will go to retail outlets that have signed up to the scheme and exchange them for the specified goods. In addition, what role will there be for the existing milk suppliers? Changing a system involving only milk to one that involves milk and food will have an impact on the dairy industry. Has the Minister or her Department made any evaluation of that impact?
How does the Minister envisage shops and stores signing up to the scheme? Providing that it sells the products that are covered by the scheme, will it be open to any retail outlet whatsoever to sign up? One would not want to see—particularly in areas of social deprivation—a scarcity of outlets at which the vouchers could be redeemed, so that those who rely on public transport might have difficulty in securing the food or milk.
Let me put some possible problems to the Minister. The new scheme proposes that all new potential beneficiaries register through health professionals. Does the Minister not fear that that will be extremely bureaucratic and could place additional burdens on already hard-pressed health professionals who have many other jobs and duties to carry out? Many of that cohort of people might not take the time and trouble to register. They might not be aware of the existing scheme, never mind the new one.
The Minister has said that, on the birth of a child, information will be provided for parents, and that there will also be leaflets. Will that information go to every mother at the time of the birth of her child, to ensure that everybody is familiar with the scheme so that they may sign up and register to benefit from it? How will the registration arrangement work? Do the Government have projected numbers of people who will be prepared to register, and what will be asked of them? In the schedules at the back of the regulations, there are statements about what has to be done. It is bureaucratic to ask a parent or parents physically to register. Does the Minister not worry that certain members of the eligible group may not bother to register because it involves an amount of effort, or because they may have problems understanding what is expected? The scheme might lose out as a result of this approach to qualifying for the benefit.
Apart from the leaflets that the Minister mentioned, how will the scheme be advertised to ensure that as many eligible people as possible will benefit from it? Is the Minister convinced that she and her Department have come up with the easiest, most user-friendly registration system? We already see in other areas of benefit application, particularly those for elderly people, that significant proportions of people do not register for benefits to which they are entitled, partly
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through ignorance but more often because of the sheer burden and difficulty of going through the process to determine whether they are eligible.
I notice that one of the regulations requires a health professional to sign the healthy start application form. Will that not add to the red-tape and bureaucracy with which health professionals have to deal while doing little to help the smooth running of the scheme? It will add a considerable burden to the work load of such individuals. Are such requirements necessary and viable? How do the Government intend to curb and minimise the excessive burdens the scheme might place not only on the NHS but, more importantly, on NHS staff who, in effect, will have to be the policemen and registrars of the Government’s scheme?
Similarly, one of the regulations provides that in phase one of the healthy food scheme, pregnant teenagers under 18, among others, will be able to qualify regardless of whether they are on qualifying benefits. The Minister alluded to that in her comments. I find that slightly contradictory, in that the scheme is, to put it in its crudest form, a means-tested scheme. Why in this one area do the Government make an exception and completely reverse the overall ethos and philosophy of the scheme? I shall not cast a judgment one way or the other, but why do the Government think that, in theory, it would be beneficial for the 17-year-old daughter of a millionaire to get exactly the same entitlement as the 17-year-old daughter of two parents, both of whom are out of work and on state benefits?
I would also be interested to know what the Government will do to minimise the opportunities for fraud. There are two prongs to that: fraud through retailers, and potential fraud and abuse by the participants in the schemes, who might seek in one way or another to use their vouchers to purchase items that are far from what the Government intended.
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