Health Experts letter to the Times

 

Letter to The Sunday Times 27 September 2015

Top marks for free school meals in fight against obesity

This is a letter to the times suggesting “experts” support universal infant free school meals. It wasn’t written by any of the signatories, but by a PR agency paid for by people with a vested interest in the continuation of the UIFSM policy. There are a number of errors, as highlighted and corrected in the numbered notes at the bottom.

SINCE last September every child in the first three years of school has enjoyed a free school lunch and we applaud the government for its continued support. With one in three children leaving primary school overweight or obese, ensuring a nutritionally balanced school lunch has never been so important (1).

Childhood obesity is one of our greatest public health challenges. Overweight and obese children face numerous health risks, including insulin resistance, hypertension, early signs of heart disease, asthma and poor mental health. And these risks increase as they enter adulthood. Only 1% of packed lunches meet nutritional standards for school food (2), whereas children who eat a healthy school lunch consume more vegetables and fewer sugary drinks and crisps (3). A free school meals policy could end up paying for itself many times over (4) and reduce the spiralling costs to the NHS of treating obesity an vd other diet-related illnesses.  It would surely be short-sighted to cut the funding in November’s spending review.

We see the provision of a free healthy school lunch for infants as the bed ww  rock of a transformative childhood obesity strategy — a strategy that also tackles the marketing and pricing of less healthy food and drink and boosts schools’ teaching of food education.

Professor the Lord Darzi of Denham, Director of the Institute of Global Health Innovation, Imperial College London
Professor Sheila the Baroness Hollins, board of science chair, British Medical Association
Ashley Adamson, Professor of Public Health Nutrition and Director, Fuse – UKCRC Centre for Translational Research in Public Health
Louise Ansari, Director of Prevention of Type 2 Diabetes, Diabetes UK
Professor John R Ashton CBE, President of the UK Faculty of Public Health
Clare Bambra, Professor of Public Health Geography Director, Durham University
Dr Emma Boyland, Lecturer in Appetite and Obesity, University of Liverpool
Sally Bunday MBE, Director of the Hyperactive Children’s Support Group
Professor Christine Bundy, President UK Society for Behavioural Medicine
Dr James Bunn, Consultant Paediatrician, Alder Hey Children’s NHS Foundation Trust
Andy Burman, Chief Executive, British Dietetic Association
Professor Simon Capewell, Professor of Clinical Epidemiology, University of Liverpool
Dr Nigel Carter OBE, Chief Executive, British Dental Health Foundation
Dr Samantha Caton, Lecturer in Public Health, University of Sheffield
Malcolm Clark, Co-ordinator, Children’s Food Campaign
Dr Helen Crawley, Director First Steps Nutrition Trust
Professor Steven Cummins, Professor of Population Health and NIHR
Senior Fellow, London School of Hygiene and Tropical Medicine
Professor Jane Dacre, President, Royal College of Physicians of London
Professor David Haslam, GP, Bariatric Physician, Chair, National Obesity Forum
Rosalind Godson, Professional Officer, Health Sector, Unite/Community Practitioners and Health Visitors Association
Kawther Hashem, Nutritionist and Researcher, Action on Sugar
Robin Ireland, Chief Executive, Health Equalities Group
Dr Clare Llewellyn, Lecturer in Behavioural Obesity Research, University College London
Barrie Margetts, Emeritus Professor, Faculty of Medicine, University of Southampton
Dr Richard Marsh, Chief Executive, Institute for Food Brain and Behaviour
Professor John C. Mathers, Director, Human Nutrition Research Centre, Newcastle University
Dr Fiona McCullough, Chairman, British Dietetic Association
Dr Colin Michie, Chair of the Nutrition Committee, Royal College of Paediatrics and Child Health
Professor Susan Michie, Director, UCL Centre for Behaviour Change
Dr Michael Nelson PhD RNutr, Director, Public Health Nutrition Research Ltd
Sonia Pombo, Campaign Manager, Consensus Action on Salt and Health (CASH)
Professor Mike Rayner, Chair, Sustain
Neville Rigby, convener, International Obesity Forum
Professor Sian Robinson, Professor of Nutritional Epidemiology, University of Southampton
Professor Roy Taylor, Professor of Medicine and Metabolism, Newcastle University
Professor Russell Viner, Officer for Health Promotion, Royal College of Paediatrics and Child Health
Peter Ward, Chief Executive, British Dental Association
Professor Richard G Watt, Professor of Dental Public Health & Head of Department of Epidemiology and Public Health. UCL
Professor Martin White, President-elect, UK Society for Behavioural Medicine
Marjon Willers, Director, Health Education Trust

