Best Start Foods: evaluation

Findings

In this chapter of the report, the data sources outlined in the methodology chapter are used to evaluate progress towards Best Start Foods' immediate, short-term and medium-term policy outcomes. Based on this, likely progress towards the Scottish Government's longer term outcomes are assessed. The section ends with a discussion of the policy implications which emerge from the evaluation findings.

Achievement against immediate Best Start Foods policy outcomes

This section evaluates Best Start Foods against the following policy outcomes:

• Best Start Foods is well promoted
• Best Start Foods and its eligibility criteria are well understood
• Best Start Foods is taken up
• Making an application is clear and easy
• Applications and payments are processed in a timely manner
• Recipients treated with dignity, fairness and respect
• Card reduces stigma and is easy to use
• Card provides access to a wide range of retailers
• Card provides access to a wide range of healthy foods

Where applicable, it uses data from Official Statistics, Social Security Scotland research, and bespoke commissioned research.

Best Start Foods is well promoted

There are a number of ways to evaluate whether Best Start Foods is well promoted. An indirect method is to look at overall take-up of Best Start Foods, as this could be related to the effectiveness of promotional activity. Take-up refers to the extent to which people receive the benefits they are eligible for. This can be estimated by measuring the 'take-up' rate, which is the number of benefit recipients divided by the number of people eligible to receive the benefit.

A provisional take-up estimate is provided for Best Start Foods in the Social security: benefit take-up strategy. It shows that over the period April 2020 to June 2021, take-up was estimated to be 77%. This means that:

1. Most people who were eligible for Best Start Foods claimed the benefit, indicating that promotions were largely effective.

2. Almost 1 in 4 eligible people had not claimed the benefit, suggesting further steps may still be needed to maximise take-up of the benefit.

However, it should be noted that the most recently published take-up figure is now outdated, and that updated an estimate of take-up will be published later this year.

Another way to evaluate Best Start Foods promotion is to consider how people find out about the benefit. The commissioned research shows that recipients became aware of Best Start Foods through a range of sources, including:

• Healthcare professionals (e.g., midwives, family nurses, health visitors)
• Other professionals (e.g. benefits advisors, case workers)
• Word-of-mouth (family and friends)
• Advertisements (online, posters, TV adverts)
• Directly from Social Security Scotland if they had previously received Healthy Start Vouchers

Of these sources, recipients most commonly became aware of Best Start Foods from healthcare professionals they were in regular contact with. It should also be noted that some recipients said they only became aware of Best Start Foods when they received a decision letter on their benefits claim. These recipients were generally unaware that Best Start Foods was part of a joint application with Best Start Grant.

All participant groups agreed that the promotion of Best Start Foods could be improved. There was a sense that there were families, healthcare professionals and retailers who had little or no awareness of the benefit. Recipients reported knowing families who were not aware of the change from Healthy Start Vouchers, and who had assumed their vouchers had stopped because they were no longer eligible and therefore had not applied for Best Start Foods. Additionally, a number of the retailers who took part in the research had not been aware of Best Start Foods before being contacted to take part in an interview. They had been aware of Healthy Start Vouchers, but had assumed that the scheme had stopped altogether.

Best Start Foods and its eligibility criteria are well understood

Overall, the commissioned research participants who had received Best Start Foods were aware that the purpose of the benefit was to purchase healthy foods for their children. They were informed of what items could be purchased in the guidance letter they received with the Best Start Foods card. The list was also stated on the card, which was found to be a helpful reminder when shopping. Recipients generally thought the guidance was clear and informative.

However, some recipients reported issues with the guidance. For example:

• Those who could not read English reported having to rely on others to read and explain guidance because they were not aware it is available in other languages.
• Recipients called for information in the guidance to cover a fuller list of retailers where the Best Start Foods card can, and cannot, be used, and information on how to use the card online
• Some found the information overwhelming and would like the guidance in a more succinct format that was easier to digest.

Additionally, there was some confusion over the list of recommended Best Start Food items. Some recipients were not aware that the card could be used to buy frozen or tinned fruit and vegetables, pulses and eggs. Others thought it could be used for foods that were not on the recommended list (e.g. fish, poultry, meat and bread), or for other essential items such as nappies and clothes.

Commissioned research participants also discussed their knowledge of Best Start Foods prior to applying for the benefit, including their understanding of eligibility rules. Having been made aware of the benefit, some recipients had conducted their own research to find out more about Best Start Foods, whilst others received information from healthcare professionals who supported them to complete an application. However, some applied with little knowledge of eligibility criteria or the purpose of Best Start Foods. Awareness that Best Start Foods was part of a joint application with other benefits was also mixed. As mentioned above, those who did not know it was a joint application said they only became aware of Best Start Foods when they received a decision letter.

