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Children’s Health: Access to Milk

Volume 624: debated on Tuesday 28 March 2017

I beg to move,

That this House has considered children’s health and access to milk in educational settings.

It is a great honour to speak under your chairmanship, Mrs Gillan. School milk is an issue that cuts across three Departments—the Department of Health, the Department for Environment, Food and Rural Affairs, and the Department for Education—but I am glad that the Minister for Vulnerable Children and Families is here today to respond to the debate.

I want to highlight the importance of school milk because it is fundamental to children’s health and is a nutritious source of energy during the school day. I thank the School and Nursery Milk Alliance for all its good work and for the information it has supplied for the debate. I am also grateful to Tetra Pak for sharing with me a copy of its forthcoming report, “Making More of Milk”, which will be formally launched on 5 April and which contains information particularly pertinent to the debate.

Milk has been an important part of our diet for hundreds of years. It is a natural healthy option for children that contains vitamins and minerals vital for good dental health and bone development. It also plays a key role in a healthy diet, helping efforts against childhood obesity and dental decay.

The Health Secretary has identified childhood obesity as a public health priority. It is estimated that 29.2% of children between the ages of two and 10 in England are either overweight or obese. Excess weight during childhood often precedes the development of cardiovascular disease, hypertension, insulin resistance and other diseases. Overweight and obese children are more prone to become obese adults.

The latest data from the Health and Social Care Information Centre show that 34% of 12-year-olds and 46% of 15-year-olds exhibit tooth decay. As well as being unpleasant for children, treating tooth decay is a significant cost to the NHS. Cow’s milk contains micronutrients, such as calcium and vitamins B3, B12 and B2, that reduce the risk of tooth decay, bleeding gums and mouth sores.

Statistics released only last week by the faculty of dental surgery at the Royal College of Surgeons showed that more than 9,000 tooth extractions were performed on young children last year, including 47 extractions performed on babies under one year old. The dean of the faculty, Professor Hunt, described the figures as “shocking” and as attributable to the amount of sugar that children consume. Sadly, although the figures were widely reported in the media and although the new soft drinks levy will exclude milk products that contain at least 75% milk, there was no mention of the fact that drinking milk as a healthy alternative to sugary drinks can help children to develop strong teeth.

In 2016, Northumbria University published a review of the available research on the impact of milk on children’s development. The evidence reviewed by the researchers suggested that milk consumption greatly improves children’s nutritional status. The review, which was drawn primarily from cross-sectional studies, reported that children who regularly drink milk have lower body mass indices, lower body fat percentages and lower waist circumferences than children who rarely drink it. That is probably due to the unique combination of essential nutrients that it contains. In particular, the evidence suggests that milk contributes to body mass control and body composition in children—possibly because of the high satiety effect, which makes it an ideal mid-morning snack—and contains multiple nutritional properties that protect against dental decay and promote good dental health.

The nursery milk scheme was subject to a lengthy consultation during the last Parliament about whether it could be made more cost-effective, possibly by giving a single large company the contract to provide milk to all settings across the country. The scheme was left in place untouched, but the problem with it is that children are no longer entitled to milk once they turn five, whenever in their reception year that happens. This confusing system not only creates extra work for teachers but seems very unfair on little children. Tetra Pak’s “Making More of Milk” report has found that 89% of parents and 93% of teachers think that school milk should be made available to all reception children, regardless of when they turn five. Will the Minister commit to changing the scheme and making free school milk available for all reception children?

The Government have given assurances that until we leave the EU we will continue to participate in the European school milk scheme, through which over-fives can receive a subsidised portion of milk, but schools and parents need to know the Government’s plans for the future. Can the Minister offer us any further information or assurances about the future of subsidised school milk for children over five?

Another worrying factor is that Public Health England’s “Eatwell Guide”, which was published in March 2016, reduced the content of milk and dairy products in the recommended daily diet from 15% to 8%. Although the guidance includes recommendations of healthier drinks for the first time, the reduced role of milk and dairy products could limit alternatives for children and young people who are unwilling to drink water or unsweetened beverages.

I congratulate the hon. Lady on securing this debate and on highlighting the many health benefits of drinking milk. I represent a constituency that produces a great deal of milk. It is fantastic to see her advocating those health benefits; I hope that the Government will listen and, more generally, that people around the country will realise that the more milk they drink, the healthier they will be.

I thank the hon. Gentleman for his intervention. He expresses a sentiment that will be shared by many people around the country.

Milk can play a role in keeping children hydrated. The British Nutrition Foundation’s healthy hydration advice for children puts milk second only to water as a drink that they should consume. Although greens are important in everyone’s diet, it is worth knowing that a 200 ml glass of milk provides the same calcium as 63 Brussels sprouts or 11 servings of broccoli—quite a thought.

