DHSC
1.1 As part of delivering key measures outlined in chapter 2 of the childhood obesity plan[1], we have held consultations on ending the sale of energy drinks to children[2], calorie labelling in the out-of-home sector[3], restricting promotions of fatty and sugary foods by location and by price[4], further advertising restrictions[5], and Government Buying Standards for Food and Catering Services[6].
1.2 We received over 6,000 responses to the consultations and it is important we take the time to consider them carefully. We will be setting out our responses as soon as we can and have already confirmed in the third chapter of the childhood obesity plan, published as part of ‘Advancing our health: prevention in the 2020s’[7], that we will end the sale of energy drinks to children under the age of 16, following our consultation in 2018.
1a. Given that the recent Marmot review shows that some health inequalities have actually worsened in the last decade, what actions are the Government going to take to address the continuing and inequitable increases in childhood obesity and food insecurity?
1.3 Obesity is a complex problem and the causes, notably dietary, are affected by factors including our environment, behaviour, biology, physiology and our society and culture–and importantly, the interaction of these determinants. These factors can impact upon and make it difficult for people to maintain energy balance and a healthy weight.
1.4 We have set a bold ambition to halve childhood obesity by 2030 and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030. We want to achieve this by ensuring that we are supporting parents, particularly in the most deprived families, to help their children have the best start in life.
1.5 Through the three chapters of ‘Childhood obesity: a plan for action’ we are delivering a wide range of measures to reduce obesity in children. We have cut sugar from over half the drinks on sale, are funding more opportunities for children to exercise in schools and are working with councils to tackle child obesity locally through ground-breaking new programmes. We have consulted on plans to reduce children’s exposure to marketing and advertising of sugary and fatty products and are now considering the responses carefully. We will be setting out our responses as soon as we can.
1.6 Through the Healthy Food Schemes, the Government provides a nutritional safety net to those who need it the most, at an important stage of development. Healthy Start helps to encourage a healthy diet for pregnant women, babies and young children from low income households.
1.7 The Healthy Start Scheme allows pregnant women (at least 10 weeks into pregnancy) and children aged over one and under four from lower income families to receive one £3.10 voucher every week. Children aged under one receive two vouchers, worth £6.20 in total, every week. These vouchers can be used to buy, or be put towards the cost of, fresh and frozen fruit and vegetables, milk and infant formula. Recipients are also eligible for free Healthy Start vitamins.
1.8 People are eligible for the Healthy Start Scheme if they are claiming any of the following benefits:
All pregnant women aged under 18 are also eligible for Healthy Start, regardless of whether they receive any of the qualifying benefits. However, once they have given birth, they must meet the benefit criteria to continue receiving vouchers.
1.9 All eligible families receive an invitation to apply for the Healthy Start Scheme, together with a pre-populated application form for them to sign and return. The Scheme is also promoted through the Healthy Start website (which also has a valid application form available) and the Start4Life website, with local authorities, midwives and health visitors also playing a key role.
1.10 The Government has been working to review the operation of the Healthy Start Scheme and is developing a digital approach which will make it easier for families to apply for, receive and use Healthy Start benefits. We are using the experiences of families, healthcare professionals, local authorities, voluntary sector organisations and existing best practice to improve the Scheme.
1.11 The NHS Business Services Authority will deliver the project to digitise the Healthy Start service. It is currently developing and testing an online application form to replace the paper form, which we recognise can be difficult for some families to complete, with a telephone alternative for peopled needing assisted digital support. It is also developing payment cards to replace paper vouchers. DHSC remains responsible for policy and legislation in connection with the Healthy Start Scheme.
1.12 To support improvements to the Scheme, DHSC laid The Healthy Start Scheme and Welfare Food (Miscellaneous Amendments) Regulations 2020 before Parliament on 12 March 2020. These amending regulations enable the provision of a digitised Healthy Start service from 6 April 2020 and we plan to start introducing the changes later this year. Full roll-out will take time, as we will need to transition existing beneficiaries across from the current paper-based service to the new digitised service.
1.13 The regulations also amend the definition of ‘Healthy Start food’ to include pulses and tinned fruit and vegetables from 1 October 2020, providing beneficiaries with further healthy eating choices.
1.14 We remain committed to reviewing what more can be done to make sure we meet our ambition of halving childhood obesity and will continue to monitor progress and emerging evidence carefully.
1.15 As part of this process the DHSC funds research through the National Institute for Health Research (NIHR). The NIHR has a large programme of work to look at the causes of obesity, in addition to research on prevention and treatment. The NIHR has invested £5m over five years in an Obesity Policy Research Unit (OPRU)[8] which has a programme of work to provide robust evidence and a deeper understanding of obesity in childhood, including research on marketing and food environment. Health inequalities is an underpinning theme for all projects undertaken by the Unit.
1.16 Where progress is not being delivered, we will consider what further action can be taken to help us to achieve what no other country in the world has yet achieved: success in reducing levels of obesity in children.
1b. Of the measures that have been implemented, what assessments have been made of their impact on child health, including obesity?
1.17 We have seen some important successes since publication of chapter 1 of the childhood obesity plan in 2016, including the average sugar content of drinks subject to the soft drinks industry levy decreasing by 28.8% between 2015 and 2018[9] and significant investments being made in schools to promote physical activity and healthy eating.
1.18 The high prevalence of childhood obesity has been decades in the making. It is going to take time to see results.
1.19 Our actions have been recognised in Unicef’s ‘State of the World's Children Report’[10], published last October, which said “Even though much remains to be done to tackle childhood obesity, the UK is paving the way to ensure that all children grow up in a healthy food environment”.
1c. The value of Healthy Start vouchers has not increased from £3.10 per week since 2009. Why have these vouchers been allowed to devalue over time?
1.20 The value of the Healthy Start voucher is kept under continuous review. Frozen fruit and vegetables were added to the scheme in 2011 to help the voucher value to go further. The Government has also recently amended the Healthy Start Scheme and Welfare Food Regulations to introduce pulses and canned fruit and vegetables into the Scheme from 1 October 2020, which will help make the value go even further.
1.21 Our work with Healthy Start beneficiaries on the digitisation project has identified a number of difficulties with the paper vouchers–they can be easily lost or damaged, or the beneficiary may experience stigma when using them. The voucher also needs to be spent in full, which means the beneficiary cannot just shop for a pint of milk or a bag of apples. The payment card will offer greater convenience and flexibility to beneficiaries in using their Healthy Start benefit.