Some participants in the commissioned research also reported being caught off guard when their Best Start Foods payments stopped, as they received no prior warning. While there is information online that indicates that Best Start Foods will stop when a child turns 3, some recipients were unaware of this, or had forgotten.

Best Start Foods is taken up

A direct way to assess progress on this outcome is to calculate the 'take-up' rate, which is the number of benefit recipients divided by the number of people eligible to receive the benefit. As mentioned above, take-up of Best Start Foods was estimated to be 77% over the period April 2020 to June 2021. This figure is similar to other low-income benefits administered by Social Security Scotland. For example, take-up for Scottish Child Payment was estimated to be 77%, and take-up for the Best Start Grants ranged from 79%-84%.

There are other ways to evaluate the overall reach of Best Start Foods. For example, Official Statistics show that for the period covering August 2019 to February 2022, 185,725 applications were estimated to have been made for Best Start Foods^[9], of which 174,905 had been processed. Amongst processed applications, 63% were authorised, 33% were denied, and 4% were withdrawn (see Figure 2).

Investigation of Social Security Scotland management information shows the most common reason why applications were denied is because the applicant was not in receipt of a qualifying benefit.

Official Statistics also show that 790 review requests^[10] were received from Best Start Foods applicants to the end of February 2022 - representing 0.3% of all decisions processed until that time. 780 of these reviews had been completed, of which:

• 325 were allowed or partially allowed
• 315 were disallowed and
• 135 were withdrawn.

Decisions on review requests (not including requests that were withdrawn by the applicant) took an average of 13 working days. This is within the 16 working days period in which Social Security Scotland must respond to review requests.

Another way to assess the take-up and overall reach of Best Start Foods is to consider the diversity of people applying for or receiving the benefit. This can be done by examining data on the demographics and individual characteristics of applicants.

Official Statistics show that Best Start Foods applications were submitted by people living in all 32 local authorities in Scotland. To February 2022, the highest local authorities were Glasgow City (30,330), North Lanarkshire (14,370), and Fife (13,900). The lowest were Na h-Eileanan Siar (530), Shetland Islands (375), and Orkney Islands (375).

Social Security Scotland client diversity and equalities analysis provides more information on the outcomes of applications by each of the equalities groups. Table 1 presents a presents a secondary analysis of equalities data where recipients had their applications approved from December 2020 to May 2021. Please note the following about the secondary analysis in Table 1:

• The data is based on combined application outcomes for Best Start Grant and Best Start Foods applications. This is because separate analysis of client diversity information is not conducted on Best Start Foods awards only.
• The percentages are calculated by dividing the number of approved applications for each variable category by the total number of approved applications. For example, the percentage of approved applications for 16-24 year olds shown in Table 1 (21%) is calculated by dividing the number of approved applications for 16-24 year olds (3,005) by the total approved applications (14,460).

A more detailed breakdown of the data in Table 1, with additional notes, is provided at Annex A.

Table 1 Best Start Grant and Best Start Foods equalities data for approved applications, December 2020 to May 2021 (n=14,460)

Category	%
Age
16-24	21%
25-34	55%
35-44	22%
45-64	2%
65 and over	0%
Gender[11]
Woman	92%
Man	6%
In another way	0%
Preferred not to say	2%
Physical or mental health condition or illness
Yes	17%
No	76%
Preferred not to say	7%
Ethnicity
White	90%
Asian	4%
African	2%
Mixed or Multiple ethnic groups	1%
Other ethnic group	1%
Caribbean or black	0%
Preferred not to say	3%
Sexual orientation
Heterosexual	92%
Gay & lesbian	0%
Bisexual	2%
In another way	0%
Prefer not to say	6%
Transgender
Yes	0%
No	97%
Prefer not to say	3%
6-fold Urban Rural Classification[12]
Large urban area	35%
Other urban area	41%
Accessible small town	7%
Remote small town	3%
Accessible rural area	9%
Remote rural area	4%
SIMD Quintile[13]
1 (most deprived)	42%
2	26%
3	16%
4	11%
5 (least deprived)	5%
Residence on mainland or island communities
Scottish Mainland	99%
Scottish Island	1%

Finally, secondary analysis of the most recently published Official Statistics provides a further insight into the reach of Best Start Foods. For example, to February 2022:

• 63% (69,710) of those who had their applications approved for Best Start Foods were assumed to be lone parents. However, since it is possible for applicants to not fill in information about their partners, overestimation of lone parents can occur and thus caution is needed when interpreting this figure.
• 1% (1,445) of those who had their applications approved for Best Start Foods were kinship carers. An applicant is considered to be a kinship carer if at least one child attached to their application has a kinship relationship status. Data regarding relationship status was missing for roughly 2% of children and thus these figures may slightly undercount total number of kinship applicants.

