Written evidence submitted by The Food Foundation (FTDOO49)

The First 1000 Days Committee Evidence submission

Response prepared by The Food Foundation

April 2025

About The Food Foundation: We are a young, dynamic, and impactful charity with a mission to change food policy and business practice to ensure everyone, across the UK, can afford and access a healthy diet supplied by a sustainable food system. We are independent of all political parties and business. We work with others who believe there is a problem with the system and want to change it. Visit our website for more information: www.foodfoundation.org.uk

Introduction:

This Government has committed to giving every child the best start in life and to reducing health inequalities across the UK. To achieve these goals, it is essential that they improve support for people to achieve a healthy diet from preconception, through pregnancy and the first two years of life. These times of life are a critical window to support lifelong health and aid a child’s development and learning. Moreover, it is essential that services and support reaches low-income families, who are at a greater risk of food insecurity and related poor health. Investment in these early stages of life can have huge benefits later in life.

Food insecurity and the cost of a healthy diet:

Inadequate diets during pregnancy, infancy, and early childhood are contributing to diet-related ill health across the UK, especially among those experiencing deprivation. Food Foundation research shows that households with children are persistently at higher risk of food insecurity than households without: 17% of households with children under 4 reported experiencing food insecurity in January 2025, compared to 13% of households without children.[i] A recent survey of over 1000 expectant or new mothers commissioned by Maternity Action found that this group are also at a heightened risk of food insecurity, with nearly two in five (38%) eating smaller meals or skipping meals for cost reasons, and almost one quarter (24%) reported going without food themselves to prioritise their children during this time.[ii]

For many low-income families, a healthy diet is unaffordable: to afford the government recommended healthy diet, the most deprived fifth of the population would need to spend 45% of their disposable income on food, rising to 70% for those households with children.[iii] In addition to the high cost of healthy food experienced by the general population, many families with babies struggle with the additional cost of first infant formula, which for the first six months of an infant’s life is a non-substitutable product for those parents who are reliant on it or choose to use it. Formula prices have been subject to higher rates of inflation than most other food categories.[iv] In a Food Foundation commissioned survey, one in four mothers with children under eighteen months (26%) reported that they struggled to afford formula.[v] To help feed their child, mothers surveyed reported behaviours such as borrowing money (10%), introducing solid foods earlier than the recommended age of six months (10%) and skipping meals for themselves (10%).[vi]

Deprivation is also shown to have a significant impact on average breastfeeding initiation rates, with substantial differences in levels of exclusive breastfeeding in NHS Trusts between the most and least deprived areas of England.[vii]

Poor health outcomes and health inequalities:

Poor diets in infancy and early childhood put children at greater risk of nutrient deficiencies, poor growth, being underweight, or developing overweight and obesity:

-          Food insecurity during pregnancy is linked to adverse maternal health outcomes, including antenatal depression, gestational diabetes, excessive or insufficient weight gain, anaemia, and pregnancy-induced hypertension.[viii] Babies born to mothers with a poor-quality diet during pregnancy are at a greater risk of developing chronic diseases later in life, such as obesity, type 2 diabetes, and cardiovascular conditions, as well as poorer cognitive and emotional development.[ix]

-          By the first year of school, more than a fifth of children in England are living with overweight or obesity, increasing their risk of significant health consequences later in life.[x]

-          There is a stark income gradient for many of these health outcomes, with children from the most deprived fifth of the population nearly twice as likely to be living with obesity by their first year of school than children from the least deprived fifth,[xi] contributing to widening health inequalities across the UK.

Response to inquiry questions: 

Below we focus on questions 2, 4, 6 and 7, setting out the evidence and rationale for our recommendations to Government to improve early years services.

[Q2] What should the Government prioritise in upcoming funding allocations for early years services? 

We have identified three priority areas for funding in early years that can help to improve access to nutritious food, reduce inequalities and ensure all children are given the best start in life. Further details for each are provided in our answers to Q4.

1)     Strengthen the Healthy Start Scheme by:

1. Increasing the value of the Healthy Start allowance in line with inflation (costing approximately £184 million[xii]) and ensuring the value continues to be index-linked.
2. Expand eligibility to include all families on Universal Credit, families with children up to the age of five years old and permanently extend to all eligible families with no recourse to public funds.

2)     Improve support for early years settings to deliver nutritious foods by:

1. Expanding access to Free Early Years Meals (FEYM) to ensure that it reaches more low-income families by removing specifications related to setting-type and all-day attendance, and in the long term increasing the income threshold or expanding to all children in receipt of free childcare hours
2. Providing dedicated funding streams for early years food to enable providers to offer healthy meals without passing on costs to families.

3)      Invest in the health visitor workforce, including with better training, to support families from pregnancy and through the early years with breastfeeding and nutrition support. This should include more frequent and longer 1-2-1 support for families and more accredited Baby Friendly Initiative sites[xiii].

