Health Select Committee inquiry – Impact of the Comprehensive Spending Review

Written evidence submitted by the School and Nursery Milk Alliance – January 2016
About the School and Nursery Milk Alliance
1.1 The School and Nursery Milk Alliance is a coalition of organisations from the health, education and dairy sectors, which works to maximise the health benefits that children get from drinking milk in schools and nurseries. The Alliance represents over 90% of the suppliers of milk to educational settings. It also includes representation from the NFU, Dairy UK, and the Dairy Council.
1.2 The Alliance works to ensure that all children to have access to free or subsidised milk in educational settings. Positive public health messaging on milk – delivered by government, local authorities, industry and others – is an important factor in influencing schools and parents to get their children to drink milk, and for encouraging children to want to drink milk themselves. It is an excellent alternative to less healthy options such as fruit juice and carbonated drinks. The promotion and consumption of milk in school helps children to make better dietary choices outside of school.
1.3 Increased consumption of milk can contribute to the objectives in the NHS England Five Year Forward View to improve public health and prevent illnesses. Milk contains the nutrients and vitamins required to develop strong teeth and good oral health, helping to prevent increasingly common, costly and largely preventable admissions for tooth decay. It also forms part of a healthy diet, and its high satiety effect means that it keeps children feeling full for longer. Milk’s refreshing nature and good energy content makes it ideal as a mid-morning snack, enabling children to play and learn throughout the day.
1.4 Children under the age of five can receive free milk daily through the Department of Health’s Nursery Milk Scheme. Children in primary school can receive subsidised milk through the European School Milk Scheme, administered by Defra. All schools, with the exception of academies established between September 2010 and June 2014, are required to make milk available during the school day as part of the School Food Standards.
1.5 This submission argues that the 3.9% reduction in the public health budget over five years, announced in the Spending Review, is likely to negatively impact on the ability of Public Health England and local authorities to take forward their functions required to deliver Five Year Forward View. It outlines that restricted budgets will most likely inhibit both bodies from delivering sufficient messaging on milk – which has multiple health benefits for children – therefore undermining the first statement in the Five Year Forward View to deliver a “radical upgrade in prevention and public health”. The knock-on effect of this will be increased intervention costs, which will be counter-productive for the Five Year Forward View’s objective to address the £30 billion resource gap by 2020.
Reduction in the public health budget: the impact on the Five Year Forward View’s ambitions
2.10 The Spending Review outlined that the public health system will be required to deliver “average real-term savings of 3.9% over the next five years”, with the ring-fence on public health spending now due to expire from 2018-19 onwards[1]. This means that organisations responsible for developing and delivering public health messaging – most notably Public Health England (through its policy reports and Change4Life campaign), as well as local authorities (through local initiatives) – will have less money available to take forward these activities. These campaigns tend to be broadly positive about milk, encouraging an increase in consumption amongst children so that they can enjoy the health benefits.
2.11 The Alliance believes that a reduction in public health messaging could lead to children missing out on the health benefits of milk, primarily those relating to the prevention of childhood obesity and improvements to oral health. As noted in the Five Year Forward View, the previous failure to tackle preventable conditions like obesity and tooth decay has already cost the NHS significant amounts of money[2]. This is likely to continue unless there is an increased focus on public health interventions, such as better messaging on products like milk.
Obesity in childhood – the role of milk
2.20 Cow’s milk can play a useful role in helping to tackle childhood obesity, given that it is a natural option for children, enabling them to develop a good understanding of food and good eating habits. Its promotion and consumption in schools in particular can lead to children making better choices outside of schools – particularly given alternatives like fruit juice and carbonated drinks. In turn, this contributes towards a reduction in obesity rates later in life.
2.21 Government messaging on the benefits of milk should be better resourced rather than reduced, as is likely to happen as a result of the Spending Review.  The Five Year Forward View establishes the extent of the childhood obesity crisis, by noting that: “even more shockingly, the number of obese children doubles while children are at primary school. Fewer than one-in-ten children are obese when they enter reception class. By the time they’re in Year Six, nearly one-in-five are then obese”. NHS England chief executive Simon Stevens also identified tackling obesity as one his main priorities over the next five years. Stevens said that “one in 10 children when they start primary school are obese. When they leave primary school, one in five are obese. So something’s going seriously wrong with how we’re helping our kids with their future health and wellbeing, and a focus particularly on school-age kids will be important”.
2.22 The latest figures from the National Child Measurement Programme (NCMP), published in November 2015, showed that the prevalence of obese year 6 children (aged 10 to 11 years old) has increased to 19.1%, with the prevelance of children both overweight and obese also increasing to 33.2% - both of these figures are higher than when the Health and Social Care Information Centre (HSCIC) first started recording this data in 2006-2007 (17.5% and 31.6%)[3].
2.2.3 Investment in public health spending would yield significant financial savings, given the financial costs of obesity. The Health Select Committee’s November 2015 report into childhood obesity outlines that treating obesity and its consequences alone currently costs the NHS £5.1 billion ever year, with type 2 diabetes costing £8.8 billion a year and the wider economic cost being £27 billion[4]. However, it notes that the UK only spends around £638 million a year on obesity prevention programmes – with the Change4Life campaign costing £10.9 million in 2013/14[5].