Further detail on this secondary analysis is provided at Annex A.

Making an application is clear and easy

Secondary analysis of the most recently published Official Statistics shows that, for all approved Best Start Foods applications to February 2022, 95,395 (87%) were made online, 12,495 (11%) were made on the telephone, and 2,180 (2%) were paper-based. Further detail on this secondary analysis is provided at Annex A.

The Client Survey asks respondents about their experience of the application process. Amongst those who completed the Best Start Foods/Best Start Grant application form:

• 56% said their experience of the application process overall was 'very good', and 33% said it was 'good' (i.e. 89% positive responses, n=955)
• 49% 'strongly agreed' that the application process was clear, and 44% 'agreed' (i.e. 93% positive responses, n=973).

In the commissioned research, Best Start Foods recipients generally found the application process straightforward and quick to complete. Those who completed an online application found the format convenient, and those who completed phone or paper applications appreciated being able to use different formats. Additionally, recipients saw the joint application form as beneficial as it saved them time filling out multiple application forms – albeit some felt applications should be separate as they may be eligible for the payments at different time points.

While the application form was generally viewed positively, some commissioned participants needed support to complete the form. This help came from different sources, such as Social Security Scotland, family nurses, case workers or family and friends. Participants who did not speak English at all, or as a second language, found it difficult to understand certain words or phrases. Some stated that they would like the option of choosing to receive communication (e.g. application form, decision letter, guidance) in other languages, or access to a translator.^[14] Healthcare professionals explained that some of their recipients had issues with literacy skills, access to technology, and in some cases generally lacked confidence to apply.

Applications and payments are processed in a timely manner

Secondary analysis of the most recently published Official Statistics shows that 109,69 Best Start Foods applications that were approved were processed between August 2019 and February 2022 (not including cases where a review was requested - i.e. approximately 0.3% of applications). Processing times are calculated from the point of initial benefit application until a decision on the application is made, and includes time spent waiting to receive copies of documents or evidence requested from applicants.

On the basis described above, a breakdown of Best Start Foods application processing times (in cases where applications were approved) is shown in Table 2, based on financial years.^[15] The data shows that application processing times have generally increased over time. For example, while 27% of approved applications took more than 20 working days to process in the 2019-20 financial year, this went up to 41% in 2020-21, and 51% in 2021-22. Further detail on this secondary analysis is provided at Annex A.

Table 2 Best Start Foods application processing times for approved applications (excluding those subject to reviews), by financial year

Financial year	Percentage within 10 working days	Percentage in 11-20 working days	Percentage in more than 20 working days	Median average processing time in working days
2019-20	26%	48%	27%	14
2020-21	26%	33%	41%	18
2021-22	24%	24%	51%	21

The Client Survey asked respondents their opinion on (a) whether their application was handled within a reasonable timeframe, and (b) whether they got enough updates on the progress of their application. The answers for those who only applied for Best Start Foods/Best Start Grant are provided in Table 3. They show that most felt that their applications were handled in a reasonable timeframe, and that they got enough progress updates on the progress of their applications. However:

• While 11% 'disagreed' or 'strongly disagreed' that their application was handled in a reasonable timeframe,
• Only 17% 'disagreed' or 'strongly disagreed' that they got enough updates on the progress of their applications.

These findings suggest that applicants were more likely to feel negatively about communications while waiting for a decision, compared to overall time spent waiting for a decision. It is also worth noting that amongst Client Survey respondents who only applied for Scottish Child Payment (n=742-744), only 4% 'disagreed' or 'strongly disagreed' that their application was handled in a reasonable timeframe, and 9% 'disagreed' or 'strongly disagreed' that they got enough progress updates on their applications.

The Client Survey also found that 34% of respondents who had only applied for Best Start Foods/Best Start Grant (n=971) contacted Social Security Scotland to find out about the progress of their application, and 32% had done so to find out their application result.

Table 3 Best Start Foods/Best Start Grant applicants' views on application processing times and updates

	Number of respondents	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
My application was handled in a reasonable timeframe	943	6%	5%	6%	40%	42%
I got enough updates on the progress of my application	923	8%	9%	11%	37%	35%

In the commissioned research, participants were generally positive about the Best Start Foods application process. However, some reported challenges. The amount of time recipients said they waited on an application decision ranged from 2 to 12 weeks. Some of those who waited longer were concerned and anxious that they would not receive the benefit. On the other hand, those who received communication explaining that there may be delays in receiving a decision felt reassured and were more understanding of the longer waiting times.