2.1 The Government is concerned that despite strict restrictions across TV and online, children remain exposed to significant levels of advertising of products high in fat, salt and sugar (HFSS) across the media they enjoy the most. Alongside this, we know the location of products and price promotions in stores are effective at influencing food preferences and purchases.
2.2 We have consulted on further advertising restrictions and restricting promotions of HFSS products by location and by price. We will be setting out our responses to the consultations as soon as we can.
2a. Some industry groups told us that in order to make meaningful progress towards increasing access to healthy and environmentally sustainable diets, they would welcome further regulation since this creates more of a ‘level playing field’ for commercial organisations. Are there any plans to strengthen existing measures and support for reformulation and marketing to ensure these are enacted equally across the whole food industry?
2.3 Public Health England oversees the reduction and reformulation programme[11] on behalf of government as set out in all chapters of the childhood obesity plan and ‘Advancing our health: prevention in the 2020s’. The programme applies across the food industry (retailers, manufacturers and the eating out of home sector) and covers reduction on sugar, calories, salt and work to improve the nutritional quality of commercial baby foods and drinks.
2.4 Progress has been seen through the sugar reduction programme with a 2.9% overall reduction in sales weighted average total sugar per 100g for retailers and manufacturers between 2015 and 2018. Larger reductions have been achieved in some categories, breakfast cereals and yogurts, but the data shows a mixed picture overall for individual product categories, businesses and brands[12].
2.5 The next steps for the programme are:
2.6 We remain committed to reviewing what more can be done to make sure we meet our ambition of halving childhood obesity and will continue to monitor progress and emerging evidence carefully including that provided by the OPRU.
2.7 Where progress is not being delivered, we will consider what further action can be taken to help us to achieve our ambition.
2b. In a 2019 report the-then Chief Medical Officer made a number of evidence-based recommendations for more stringent measures to tackle childhood obesity. Which of these regulatory measures are being considered?
2.8 Professor Dame Sally Davies has done more than anyone to promote the health of the nation over a decade as Chief Medical Officer. Her parting independent report was no different and provides a valuable contribution to the debate on what could be done in the future to reduce obesity. We are studying the report closely and will act on the evidence.
2.9 We are taking action in around a third of the areas identified in the report including the introduction of policies like the soft drinks industry levy, which has reduced the amount of sugar in soft drinks, and we have invested millions promoting physical activity in schools.
2c. What consideration is being given to extension of the Soft Drinks Industry Levy? To which drinks?
2.10 The Government continues to monitor the evidence around the soft drinks industry levy (SDIL). As set out in ‘Advancing our health: prevention in the 2020s’, if the evidence shows that industry has not made enough progress on reducing sugar, we may extend the SDIL to sugary milk drinks.
2d. Are any further fiscal measures being considered? If so, for what foods or drinks?
2.11 There are no plans to add further fiscal measures at this time.
Defra
3.1 The Government has a shared ambition to ensure that our food system delivers healthy and affordable food that everyone can access, and that it is built upon a resilient and sustainable agriculture sector.
3.2 Our food system is facing unprecedented challenges. The way we produce and consume food, and global changes such as population growth and climate change, are having impacts on our food security, health and environment. This is why the Government has initiated the National Food Strategy. In 2019 an independent review of the food system in England was launched, led by Henry Dimbleby. At the heart of its vision is a resilient, sustainable and humane agriculture sector, and a food system that enhances the natural environment for the next generation in this country.
3.3 The National Food Strategy has been engaging extensively with industry on all aspects of the food system, including in depth discussions about sustainable, healthy and affordable food. The Government has committed to responding to the National Food Strategy with a White Paper within 6 months of its publication.
3.4 Work on the review has been temporarily paused so that the team can concentrate on supporting the Covid-19 response. The National Food Strategy remains a priority for this Government. The team will be returning to their work with renewed vigour as soon as they are able to do so.
3.5 The Climate Change Act 2008 introduced our legally binding 2050 target to reduce greenhouse gas (GHG) emissions by at least 80% relative to 1990 levels. On 27 June 2019, government passed legislation to increase the 2050 target to at least 100% (net zero). The Act also introduced carbon budgets which cap emissions over successive five-year periods and must be set 12 years in advance. The Committee on Climate Change, our independent advisor, assesses emissions data to judge whether the UK is on course to meet its carbon budgets, and reports this progress to Parliament and the devolved administrations annually. The Government then has a statutory obligation to respond to this advice, laying out the progress and policies underway to meet our targets.
3.6 In January 2018, we published our 25 Year Environment Plan, setting out how we will achieve our ambition to leave our environment in a better state than we found it. Its goals are clear: cleaner air and water; thriving plants and animals; and a cleaner, greener country for current and future generations. This includes addressing the challenge to ensure food production is sustainable.
3.7 Agricultural GHG emissions have reduced by 16% since 1990, with many farms using more efficient agricultural practices. Land use, land use change and forestry continue to provide benefits in carbon sequestration. The Government recognises the importance of reducing emissions further in these sectors. The Clean Growth Strategy and the 25 Year Environment Plan set out the Government’s ambition for how this will be achieved.
3.8 Our Environmental Land Management scheme is the cornerstone of our new agricultural policy, and is one of the key ways we are working to deliver our vision. Founded on the principle of ‘public money for public goods’, it will allow the Government to support farmers and land managers by rewarding those who protect our environment, improve animal welfare and produce high quality food in a more sustainable way. It is intended to provide a powerful vehicle for achieving the goals of the 25 Year Environment Plan and commitment to net zero emissions by 2050, while supporting our rural economy.
3.9 Research & Development and Innovation are key to boosting productivity while, at the same time, enhancing the environment and feeding a growing global population. The Government has committed significant funding for agri-tech and innovation through the 2013 Agri-Tech Strategy and currently with the £90m Industrial Strategy Challenge Fund ‘Transforming Food Production’ initiative. This will set food production systems on the trajectory to net zero emissions by 2040 by producing food in ways that are more efficient, resilient and sustainable.
3.10 The Government has established a Global Resource Initiative to identify actions the UK can take across forest-risk commodity supply chains to improve the sustainability of products and reduce deforestation. The Global Resource Initiative published its recommendations at the end of March. These will be carefully considered by the Government.
