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Research Specification - PRP (39-01-01) Evaluation of the Nursery Milk Scheme

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Published: 14 May 2024

Version: 1.0 May 2024

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Timetable and Budget

DescriptionDeadline/Limit
Deadline for Stage 1 Applications 18 June 2024, 1 PM
Notification of outcome of Stage 1 Application September 2024
Deadline for Stage 2 application 22 October 2024, 1 PM
Notification of outcome of Stage 2 Application February-March 2025
Earliest Potential Project Start March 2025
Project Duration 24 to 30 months
Budget £500,000

Introduction

The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to evaluate the Nursery Milk Scheme (NMS) to understand how the scheme contributes to the dietary requirements of children attending early years settings, the value of the scheme, and whether the scheme is cost-effective and equitable.

This research is proposed to help to fill the gaps in robust evidence and will inform policymakers in making decisions about the NMS.

Background

The NMS allows early years childcare settings to reclaim the cost of providing one-third of a pint of milk to children in their care aged under five, who attend for at least two hours per day. For babies under the age of one, reimbursement for one-third of a pint of infant formula can be claimed instead. The rules of the NMS are set out in legislation [1]. Eligible early years childcare settings are those which offer care to children aged birth to five, and must meet the requirements of the Early Years Foundation Stage statutory framework for childminders and group and school providers [2,3]. Early years settings which claim from the NMS are typically childminders, nurseries (private, third sector or local authority-run), and schools in respect of the Reception year pupils aged under five.

The Early Years Foundation Stage statutory frameworks specify that early years settings must provide food and drink which is “healthy, balanced and nutritious”. Government advice [4, 5] recommends that children of this age should consume a minimum of 350ml of milk or two servings of dairy products per day. The NMS supports early years settings in meeting these requirements.

The NMS has existed in its current form, largely unchanged, since at least 1940. The NMS costs the public purse about £55m per year. The legislation which governs the NMS allows early years settings a free choice of milk supplier – settings are not required, for example, to buy milk from the cheapest supplier available to them. Costs of the NMS rose very steeply from around £27m per year to around £48-50m per year in 2007/08 with the entry to the NMS market of more expensive, specialist suppliers known as “milk agents”, which now account for around 75% of milk funded by the NMS. In more recent years, costs have climbed again due to historically high levels of food inflation – as reported by the Office for National Statistics, the average retail price of a pint of milk rose from 42p in March 2021 to 70p in March 2023, and now stands at about 65p [6].

There has been no evaluation of the NMS in at least the last thirty years, so policymakers need evidence to understand how the NMS operates, its impact and costs.

We do not have robust national evidence on children’s consumption of milk or dairy products. The National Diet and Nutrition Survey only has very small sample sizes for the age group covered by the NMS (1-5) even for cumulative data for years 2008-2019. For early years settings in particular, there are voluntary guidelines and sample menus [7], which include recommended levels of milk and dairy consumption in line with the Government recommendations mentioned above. While we are aware of some work on the use of these guidelines [8], we do not know how widely they are used. We have similarly limited knowledge about wider food provision and charging arrangements in early years settings, for example, whether the cost of food and drink is included in fees, or whether parents are required, or have the option to, supply food and drink themselves.

It is not compulsory for children aged under five to attend an early years setting. Many settings offer “sessional” care – that is, morning and afternoon sessions, and parents of some children may choose an attendance pattern which fits their working hours. For some years now, the Government has provided some parents with access to a certain number of free hours of childcare. In the next year this free provision will be expanded [9]. More children attending early years settings may lead to more claims to the NMS, and therefore further increase the cost of the scheme.

Against this background, DHSC wishes to know about the contribution made by the NMS to meeting the Government recommendations for consumption of milk and dairy products, and the benefits of the scheme. We also wish to know whether it could be possible to change the current delivery model in order to realise the same or similar benefits at a lower cost.

Research priorities

The research has three priorities:

  1. To establish the role that early years settings play in supporting children’s dietary requirements for milk and dairy products, the contribution that milk funded by the NMS makes to this, and how this may vary across different demographic groups.
  2. To establish how the scheme operates.
  3. To provide information on whether the scheme is a cost-effective way of providing milk, whether it offers value for money, and whether it could be improved.

The research should address the following questions:

Understanding the role of early years settings and the NMS in supporting children’s consumption of milk and dairy products

This research should establish the extent to which children attending an early years setting are meeting the nutritional guidelines for milk and dairy intake and the role that the NMS plays in this consumption.