[Q4] What are the key barriers to delivering high-quality early years services, particularly in Family Hubs and through neonatal and paediatric services, and how can they be addressed? 

1)     Insufficient prioritisation of the Healthy Start Scheme is resulting in missed opportunities to support low-income families

As highlighted in the introduction, many households with young children are food insecure, and for the most deprived households the government’s recommended healthy diet is simply out of reach. The Healthy Start scheme is a critical nutritional safety net for many, providing payments that can go towards the purchases of fruit, vegetables, pulses, milk and formula. Healthy Start has the potential to help eligible low-income families access better diets, with evidence showing that the scheme increased fruit and vegetable purchases by 15%,[xiv] supported families to establish good eating habits[xv] and meet their recommended nutrient intakes.[xvi]

However, due to neglect in recent years, the scheme is failing to achieve its intended aims.

• A restrictive eligibility criterion which requires eligible families to be in receipt of a qualifying benefit and earning less than £408 per month, excludes many families living in poverty.
• The scheme is also only available for families with children four years old and under, creating a gap before children start school where Free School Meals are more widely accessible than in early years settings
• The value of weekly payments has also fallen behind rising food costs; the value has not been increased since April 2021 despite significant food price inflation.[xvii]
• Poor coverage, created by application hurdles and stigma, means eligible families are missing out on this statutory entitlement.[xviii]

In addition to the funding priorities laid out in Q2 (increasing the value of Healthy Start in line with inflation and expanding eligibility), there is a need to introduce auto-enrolment to reduce barriers to accessing the Scheme. Furthermore, embedding promotion of the scheme into statutory services (such as health visiting, Family Hubs, and breastfeeding support services) would ensure that families are equipped with necessary information about the scheme, along with additional guidance and support related to healthier diets and feeding practices.

2)      Support for Early Years Settings to deliver nutritious food for all children is insufficient:

Early years settings are currently facing multiple barriers to providing nutritious food:

-          Free Early Years Meals (FEYM), the Government’s scheme to provide free meals in early years settings to children from low income families, provide a vital nutritional safety net for many families, but are limited due to a restrictive entitlement criteria that excludes many children living in poverty, as well as additional restrictive criteria linked the settings where FEYM can be accessed and sessional care.

-          Recent Guidance provided by the Department for Education related to the expansion of free childcare has confirmed that early years settings cannot mandate charges for food[xix]. This has caused widespread sector concern, undermining efforts to provide healthy communal meals and risks a shift towards less healthy packed lunches, as well as raising practical and safety concerns among staff.

Providing a dedicated funding stream for nutritious food in early years settings and expanding the eligibility criteria/removing barriers to accessing FEYM, as outlined in our answer to Q2, can help to address these barriers and ensure all children are able to access nutritious food when in childcare.

For more details on the evidence and barriers faced by Early Years settings in providing nutritious food, please see the submission made by Bremner & Co on behalf of the Early Years Nutrition and Data Coalition.

3) Insufficient funding and capacity shortages of health visitors and early years health care professionals

Health visitors and healthcare professionals play a critical role in supporting pregnant women and families with young children, both in terms of providing nutrition and diet advice, and breastfeeding support[xx].

Breastfeeding has substantial benefits for both the health of mothers and infants.[xxi] In a Food Foundation commissioned survey of 500 mothers with children under 18 months, 42% of mothers who exclusively breastfed said that more support from healthcare professionals would have helped them to breastfeed for longer.[xxii]

Across the UK, there is considerable variation in the number of health checks or visits that mothers and babies should receive. Whilst support systems, including mandatory visits from health visitors, are in place, in practice many women are missing out. A survey of health visitors found that just 54% reported delivering a six to eight week review to all families.[xxiii] A survey by the iHV found that the number of health visitors in England has decreased by over a third (37%) between 2015 and 2022, with a shortfall of around 5000 health visitors reported.[xxiv] The Royal College of Midwives (RCM) have highlighted a shortage of midwives and lack of specialist infant feeding midwives which are necessary to provide sufficient infant feeding support.[xxv]

Investing in health care professionals, such as health visitors, midwives and other early years specialists (as noted in our answer to Q2), will ensure that professionals are able to provide more frequent and longer sessions with families in order to provide the necessary feeding support and nutritional advice. Furthermore, better training will improve the quality of information that families have access to.

4) Lack of co-ordinated leadership and ministerial oversight of early years nutrition

Early years settings, including Family Hubs, are a critical means for supporting the health and wellbeing of young children through health and nutrition advice, breastfeeding support and the provision of nutritious food. However, nutrition in early years settings is currently neglected in national policy, with no clear ministerial oversight. Similarly, there is no national breastfeeding strategy[xxvi].

To help prioritise early years and give children the best start in life, the government should:

-          Establish a coordinated strategy across departments to ensure policies on health and wellbeing in the early years include a focus on nutrition and diet and adopt a life course approach which explicitly includes preconception and pregnancy.

-          Dedicating a specific government team to breastfeeding.