3.11 The Defra-funded Clean Growth through Sustainable Intensification (CGSI) research project was launched in 2018. The project aims to support Defra’s work on emissions reductions in agriculture, in alignment with the 25 Year Environment Plan, Health and Harmony Command paper, and UK Climate Change Act 2008. The CGSI project is due for completion in November 2020. A report will be published outlining the results of the research. This will comprise a set of mitigation trajectories under three scenarios based on the technologies and practices evaluated, and a list of recommendations for future policy to deliver these, including associated costs.
3a. What measurements are you planning to use to evaluate environmental sustainability and public goods for the purposes of the Agriculture Bill?
3.12 The Agriculture Bill was introduced to Parliament on 16 January 2020. This Bill will introduce an ambitious new Environmental Land Management scheme in England, based on the principle of ‘public money for public goods’.
3.13 Defra currently uses a number of indicators to measure environmental outcomes, such as water and air quality, and increased biodiversity. For example we measure ammonia emissions, farmland bird populations and chemical levels in rivers. We will continue to use these methods.
3.14 We will also develop and assess other scheme indicators and evaluation frameworks that relate to our 25 Year Environment Plan, Net Zero and other policy ambitions. These will enable us to assess the benefits realised as a result of our new schemes.
3.15 We are committed to publishing data on the impact and effectiveness of our new agriculture policy wherever possible to ensure openness and transparency concerning its use of public funds. That is why Clause 6 of the Agriculture Bill contains an obligation on the Secretary of State to produce reports on the impact and effectiveness of financial assistance given under Clause 1 purposes. These reports will be laid before Parliament and published to provide the opportunity for public scrutiny.
3b. The Committee has been told that there are opportunities to use the UK’s new
Agriculture Bill to improve the public’s diet and health. What concrete plans do you have? How can British producers be more effectively supported to produce healthier diets, including the production of fruit and vegetables? Would this support be financial?
3.16 We are committed to ensuring that the public continues to have access to UK grown nutritious food produced in an environmentally sustainable way.
3.17 The Agriculture Bill allows us to provide financial assistance for the purposes of starting or improving the productivity of agricultural and horticultural activities and certain related activities. This includes the opportunity to provide support to help growers increase the productivity of fruit and vegetable production.
3.18 Domestic horticulture production already provides a valuable part of a healthy balanced diet in the UK. In the UK, horticulture (including ornamentals) accounts for 2% of the utilised agricultural area and 17% of farm gate output. In 2018, the UK was 53% self-sufficient in vegetables and 17% self-sufficient in fruit. There is potential for the UK to increase our self-sufficiency in fruit and vegetables, and the Agriculture Bill could support this outcome.
3.19 Beyond supporting farmers to improve the productivity of fruit and vegetable production, we want the entire supply chain to help deliver healthier food and encourage healthy eating. To that end, our National Food Strategy will build on policy work that will be developed under the Agriculture Bill to help ensure that our food system delivers healthy and affordable food for all people and is built upon a resilient and sustainable agriculture sector.
3c. How will the new trade arrangements to be negotiated following Brexit be used to support more sustainable food production in the UK and overseas? Has any assessment been made of the potential environmental impact of increasing the amount of food and vegetables that are produced in the UK?
3.20 The UK is a world leader on climate action and we will look to use our free trade agreements to support delivery of the UK’s strong environmental and climate commitments. The UK was the first major economy to pass new laws for net zero emissions by 2050. The Prime Minister has set out his vision to ensure Britain has the most ambitious environmental programme of any country on earth.
3.21 In all of our trade negotiations we will not compromise on our high environmental protection, animal welfare and food standards. We are committed to supporting global decarbonisation and we are clear that trade will not come at the expense of the environment.
3.22 Nothing in new trade agreements will stop us taking the domestic action necessary to deliver our commitment to net zero by 2050. Any agreement will ensure high standards and protections for consumers and workers, and will not compromise on our high environmental protection, animal welfare and food standards. For example, we have negotiated organic equivalency arrangements with all the countries with which the EU has such arrangements. This allows UK organic producers to continue to export and provide consumers with more choice.
3.23 The UK Government set out its ambition in the 25 Year Environment Plan to leave a lighter footprint on the world by protecting the world’s forests, and by supporting sustainable agriculture and zero-deforestation supply chains.
3.24 Defra, alongside DFID and BEIS, is supporting work to promote sustainable commodity supply chains, such as palm oil and soya, that can put forests at risk. In 2019 Defra, DFID and BEIS convened leaders from business, finance and environmental NGOs to establish the Global Resource Initiative Taskforce. The Taskforce recently published their final recommendations report that identifies actions the UK can take to improve the sustainability of its international commodity supply chains and reduce deforestation[13]. The Government will consider the Taskforce’s findings and recommendations and respond in due course.
3.25 We also actively engage with international efforts to promote sustainable supply chains, working with other countries in the Amsterdam Declaration Partnership to promote zero-deforestation commodity supply chains in Europe, and with the Tropical Forest Alliance and other business-led initiatives to promote responsible investment.
3.26 The environmental implications for producing foods in the UK as opposed to other countries are very context specific and need to take account of a variety of factors, such as production methods, technology, land use, and climatic conditions. This could lead to trade-offs and unintentional consequences if UK produced foods are uncritically promoted. The UK’s high degree of food security is built on access to a range of sources including robust supply chains across a range of countries, in addition to strong domestic production.
3.27 Defra’s ‘Clean Growth through Sustainable Intensification’ project, due to report in 2020, is considering the most promising technology and practices which can support both environmental and productivity objectives.
DWP
4.1 For the current suite of means-tested benefits, the amount payable comprises a personal allowance paid according to age and family status, supplemented by flat-rate premiums for groups recognised as having additional needs, such as disabled people and carers. The current income-related benefit rates are not, however, based on a single mathematical calculation or historic set of rules but derive from a review in the 1980s. At the time, it was clear that new and simpler benefits were required which addressed the needs of broad groups. The weekly allowances were developed by first looking at how well, or poorly, previous schemes, such as Supplementary Benefit, directed help to those most in need.
4.2 Successive Governments have made decisions about the rates of benefits taking account of the competing demands on public expenditure and taxpayers who fund it. Furthermore, the Government firmly believes that claimants should be allowed to spend their benefits in accordance with their varying individual needs and preferences, rather than having a set pattern of expenditure imposed on them.
