National Child Measurement Programme (NCMP) School Level Results with LA Flag

The objective of this study is to investigate the impact of Universal Free School Meal (UFSM) programmes run in several local authorities in England since 2004 on children's bodyweight outcomes. Previous research by the applicants showed that the Universal Infant Free School Meals policy (UIFSM) which from 2014 makes a free lunch available to all infants in state-funded schools in England significantly reduces children's bodyweights in Reception year. Evaluating the earlier and ongoing local authority schemes will provide additional evidence on the longer-term impacts of UFSM on children's outcomes at age 11 and assess the programme features (such as the number of years free meals are provided and the ages at which they are provided) that are linked to positive outcomes for students, and how these differ by student background. This will be achieved by estimating a statistical model to compare the outcomes of children in local authorities implementing such schemes with the outcomes of otherwise-similar children for whom these were never available.

The analysis will help establish if UFSM policies are, or could be adapted to be, cost-effective in terms of future health of those receiving it. Results may feed into ongoing policy discussions around the retention, expansion and further development of the UIFSM policy, as well as into the development of any local authority-based UFSM initiatives.

The data request asks for inclusion of a Local Authority (LA) identifier which was not included in a previous data extract disseminated to the University of Essex under a separate data sharing agreement. The LA identifier will allow The University of Essex to link to the data extract of publicly available data on characteristics of the LA such as expenditure on health, for example. This will allow The University of Essex to control for other LA-level factors and policies that may affect child weight outcomes, other than the Universal Free School Meal policies that is currently being studied, and therefore avoid confounding the effect of interest with other LA-level effects.

This research proposal is aligned with the overarching NCMP Research Priority to improve the use of NCMP data to benefit child health. The Government remain committed to addressing obesity and to halving childhood obesity and this research will provide insights as to how other government policy is impacting that ambition.

The University of Essex will be the Data Controller for this disseminated data, and will process the disseminated data.

The application is based on external funding from the Nuffield Foundation who will have no access to any data and will not be able to influence or suppress the findings of the survey

NHS England will transfer the NCMP data requested to the Institute for Social and Economic Research at The University of Essex by Secure Electronic File Transfer where it will be analysed by researchers at the University of Essex ("the research team") only. Data processing is only carried out by substantive employees of The University of Essex who have been appropriately trained in data protection and confidentiality.

The data requested will be aggregated to the school level and will use pseudonymised school IDs. Data in each field will be calculated to 1 decimal place, and schools with less than 20 children per year group on average in a particular year will be excluded from the file. No further suppression of small numbers will take place as this will suppress the obesity prevalence levels for around two-thirds of schools making the data not usable for this project.

NHS England does not hold information on school characteristics such as proportion of children eligible for or taking up means-tested Free School Meals, school type (e,g, Community, Academy), or Ofsted rating. The University of Essex will transfer a file of school-by-year level data containing this information to NHS England which will be merged with the NCMP data before it is passed back to the University. The data will not be transferred to or shared with any other organisation. The school-level data for linkage, to be supplied by The University of Essex, are derived from Department for Education ‘Schools, Pupils and Characteristics’ datasets that are publicly available and freely downloadable (https://www.gov.uk/government/statistics/schools-pupils-and-their-characteristics-january-2019 and equivalent for earlier years); and from a database of dates of provision of universal free breakfasts, supplied by the charity Magic Breakfast to The University of Essex for the purposes of this project.

The data will be analysed using statistical methods such as regression analysis, before/after introduction comparisons, difference-in-difference statistical techniques. The research team is requesting a number of years before and after the implementation of the free lunch programs so that they can appropriately control for trends in weight.

There will be no attempt or requirement to re-identify any individuals or schools in the data.

The main outputs of the project will be a project report and a research brief. It is expected that an academic paper will be submitted to a leading international economics journals, which will also be presented at national and international academic conferences.

The results of the project will be of interest to a variety of stakeholders, including policy makers at the Department for Education and Department of Health, practitioners at schools, third sector organisations such as the Children's Food Trust and those interested in child obesity, the media and the general public. The findings will be disseminated widely through dedicated web pages, Institute for Social and Economic Research (ISER) newsletter, a dissemination event aimed at policy makers, practitioners and academics, press release and subsequent media engagement to ensure the policy audience is reached.

The results included in these outputs will be descriptive statistics such as means and standard deviations, and regression coefficients from statistical models; small numbers will never be included. Outputs will contain only aggregate level data and no school level data will be published. All outputs will comply with the ICO Guide for Anonymisation. All outputs will be cleared with NHS England before publication.

The project will begin in January 2023. Presentation of results will take place from the spring/summer of 2023 and throughout the year, with publication of the report, research brief and dissemination event for academic and non-academic audiences (including press release) planned for May 2023.

The findings of this research study are expected to contribute to evidence-based decision-making for policy-makers, local decision-makers such as doctors, and patients to inform best practice to improve the care, treatment and experience of health care users relevant to the subject matter of the study. The main benefit to health and social care is to assess if the Universal Free School Meals programs run by local authorities lead to fewer children being overweight or living with obesity. It is known that children living with obesity are more likely to become adults living with obesity and develop associated health conditions. If there is no reduction in the number of children being overweight or living with obesity then it calls into question whether the Universal Free Schools Meals are an efficient use of public funds.

The use of the data could :

• help the system to better understand the health and care needs of populations.

Over a quarter of children in reception year were overweight or living with obesity in 2020/21 and this figure was 40% in year 6.

• lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience.

Overweight children and children living with obesity are more likely to be ill, be absent from school due to illness, experience health related limitations and require more medical care than normal weight children (see Wijga A, Scholtens S,Bemelmans W, de Jongste J, Kerkhof M, Schipper M, et al. Comorbidities of obesity in school children: a cross-sectional study in the PIAMA birth cohort. BMC Public Health 2010;10(1):184). They are also more likely to become adults living with obesity, and have a higher risk of morbidity, disability and premature mortality in adulthood.

• advance understanding of regional and national trends in health and social care needs.

• advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions such as obesity

• inform planning health services and programmes, for example to improve equity of access, experience and outcomes.

• inform decisions on how to effectively allocate and evaluate funding according to health needs.

It is estimated that the NHS spent £6.1 billion on overweight and obesity-related ill-health in 2014 to 2015 (see: https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2). Universal Free Schools Meals programs cost about £400 per person and per year to run. The results will be of use to policy makers who need to decide whether to continue funding free meals in local authorities or whether to amend the program.

• support knowledge creation or exploratory research (and the innovations and developments that might result from that exploratory work).

Through informed policy decisions there is a benefit for children who take part in the program, and the wider public through an efficient use of public resources. At the very earliest, this project may inform Treasury decisions to be announced in the budget in spring 2023, and any Local Authority decisions would come into effect for the 2023/24 academic year onwards.

It is hoped that through publication of findings in appropriate media, the findings of this research will add to the body of evidence that is considered by the bodies, organisations and individual care practitioners charged with making policy decisions for or within the NHS or treatment decisions in relation to specific patients.

Yielded Benefits is not a requirement for new applications.