-          Appointing a dedicated ministerial lead for early years food and health, with responsibility for coordinating across departments (DfE, DHSC and DEFRA), strategies (food strategy, child poverty strategy) and Missions.

[Q6] How can the Government most effectively tackle inequalities in access and infant health outcomes for those from underserved groups including those with disabilities, or from ethnic minority or deprived backgrounds? 

As outlined in Q2 and Q3, investing in nutritional safety nets such as the Healthy Start Scheme and Free Early Years Meals can help tackle inequalities and ensure that low-income households can access nutritious food. Support for health care professionals is also critical for reducing inequalities, particularly related to breastfeeding where rates are typically lower amongst those from deprived areas and ethnic minorities.[xxvii]

In addition, the government should:

a)      Improve parental leave pay and financial support during pregnancy and the first year of life is a critical step to reduce inequalities and financial pressures commonly felt during this period.

Increasing maternity pay to, at a minimum, align with the national living wage, can reduce financial pressures during maternity leave and support parents with affording a healthy diet for themselves and for their child (including formula where needed). Our research has found that during pregnancy and parental leave, financial pressures can be even greater than normal. In focus groups some parents commented on having less household income during maternity/parental leave, which added pressure to budgets and made food purchasing decisions more difficult.[xxviii] Not only does this put this group at risk of food insecurity at a critical time, it has wider effects on their mental and physical health: a Maternity Action survey found that three in five expectant and new mothers (59%) report that money worries impact their mental and physical health and wellbeing during pregnancy or maternity leave, including stress from overwork, feelings of shame and inadequacy, and concerns about the impact on their children.[xxix] The weekly statutory maternity payment of £187.18 works out as approximately 44% of the national living wage, based on a 35 hour working week. The OECD, who have compared maternity provisions as a proportion of national average income, and number of weeks at full pay, found that the UK was one of the worst performing countries in the OECD, with only Ireland and the USA performing worse in relation to national average earnings.[xxx]

b)        Adopt the full set of recommendations made by the CMA related to first infant formula.

Infant formula prices have increased significantly in recent years. For the first six months of an infant’s life, first infant formula is an essential non-substitutable product for those parents who need or choose to use it. However, formula prices have been subject to higher rates of inflation than most other food categories, putting pressure on family finances[xxxi]. In a Food Foundation commissioned survey one in four mothers with children under eighteen months (26%) reported that they struggled to afford formula[xxxii]. There is evidence that when faced with financial difficulties, stretching available household budgets to cover the cost of formula can lead to parents being forced into unsafe feeding practices, such as watering down formula, increasing the time between feeds, and substituting formula with other milks which are not appropriate for the age of infant[xxxiii]. There are large price differentials between infant formula products, despite all having to meet the same nutritional composition standards[xxxiv]. These challenges and price rises were recognised by the CMA who were concerned that parents are being misled and feeling obliged to pay for higher cost formula even though all formula contains sufficient nutrition for a child. Following an investigation, the CMA made a series of recommendations related to the way in which formula and follow on formula is priced and marketed to parents in hospitals through to retailers. The final recommendations were published in February 2025 and the government is expected to respond in May 2025[xxxv].

[Q7] What could the Government learn from examples of best practice that exist in local authorities, NHS Trusts, or internationally?  

Best Start Foods is the Scottish equivalent to the Healthy Start scheme and is widely recognised for successfully reaching more low-income families and providing higher weekly payments.

Wider eligibility: Best Start is available to all pregnant people and families with a child under three who are in receipt of Universal Credit; unlike England, Wales and Northern Ireland, there is no additional earnings threshold meaning more families in poverty are able to access it. Linking it to UC also has benefits for uptake - Best Start reaches 92% of eligible families compared to approximately two thirds for Healthy Start,[xxxvi] demonstrating that higher uptake rates should be achievable across the UK.

Higher value: The weekly payments for Best Start have been recently increased to £5.30 for pregnant people and children under three (compared to £4.25 under Healthy Start), and £10.60 for under one year olds (£8.50 under Healthy Start), to reflect rising food costs and inflation. This allows families to purchase more food with the payment, and the scheme to have wider benefit to diets and to the economy.

-END-

To find out more about the evidence base for these recommendations please see our series of early years reports:

-          Preconception, Pregnancy and Healthy Weight in Childhood: https://foodfoundation.org.uk/sites/default/files/2023-02/Early%20Years%20report_A4_NEW_0.pdf

-          Breaking down the barriers to breastfeeding to support healthy weight in childhood https://foodfoundation.org.uk/sites/default/files/2024-02/TFF_Nourishing%20children%20early%20years_DIGITAL.pdf

-          Boosting early years nutrition to support a healthy childhood (forthcoming – mid-May 2025) https://foodfoundation.org.uk/initiatives/early-years

For any questions or more information, please contact Tilda Ferree, Senior Policy and Advocacy Officer at The Food Foundation, tilda.ferree@foodfoundation.org.uk

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