4.3 The end of the benefit freeze means that benefits that were previously frozen increased with the Consumer Price Index (CPI) of inflation (1.7%) in April this year, benefitting more than 10 million people. In its calculations, the CPI reflects the changing costs of a wide array of consumer goods, including food. DWP predominantly uses the CPI as it is the target level of inflation used by the Bank of England and it is also in line with international standards.
4.4 The current benefit rates derive from a comprehensive review of income-related benefits first set in the 1980s, and the many factors involved in the evolution of the rates since then mean that there is no straightforward relationship between the amounts now payable and any original rates. It is not therefore possible to provide a breakdown of today’s benefit rates by reference to separate amounts for specific items such as food. Furthermore, the Government firmly believes that claimants should be allowed to spend their benefits in accordance with their varying individual needs and preferences, rather than having a set pattern of expenditure imposed on them.
4.5 Universal Credit is much more generous than the system it replaces and is already giving better support to millions of claimants. For example, working parents can receive up to 85% of childcare costs, compared to 70% in legacy benefits, and work allowances were increased by £1,000 per year from April 2019, allowing an estimated 2.4 million households to keep an extra £630 of income each year.
4.6 Universal Credit includes separate elements to provide support for housing costs, children and childcare costs and support for disabled people and carers.
4.7 The Government is committed to maintaining a strong welfare safety net. Total welfare spending in 2019/20 was over £227bn, including over £103bn a year on working age welfare benefits for those who need them. Additionally, the measures we have taken to strengthen the safety net of welfare support for those affected by Covid-19 will provide over £6.5bn of additional support.
4a. We have been told that the five-week wait for Universal Credit is a major driver of food insecurity and, in particular, food bank use. How do you respond to the suggestion we have received that the Department’s mitigation measure, an advance, presents a choice between destitution now or destitution later?
4.8 We have made numerous improvements to Universal Credit, including reducing the waiting time for the first payment.
4.9 New Claim Advances are available to support those in immediate financial need until their first Universal Credit payment is made. Where taken, New Claim Advances effectively spread annual Universal Credit payments over 13 periods rather than 12.
4.10 Around 60% of new claims take an advance payment. This has increased since the introduction of Universal Credit demonstrating that claimants are being made aware of advances consistently and are using the facility, in conjunction with budgeting advice, where required.
4.11 We have already acted to make advance repayments more affordable by increasing the repayment term from 6 months to 12 months. We will be doubling the repayment term to 24 months from October 2021 alongside lowering the standard deduction cap from 30% to 25%
4.12 This will mean new Universal Credit claimants taking up an advance will have their monthly repayments reduced by around £30 per month on average. For claimants who find themselves in unexpected hardship, advance repayments can be deferred for up to three months in certain cases.
4.13 There are many reasons why some people may need to use a food bank. Both the Trussell Trust and the Independent Food Aid Network have published research which highlights this fact.
4.14 Additionally, we have introduced a new set of food security questions in the Family Resources Survey from April 2019. This means that we will be able to monitor the level and depth of household food security at national level and for specific groups to better understand the drivers of food security and identify which groups are most at risk.
New experimental poverty statistics
5.1 Work to develop experimental statistics has been suspended under the current circumstances. DWP’s focus at the current time is on activity that ensures people receive benefit payments and that it supports those who need us the most.
5.2 Before this point, officials met with the Social Metrics Commission and assessed their measure of poverty. This work included understanding data limitations and looking for opportunities to collect improved or new data using the Family Resources Survey (FRS).
Food Security
5.3 To improve statistics on household food security, DWP introduced several new questions into the FRS in April 2019. The new data will provide information on families experiencing challenges to food security, allowing us to investigate drivers and identify groups most at risk. The new questions follow a well-established and internationally recognised methodology, used in the US Adult Food Security Survey Module.
Challenges to collecting data in the current circumstances
5.4 In order to develop our understanding of these issues, collection of accurate data is essential, particularly on incomes, housing costs and tenure, disability, caring needs and family circumstances.
5.5 The FRS was designed to be conducted using face-to-face interviews. DWP is doing all it can to protect the integrity of the data collected by the FRS during a time when face-to-face interviewing represents significant and unnecessary risk to public health.
5.6 From this April, and in common with the Government’s other large surveys, the FRS will move to a telephone interview, for at least the first part of the survey year. While we are doing all we can to minimise disruption to the FRS, the current circumstances may impact on the DWP’s ability to collect data in 2020/21 around poverty and food security.
DfE
6.1 Our School Food Standards mean that the food children eat at school is healthy and nutritious, restricting foods high in fat, salt and sugar. Compliance with the School Food Standards is mandatory for all maintained schools. We also expect all academies and free schools to comply with the standards, and since 2014 we have made this an explicit requirement in their funding agreements.
6.2 School governors have a responsibility to ensure compliance and should appropriately challenge the headteacher and the senior leadership team to ensure the school is meeting its obligations. Governors can meet this responsibility by asking the headteacher for evidence that the school is compliant with the standards. The governing board can also appoint a named governor responsible for health and wellbeing, which could include school food.
6.3 The food-based standards were designed in a way to be easy to understand, and they do not require parents to have technical nutritional expertise. For example, there are clear and simple requirements for how often fruit and vegetables must be served, and clear restrictions on foods that are high in fat, sugar and salt. A poster is available describing the standards in accessible terms[14], and school governors and parents are easily able to determine whether the food served to their children meets the standards.
6.4 Where parents feel there is an issue with the content of the food being served at their child’s school, they should in the first instance raise this with the headteacher, and should they be unhappy with the response, they may choose to make a complaint using the school’s own complaints procedure.
6.5 It is right and fair that a school has the opportunity to address a complaint in the first instance, and many issues can be resolved between schools and parents at a local level. However, if a parent has been through the school’s complaints process and is not satisfied, they can make a complaint to the Secretary of State, which the Department can then investigate.
6.6 We do not collate exact numbers of enquiries from parents or schools on this matter. Some inquiries to our Department are informal and are received through our helpline, contact form or informal and formal queries with officials. Some enquiries may not name the school involved. If we receive evidence that a school is not following the standards and this cannot be resolved locally, we will not hesitate to take action. To date the Department has not needed to issue a direction or notice in relation to non-compliance with the School Food Standards.