(1) the school food standards do not apply to many schools, no one checks compliance and many schools simply ignore them through ignorance or because of costs, (a vending machines bring in £15-£20,000 a year). perhaps most importantly in this instance is the fact, even where applied, the food based standards do NOT ensure “a nutritionally balanced school lunch”. there are no limits on fat, salt or sugar, nothing to stop a school doling out turkey twizzlers and chips. Some school meals are fantastic, but let’s not pretend they are nutritionally balanced and all healthy.

(2) Only 1% of packed lunches met nutritional standards for school food in 2009, under the old stricter nutritional standards. But it is worth remembering that these standards were never intended to be applied to packed lunches, they were never sent to parents and do not necessarily mean that a child isn’t having a healthy balanced diet.  It is worth noting that a significant number of the meals served under the new standards would not meet the old more stringent nutritional standards. Just because a packed lunch didn’t meet standards, doesn’t mean they are unhealthy.

(3) Whilst the UFSM Pilot did find children who eat a school lunch consumed more vegetables and fewer sugary drinks and crisps, they also found the children were more likely to eat chips or roasted or fried potatoes and other starchy food. The children were also less likely to eat whole pieces of fruit. but publicising that doesnt suite the cause, so the letter  ignores the facts.

(4)It seems extremely unlikly that any accrued health benefits will save £800m a year. Saying “A free school meals policy could end up paying for itself many times over” is little more than wishful thinking and wild speculation. There is no evidence to back up these claims, not one iota to show uifsm reduces obesity rates. I have real concerns that some of these signatories have put their name to a campaign they actually know little about.

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Uifsm avoids means testing 

It is being argued that by having a universal policy, there is no need to means test people for free school meals.

The slight flaw in this argument is that FSM are not actually means tested, they are passported.

If you are eligible for certain benefits, your children automatically become eligible for Free school meals. 

There is no saving of manpower or great reduction in process to be had by making the meals universal. 

School meals are healthy

School food is automatically healthy is a misnomer that we would all like to be true (and certainly is in some cases), but often isn’t.

There are no longer any nutritional guidelines for schools, they were replaced in January 2015 by wider “food standards”, which say things like “No more than two portions a week of food that has been deep-fried, batter-coated or breadcrumb-coated” 

To be clear, the new standards do not put any limits on salt, sugar or fat levels.

So in themselves these food standards don’t automatically mean the meals are healthy. There is nothing to stop a caterer bringing back turkey twizzlers, or having hamburgers, pizzas and fish and chips on the menu.

Even if these kind of foods were banned under the standards, over 4000 schools are exempt from the standards. Which completely undermines the argument, the majority of school children attend these schools which can ignore the rules. It’s not unusual to see vending machines in these academies, many keep them because they bring in up to £20,000 pa in profit.

No one can know if meals are healthy or not in unregulated schools.

What’s worse, we are still faced by the fact that no one monitors the standards even where they apply, no one looks to see if the food provided meet the quality required of the government set school food standards. We continue to pour millions of pounds from the public purse into school food provision yet there is still no government body that holds providers to account or monitors quality of the food.

Much is being made of evidence from the pilots where children ate less crisps and had fewer sugary drinks, what they didn’t say was the same research found a 13%% increase in the amount of chips being eaten and a 19% decrease in fresh fruit consumption. Convenient and selective use of evidence by uifsm supporters as per usual!

This sums up the findings from the pilotThere was no evidence that the FSM pilot led to significant health benefits during the two year pilot period. For example, there was no evidence of any change in children’s Body Mass Index

Whilst the best school meals are undoubtedly healthy, without regulation and monitoring, it is little more than wishful thinking to sugest they all are.

Who knows? Who cares? Not government it would seem

Uifsm will have a dramatic impact on attainment, or will it?

In 2014 Nick Clegg told The Telegraph: “The evidence is clear – free school meals will not only save families hundreds of pounds a year but will also have a dramatic impact on how a child performs works in the classroom so that, regardless of their background, every child can have the best possible start in life.”

