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Sustain urges Government to extend Healthy Start to migrant and refugee families facing destitution

A group of 148 organisations, including Sustain and the Food Foundation, are calling for the extension of Government support of free fruit, veg, formula milk and multivitamins to families with no recourse to public funds. A new Sustain survey reveals pregnant mums and children are experiencing malnutrition and destitution and charities are unable to meet level of need.

Pregnant woman looking at coins on a table. Copyright: Motortion Films | shutterstock

Pregnant woman looking at coins on a table. Copyright: Motortion Films | shutterstock

Sustain and the Food Foundation have sent a letter to Andrea Leadsom MP, Minister for Primary Care and Public Health, calling for children from migrant and refugee households on low incomes with no recourse to public funds (NRPF) to be given permanent access to the Healthy Start Scheme.

The letter has been signed by 148 signatories representing NGOs, local government institutions, charities and medical bodies. It states that children from NRPF households still face unacceptable barriers to accessing much needed support.  

NRPF is an immigration restriction applied to an estimated 1.4 million people, and 175,000 children, in the UK. This figure includes asylum seekers who sometimes have to wait years while their case is pending. 

Healthy Start is a means-tested scheme for low-income pregnant women and young children, providing vitamins and funds, which can be used for foods to support basic nutrition, including milk, pulses, fruit and veg and formula milk. It is available to pregnant women and children under four years old who are in receipt of qualifying benefits. Good nutrition in childhood is essential for improving long-term health and resilience, as well as reducing both malnourishment and the risk of diet related illness. 

Alongside the letter, a survey of frontline health service workers and representatives from community organisations conducted by Sustain found that the biggest factors affecting families with NRPF during the cost of living crisis are reduced nutrition and calorific intake due to the rising cost of food, followed by reported worsened mental health. 

The survey found that nearly 90% of respondents believe that the Healthy Start Scheme should be extended to all families on low incomes with children under the age of four who have no recourse to public funds. 58% of respondents are only able to support families with NRPF by securing additional resources or volunteers. Worryingly, 18% of respondents are unable to meet the level of need at all.

Florence Emakpose at World of Hope, a charity working with vulnerable families in South London, said:

“We have up to 30 families whose cases are still pending and who are unable to work. They depend on the food we give them to feed their children and their families. This is very sad. Some have to pick food from the bin to feed their children due to the cost of living crisis.” 

A community midwife working in the South East said:

“The pregnant women that I support who live in the Home Office hotel appear to have health issues related to the substandard food provided by the hotel. This is an ongoing issue.”  

A health visitor based in West London said:

“The families I work with from NRPF households often struggle to eat healthy foods during their pregnancy and when their babies are born, which has a notable and significant impact on their health and well-being.” 

In June 2021 the Department of Health and Social Care (DHSC) agreed to “temporarily” extend the Healthy Start Scheme, but only to British children who would otherwise be eligible for the scheme but whose families are excluded from claiming public funds as a consequence of their immigration status or lack of immigration status. Last year, the Government promised to hold a consultation on the permanent extension of the Scheme to NRPF households “in due course.” This consultation has never materialised, leaving NRPF households uncertain as to their future eligibility for the scheme.  

Just as access to the Healthy Start Scheme for NRPF households should be made permanent, it must also be made easier. The application process for NRPF households to receive Healthy Start under temporary measures is burdensome and non-transparent. Applicants with recourse to public funds can apply online or by phone, whereas NRPF households have no choice but to apply by email and wait for the DHSC to “contact them to discuss the application process.” This leaves NRPF households with no control over their application process and removes all transparency and certainty as to when they will be contacted to move matters forward. 

The low number of NRPF household applications, and even lower number of successful applications and payments made to NRPF households, are clear indicators that change is needed. On 19 September 2023, in response to a Parliamentary Question about NRPF households accessing the scheme, the previous Parliamentary Under-Secretary for DHSC said that they had “sent out over 1,300 application forms to those who have requested them," and confirmed that the Department had received only 110 fully completed applications that have demonstrated that the applicant met the eligibility criteria

Vera Zakharov, Sustainable Food Places Local Action Coordinator at Sustain, said:

“Our research tells a grim story of families with no recourse to public funds, including pregnant mothers and very young children, facing extreme food insecurity and in some cases destitution. Lack of government support is being compounded by the current cost of living crisis which has driven up food prices. In addition, health professionals and community organisations are diverting resources from other work in order to help these families, thus stretching already strained community services paper-thin. The overwhelming message from frontline services is that every family deserves a nutritional safety net, irrespective of their immigration status. 

It’s unacceptable that, as some of our most vulnerable families are facing extreme poverty and malnutrition, the Government keeps delaying its promised consultation on extending the Healthy Start Scheme to all families on very low incomes with no recourse to public funds, and we urge ministers to launch it without delay.” 

Shona Goudie, Policy and Advocacy Manager, Food Foundation said:

“No child’s health should be due to their immigration status. We believe the Healthy Start Scheme should be extended permanently to children from NRPF households without further delay. It is not good enough that this seems to have been put off indefinitely. We need to ensure children from immigrant families are getting the basic nutrition they need, in line with the UK Government’s commitment to adhere to the UN Convention on the Rights of Child. We are calling on the DHSC to set a date for the promised consultation immediately, as a first step towards setting up permanent access to the scheme.” 

Peter Dowd, Labour MP for Bootle, said:

“The Healthy Start Scheme is crucial to ensure that some of the most vulnerable young children in our society get access to healthy food, milk, and vitamins. The Government said last year that it will consult on the permanent extension of Healthy Start to all children in families with no recourse to public funds, but it must now get on and do it. Every child in our country should have the right to receive basic nutrition, regardless of their family’s circumstances.”  

Sir Stephen Timms MP, Chair for the Department for Work and Pensions Select Committee said:

“As the most vulnerable in our society continue to struggle with the cost-of-living crisis, the Government have a responsibility to make sure every single child in the UK has access to decent nutrition. The Healthy Start Scheme is a crucial part of that. The question of whether to feed a hungry child should not be difficult to answer. The Government must immediately bring forward its consultation on the permanent extension of Healthy Start to all children in families subject to No Recourse To Public Funds.” 


  • Department of Health should immediately launch the promised public consultation on permanently expanding Healthy Start to pregnant people and low income families with children under four with no recourse to public funds.

  • Department of Health and the NHS Business Services Authority must make the guidance on eligibility for the Ex Gratia extension publicly available and promote it to frontline health professionals.

  • DHSC should communicate response and application processing wait times to Ex Gratia applicants when receiving enquiries and applications.

Read the Open Letter and signatories.

Download Sustain's survey findings in brief.


Published Monday 20 November 2023

Sustain: Sustain The alliance for better food and farming advocates food and agriculture policies and practices that enhance the health and welfare of people and animals, improve the working and living environment, enrich society and culture and promote equity.

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