6.7 The Department has published details for its new healthy schools rating scheme which celebrates the positive actions that schools are delivering in terms of healthy living, healthy eating and physical activity, and supports schools in identifying further actions that they can take in this area[15]. This voluntary rating scheme is available for both primary and secondary schools. Schools engage in a self-assessment exercise and receive their rating based on their responses to questions around food education, compliance with the mandatory School Food Standards, time spent on PE in school and the promotion of active travel for pupils’ journeys to and from school. This was launched in a beta testing phase in July 2019 and will give us some useful information on the steps schools are taking to follow the standards.
6.8 Schools can notify Ofsted school inspectors about the rating they have achieved in the healthy school rating scheme. They will be able to draw attention to the scheme as evidence of their provision to pupils. Where relevant, Ofsted inspectors may wish to consider the scheme as evidence when reaching the judgement on ‘personal development’.
6a. The allowance for children receiving free school meals is £2.30 per day. When was this amount last reviewed and why has the value of this been allowed to deflate over time?
6.9 As part of the increased funding for schools announced by the Prime Minister on 30 August 2019, the benefits-based free school meals factor in the national funding formula has been increased in line with inflation in 2020-21. We will communicate arrangements for universal infant free school meals in 2020-21 in due course.
6.10 The previous £2.30 benefits-based free school meals factor in the national funding formula was based on the average cost of providing a meal according to a survey carried out by the School Food Trust in 2012 and on discussion with stakeholders and school food experts.
6.11 We allocate funding to local authorities for each of the pupils in their area eligible for free school meals. Local authorities then distribute this money to schools through their local funding formula, which must include additional funding for pupils from disadvantaged backgrounds, such as those eligible for free school meals. It is then for schools to decide how to use their budget, including how much to allocate to pay for benefits-based free school meals.
6b. How do you respond to the suggestion we received that children on free school meals are, compared to their more fortunate peers, receiving a reduced calorie intake?
6.12 We provide significant funding to schools and have published School Food Standards to ensure that all eligible children receive nutritious and healthy free school meals. Many schools and caterers have the same meal offers in place for all their children, including both those on free school meals and children who pay for meals, and many schools publish their school menus on their websites. We are supportive of schools that make the same meal choices available to children who receive free school meals and those who pay for meals. This is important in terms of ensuring that children on free school meals have the same healthy meals and calorie intake at lunchtime as their peers, and also helps ensure that children on free school meals are not subject to any stigma through being identified by their meal choices.
6c. We are told that between £70-88 million per year has ‘gone missing’; wiped from the lunch cards of children on free school meals who have not taken their entitlement. What is the true amount and where is this money?
6.13 Free school meals are intended as a benefit in kind, rather than a cash benefit, and our primary interest is that schools meet their legal duties to provide nutritious free lunches to eligible children.
6.14 We trust school leaders to make the best decisions in the interests of their pupils and it is right that they have flexibility around how they deliver free school meals. We are, of course, determined to ensure that all eligible children receive their full entitlement to free school meals.
6.15 We do not collect any information on the total or proportion of unspent funds at school or pupil level. We know that some schools will allow pupils to carry over their benefit, however we would not want to instruct schools to follow any specific approach nationally. We are interested to hear about new and creative steps schools are taking to support eligible children and we will consider how we can share the very best practice around the delivery of free school meals.
7.1 Under the benefits-based criteria, around 1.3 million of the most disadvantaged children are eligible for and claiming free school meals. Benefits-related free meals were extended to disadvantaged further education students in September 2014. A further 1.4 million infants receive a free nutritious meal under the Universal Infant Free School Meals (UIFSM) scheme.
7.2 A key success measure for UIFSM is take-up of the meal, which has been consistently strong. We monitor this through the schools census. 1.4 million infants, excluding those eligible for benefits-related free school meals, receive a free meal through this programme.
7.3 Under the new eligibility criteria that we introduced in April 2018, we estimated that more pupils will benefit from free school meals by the end of the roll-out of Universal Credit, compared with the previous benefits system. We also introduced generous transitional protections so that all children will keep their free meals during the change to the new criteria.
8.1 The Department will consider the Children’s Future Food Inquiry report and its recommendations carefully. However, our clear focus at the moment is on the Covid-19 outbreak, including ensuring that eligible children continue to have access to healthy free school meals during this period.
Overall
9.1 Where we live has a role to play in reducing levels of obesity in children and improving diets, whether it is the way our towns and cities are designed to ensure greater active travel or safe physical activity, or how many fast food outlets can operate near schools. Each local authority already has a range of powers to find local solutions to their own levels of obesity in childhood.
9.2 The Government has invested over £3bn in local authority public health services through the Public Health Grant in 2019/20, in addition to what the NHS spent on preventative interventions such as our world-class immunisation and screening programmes. We announced as part of the Spending Round 2019 that the Public Health Grant would rise in real terms for 2020/21.
9.3 Local authorities have been doing a great job in achieving value for money in the services they provide to improve people’s heath. But improving the public’s health is about far more than money; it’s about action by local and central government, the NHS, industry, communities and individuals.
9.4 Challenges vary across local areas but many local authorities face common issues, including: a proliferation of fast food outlets on high streets and near schools; less active travel; limited access to green spaces and physical activity; and unhealthy food marketing dominating many public spaces. These factors create an environment that makes it harder for children and their families to make healthy choices, particularly in some of our most deprived areas.
9.5 We want to ensure that the places our children live, learn and play are promoting a healthy lifestyle. But many local authorities are struggling to tackle the complexity of the childhood obesity challenge.
9.6 Local authorities have a range of powers and opportunities to create healthier environments. They have the power to develop planning policies to limit the opening of additional hot food takeaways close to schools and in areas of over-concentration, to promote walking and cycling in transport plans and deliver walking and cycling infrastructure through Local Cycling and Walking Infrastructure Plans, and to ensure access to quality green space to promote physical activity. They can also offer professional training, parenting support, social marketing campaigns and weight management services. They can partner with leisure and sport facilities to offer accessible physical activity opportunities. But while some local authorities are already taking bold action, others are not.
9.7 We want to make sure that all local authorities are empowered and confident in finding what works for them, whilst learning from local authorities both here and international examples such as Amsterdam that are tackling the problem.
9.8 Through chapter 2 of our childhood obesity plan, we are delivering a Childhood Obesity Trailblazer Programme[16] in partnership with the Local Government Association and Public Health England, working with local authorities to address childhood obesity at local level.
9.9 The programme has a focus on inequalities in childhood obesity and is supporting a small number of local authorities to take innovative action in their community. It is a priority to encourage and support all local authorities to address this challenge and we will share learning throughout the programme.