His “dramatic impact” line was a favourite and often repeated one.

So with a cost of getting on a billion pounds and the big build up how dramatic would the impact of Mr cleggs Universal infant free school meals policy be? 

The 2015 key stage one SATs results have just been published and whilst it’s only a year into the policy, any “dramatic impact” should be visible.

Only there isn’t any significant change to attainment.  

 

Whilst the maths and writing results have risen by a single percentage point, reading stayed the same.  

There is nothing statistically significant here, it is in keeping with the trend and certainly can’t in any way  be described as “dramatic”, never mind £13000 per class “dramatic”

In reality there doesn’t appear to have been any impact, the results are  fairly flat and actually don’t  prove anything  one way or another. 

What all this does show is how hard it is to disetangle the specific influence of any one policy on an incredibly complex education system. It is for this very reason the authors of the pilot report, used by Clegg to justify the uifsm, never made any such claims, they understood that many of the interventions that ran alongside the pilot might well have been influential to the output. 

The authors didn’t ascribe causation because they knew better. 

Mr Clegg however didn’t seem to mind conflating the pilot with his policy and was more than happy to tell anyone who would listen how the policy would result in improvements in attainment. 

The reality is now laid out for everyone to see, we have actual data ttelling us little  about benefits derived from uifsm, but massive amounts about the people who continue to claim clear or dramatic improvements in attainment are at best over egging, at worst deliberately deceiving people.

“Where’s the beef?” As Walter Mondale once said. Next time someone claims uifsm impacts on attainment, ask for the evidence it does, but be prepared to wait. 

Incedentaly the format of ks1 data will change next year so we won’t ever get any more comparable data to show if uifsm has any impact on attainment or not. 

How many children benefit from UIFSM

So how many children benefit from the uifsm policy?

I would suggest that it is only those who didn’t previously take a school meal who actually benefit. Those eligible for free school meals and those whose parents previously paid, would have already been in receipt of any perceived benefits, so it should be fairly simple maths.

Take the number of children now taking a school meal and subtract the number eating prior to the introduction of uifsm.

It is slightly more complicated, because we don’t have the exact numbers, however we know that in 2012, 46.3% of primary children took a school meal. That is an average and importantly the trend was upwards and significantly upwards. It is therefore safe to say that in the run up to 2014, the numbers would have exceeded 50%, that is around 900,000 children.

The total currently taking a meal is again slightly problematic, the government would have you believe the census figures of 86%, but as I show here, the numbers are exaggerated.

As the prior take up was an average, it is right that the numbers used for comparison are also averages, as I explained previously, the best figures we have come in at around 72% of infants  (I could try and extrapolate to all primary. But that would be tricky and distort the comparison)

So we are left with 72% compared to 50% a net total of 22% of the infant children newly benefiting. The remainder are politely described as dead weigh, as in they are receiving no new benefit, but are part of the cost.

To give this a head count number, assuming around 1,800,000 infants, we are looking at just shy of 400,000 actual beneficiaries.

The policy cost the tax payer pushing a billion pounds once you add in all the subsidies and the infrastructure spends from central government, LAs and schools.

That’s £850,000,000 to impact on 400,000 children, £2000 each

Uifsm take up is 86%

This claim is based entirely on the Dfe data which shows on census days, on average schools had 85% of children “taking a meal” which is all well and good, until you look a little deeper.

Firstly we need to understand that Schools are only paid based on the numbers “taking a meal” on census day. As such they are incentivised to boost numbers with cold hard cash. This is why we see census day special menus, schools know the more they have eating on census day, the higher number they input, then the more money they will receive.

But its not just schools who manipulate the figures, the government instruct schools to include absent children in the figures (the only time in the census schools can do this) because the coalition wanted it to appear more successful. There are significant gains to be had from enhancing the figures and major downdoes to anyone who understates their figures.

If you want the true number of children eating school meals you could do worse that look at the numbers stated by Compass, the world’s largest catering firm and one of England’s largest school meal provides, their sample size is enormous and rather than 86% they claim 73% take up. This figure is reinforced by the stats of Portsmouth who have 84% in the census but state an average of 70% and West Berkshire 82% again claiming a regular take up of 70%. Leading anyone with any sense, to the conclusion that there is a 12-14% difference between the census and reality, ie if like Slough, you have 78% on census day, the regular take up percentage will likely be in the mid 60s.

