Healthy Start: A Scheme in Crisis, A Call for Innovation

One of the most important innovation concepts I learned at Amazon was the idea of the ‘mechanism.’ A mechanism helps you do things faster and better than before; they are the engines that unlock new value. It’s not a process, it’s not a KPI. It’s a living system that needs to be cultivated, managed, and monitored. When things go wrong, the mechanism requires careful, deliberate interventions to repair what is broken. When you design a mechanism, you are held accountable for its performance. You need to understand every aspect and risk involved. You measure the outcomes in terms of actual value achieved, not through proxy KPIs.

Thinking in terms of mechanisms was new to me. Over my career, I’ve designed and adjusted many processes, monitored countless KPIs, and mitigated negative outcomes from existing ways of working. This often meant I became both the engineer and the engine. But I learnt that with mechanisms, you design something that runs by itself—until something goes wrong. And when things go wrong you have a plan there to fix it. Amazon’s success lies in the mechanisms it designs and, most importantly, the people who design them. So, I’ve been asking myself this question: when it comes to helping people struggling with the cost of living crisis, ‘where are the mechanisms to better support them?’

Take, for example, the Government’s ‘Healthy Start’ scheme. This program is designed to help young families struggling with the costs of adequately feeding their infants and babies. It’s a restrictive scheme, available only to households earning less than £408 per month. Tragically, this much-needed mechanism was neglected under the previous Government, with no adjustments made for the inflationary crisis between 2022 and 2023. As a result, families in poverty receive just £4.25 per child per week. By my calculation, that’s barely enough to cover two days’ worth of powdered milk for babies in families where breastfeeding is not an option.

Even worse, enrolment in the scheme lags far behind eligibility. In London, less than 50% of the families who qualify for this support are accessing it. Nationally, enrolment rarely exceeds 65%. A 2023 report conducted by Which? estimates that low take-up of the Healthy Start scheme leaves at least £45 million a year in unclaimed support for families with young children in England, Wales, and Northern Ireland. This is money that could help millions of families struggling to put food on the table.

The Healthy Start scheme is the UK’s approach for ensuring the most vulnerable children and babies receive sufficient calories and nutrition. And it is failing. This isn’t a problem of economics or incentives; it’s a failure to adapt and to reimagine new possibilities. 

So, let’s imagine we apply the concept of mechanisms to Healthy Start. What would this look like? How might we avoid designing a scheme that prioritizes mitigating financial risk to the government over improving enrolment, availability, and affordability? Where would the win-win scenarios come from?

A 2023 Which? report estimates that £45m of infant food support goes unclaimed each year in the UK

Clearly, an additional £45 million would be meaningful to retailers and brands. The essential nourishing milk and food reaching children is a win for society. It’s also a win for the NHS, reducing downstream costs related to poor health outcomes. But this should only be the starting point for such a system. With better mechanisms in place, we could go beyond the basics. Imagine leveraging the data generated by such a scheme to create actionable insights—insights that enable targeted interventions, improve resource allocation, and ensure every family experiencing food insecurity receives the support they need. This kind of mechanism wouldn’t just address the symptoms of food poverty; it could actively work to eradicate its root causes and help all families nourish their infants with dignity and ease.

At Change Box, we have taken a hard look at the food security landscape. We’re experimenting with mechanisms to find what works and unlock win-win scenarios that improve the lives of the most vulnerable. We believe that new, improved, and innovative mechanisms don’t need to cost millions to taxpayers. They simply require ownership, action, and intention.

Curious to learn more about what we’re doing at Change Box? Connect with us at hello@change-box.net.