9.10 Throughout the programme, we will work closely with councils to explore the challenges and develop solutions. This will help to inform further action the Government can take in the future to enable ambitious local action. We will also share the learning from the programme to encourage and empower wider local action across the country.
9.11 MHCLG has made changes to both national policy and planning practice guidance to support local planning authorities to put in place relevant local plan policies to tackle the further proliferation of A5 hot food takeaways. The revised Healthy and Safe Communities planning practice guidance[17] makes clear that planning policies can, where justified, seek to limit the proliferation of particular uses such as hot food takeaways, where evidence demonstrates this is appropriate. In particular, the guidance notes that planning policies and proposals could have regard to the proximity to locations where children and young people congregate such as schools, community centres and playgrounds, where there is evidence indicating high levels of obesity, deprivation, health inequalities and general poor health in specific locations and over-concentration of certain uses, such as hot food takeaways, within a specified area.
9.12 It is important that councils have confidence in the planning system and that there is consistency in planning decisions on hot food takeaways. That is why in chapter 2 of the childhood obesity plan, DHSC and MHCLG committed to updating guidance and training for planning inspectors, and to make sure that these align with national policy and planning practice guidance. To begin taking this forward DHSC presented at the recent Planning Inspectors training event, and DHSC and MHCLG will continue to work together to deliver this in the future.
9.13 In chapter 3 of the childhood obesity plan, we set out what we can do to support individuals to maintain a healthier weight. This included a commitment to continue the development of Our Family Health[18], a digital approach to support families with children aged 4 to 7 years with lifestyle behaviour change. DHSC will work with local authorities to explore how Our Family Health can support families living in some of our most deprived areas with high childhood obesity rates.
9.14 As we said in the written evidence provided to the Committee last September, the Government is concerned that, despite strict restrictions across TV and online, children remain exposed to significant levels of high fat, salt and sugar (HFSS) advertising across the media they enjoy the most. This is a concern as evidence suggests that exposure to HFSS advertising can affect what and when children eat, both in the short term and in the longer term by shaping children’s food preferences from a young age. Over time, eating more than they need can lead to children becoming overweight or obese which is putting their future health at risk.
9.15 Through the second chapter of our childhood obesity plan, we have consulted on further advertising restrictions and we will be setting out our response as soon as we can.
9.16 The Government is also concerned about advertisements along the streets. To prevent trojan phone boxes popping up and displaying HFSS adverts, MHCLG has removed the permitted development rights for phone boxes and the deemed consent for advertisements on them. This puts the power back in councils’ hands and means that any new phone box will need to get planning permission from councils.
9.17 Schools, colleges and early years settings arrange their own food provision, and for schools this is often through local authorities’ or academy trusts’ arrangements. Some have in house arrangements and some contract out to small, medium or large suppliers. Our update to the School Food Standards will include detailed guidance to caterers and schools that can be applied locally.
9.18 DfE’s Holiday Activities and Food programme is a good example of how central Government can complement the work of local initiatives in this space. This programme enables children in disadvantaged areas to receive healthy meals and enriching activities over the summer holidays. In 2019 DfE awarded £9m to 11 organisations to establish local coordinators of free holiday clubs in 11 local authority areas. The role of these coordinators was to work with providers and services in their local area, including with local authorities, to ensure a more joined-up and coordinated approach to provision. They were responsible for funding provision in their area and working with providers to ensure they could meet the minimum standards we put in place, which included that they must serve food which met School Food Standards. On 16th March DfE wrote to all bidders to let them know whether or not they were successful in bidding for funding in summer 2020 and the successful areas will be announced in due course.
10.1 The food system affects many areas of our lives, and as such is incorporated into the work of several departments. The Government recognises the importance of coordination on food policy across Whitehall in order to deliver our shared ambition of ensuring that our food system delivers healthy, affordable and sustainable food that everyone can access.
10.2 To support this, there are many channels and forums, both formal and informal, that allow Ministers and officials to work together effectively. For example, there are ongoing discussions across Government including formal monthly and quarterly meetings as part of the governance of the childhood obesity programme.
10.3 Ministers also discuss these matters frequently through formal and informal channels, and all new policy is collectively agreed by members of the Cabinet.
10.4 These working relationships between departments allowed us to respond quickly to the Covid-19 outbreak. To date, this working has allowed us to deliver over 1 million food parcels to those deemed to be clinically extremely vulnerable. This was led by MHCLG, with significant input from Defra, DHSC and DWP.
10.5 Going forwards, the National Food Strategy will be a cross-Government piece of work that will further enhance joint working in this space, and will build on work already underway in the Agriculture Bill, the Environment Bill, the Fisheries Bill and the childhood obesity plan.
10.6 The relevant Government departments, including DHSC, DfE and BEIS among others, are sighted on the conclusions and emerging recommendations of the review at the appropriate junctures. The review team engages with senior officials across Whitehall as well as with civil servants from the devolved administrations through various channels. This includes running a series of information events and sharing the evidence that underpins the review.
10.7 The independent review also explores the issue of cross-Whitehall governance of an effective, joined-up food policy, and will make recommendations on this topic as necessary, although it would be premature to pre-empt specifics at this stage.
10a. If the National Food Strategy review makes recommendations spanning different
Government departments, who will have responsibility for coordinating actions on these recommendations?
10.8 The Government has committed to responding to the review’s recommendations in the form of a White Paper within 6 months of the release of the final report. We will consider the recommendations on governance and will set out plans for how we will co-ordinate actions going forwards in our White Paper.
10b. Many of our witnesses have spoken of the need for accountability in these overlapping policy areas. Suggestions have included a children’s food watchdog, a royal commission, or a right to food embedded in legislation. What is the Government’s view on each of these? If we were to attempt to increase Government’s accountability, what type of body would you accept? What powers would it be given?
10.9 The Government will carefully consider the recommendations of the Committee and its witnesses, and will give an official response. Our clear focus at the moment is on the Covid-19 outbreak, including ensuring continued access to healthy, affordable food for everyone in society.
11.1 The Government advocates a healthy balanced diet, based on the national food model the Eatwell Guide. The Guide depicts a diet that is based on fruit, vegetables and higher fibre starchy carbohydrates. It shows the proportions of the five main food groups that are needed for a well-balanced and healthy diet. It applies to most people over the age of five and is suitable for those following plant-based diets.