These figures are of great importance because prior to uifsm school meals take up been moving up towards those figures anyway, the blue line in this graph shows the trend, it is also worth noting that Bolton Council managed a genuine 70% take up by increasing subsidies and cutting costs. These school food trust figures are based on averages, not census, so comparisons should only be made using regular average take up numbers.

The figures matter even more when they are abused to justify keeping the uifsm policy. The original take up figure  used in planning uifsm was 87%, to have around 15% lower shows up how badly thought through and implemented this all was.

We are spending over £800,000,000 on feeding an additional 20-25% of the infant population, the majority of children either paid for a meal or were eligible for a FSM.

Ending UIFSM will have a detrimental impact on children’s health

The headline in The Independent shrieks “Scrapping free lunches puts pupils’ health at risk”

The whole basis of this argument would seem to rely on Universal free school meals having a positive impact on children’s health. Sadly in the major universal free school meal pilot (used as justification for the policy), no evidence of any health benefits was found.

I don’t think the authors could be any more specific about this, on page 3, the UFSM pilot report states

“There was no evidence that the FSM pilot led to significant health benefits during the two year pilot period. For example, there was no evidence of any change in children’s Body Mass Index.”

It would therefor seem to defy logic to claim cutting the policy would harm health when there isn’t actually any evidence that on its own UIFSM  improves health.

Ending UIFSM means children will go hungry

I see headlines on the ending of the universal infant school meals screaming out  “How can children expect to be educated … if they’re hungry?”. But as so often with knejerk reactions, they miss the obvious.
Infant schools have always been extremely proactive when it comes to ensuring children eat their lunches, modern lunchtime supervisors don’t just dish out food, they monitor what children eat and report up any concerns. Schools just would not allow a pupil go without food simply because they forgot a packed lunch or the parents didn’t order a meal. It’s just unheard of. I have seen teachers bring children up to the counter and organise for them to get something to eat and I can’t think of a school who wouldn’t take this course of action.

I am therefore fairly certain of my ability to claim that even without universal infant free school meals, infant children were not going hungry for lack of a lunchtime meal. 

I am not saying that there aren’t issues with hungry children, but I am saying that UIFSM isn’t addressing them and therefore ending the policy won’t lead to more infants going hungry.

The 2 major areas we actually see most hungry school children are in secondary, where children have more control over the money and often choose not to eat properly and in the mornings.  Mornings are important, Children are far far more likely to be hungry because they skipped breakfast than because they miss out on a lunch. It is the mornings where children look tired and in need of food not after lunchtimes. 

We need to be clear, UIFSM doesn’t address these two problems and it is disingenuous to suggest they do. The policy hasn’t ended hunger in schools and scrapping it won’t lead to a surge in hungry kids. It is little more than a desperate attempt by supporters to grab the headlines by spreading fear.

One final point I would make, is given the dubious quality of some school food being churned out, it seems likely that some children who would previously enjoyed a packed lunch have gone hungry because they don’t eat the school meal they are presented with. This isn’t simply a case of being picky, some of the food I have seen being served in the last year it truly awful. As I say time and again, quality is one of the biggest drivers for take up, let’s offer up better meals so children want to eat them.

Nick Cleggs Universal free school meal anouncement

My twitter timeline has been full of Nick Clegg telling everyone about his new idea to extend universal free school meals to all juniors.

What he doesnt mention is the major caveats in the manifesto (page 58).

1. The Lib Dems slipped in “as resources allow” which is a handy cop out that could well mean “never”? It is a handy device to avoid having to cost out the details or say where the money is coming from. Reality is any political party could promise to do anything “as resources allow”?

Free holidays in the Maldives for all (“as resources allow”)

Everyone gets a free Bentley (“as resources allow”)

2. They add “Following a full evaluation of the free meals for infants” Not only does this suggest that there are murmurings of disquiet about the success of the UIFSM policy, but it is another get out clause.

Unless the report is authored by a vested interest, there are obvious and serious concerns over the evidence abound UIFSM and it is unlikely to be shown to offer value for money,which begs the question, what to do if the report suggests UFSM shouldn’t be a priority?

On the audio clip Clegg conveniently goes on and gives us his three reasons for supporting the policy

Firstly as usual he concentrates on the savings for families. this is the key message he repeatedly tries to get out. In essence he is returning £430 to wealthier parents and he wants to stress the point.