Participants made suggestions to improve waiting times, including:

• Allowing applicants to submit evidence at the time of application^[16], as waiting for Social Security Scotland to request information and then finding and submitting evidence was viewed as time consuming
• Clarifying in advance the type of evidence that was required for applications
• Offering the option to receive notification of application decisions by email.

While some commissioned research participants were very postive about the communication and support they received from Social Security Scotland when they waited for an application decision, others encountered issues. For example, recipients and healthcare professionals reported long wait times when calling the Social Security Scotland helpline to enquire about applications. Healthcare professionals commented that some of the young parents they worked with lacked the confidence to pursue support for themselves, and due to these waiting times it was not always possible for them to sit with parents while they made the call.

Additionally, some recipients reported receiving multiple requests for the same information (i.e. supporting evidence) from Social Security Scotland, which they found stressful, and which led to delays in receiving Best Start Foods. Also, some who had their first application for Best Start Foods turned down said the letter did not explain why – which caused distress and meant they had to contact Social Security Scotland to find out more information.

According to Official Statistics, the total value of payments made to Best Start Foods recipients between August 2019 and February 2022 was £27,391,947. The Client Survey asked respondents questions about their experience of receiving payment(s). Amongst those who only received Best Start Foods (n=86) 80% rated their overall experience of receiving payments as "Very good" or "Good", whilst 8% rated their experience as "Very poor" or "Poor".

Recipients treated with dignity, fairness and respect

The Client Survey asked applicants directly about their experiences with Social Security Scotland, including how they felt they had been treated by the organisation. The responses from people who only applied for Best Start Foods/Best Start (see Table 4) show that a large majority 'agreed' or 'strongly agreed' that they had been treated with dignity, fairness, and respect.

Table 4 Best Start Foods/Best Start Grant applicants' treatment by Social Security Scotland

	Number of respondents	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
I was treated with dignity	969	1%	1%	6%	41%	48%
I was treated with fairness	967	1%	2%	6%	41%	48%
I was treated with respect	965	1%	1%	6%	41%	49%

The Client Survey also shows that 44% of respondents who had only applied for Best Start Foods/Best Start Grant (n=973) had been in contact with Social Security Scotland staff. Of the respondents who had been in contact with staff:

• 58% rated their experience with staff as very good
• 33% rated their experience as good
• 5% rated their experience with staff as poor or very poor.

Survey respondents were asked more questions about their interactions with staff. As shown in Table 5, large majorities of those who only applied for Best Start Foods/Best Start Grant felt that (a) they had been treated with kindness by staff, (b) staff were able to help them, and (c) staff were knowledgeable about benefits.

Table 5 Best Start Foods/Best Start Grant applicants' thoughts on interactions with Social Security Scotland staff

	Number of respondents	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
I was treated with kindness	421	1%	1%	4%	37%	56%
Staff were able to help me	421	3%	4%	6%	35%	50%
Staff were knowledgeable about benefits	418	3%	3%	6%	37%	49%

The Client Survey also asked whether respondents felt that they had been discriminated against at any point during their experience with Social Security Scotland. Amongst those who only applied for Best Start Foods/Best Start Grant (n=760), 2% said they had been discriminated against, whilst 4% preferred not to say.

Card reduces stigma and is easy to use

The commissioned research explored whether the Best Start Foods card has reduced stigma compared to Healthy Start Vouchers, and whether it is easy to use. Overall, the Best Start Foods card was viewed postively by recipients, retailers and healthcare professionals, and was favoured over the previous Healthy Start Vouchers system. Recipients preferred the card format because it was more discreet – those that had previously received the Healthy Start Vouchers reported feeling embarrassed and judged by others when using them in shops.

Recipients also reported that the card format was easier and more convenient to use than vouchers. Reasons they gave included:

• It allowed them to use contactless payment and Chip & Pin, which also enabled them to use self-checkout
• There was no expiry date on the monthly payments - anything that was not used stayed on the card
• It was familiar to recipients who did not speak English, and did not require them to be able to speak or read English to use it.