11.2 The Carbon Trust conducted a sustainability assessment of the Eatwell Guide when it was launched in 2016. The analysis shows an appreciably lower environmental impact than the current UK diet[19]. A study looking at the cost to the consumer of achieving a diet in line with the Eatwell Guide concluded that although achieving this would require large changes to the current average diet, these changes would not lead to significant changes in the price of the diet[20].
11.3 Horticulture production in the UK provides a valuable part of a healthy diet in the UK through valuable nutrition through products such as home-grown fruits (such as apples, pears, strawberries) and home-grown vegetables (cabbage, broccoli, carrots). In England alone, horticulture (including ornamentals) accounts for 2% of the utilised agricultural area, growing a number of horticultural products that the UK population enjoy.
11.4 There is potential that the UK could increase its home-produced marketed share and it is likely that the industry would be keen to do this. However, the requirement for imports should not be underestimated, given consumer demand for year-round supply. In addition, there are a number of products that cannot be grown on a commercial scale in the UK that would need to be imported, for example bananas and citrus fruits.
12.1 Public safety and making sure that those most at risk from the virus get the support they need is our top priority in this time. The Government is working hard to ensure everyone can continue to access sufficient healthy and affordable food.
12.2 We have a highly resilient food supply chain and the food industry has adapted quickly to the very significant recent changes in demand, working to ensure people have the food and products they need. The Government has regular ongoing engagement with industry leaders who are continuing to monitor the situation closely and is taking the necessary steps to address issues where they arise. We would like to formally recognise and commend the food industry for its superb response to this very challenging situation.
12.3 The Government has already introduced new measures to make sure businesses can continue to keep food supply flowing. These measures include extending delivery hours to supermarkets and flexing rules on driver’s hours to allow a higher frequency of deliveries to stores to ensure shelves are being replenished more quickly. We have temporarily relaxed elements of competition law to enable supermarkets to liaise with one another to ensure people can access the products they need. We have expanded the eligibility for testing to all essential workers with symptoms of coronavirus, including those working in the food and drink industry. Following a significant spike in consumer demand caused by consumer stockpiling, we have now seen stock levels in supermarkets improve steadily since the end of March.
12.4 We are working closely with the food industry, voluntary sector and across Government to ensure access to food and essential supplies for those affected by the pandemic.
12.5 The Government launched a Shielding Package scheme in late March, with packages of essential groceries being delivered directly to the homes of those who are identified by the NHS as being clinically extremely vulnerable and have requested essential supplies through the gov.uk website or the Government’s dedicated call centre. The boxes have also been reviewed by nutritionists, and will include fresh fruit and vegetables.
12.6 These packages are being delivered to clinically extremely vulnerable people across England and will arrive within 7 days of a request for support via the webportal or phone line, as soon as their status as a shielded person is verified. They are assembled and delivered by Brakes and Bidfood.
12.7 In addition, and in line with data protection, the Government is sharing data with supermarkets to support prioritisation of delivery slots for clinically extremely vulnerable people.
12.8 Shielded individuals must register on the gov.uk website as clinically extremely vulnerable once they have received their NHS letter, or use the phone line available. When signing up, they must request essential food supplies in order for their data to be passed onto supermarkets.
12.9 Supermarkets are putting these customers at the front of the queue for online delivery slots. Customers must be registered with a supermarket to be prioritised in this way.
12.10 Supermarkets are working round the clock to increase delivery slots and will continue to prioritise slots for the shielded group. Approaches to this may vary depending on the supermarket and we recommend customers check the supermarket website first.
12.11 Should clinically extremely vulnerable people no longer wish to receive parcels, they can de-register online. This will not affect their priority delivery status with supermarkets.
12.12 Defra is also working across Government to ensure access to food and essential supplies for those affected by the pandemic, including those who do not fall into the extremely clinically vulnerable category.
12.13 Supermarkets have been working at pace to expand the total number of delivery and click and collect slots and we are working with major retailers to ensure that they prioritise delivery slots for those who are most vulnerable and at risk including food vulnerable people who do not fall into the shielded definition. This includes all people who are unable to access food and other essential supplies due to a Covid-19 related change in physical and/or financial circumstance.
12.14 Most supermarkets are offering prioritised delivery or click and collect slots to those they have identified as vulnerable from their customer database, for example by age, shopping habits, previous use of vulnerable customer helplines etc.
12.15 We are engaging with food aid organisations and charities to fully understand the impacts of the current situation on the voluntary sector and those that use their services to help inform policy thinking and decision making both during and subsequent to the Covid-19 response.
12.16 We are working closely with local authorities, retailers, food businesses and charities to enable vulnerable groups to access food through a variety of ways including: volunteers shopping for them, food deliveries from local retailers, wholesalers and food businesses, many of whom will take orders over the phone, as well increasing access to supermarkets for a priority delivery or click and collect slots.
12.17 The NHS Volunteer Responders programme can be used by people who need to access food and essential supplies.
12.18 Many of those affected will have local family and friends who will be able to help them get access to the vital provisions they need, but we know some do not. Vulnerable individuals who have not been instructed to shield should contact their local authority for support.
12.19 It is critically important that eligible children continue to receive benefits-based free school meals during this period. DfE has published guidance for schools explaining what they should do to make sure that eligible pupils have continued access to this provision[21].
12.20 Schools are central to the country’s response to the Covid-19 outbreak and we are hugely thankful to them for the role they are playing to support children and families at this time.
12.21 It is right that schools concentrate their effort and resources on those who are eligible for benefits-related free school meals at this time. This is why we have introduced a number of immediate measures to ensure children who usually receive this support still have access to it while they are not attending school.
12.22 Schools which are open for the children of critical workers and vulnerable children should provide meal options for children who are in school, and free school meals for all eligible pupils in attendance.
12.23 We also expect schools to continue to provide support for children who are eligible for free school meals who are staying at home during this period. Schools should speak to their school catering team or provider to see if they can prepare meals or food parcels that could be delivered to or collected by families who are eligible for free school meals.
12.24 Where it is not possible for a school to offer collections or food parcels, these schools should offer an alternative to eligible children. To support this, we have developed a national scheme to provide supermarket vouchers for these children via the Edenred online portal. The Government has confirmed that the total value of vouchers offered to each eligible child per week will be £15, recognising that families will not be buying food in bulk and may therefore incur higher costs than schools.
12.25 The Government will continue to provide schools with all their expected funding, including funding to cover free school meals, throughout this period of closure. We are investing a significant amount of extra money in the national voucher scheme, in addition to all of the funding that schools would normally receive.