The fact that it doesn’t help the poorest (who already get as FSM), or offer value, is irrelevant, as is the fact the policy is a drain on many schools resources, this is a thinly disguised £430 election bribe and Clegg wants to remind everyone of that fact it is he who is handing over the money.

Secondly he says ” all the evidence shows it is a great way to help in the education of children”

Sadly this is a great big fat lie!

The evidence does not support simply giving children a free school meal improves attainment. Clegg obviously doesn’t understand there is a difference between ALL the evidence and NO evidence.  Don’t just take my word for it, the pilot authors have complained about his abuses of evidence numerous times.

Thirdly “a healthy meal at lunch time is of course good for the health of our children”

This is a nonsense statement in relation to the specifics of the universal free school meals policy. Of course a healthy lunch is good for children, but so is a healthy breakfast and a healthy dinner?

Clegg seems to imply that universal free school meals are the only way that children eat at lunch, I would point out that many children already Paid for a meal and as such get no new benefit, also no primary age child goes without a meal at lunchtime, it simply doesnt happen,staff ensure that pupils get to eat something. (breakfasts and holidays on the other hand are when children do go hungry)

I genuinely don’t know how he is trying to justify the universal free school meals policy with this statement.

On the web page the Lib Dems claim “Pilot studies have shown that a hot, healthy meal at lunchtime greatly improves the health, behavior and results of school children, providing them with the best start in life”

These are LIES and easily provable to be so, quite simply the pilot found no such thing.

Here are a couple of blogs exposing these lies on Health, behaviour and one on how UIFSM doesn’t address Stigma.

So all Clegg has in support of the policy is  a £437 bribe.

Just a final couple of points, it has been suggested that the lib dems are putting forward, £100m for infrastructure costs.

They have clearly didn’t learn anything from the mess they made of UIFSM implementation. There are currently almost 700 infant/primary schools who already applied for over £50m  and were turned down in January. Feeding Juniors will require lots and lots more infrastructure as school kitchens and halls are already overstretched and over committed.

They also propose spending £610m a year on feeding juniors, which is less than they currently spend on infant free school meals. Not only will inflation increasing rolls and portion size make those figures look unrealistic, but the lib dems seem to have ignored the simple fact that there are three year groups in infants and four in juniors.  So an extra 33% to feed on less money. The lib dems must think we are as stupid as they are? Or perhaps Nick Clegg has some loaves and fish to go with his delusions of grandeur?

You might also be interested in this longer blog exposing some of the latest goings on with the policy?

UIFSM will end the stigma of free school meals

I see people arguing that Universal Infant Free School Meals (UIFSM) is a policy worth pursuing “because it ends the stigma for children on Free school meals” (FSM).

Firstly this ignores the fact that infant aged pupils rarely, if ever, pick on each other because a child receives FSM. At 4,5 and 6 they are too young to understand the relevance of FSM. If you want to address stigma, target the age groups who it impacts.

Secondly things are very different in education these days, almost all schools have moved on and use recommended best practice in this area. Great efforts are made to not identify pupils being given FSM, things like cashless cards, wristbands and biometric systems are common place these days

This isn’t to say children aren’t still stigmatised for being poor, especially in secondary, but we should acknowledge that the issue is poverty, address that and not pretend feeding wealthier infants is in any way some panacea.

The problem that does exist and is actually compounded by people using the stigma argument, is that some parents are put off applying because they still think children will be identified by the school. Correcting this perception rather than encouraging it, will improve take up and help those children receive the meal they are entitled to.

If people really, truly want to end stigma, we need to address the poverty! Address the fact that there are children officially living in poverty, whose parents are on WTC, who are not entitled to FSM. Don’t just mess about targeting one age group, change the criteria for FSM and help the poorest in society whatever school year they are in.

A couple of further points, in my experience the biggest sign of poverty picked on by children, is shoes. If you want to see who is poor in a school, look down, look at the state of a childs shoes. I have also seen children notice the extra support coming through PP, it’s a bizarre unintended consequence, but PP may be a cause for signalling children out. (Please dot use that as an excuse to cut PP).

UIFSM is a phenomenally expensive way to solve a problem that exists mainly in the mind of people who have run out of other ideas, those desperate to justify the policy, because the other evidence for UIFSM doesn’t stack up.