2.2.4 The Five Year Forward View notes that Public Health England sets out priorities for tackling obesity and ensuring children get the best start in life, and that it will “support these priorities and work to deliver them”. It also outlines that: “local authorities now have a statutory responsibility for improving the health of their people, and councils and elected mayors can make an important impact”. Public Health England’s Change4Life programme recognises that if children learn basic food and nutrition principles early on and are introduced to a healthy and balanced diet, they will continue to eat sensibly as they grow older and become more independent.
Oral health and tackling tooth decay
2.3.0 Increased investment in public health messaging on milk is likely to also lead to improvements in oral health and reductions in admissions for tooth decay in the under tens.
2.3.1 Tooth decay is now one of the biggest health problems facing children in England. The 2013 Children’s Dental Health Survey, commissioned by Health and Social Care Information Centre and published in March 2015, found that 31% of five year olds and 46% of eight year olds had obvious dental decay in their primary teeth[6]. The survey also found that untreated decay into dentine in primary teeth was found in 28% of five year olds and 39% of eight year olds. A 2015 report by the Royal College of Surgeons’ (RCS) Faculty of Dental Surgery found that the NHS spent £30 million on hospital-based tooth extractions for children aged 18 years and under in 2012-13[7].
2.3.2 The RCS report also found that 46,500 children and young people under 19 were admitted to hospital for a primary diagnosis of dental caries in 2013-14. These numbers were highest in the five to nine year age group, which showed a 14% increase between 2010-11 and 2013-14, from 22,574 and 25,812. Dental caries are “by far” the most common reason for children aged five to nine being admitted to hospital, ahead of tonsillitis with approximately 11,500 admissions in 2013-14.
2.3.3 Milk can play an important role in supporting the Five Year Forward View’s ambition to prevent these illnesses from occurring in the first place.  A portion of semi-skimmed milk contains the following percentages of the reference nutrient intake for children aged 4-6: 8% retinol (vitamin A); 8% thiamin (vitamin B1); 59% riboflavin (vitamin B2); 10% niacin (vitamin B3); 13% vitamin B6; 17% folate (vitamin B9); 213% vitamin B12; 13% vitamin C; 17% magnesium; and 12% zinc[8]. A food factsheet by the British Dietetic Association, hosted by the NHS, outlines that children aged 1-3 require 350mg of calcium per day, with children aged 4-6 requiring 450mg a day.[9] The factsheet also notes that a 1/3rd pint of a milk – the standard serving for children under five – contains 240mg per serving.
2.3.4 Vitamins and minerals have a diverse range of functions which in general keep people healthy, particularly their teeth, bones, skin and immune system. Calcium is particularly important as it is used in tooth development, as well as vitamin B3 (niacin), which protects against bad breath and canker sores, and vitamin B12 and B2 (riboflavin), which helps prevent mouth sores[10]. An inadequate level of Vitamin C can also lead to bleeding gums[11].
Moving forward: recommended policy changes
3.1 The Health Select Committee should recognise that reductions to the public health budget outlined in the Spending Review will undermine the objective in NHS England’s Five Year Forward View to deliver a “radical upgrade in and prevention and public health”. Both of the main bodies responsible for public health functions – Public Health England and local authorities – will have less money available to carry out campaigns and messaging of the magnitude required to deliver this objective.
3.2 This means that there will be less frequent and effective promotion of products like milk, which are healthy, natural and full of nutrients. Milk in particular forms part of a healthy diet, and its high satiety effect means that it keeps children feeling full for longer. When consumed as a mid-morning snack, it gives children the energy to focus and play later in the day. Milk also contains a plethora of nutrients which help form strong teeth, which help guard against common, costly and preventable conditions like tooth decay.
3.3 Failure to adequately promote the consumption of products like milk will contribute to an increased burden of preventable illnesses like obesity and tooth decay, thereby working against what the Five Year Forward View is trying to achieve. In turn, this will lead to increased short-term costs (continued high admissions for tooth decay) and long-term costs (the management of obesity in children and adults).
3.4 The Alliance believes that the Health Select Committee should:
  • Call for the ring-fencing of the public health budget to be extended beyond 2017-18.
  • Call for an increase to the public health budget, specifically for prevention campaigns on conditions like obesity, to support the Five Year Forward View.
  • Recognise the role that milk can play in tackling tooth decay and obesity.
1 HM Treasury (2015) Spending Review and Autumn Statement 2015. Available at Last accessed 13th January 2015
2 NHS England (2014) Five Year Forward View. Available at
3 Health and Social Care Information Centre (2015) “National Child Measurement Programme: England, 2014/15 school year. Available at: Last accessed 13th January 2015
4 Health Select Committee (2015) Childhood obesity - brave and bold action. Available at: Last accessed 13th January 2015
5 Public Health England (2013) “Marketing Plan 2013-14”. Available at:  Last accessed 13th January 2015
6 Health and Social Care Information Centre (2015) “Child Dental Health Survey 2013, England, Wales and Northern Ireland” Available: Last accessed 13th January 2015
7 Royal College of Surgeons: Faculty of Dental Surgery (2015) “The state of children’s oral health in England”. Available at: Last accessed 13th January 2015
8 Nutritional Components in Milk. Available: Last accessed 13th January 2015
9 British Dietetic Association (2014). Food Fact Sheet: Calcium. Available:  Last accessed 13th January 2015
10 Academy of General Dentistry. (2012). Why Are Minerals and Nutrients Important for Oral Health? Available: Last accessed 13th January 2015.
11 Ibid
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