12.26 By giving schools flexibility on how they can get meals or vouchers, they can make the most appropriate decisions for families in their communities, and provide immediate reassurance to families that this important support will continue. Schools and local authorities should continue to accept free school meal applications. Parents should make contact with the school or local authority, who will verify eligibility and award free school meals.
12.27 DfE’s priority at this time is for children who would normally have a free school meal, not to go hungry. We would of course always encourage families to consider their health and nutrition when buying food. There are a number of online resources available to support families in preparing healthy and nutritious food, including on the NHS Eat Well website[22]. Bite Back 2030 along with School Food Matters have created a simple shopping list and meal ideas to help parents plan lunches for the week within the £15 voucher system[23].
12.28 The Eatwell Guide underpins Government nutrition policy. It is embedded in all Public Health England’s (PHE) public health nutrition campaigns and will continue to be actively promoted wherever possible. The current Government Buying Standards for Food and Catering Services (GBSF) help to ensure that food is produced to higher sustainability and nutrition-related standards. The nutrition-related standards are underpinned by the Eatwell Guide and supported by a range of guidance and tools published by PHE. School Food Standards recommend using the nutrition-related elements of GBSF. The wider public sector is encouraged to apply these standards, and the Government’s childhood obesity plan encourages local authorities to adopt the GBSF.
12.29 In respect of the Healthy Start scheme, the recent regulatory changes that came into force on 6 April 2020 removed the requirement for a health professional signature on the Healthy Start application form. This is publicised on the Healthy Start website and via the Healthy Start helpline and we have ensured that local authorities and voluntary sector organisations are aware of the changes. This will assist people, for example pregnant women who are self-isolating, to apply for the scheme and will reduce pressure on healthcare professionals at this time.
12.30 DHSC is aware that some Healthy Start beneficiaries have been concerned about the availability of infant formula when supermarket shopping. The Government, manufacturers and retailers have been working together to ensure infant formula continues to reach the shelves. The manufacturers recently published a letter about how they were responding to the current situation and to remind customers to be considerate when shopping so that there is enough for everyone[24].
12.31 The Healthy Start website[25] and helpline are reminding people who wish to use their vouchers to purchase infant formula but are concerned about availability, that they can use them in smaller local shops and pharmacies which are registered with the scheme, as well as in large supermarkets. They can check which shops in their area are registered on the Healthy Start website. They may also now use their vouchers to buy infant formula online, details of which are also on the Healthy Start website[26].
12.32 As part of the Government’s strategy to support people affected by Covid-19, DWP has made a number of changes to its benefit processes to ensure people who need financial help have access to the benefit system.
12.33 The Department has increased Universal Credit and Working Tax Credit from 6 April 2020 for one year. This will provide up to £1,040 extra this year, benefiting over 4 million of the most vulnerable households, and helping them to afford the food they need. This measure increases the Universal Credit standard allowance by over £80 per month, on top of the 1.7% increase already announced.
12.34 The UK Government’s package of support in response to Covid-19 is one of the largest in the world. It provides a cash investment of £6.5 billion into the welfare system alone to support people through the current crisis—the biggest ever in Universal Credit response.
12.35 As mentioned in questions 4 and 5, we introduced a new set of food security questions in the Family Resources Survey questionnaire from April 2019 onwards in order to develop a better understanding of the drivers limiting food security and identify which groups are most at risk. This will enable us in the future to monitor the prevalence and severity of household food security challenges across the UK, including for specific groups.
12.36 Beyond the immediate response to Covid-19 the Government remains committed to ensuring that the food system is resilient and sustainable. Defra has commissioned its lead Non-Executive Director to lead an independent review to develop a series of recommendations that will help shape a National Food Strategy. The review is taking a joined up approach to identifying and tackling key challenges in our food system, including those that have emerged through the Covid-19 situation, and covers the entire food chain from farm to fork.
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[1] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/718903/childhood-obesity-a-plan-for-action-chapter-2.pdf
[2] https://www.gov.uk/government/consultations/ending-the-sale-of-energy-drinks-to-children
[3] https://www.gov.uk/government/consultations/calorie-labelling-for-food-and-drink-served-outside-of-the-home
[4] https://www.gov.uk/government/consultations/restricting-promotions-of-food-and-drink-that-is-high-in-fat-sugar-and-salt
[5] https://www.gov.uk/government/consultations/further-advertising-restrictions-for-products-high-in-fat-salt-and-sugar
[6] https://www.gov.uk/government/consultations/updating-the-government-buying-standards-for-food-and-catering-services-gbsf
[7] www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s
[8] https://www.ucl.ac.uk/obesity-policy-research-unit/
[9] https://www.gov.uk/government/publications/sugar-reduction-progress-between-2015-and-2018
[10] https://www.unicef.org/media/61356/file/SOWC-2019.pdf
[11] https://www.gov.uk/government/publications/reduction-and-reformulation-programme-spring-2019-update
[12] https://www.gov.uk/government/publications/sugar-reduction-progress-between-2015-and-2018
[13] https://www.gov.uk/government/publications/global-resource-initiative-taskforce
[14] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/786338/School_Food_Standards-poster.pdf
[15] https://www.gov.uk/government/publications/healthy-schools-rating-scheme
[16] https://www.local.gov.uk/childhood-obesity-trailblazer-programme
[17] https://www.gov.uk/guidance/health-and-wellbeing
[18] https://digitalhealth.blog.gov.uk/2019/05/02/our-family-health-a-healthy-weight-companion-for-families/
[19] https://prod-drupal-files.storage.googleapis.com/documents/resource/public/The%20Eatwell%20Guide%20a%20More%20Sustainable%20Diet%20-%20REPORT.pdf
[20] https://bmjopen.bmj.com/content/6/12/e013182#ref-29
[21] https://www.gov.uk/government/publications/covid-19-free-school-meals-guidance/covid-19-free-school-meals-guidance-for-schools
[22] https://www.nhs.uk/live-well/eat-well/?tabname=recipes-and-tips
[23] https://www.biteback2030.com/real-story/making-your-ps15-free-school-meal-voucher-go-further-home
[24] https://bsna.co.uk/news/2020/infant-formula-manufacturers-reassure-parents
[25] https://www.healthystart.nhs.uk/
[26] https://www.healthystart.nhs.uk/healthy-start-vouchers/where-to-use-the-vouchers/