Shared learning database

North East Lincolnshire Care Trust Plus
Published date:
October 2012

We wanted to ensure that the Healthy Start vitamins (containing Folic Acid, Vitamins C and D) were available to everyone who needed them.

We set up a local scheme so that Healthy Start vitamins were available to buy or on voucher exchange (for those on the Healthy Start welfare programme) in all children centres across North East Lincolnshire (NEL).

In addition we offer a free 'starter' pack (2 months supply) of women's vitamins for all pregnant women through maternity services. We also are offering a free 'starter' bottle of children vitamin drops through health visiting teams.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

-To provide better access to Healthy Start vitamins for women and children
-To increase uptake of Healthy Start vitmains in NEL
-To increase staff knowledge on Healthy Start vitamins

Reasons for implementing your project

Low uptake of Healthy Start vitamins as indicated by the voucher returns to the Department of Health (DH) (baseline)

Healthy Start vitamins were available in some primary care centres and children centres. (Inconsistency in access and poor uptake in primary centres)

The lead for the Healthy Start vitamin coordination was transferring to another organisation as part of some planned NHS changes. (Opportunity to revise systems)

A stakeholder group involving maternity, health visiting, children centres, Clinical Commissioning Group lead for women and children led by public health was set up to review systems for better coverage and access.

Chief Medical Officer letter February 2012 on Vitamin D deficiency. (This reinforced and supported the information in NICE guidance).

How did you implement the project

We reviewed the guidance and identified gaps in local provision. Though it states that Healthy Start vitamins should be available for purchase through community pharmacies (R4) we checked if this was possible with the Department of Health Healthy Start programme and found that they cannot accommodate this at this stage. Therefore we had to look at other local solutions for access.

We wanted to ensure all vitamins were available in all children centres with one person ordering for all. The children centres were keen to display and promote the Healthy Start vitamins for sale or voucher return. They collated the vouchers on behalf of the local scheme and kept a record of the number of vitamins (women and children) sold or exchanged for vouchers.

We identified that as Children Centres are part of the local authority and therefore non NHS this caused a problem with ordering and financial systems. We raised this as an issue with the Healthy Start programme at the time and over time their systems have changed to overcome this. In the meanwhile we arranged a system for ordering and payments which though were a long process enable us to move forward locally. It really helped having a lead for the children centres that was positive and proactive.

The costs we incurred were funding from public health to pay for the Healthy Start vitamins 'starter' packs to be given out free at antenatal booking and during health visiting contacts.

We also raised the availability of the Healthy start vitamins with key professional groups- GPs, Health Visitors and midwives and children centre staff and this formed part of the training and learning for these groups.

Key findings

The NICE guidance helped to highlight the gaps locally and for us to discuss how we could improve. We are monitoring progress in a number of ways.

Uptake of vitamins locally over time:
As the figure in the supporting material shows, the uptake of women and children receiving Healthy Start vitamins has increased since 2008. In 2008, 53 vouchers were used for Healthy Start vitamin drops for children, this increased to 70 in 2009 and 185 in 2010, in 2011 this decreased slightly to 166. The number of Healthy Start vitamins for children sold followed the same pattern as for the vouchers, with the number increasing from 28 in 2008 to 169 in 2010, followed by a decrease in 2011. The number of vouchers used for Healthy Start vitamins for children has remained higher than the number purchased. The number of vouchers used to get Healthy Start vitamins for women has increased from 20 in 2008 to 114 in 2010. Women purchasing Healthy Start vitamins increased but remained lower than the number using vouchers for their Healthy Start vitamins. In 2012 over a 7 month period the uptake has exceeded that in a year. For children 277 vitamins were brought for cash payments and 229 exchanged for vouchers and for women similar with 262 vitamins for cash and 137 for vouchers. Therefore when we review at the end of the full year we will have exceeded that of similar years. We can see if the uptake of voucher exchange for vitamins improves over time against other similar areas (the national healthy start teams provide reports on uptake across areas). The uptake by voucher scheme as monitored by the children centres as above and data returned to the DH remains low compared to other areas. More work needs to be undertaken to ensure women and their families who are eligible start and continue to use their vouchers for vitamins.

How many vitamins are given out during the antenatal booking, and were any refused? (However we will not know if women actually take them): This has increased from none given out prior to April 2012 to around 500 women's vitamins packs per quarter. To date no one has refused to take the free starter pack when given by the midwife. These numbers given out are separated to those provided from the children centres. The monitoring is on-going but so far the results are meeting expectations (the access and uptake is improved) but we need to do more to ensure that professional and families are aware of the need for vitamin supplements.

Key learning points

-Having dedicated and interested individuals helps with overcoming any problems.
-Work with and raise issues with the National Healthy Start team who can help.
-Though the vitmains are a small cost to organisations the benefits to women and children has long term outcomes (i.e. reduction in Vitamin D deficiency and neural tube defects) so continue to overcome any barriers that might arise.
-Keep reviewing the local situation and make improvements as necessary.

Contact details

Isobel Duckworth
Public Health Consultant
North East Lincolnshire Care Trust Plus

Is the example industry-sponsored in any way?