A Healthy Start for All : a new scheme for Hackney and the City

1. A Healthy Start for All: a new scheme for Hackney and the City 17th July 2012

2. Why is Vitamin D important? Classical function: • regulates calcium levels in the body • Vital for healthy tooth and bone development • Deficiency in children can lead to bone deformities and rickets and in adults can lead to osteomalacia (bone pain, muscle ache and weakness) and increased risk of bone fracture Non-classical function: • Low levels have been associated with increased overall and cardiovascular mortality, cancer incidence and mortality, autoimmune diseases such as multiple sclerosis. • Vitamin D may modify risk for cardiometabolic outcomes (type 2 diabetes, hypertension, or cardiovascular disease), multiple sclerosis, Crohn’s disease, and certain cancers such as colon, breast, and prostate.

3. Sources of vitamin D • Synthesised through the skin through the action of UV light on cholesterol • Seasonal variation in individual Vit D levels due to levels of sunlight (primarily takes place April – Sept in UK) • Longer exposure required in people with darker skin • Small quantity from diet – oily fish, meat, eggs, soya products, fortified foods e.g. margarine, some cereals and fortified infant formula.

4. Who is at increased risk of deficiency? • Pregnant, postnatal and breastfeeding women • Young children • People with little sun exposure • People with darker skin • People over 65 • People with restrictive diets e.g. vegetarian/vegan • People with some chronic conditions

5. Background to the new local scheme • High costs and inconsistency relating to prescription of vitamin D and folic acid • Anecdotal reports of increased cases presenting with symptoms linked to vitamin D deficiency, including increased rickets cases • Local screening identified a high proportion (70%) of the population were insufficient or deficient • National Healthy Start programme is means-tested and therefore not available to all • Low uptake of national Healthy Start vitamin programme

6. Who is eligible for the new scheme? • All women who are pregnant • All women who have had a baby in the last year or who are breastfeeding • All children under four years old (from birth if breastfed; from 6 months if formula fed) • Can be recommended to buy OTC to: • Women intending to conceive • People in at risk groups who do not fall in previous categories

7. How does the new scheme operate? • Registration forms in a range of venues e.g. children’s centres, GP practices, Hackney Service Centre, midwives, health visitors, pharmacies • Form authorised by GP, midwife, health visitor or other health care professional • Form presented at pharmacy and woman/child(ren) registered on SONAR system • Vitamins collected every 8 weeks and logged on SONAR – from any participating pharmacy • Vitamins delivered direct to pharmacies by NHS Supply Chain – arranged by Public Health • Pharmacy to ask whether families are receiving food vouchers and log – to enable PCT to reclaim costs

8. Pharmacy role and agreement • Hold stocks of children’s vitamin drops and women’s vitamin tablets • Register child(ren) and women on SONAR when presenting • Record in SONAR all vitamins issued • Record in SONAR when women/child eligible for national Healthy Start scheme • Opportunistic promotion of Healthy Start for All and national Healthy Start schemes • SONAR will identify immunisation schedule for each child to prompt discussion • Opportunistic promotion of other key health messages e.g. immunisation, breastfeeding, early booking for maternity

9. Additional information • Vitamins are Vegetarian Society approved • For Orthodox Jewish community: both women’s and children’s vitamins are considered parev/parve (neutral) • On Kosher product search (www.kosher.org.uk

10. For further information contact: Sarah Rees Public Health Strategist NHS East London and City Email: sarah.rees@elc.nhs.uk Tel: 020 7683 4557 Suman Barhaya Specialist Pharmacy Lead NHS East London and the City  Email: suman.barhaya@elc.nhs.uk Tel: 020 7683 4007