While most found using the Best Start Foods card to be straightforward, some recipients experienced challenges. They reported instances of having the card rejected the first time they tried to use it, which could cause embarrassment. This was particularly confusing in cases where the card was rejected in a shop which had previously accepted Healthy Start Vouchers. Reasons given for card rejections included that:

• The card had not been activated (either because the client had not read, or was unable to read, the guidance)
• The client tried to use contactless for the first transaction (the PIN needs to be used for the first transaction)
• Some shops were not verified to accept Best Start Foods (e.g. because they are not classified as food shops)

There were also recipients who reported experiencing challenges using contactless payment in stores, and were always asked to enter their PIN. If they had forgotten their PIN as they would need to call allpay to retrieve it or resort to using another card. Notably, some faced barriers to calling allpay – e.g. if they did not speak English, had hearing impairments, or struggled with phone calls. To address these barriers, recipients suggested introducing an app for card management.^[17]

Retailers also thought the card format was an improvement and easier for them to implement than vouchers. With Healthy Start Vouchers, retailers had to scan and keep the vouchers and then submit them to receive payment, but with Best Start Foods they received payment automatically. However, while retailers were generally positive about the Best Start Foods card, they also found it challenging not having any information on the use of Best Start Foods in their shop(s). They said that data on the items being bought and how often would enable them to make informed choices on stock and in store promotions.

Card provides access to a wide range of retailers

Participants in the commissioned research used the Best Start Foods card in a wide range of shops, including large and small supermarket chains, smaller franchises and local independent shops.^[18] There was also the perception that the Best Start Foods card could be used in a greater variety of shops to buy a wider range of foods than the previous Healthy Start Vouchers. This enabled recipients to choose to shop at different retailers to find the lowest prices.

Despite the above, recipients called for information in the guidance to cover a fuller list of retailers where the Best Start Foods card can, and cannot, be used. Participants also called for more information about using Best Start Foods online - there was a lack of awareness that the card could be used this way, and uncertainty over how shopping online would work. For example, recipients did not know how they would go about splitting the payment for recommended items and other items, or whether the card could be used to pay for delivery.

Card provides access to a wide range of healthy foods

Participants in the commissioned research expressed contrasting views on the recommended range of food items which could be bought using Best Start Foods. Some thought the range was appropriate and reasonable, allowing them to buy essential foods for their children, prepare healthy meals, and eat a healthier diet. However, while recipients reported that Best Start Foods allowed them to buy a wider range of healthy items than Healthy Start Vouchers, some felt that expanding the range further would be beneficial. Items which are good sources of protein (e.g. meat, poultry), fibre (e.g. wholegrains) and other nutrients (e.g. fish) were seen to be essential for a healthy diet for their children. Recipients also mentioned that catering for children with special dietary needs (allergies and intolerances) was expensive and they were uncertain whether Best Start Foods could be used to purchase items such as milk alternatives (e.g. oat milk).

Overall, healthcare professionals' views on the range of foods were positive. When informed of the additional foods that recipients could buy with Best Start Foods that were not included with Healthy Start Vouchers, they were pleased that foods such as pulses were included, because they provide protein which is important for children's healthy development. However, there were healthcare professionals that raised concerns that the range of foods recipients could purchase was restrictive and did not reflect the eating habits and cooking skills of their clients. There was a view that young recipients in particular do not have the skills or confidence to cook healthy meals from scratch, so they opt for pre-made baby food or meals. It was therefore a concern that limiting what can be purchased with the Best Start Foods card would lead to greater difficulties with promoting healthy eating habits.

Achievement against short-term policy outcomes

This section evaluates Best Start Foods against the following policy outcomes:

• Healthy foods are more affordable
• Supports healthier shopping habits and meal planning
• Mothers and children eat more healthy foods
• Reduced pressure on household finances

It is based on findings from bespoke commissioned research, but also draws on findings from the Client Survey where possible.

Healthy foods are more affordable

Client Survey respondents were asked to rate, on a scale of 0-10 ('not at all' to 'a lot'), how much their benefit payment helped them to pay for what they needed. The average score given by respondents who had received Best Start Foods (n=86) was 6.7 out of 10. This figure indicates that the benefit generally helped people to pay for what they needed, without necessarily covering all of their costs.

The commissioned research shows that Best Start Foods has helped families to pay for healthy foods, enabling them to purchase better quality and fresher fruit and vegetables. Recipients reported using it to mainly buy cow's milk, baby formula, fresh fruit and vegetables. Some also used it for other recommended items (e.g. eggs, pulses, and frozen or tinned fruit and vegetables). In addition, they mentioned using the BSFs card to buy a range of items not included on the recommended list (e.g. bread, pasta, fish, poultry and meat). They also used the BSFs card to buy some non-food items (e.g. nappies, baby toiletries and clothes).