  • Are children who attend early years settings meeting the Government recommendation on daily consumption of 350ml of milk or two servings of dairy products per day?
  • What contribution does the NMS-funded milk provided in the early years settings make to the volume of milk and dairy products consumed during a typical day on which they attend the setting, and how does this differ to a typical day on which they do not attend the setting?
  • Does the consumption of milk and dairy products by children attending early years settings, and the consumption of NMS-funded milk, differ by factors such as the number of hours of attendance at early years provision, type of setting, geographical location, age, socio-economic group and ethnicity?
  • How does the daily consumption of milk and dairy products by children attending early years settings compare with daily consumption of milk and dairy products by children who do not attend early years settings at all? Does this differ by age, socio-economic group, ethnicity or geographical location?
  • How do parents decide whether milk and dairy products should be offered at home? Do parents give their children other drinks instead of milk? If milk and dairy products are consumed, what factors influence decisions about the quantities consumed? Does knowledge of the amount of milk and dairy products consumed in early years settings play any role in decisions about the amounts consumed at home?

Understanding how the NMS operates

  • How do early years settings obtain the milk funded by the NMS? Are there differences between childminders, nurseries and schools?
  • How is the milk funded by the NMS used within the setting, including the proportion of children drinking the milk, demand for non-dairy drinks to be provided, whether the milk is provided as a drink or used in cooking, the time of the day at which the milk is provided, and any wastage?
  • Which milk suppliers are used and why? How do costs of provision vary between different types of milk supplier and different types of setting (childminders, nurseries and schools), and what is the average unit cost of provision?
  • What are the views and experiences of early years providers of the NMS, and how does the NMS affect their policies on charging and food provision?
  • Do the following factors affect a setting’s willingnessorabilitytoprovideNMS-funded milk:
    • Knowledge or experience of the NMS
    • The type of early years setting
    • Child attendance patterns – full or part-time
    • Demographic make-up of the children attending the setting?

Understanding whether the NMS is a cost-effective way of providing milk, whether the amount spent on the scheme provides value for money, and how the scheme might be improved

  • Beyond dietary and nutritional impacts of the NMS captured above, what benefits does NMS-funded milk bring to those children who receive it, and are there any unintended consequences? Are any benefits from the scheme experienced equally by all children who receive NMS-funded milk?
  • How do the costs per pint of milk reimbursed by the NMS compare with the average price of milk? Can any higher costs reimbursed by the NMS be justified by any added value offered by these suppliers?
  • Are there ways in which operational delivery of the NMS might be changed to reduce costs and/or offer improved value for money?


We envisage that mixed methods research covering the requirements detailed above is required. This might include:

  • a dietary survey focused on quantifying milk/dairy consumption and understanding parental decision-making relating to the provision of milk/dairy products
  • a survey of early years settings, including those that do and do not use the NMS
  • in-depth interviews or case studies to explore relevant policy/practice issues and experience of the scheme.

Robust quantitative information will be required to allow us to:

  • compare dietary intake for children attending early years settings and those who don’t and to provide a robust assessment of whether this differs by SES/deprivation
  • compare dietary intake for children on days when they attend an early years setting and on days when they don’t and whether this differs by SES/deprivation.

Bidders are requested to include in their bids their understanding of the challenges of conducting research with early years providers and any strategies they might use to increase participation in the research. The challenges of collecting children’s dietary information should also be considered.

Eligibility

Eligibility rules for the NIHR Policy Research Programme are explained in the Standard Information for Applicants and these apply to all calls unless otherwise stated in the individual research specification

Expertise required

Policy evaluation, early years nutrition, food and nutrition.

Outputs

The outputs from this research should provide policymakers with evidence on the impact and value of the NMS. This may also include recommendations to improve or change the scheme, based on findings from this study.

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Budget and duration

The maximum budget available for this call is £500,000. We anticipate this research completing within 24-30 months.

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning committee members will assess applications against.

Management arrangements

A research advisory group including, but not limited to, representatives of DHSC, other relevant stakeholders, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress
  • Produce timely reports to the advisory group
  • Produce a final report for sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

Guidance on Health and Care Inequalities and associated data collection within NIHR PRP Research:

Health and care Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects.We are now assessing all NIHR research proposals in relation to health inequalities. We ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.

Improving Data Access Pilot

The NIHR are working together with the Data Access & Partnerships Team in NHS England (NHSE) to better align NHSE requirements for data access with NIHR commissioning processes.

This funding call will include a pilot to support researchers in making data access requests by identifying any potential issues and resource impact earlier in the process. If your research will require access to NHSE data, please find further details of the pilot on the Data Access Pilot Guidance Webpage.

References and key documents