The “Eatwell Guide” caused great concern among stakeholders in the dairy industry, who did not feel that they had been properly consulted during its development. Although Public Health England published information last December on the process of developing the guide, it did not make it clear why the recommendations to reduce the level of dairy were introduced. Can the Minister offer reassurances that the new guide will not discourage children from drinking milk? Will he commit to involving the full range of stakeholders next time any important public health guidance is being revised?

Finally, I would like to raise the issue of school food standards. The school milk sector was broadly positive about their introduction in January 2015, but the School and Nursery Milk Alliance has highlighted the fact that there is no clear evaluation or monitoring of them. To ensure that we make the most of the standards, schools not only need to provide milk, they need to provide it in a way that is appealing to children and that encourages them to drink it. Does the Department for Education have any plans to evaluate the implementation and impact of the standards?

Today, school milk tends to be chilled and served in individual cartons—a big contrast to the warm milk that some MPs may remember from their childhood—but there are other factors that affect whether children want to drink it. For example, milk is more appealing at the mid-morning break than at lunchtime, because its high satiety effect means that it does not make a good accompaniment to a meal. A mid-morning break is also a good time to have a healthy snack, to help children to get through until lunch, particularly if they did not eat a proper breakfast.

Evidence shows that many children drink only skimmed or semi-skimmed milk at home, so if they are given full-fat milk at school, they tend not to like the taste. The school food standards will be revised as part of the childhood obesity plan and it is important that the requirement to provide milk is retained. Can the Minister provide any details about the plans to update the standards as part of the childhood obesity plan? As part of the childhood obesity plan, a new health rating scheme for primary schools will be introduced in September this year. It would be helpful if it covered access to milk in schools, including how it is offered to children. Will milk be included at least once a day?

Ofsted is also planning to produce guidance for schools following its thematic review of obesity, healthy eating and physical activity in schools. It would be helpful for this guidance to include information on milk, including best practice on how to serve it. Academies established between June 2010 and September 2014 are not required to implement the school food standards, although we understand that many of them do so voluntarily. Are there are any plans to make compliance compulsory for all schools?

There are a wide range of issues impacting on school milk today. I look forward to hearing the Minister’s response to this debate. As these issues cut across a number of Departments, I hope he will be able to tell us how they are working together to ensure that children are able to access milk in schools for the benefit of their health, for now and for their lifetime.

As ever, Mrs Gillan, it is an absolute pleasure to serve under your chairmanship.

I begin, in the customary way, by congratulating the hon. Member for North Tyneside (Mary Glindon) on securing this debate. It goes without saying that, like her, we want to ensure that all pupils are healthy and well-nourished. To that end, we promote and encourage a healthy, balanced diet and healthy life choices, through school funding, legislation and guidance—the tools at our disposal. We use our legislative frameworks, such as the school food standards, to ensure that children receive a healthy, balanced diet within all educational settings.

We know, of course, that most adults and children in the United Kingdom eat too much sugar. That is why the Government recommend that we reduce our intake by eating fewer sugary foods and drinks, such as sweets, cakes and biscuits. We also know that the earlier that eating and drinking habits are ingrained, the harder it is to disrupt them and put people on a different dietary path in the future.

It is in such a context that this debate is timely, as it gives me the opportunity to explain how we are promoting a healthy, balanced diet and milk consumption within educational settings, particularly among those children who are most in need. For example, children under the age of five who attend a day care or early years setting receive milk via the nursery milk scheme, which the hon. Lady referred to. That scheme is funded by the Department of Health, so it is a cross-Government scheme, but we work together to ensure that it reaches the children who need it most. It has actually been in existence since the 1940s, so it is a very well-established route to ensure that those children who perhaps would not enjoy that level of milk consumption at the early age they need it are able to do so.

Indeed, I suspect that I was a beneficiary of that scheme in the 1970s, believe it or not, when I was at Mrs Batsen’s nursery in Wilmslow, where—from memory—I was first faced with the reality of needing to learn to share with others and not just think about myself. I was very excited on the day I was asked to be the milk monitor. The job was to go downstairs with another child—my fellow milk monitor—to collect a crate of small milk bottles for distribution upstairs among our peers. Now, we knew that there were two children absent that day, so we concocted a plan to drink two of the bottles downstairs and then bring the remaining bottles upstairs, where we would then be able to consume another bottle, knowing that there should be two bottles spare. Unfortunately, the plan did not turn out to be the grand plan that we had hoped it would be, as a number of bottles had already been taken out of the crate by the staff, who recognised that they needed to reduce the number of bottles to reflect the level of attendance. So we were caught red-handed and I was never made milk monitor again.

Consequently, when I visited Beechwood school in my constituency in 2011, on what was World School Milk Day, it was something of a surprise to be made an honorary milk monitor. That gave me an opportunity to reflect on the role that milk has played in my life, both in learning life lessons and in being able to access what is an important part of a healthy diet in those formative years as we grow up.