Recipients also felt happy knowing they no longer had to pick the cheapest options if they did not want to. Since receiving the benefit, these participants could afford to buy less frozen and processed foods and replace it with fresh fruit and vegetables. Healthcare professionals that felt that Best Start Foods made a particular difference to their clients' ability to afford formula milk as it is more expensive in comparison to fruit and vegetables.

However, whilst participants generally felt that Best Start Foods had made healthy eating more affordable, opinions were varied on the different Best Start Foods payment values. Some felt the different payment values were suitable and understood that payments were higher when a child is born to help compensate for the cost of formula milk (though they did not know it was higher to also support breastfeeding mothers). However, others highlighted that their food expenses did not change as their child aged. Children became used to, for example, having fruit as a healthy snack and recipients found it difficult to adjust their shopping once their payment dropped. Both recipients and healthcare professionals felt that cutting the payment amounts in half when a child turns one would sacrifice the quality and the amount of fruit and vegetables that are bought.

Supports healthier shopping habits and meal planning

In the commissioned research, healthcare professionals and recipients reported that Best Start Foods has enabled families to make healthier food choices. Being able to afford to buy more fruit and vegetables encouraged participants to purchase healthier snacks, such as different types of fruit for their children instead of processed and unhealthy foods like crisps. Best Start Foods also had an impact on recipients' healthy eating in terms of trying new recipes. There were recipients who said that receiving Best Start Foods enabled them to experiment with preparing new types of meals in order to incorporate more fruit and vegetables into their children's diets. Healthcare professionals reported that families that had not previously eaten a lot of fruit and vegetables were excited about trying different healthy foods and new recipes as a result of receiving Best Start Foods.

Despite these positive changes, there were participants that perceived that receiving Best Start Foods had made no difference to the type of foods they purchased, their meal planning, or shopping habits. These recipients were already purchasing fruit, vegetables and milk prior to Best Start Foods and felt they were already eating healthily as a family. However, for some recipients, while they regularly bought milk, fruit and vegetables as part of their shopping, Best Start Foods enabled them to buy these healthy items in greater quantities.

Mothers and children eat more healthy foods

According to the commissioned research, in addition to being able to buy a greater quantity of healthy foods, Best Start Foods allowed participants the financial capacity to buy a wider range of fruits and vegetables for their children to try. Prior to receiving Best Start Foods this would not have been considered, as participants would not purchase foods that they were uncertain their children would enjoy or that they did not enjoy themselves. Their reasoning was that they could not afford to waste food or money if their children decided they did not want to eat it. Best Start Foods has therefore given recipients the financial freedom to ensure their own and their children's diets are varied as well as giving their children enjoyable experiences when trying new foods. Being able to afford a wider variety of foods was particularly beneficial for participants whose children had food intolerances, digestive problems or were fussy eaters as catering for them could be expensive.

Best Start Foods also allowed recipients to reconsider their own attitudes towards healthy eating. This was particularly the case for participants who did not eat a lot of fruit and vegetables when they were younger. Watching their children's excitement in trying new fruits and vegetables made recipients realise the importance of providing their children with a variety of healthy foods. This impact was also reflected by healthcare professionals, who reported having more discussions with families about their attitudes towards healthy eating. Best Start Foods had helped change their mindset and recipients were excited to share their own and their children's experiences of trying new fruit and vegetables with the healthcare professionals.

Reduced pressure on household finances

Client Survey respondents were asked to rate, on a scale of 0-10 ('not at all' to 'a lot'), how much their benefit payment helped them to to control their finances. The average score given by respondents who had only received Best Start Foods (n=86) was 6.5 out of 10. This figure indicates that the benefit generally helped people to control their finances, without necessarily having a transformative impact in all cases.

The commissioned research shows that, overall, Best Start Foods had helped to reduce pressure on household finances. Some recipients said that when finances were difficult they worried about not being able to buy food. As such, Best Start Foods provided reassurance they could buy essential foods for their children. In these circumstances the Best Start Foods card was described as a "safety net" or "lifesaver".

For some recipients the benefit also offered some relief in terms of other household expenses. It meant that families could focus on using their other income to pay for utilities and other family or household expenditure. In some cases Best Start Foods was considered a massive help in meeting the costs of their household expenses, and they considered the benefit to be a kind of financial lifeline. Healthcare professionals recalled recipients telling them that Best Start Foods had been their only source of income between receiving Universal Credit payments.

Some relied on Best Start Foods to a lesser extent, and used the card only when they were running particularly low financially. In these instances, healthcare professionals believed that Best Start Foods was useful in providing families with additional income but that it was not necessarily life altering. For some households, Best Start Foods enabled them to set aside money, in some cases for the first time, that would have previously been spent on food and used it to buy other items for their children (e.g. clothes or art supplies). However, when the payment dropped after their child turned one, recipients reported finding it harder to redirect funds in the same way.

