In 2006, the government launched the Healthy Start programme in an effort to improve the health of low-income mothers and their families. As well as offering vouchers for formula milk, fruit and vegetables, this UK-wide scheme (see box, below) provides coupons that can be exchanged for free vitamins for pregnant or breastfeeding women and children under four.
With community pharmacy a natural destination to purchase vitamins, you might assume the sector should have a valuable role to play in delivering the scheme. However, just seven local pharmaceutical committees (LPCs) on the Pharmaceutical Services Negotiating Committee's database – out of 80 across England – are listed as delivering the vitamin scheme in their areas.
So have pharmacies in England been given sufficient opportunity and incentive to get involved? C+D spoke to the experts to find out.
Parents “surprised” community pharmacy not involved
A DH-commissioned study in 2013 by researchers at the University of Bristol looked at 13 areas across England, speaking to 107 families and a range of healthcare professionals – including staff at two pharmacies.
Researchers found that “families felt the best solution would be to collect vitamins from supermarkets and high street pharmacies“. Parents were therefore “surprised they couldn’t get vitamins covered by the scheme from their local pharmacy, as in their mind this was the obvious place to go”, says lead researcher Dr Patricia Lucas, reader in child health research at the University of Bristol.
There was also a “lack of awareness among pharmacists about the scheme”, Dr Lucas tells C+D.
She suggests pharmacy was often excluded because each local authority had its own solution to securing access to, distributing, and processing reimbursements for Healthy Start vitamins.
Community settings owned and run by a local authority, such as children’s centres, were often handed a licence to distribute vitamins. But because pharmacies are independent businesses, there was a “question [of] who is the holder of that licence”.
Perhaps another answer lies in attitudes to the Healthy Start vouchers for formula milk, fruit and vegetables. Pharmacies who were involved in offering these vouchers pointed out that “financially [it] wasn't a sensible decision” to deliver the service, Dr Lucas remembers. “They thought the work of being involved in the [voucher] scheme cost more money than they'd ever...get back from the government.”
However, “they saw themselves as serving their community”, she adds. “By definition” users of the scheme were young families, and pharmacies and retailers offering the vouchers “felt a responsibility to be looking out for these families”.
While Dr Lucas is talking specifically about the vouchers for fruit and vegetables here, she suggests “the same feelings were true for the vitamin scheme”. To find out how one pharmacist views this aspect of the Healthy Start scheme, see the case study below.
Dr Lucas believes the system for distributing vitamins still needs to be examined, and “we still need to answer the fundamental question – whether the scheme can be made to work well and how we can do that”.
A “missed opportunity”
The title of a 2014 DH-funded research study that evaluated the scheme speaks volumes. Healthy Start vitamins – a missed opportunity assessed how well the initiative worked from 2012-13.
Researchers analysed the opinions of 669 health and social care professionals in primary care and community settings across London, and Yorkshire and the Humber.
But no pharmacists were involved in the study, recalls its lead author, Dr Alison McFadden – senior research fellow and director of the mother and infant research unit at the University of Dundee. “In England, pharmacists weren’t included, particularly at the beginning of the scheme,” she says.
Arrangements to deliver the scheme varied in different areas, the study found. “For example, in one locality, health centres would distribute the vitamins, which was not terribly successful as some women had to travel, unless they lived near that particular centre,” says Dr McFadden. “Often they could only collect vitamins at certain times on certain days, which was not very user-friendly.”
Some areas tried to distribute vitamins via community pharmacies, but “there were problems with distributing them logistically, and [there were] additional costs involved”, she adds.
Dr McFadden says that while the healthcare professionals she spoke to were “very enthusiastic”, it was “incredibly difficult” to deliver the scheme. And she says she is not aware of any “great advances” since it was introduced.
As for the reasons for this lack of progression, she suggests: “I don’t think this scheme was a priority for [successive] governments at all.”