A Healthy Start
for All: a new
scheme for Hackney
and the City
17th July 2012
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.
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.
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
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 meanstested and therefore not available to all
 Low uptake of national Healthy Start vitamin
programme
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

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
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
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
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