Finally, while recipients were appreciative of the financial support offered by Best Start Foods, they felt the impact would be even greater if eligibility for Best Start Foods was extended until their child starts school. Participants shared that their personal circumstances meant that they would find it difficult to cover the costs of nutritious food after Best Start Foods came to an end.

Achievement against medium-term policy outcomes

This section evaluates Best Start Foods against the following policy outcomes:

• Reduced incidence of food insecurity
• Increased healthy eating behaviours
• Improved health and wellbeing for children and mothers

It uses data from bespoke commissioned research. However, a full evaluation against these outcomes would require: (a) more time to have passed since the benefit was implemented, and (b) access to more robust quantitative data.

Reduced incidence of food insecurity

As mentioned earlier in the findings section, Client Survey respondents who received Best Start Foods gave the benefit an average score of 6.7 out of 10 when asked if it helped them to pay for what they needed (where 0 is not at all and 10 is a lot). This could be viewed as an indirect way to assess whether Best Start Foods has reduced food insecurity. The score indicates that the benefit has generally helped people to pay for what they need, but that this is not necessarily the case for everyone all of the time.

Also discussed previously, the commissioned research shows that Best Start Foods has helped recipients to access a greater quantity (and a wider range) of healthy foods. Additionally, some recipients said that they worried about being able to pay for food when their finances were difficult, and that Best Start Foods had provided reassurance that they could always buy essential food for their children. This evidence also suggests that the benefit may have helped to reduce food insecurity. However, the testimony of recipients and healthcare professionals also indicates that when the payment amount drops (i.e. when eligibile children turn 1) it has a negative impact on the quality and the amount of fruit and vegetables that families can buy.

Increased healthy eating behaviours

The commissioned research indicates that Best Start Foods has led to increased healthy eating behaviours. As discussed earlier in the findings section, the benefit has allowed recipients to (a) purchase a greater quantity and quality of healthy foods, (b) experiment with preparing new types of meals in order to incorporate more fruit and vegetables into their children's diets, and (c) ensure their own and their children's diets are varied, as a result of having less financial constraints.

Improved health and wellbeing for children and mothers

In the commissioned research, participants reported a number of positive ways Best Start Foods had impacted on their children's health and wellbeing. Firstly, they observed their children eating more and a greater variety of fruits and vegetables. This was viewed positively as fruit and vegetables are good for them nutritionally and support their development. Best Start Foods also had a positive impact on how recipients felt about providing for their family. They reflected on a desire to provide their children with the nutrients they needed and were pleased that they could accomplish this with the Best Start Foods card.

Recipients also experienced reduced levels of stress and anxiety in relation to finances as a result of receiving the Best Start Foods card. It had given participants a sense of relief knowing they could use it to buy healthy foods for their families. This freed up their own money to pay for other household bills or purchase essential non-food items. They also expressed relief as Best Start Foods enabled recipients to be financially independent, whereas they previously had to ask for support from other family members. This was reiterated by healthcare professionals who observed that their recipients were less burdened by financial worries. Healthcare professionals were pleased to see the positive impact Best Start Foods was having on the health and wellbeing of families as a preoccupation with finances could impact the relationship they had with their children.

The practical use of a prepaid card was also discussed as having an impact on the mental wellbeing of Best Start Foods recipients. Participants who had previously received Healthy Start Vouchers reported a positive impact on how they felt when it was replaced with Best Start Foods. They shared that they felt less anxious or self-conscious going into shops compared to when they received Healthy Start Vouchers. Additionally, participants that experienced mental health problems appreciate the option to use the card online, which for some was seen as more convenient and comfortable.

Evidence of progress towards long-term outcomes for children and their families

As set out in the Tackling Child Poverty Delivery Plan^[2]and Scotland's healthy weight and diet delivery plan^[3], the Scottish Government has been delivering support for families and children which is intended to contribute to the following long-term government outcomes:

• Reduced health inequalities
• Reduced child poverty

Best Start Foods will make an important contribution towards these targets. However, it will not play an exclusive role. Measuring the impact of Best Start Foods would also require (a) suitable time to have passed since the benefit was introduced, and (b) access to more robust and suitable quantitative data than is currently available. It should also be noted, however, that isolating the specific role of Best Start Foods would be challenging even with additional data.

Nevertheless, the Scottish Government does publish child poverty statistics, which can be used to monitor general progress towards its stated targets. In addition, it can be reasonably expected that success against Best Start Foods' immediate, short-term, and medium-term policy outcomes could contribute to the Scottish Government achieving its long-term outcomes. Based on the evidence presented in this report, the following summary of progress can be made.

