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Healthy StartLondon Region: Workshop 2

7th March 2011

Anna Kitt

Anna.Kitt@dh.gsi.gov.uk

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AgendaTime Item Lead

9.30am Refreshments

9.45am Welcome & overview Anna Kitt

10am Case Studies – Sharing best practice

Ealing PCT

Westminster PCT

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

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• Replaced Welfare Food Scheme in 2006

• A statutory scheme for PCTs

• A nutritional safety net

• A public health tool

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What does Healthy Start provide?

Vouchers: Vitamins:

Liquid milk For women Fresh fruit and vegetables For childrenInfant formula milk

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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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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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

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Children’s Drops

Code: ABX 072

Cost to PCT: £1.61

Cost when selling:

£1.77

Available to: Children; 6 months – 3 years

Contains: 233mcg Vitamin A20mg Vitamin C7.5mcg Vitamin D

One bottle: 10 mls (8 week supply)

Daily Dose: 5 drops

Classification: General Sales List Medicine

Manufacturer: SSL International

Women’s Tablets

Code: ABX 073

Cost to PCT: 82p

Cost when selling:

90p

Available to: Women; pregnant and until child is 1 yr old

Contains: 70 mg Vitamin C10 mcg Vitamin D400 mcg Folic Acid

One bottle: 56 tablets (8 week supply)

Daily Dose: 1 tablet

Classification: Multivitamin Food Supplement

Manufacturer: Bayer

Vitamin Facts

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Vitamin D SupplementRecommendation

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

(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)

6 months to 5 years - 7µg/day

• 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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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

Can a healthy diet provide adequate vitamin D?

Simple Answer NO!

10Univ Westminster Carol Williams, 2009

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

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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

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Vitamin D Supplements

Prices correct Nov 2010

• Boots • 12.5mcg (90 tablets)

£2.79

• ASDA • 10mcg (60 tablets)

£2.23

• Holland & Barrett• 10mcg (100 tablets)

£3.19

• Healthy Start (DH)• 10mcg (56 tablets)• 90p

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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?

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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

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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

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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

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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?

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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?

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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%

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All regions Healthy Start scheme uptake December 2010

84.4%

80.4%81.2%

79.6%

81.7%

74.4%

78.1%

74.0%

77.3%

78.9%

68%

70%

72%

74%

76%

78%

80%

82%

84%

86%

North East North West Yorkshire &Humber

East Midlands West Midlands East of England London South East South West England

Regions

% u

ptak

e

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Healthy Start scheme uptake London- December 2010

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

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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%

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Vitamin uptake- London June 2010

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Children's drops uptake Women's tablets uptake

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Vitamin D uptake- London December 2010

0.0%

1.0%2.0%

3.0%

4.0%

5.0%6.0%

7.0%

8.0%

Children's drops uptake Women's tablets uptake

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Vitamin D uptake- London December 2010

0.0%

1.0%2.0%

3.0%4.0%

5.0%

6.0%7.0%

8.0%

Children's drops uptake Women's tablets uptake

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Number of women’s vitamins ordered compared with the potential number eligible 09/10

0 2000 4000 6000 8000

Barking and Dagenham PCT

Barnet PCT

Bexley Care Trust

Brent Teaching PCT

Bromley PCT

Camden PCT

City and Hackney Teaching PCT

Croydon PCT

Ealing PCT

Enfield PCT

Greenwich Teaching PCT

Hammersmith and Fulham PCT

Haringey Teaching PCT

Harrow PCT

Havering PCT

Hillingdon PCT

Hounslow PCT

Islington PCT

Kensington and Chelsea PCT

Kingston PCT

Lambeth PCT

Lewisham PCT

Newham PCT

Richmond and Twickenham PCT

Redbridge PCT

Southwark PCT

Sutton and Merton PCT

Tower Hamlets PCT

Waltham Forest PCT

Wandsworth PCT

Westminster PCT

NHS Supply Chain Potential Claim

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Number of children’s vitamin drops ordered compared with the potential number eligible 09/10

0 5000 10000 15000 20000 25000 30000

Barking and Dagenham PCT

Barnet PCT

Bexley Care Trust

Brent Teaching PCT

Bromley PCT

Camden PCT

City and Hackney Teaching PCT

Croydon PCT

Ealing PCT

Enfield PCT

Greenwich Teaching PCT

Hammersmith and Fulham PCT

Haringey Teaching PCT

Harrow PCT

Havering PCT

Hillingdon PCT

Hounslow PCT

Islington PCT

Kensington and Chelsea PCT

Kingston PCT

Lambeth PCT

Lewisham PCT

Newham PCT

Richmond and Twickenham PCT

Redbridge PCT

Southwark PCT

Sutton and Merton PCT

Tower Hamlets PCT

Waltham Forest PCT

Wandsworth PCT

Westminster PCT

NHS Supply Chain Potential Claim