That is why the Government promote a healthy, balanced diet to children, using legislative frameworks such as the school food standards. Those standards, which apply to the overwhelming majority of maintained schools as well as to maintained nurseries, restrict the amount of fat, sugar and salt that can be served during the day. I heard what the hon. Lady said about the fact that there are some academies formed between September 2010 and 2014 to which those school food standards do not apply. We encourage those schools to follow the standards, but of course we keep this matter under review and in the future we will look to see how we can ensure a greater level of engagement with those standards, as they reflect exactly what we want to see happen in schools for the good of children.

The benefits of providing a healthy school meal and milk to the most disadvantaged children are well-recognised. Currently, around 1.15 million of the most disadvantaged children are eligible for and claim a free and nutritious meal. As for milk specifically, we promote its consumption as part of a healthy, balanced diet through funding, legislation and guidance.

Why do we do that? As the hon. Lady rightly highlighted, we know that milk is excellent for children’s growth and development, which is why the school food standards require lower-fat or lactose-reduced milk to be available for children who want it during school hours, and it is offered free to disadvantaged pupils. We also provide significant funding to schools to support the provision of milk, through the European Union, which I will move on to in a moment, as well as through top-up and nursery milk schemes, as part of free school meals, and more recently through universal infant free school meals, which benefit 1.4 million infants.

The hon. Lady made it clear that we have continued our commitments to the European Union scheme during our period of membership of the EU. Of course, like all areas of policy that will be moving into a domestic arena, we will carefully consider how we will continue to support schools, so that we can fulfil our obligation to provide children with a healthy and balanced diet. I cannot say at this stage where that consideration will lead us, but the fact that we can go back to the 1940s to see how Governments have provided help and support in this area is an indication of where we may want to take the evidence in future, when we come to make those decisions in a few years’ time.

Notably, we provide around £60 million each year, outside the EU arrangement, to reimburse costs for the nursery milk scheme, which is targeted at children under the age of five, to ensure that they get the important nutrients they need in those important years of development.

The hon. Lady asked about the over-fives who are still at nursery school. I will look carefully at what she said and discuss it with my ministerial colleagues. However, it is worth pointing out that over-fives who are entitled to receive a free school meal do so, and where they are entitled to a free meal they also receive free milk. Also, under the universal infant free school meals scheme that I referred to a few moments ago, free milk is available to infants if it is served as part of their lunch. We will look at the impact that is having as part of our consideration of where we go next with our commitment in this area.

I thank the Minister for giving way, and it was very entertaining to hear about his time as a milk monitor. I just wanted to emphasise the issue of children having free milk throughout reception, rather than the current situation, where a child stops getting free milk the moment they are five, even though they will obviously be in a class with other children who are younger than they are. That is the point I want to emphasise. If free milk could be guaranteed to children while they are in a reception class, it would make life a lot easier for the teachers and it would seem fairer to the little children themselves.

As I have said, I will look carefully at what the hon. Lady has said, but there are a number of routes that I have described whereby children over the age of five in a nursery setting are able to access free milk, whether that is through free school meals or universal infant free school meals. There will be a continuation of the policy in the deliberations by different Government Departments about where it goes next, and clearly that issue will be part of future discussions.

The scheme we support—the nursery milk scheme—has extensive reach, providing milk to 1.5 million children, and it should not be forgotten that it saves families about £400 a year and ensures regular milk consumption. Because milk is a valuable source of a range of nutrients, including calcium, protein and B vitamins, the Government recommend the consumption of lower-fat milks for the general population aged over five years, and promote that through the “Eatwell Guide” the nation’s food model and the Change4Life social marketing campaign, which recommends swapping sugary drinks for water, lower-fat milks, and diet, sugar-free or no-added-sugar drinks. The “Eatwell Guide” has been distributed to all primary, secondary and independent schools in England. I hear what the hon. Lady says about the guide and the advice, but the advice was set after a review of all the evidence, including the recommendations of the Scientific Advisory Committee on Nutrition on the basis of a full public consultation. The intention is absolutely not to discourage children from drinking milk but to encourage them to do so as part of a healthy, balanced diet. That important message should be taken away from the debate.

I turn to the early years foundation stage framework, which sets out the regulatory standards for all early years providers. The framework requires early years settings to

“promote the good health of children attending the setting”,

and to provide meals, snacks and drinks that are “healthy, balanced and nutritious”. About 40,000 childcare settings are currently registered with the nursery milk scheme in their fulfilment of that responsibility. Such settings must also help children to make healthy food and drink choices, so that they can formulate healthy lifestyle habits early on. In line with our commitment in the childhood obesity plan, we will publish and promote example menus for early years settings in England, to help them meet the latest Government dietary recommendations. I am sure that the hon. Lady will be interested in looking at those.