Progress towards immediate outcomes

• Best Start Foods is claimed by people (predominantly women) from across Scotland who possess a wide range demographic characteristics.
• As of June 2021, it was estimated that a majority of eligible people had claimed the benefit. However, almost 1 in 4 eligible people had not taken it up.
• People find out about Best Start Foods via a range of sources, including paid advertising. However, there is a perception that there are families, healthcare professionals and retailers who have little or no awareness of the benefit.
• Some people do not realise Best Start Foods is part of a joint application with other benefits, and only find out about the benefit when they receive a decision letter on their claim. Some people also do not realise Best Start Foods payments will stop when their child turns 3.
• The purpose of Best Start Foods is well-understood, and guidance on using the card is generally felt to be clear and informative. However, there are perceived issues with the guidance information e.g. that it does not provide a fuller list of participating retailers, or it is not clear that it comes in other languages.
• Most find the application form easy and quick to complete. However, some need support to apply e.g. due to poor literacy skills or not being able to read English.
• Most feel well treated by Social Security Scotland, and report positive interactions with staff.
• While most feel their application is processed in a reasonable timeframe, processing times have increased each year. Also with regards to the application process:
  • Recipients sometimes experience long waiting times when trying to phone Social Security Scotland about their application progress
  • Some receive multiple requests for the same supporting information for their application
  • There is a perception that outcome letters do not provide a clear explanation for application decisions in cases where applications are denied.
• People feel less stigma using the Best Start Foods card compared with the former Healthy Start Vouchers scheme. Recipients and retailers also feel the card system is more convenient. However, some people experience technical issues with cards e.g. contactless payments not working.
• It is felt that Best Start Foods can be used in a wider range of retailers than Healthy Start Vouchers. However, there is a lack of awareness that Best Start Foods can be used online, and uncertainty about how online shopping would work with the card.
• There are contrasting views over the range of recommended foods that can be purchased with the card. While some recipients feel it is appropriate, others feel it could be expanded to include other items e.g. meat, wholegrains and fish.

Progress towards short-term outcomes

• Best Start Foods helps people to buy more (and better quality) healthy foods. However, some recipients and healthcare professionals feel that cutting the payment amount in half when a child turns 1 can sacrifice the quality and the amount of fruit and vegetables that are bought.
• Best Start Foods supports healthier shopping habits and meal planning. For example, it encourages recipients to buy healthier snacks for their children, and to prepare new meals which incorporate more fruit and vegetables into their children's diets. Healthcare professionals report that families are excited about trying different healthy foods since receiving the payments.
• Best Start Foods lets recipients try new foods and provide a more varied diet for their children, with less fear of wasting food or money. The benefit also encourages recipients to reconsider their own attitudes towards healthy eating.
• The benefit has generally reduced financial pressure on households. For some it is a 'lifesaver', assuring them that they can always provide essential food for their children when finances are difficult. It allows some recipients to focus their remaining income on other expenses (e.g. utilities or clothes for their children). However, some recipients are less reliant on the benefit.
• There is a feeling amongst recipients and healthcare professionals that the impact of Best Start Foods would be greater if payments extended until children start school.

Progress towards medium-term outcomes

Medium-term outcomes cannot be fully evaluated until (a) more time has passed since Best Start Foods was implemented and (b) more robust quantitative data has been obtained. However, the following summary can be made based on existing evidence:

• Best Start Foods has allowed recipients to buy more healthy foods, and reassures them that they can always afford essential foods for their children. It is therefore likely it has led to reduced incidence of food insecurity.
• Payments have allowed people to spend more on healthy foods, buy children healthier snacks, and experiment with new healthy recipes. It is therefore likely that Best Start Foods has led to increased healthy eating behaviours.
• Recipients feel that their children's health and wellbeing has improved as a result of eating a more nutritious diet. It is therefore likely that Best Start Foods has led to improved health and wellbeing for children and mothers. Recipients also report:
• o Feeling positive that they can provide healthy foods for their children,
• o Less anxiety and stress over their financial situation
• o Less self-conscious using the payment card compared to vouchers.

This summary shows that positive progress has been made against immediate and short-term Best Start Foods outcomes. It also indicates that positive steps have been made towards its medium-term outcomes. In combination, it can be reasonably assumed that Best Start Foods is making some contribution towards the Scottish Government's long-term aims for children and families.

However, the evaluation has also highlighted that there are some outstanding issues with the benefit. Implications are discussed in the conclusion chapter below.