We are also committed to improving young children’s oral health. That is a Public Health England priority, and it has established a child oral health improvement programme board, with a substantial programme of work and a wide range of partners, to improve the oral health of children under the age of five. In fact, only a few months ago, in December, Public Health England and the Department for Education—another example of cross-Government working—published a toolkit for early years providers, to support those considering setting up a supervised teeth-brushing scheme. In addition, Government measures to reduce sugar consumption, as set out in the childhood obesity plan, are designed to have a positive effect, and they include the soft drinks industry levy announced last year and wider measures to reduce sugar in food and drink products.

Although it is encouraging that the data published by Public Health England show that over the past two years the number of tooth extractions for children in hospital has reduced, there is no let-up in doing all we can to improve children’s oral health. Public Health England and the National Institute for Health and Care Excellence have published evidence-based guidance and toolkits to support local authorities, and NHS England is also working up plans to test, in 10 high-need areas, more creative ways of using commissioning expenditure to improve children’s oral health. I understand that those areas will be announced shortly. The Department of Health is working with NHS England to test the NHS dental contract focus on improving oral health, particularly in children.

This is about promoting not just milk but other physical activity that can be undertaken by children, at home or at school, to support a healthy, balanced diet. As part of the work to tackle childhood obesity, we are also committed to updating the school food standards, to align them with the latest scientific advice on sugar. We are in the process of scoping out the timeliness of that work, and I hope further information will be available later in the year. We will take into account the hon. Lady’s points about who the standards apply to and will ensure that the standards best reflect what we know works for children in instilling good, healthy lifestyle choices, including the regular consumption of milk as they grow up.

Sugar consumption is a major factor in childhood obesity, and sugar-sweetened soft drinks are now one of the biggest sources of dietary sugar for children and teenagers. The introduction of the soft drinks industry levy is a clear indication of our determination to address that vital issue. The levy will generate significant funding for a variety of initiatives announced in the childhood obesity plan, including the doubling, from September 2017, of the primary physical education and sport premium from £160 million to £320 million a year, the provision of £10 million a year to fund breakfast clubs in up to 1,600 schools, targeting pupils most in need—milk could play a part in those clubs—as well as £415 million towards the creation of a new healthy pupils capital programme, supporting schools to pay for facilities for PE, after-school activities and healthy eating. There is an opportunity there to use significant new money to promote the cause that the hon. Lady has articulated so well.

On the levy, I asked the Minister whether the Government would consider it a good idea to promote drinking milk as opposed to sugary drinks, since not all children like water or unsweetened beverages. That is my key point on the issue; the Government should say, “Milk is good for you. Drink it” instead of a glass of sugary pop.

At the risk of harking back to the halcyon days of the 1970s and 1980s, I remember the adverts, “Gotta lotta bottle” and “Nice cold, ice cold, milk”, which did a lot to promote milk consumption, not just within educational settings but in the wider community. I think I have given a strong message today about the Government’s support for the continuation of milk as a central tenet of a child’s dietary upbringing. Through the various schemes that we still support and also the new money that we have announced, there is an opportunity to help that to infiltrate even further into our education system.

However, we still have a lot of educating of parents to do. Last year a survey in Scotland showed that a third of parents still did not think it an issue if their child had tooth decay by the time they were a teenager. There are some perceptions and societal norms that we would not want to support, and there is work to do to bust them as we strive to improve the health of our nation. The Government want to help children to achieve a healthy, balanced diet and to encourage them to make the right food choices, and I want to reassure the hon. Lady that we will continue to encourage the consumption of dairy products, including milk.

It is useful to hear about the role the Minister sees for his Department in promoting the drinking of milk. Does he see a wider role in promoting an affinity with farming, to encourage children to have a greater interest in the provenance of their food? That might be a catalyst for healthier eating and for support for the UK’s agricultural industries.

As a Member of Parliament with a strong dairy industry in my constituency, I am always keen to find ways of bringing children closer to the land and helping them to understand the importance of the industry and its produce to them and their health as they grow up. My hon. Friend’s suggestion is helpful. The more we can do to bind those things together, the better.

Through the likes of the nursery milk scheme, we can ensure that children under the age of five receive free milk every day. In addition, through the early years foundation stage, we are ensuring that early years settings are promoting good health choices and providing meals, drinks and snacks that are healthy, balanced and nutritious. We are always open to suggestions and evidence that point towards other approaches to help us tackle what is, as the hon. Lady said, and as the Secretary of State for Health has said on many occasions, a public health issue. I thank the hon. Lady for using the debate to do just that, and I hope that she has been reassured by the Government’s continued commitment to ensuring that children can grow up and have a healthy and fulfilling life, in which milk plays a prominent part.

Question put and agreed to.

Sitting suspended.