An Investigation into Operations Research (OR) Methods for the Demand and Supply-side Modelling of Donor Human Milk Banks

Recently, national initiatives in Scotland (NHS Scotland, 2016), Wales (Addis, et al., 2018) and England (NHS England, 2017), have emphasised co-production, "ensuring that the voices of people with lived experience are included in decision-making, from commissioning to co-design and co-delivery" (McNally, 2016), to be embedded "not just sometimes but all the time" in service provision. Reportedly, coproduction has led to improvements to service provision, with reduced burden of illness, improved treatment, and reduced costs (e.g. in oncology (Basch, et al., 2017) and rheumatology (Essen & Lindbland, 2013)). Co-production is relevant to the proposed project objectives below.

Literature Gaps and Research Questions Despite the health benefits and long-term financial savings associated with pDHM use, the National Institute for Health and Care Excellence (NICE, 2010) provides no recommendations on clinical usage of pDHM. Battersby et al. (2018) highlights non-uniform use of pDHM across NICUs in England in 2012-13. Otherwise no information has been found in the literature on: policy variations for pDHM provision between NHS Trusts/hospitals; stakeholder engagement (co-production) in determining policies; characteristics of donors; actual or achievable donation volumes in the UK, or any links between pDHM provision and subsequent donation rates. Furthermore, no information has been found on any aspect of operations (including supply and demand sides) or robustness (for instance contamination events or equipment failures) of milk banking in the UK. Given the above, high-level research questions, and associated linked objectives, follow: Question-1. What are the characteristics of the full-cycle of human milk donation, milk banking, and hospital use, in the UK, including policy-setting and public engagement? Objective: Understand structures of relationships between donors, milk banks, Trusts/hospitals, recipients, including degree of stakeholder involvement in policy-setting, across NHS Trusts. Understand policy variations between NHS Trusts and if any observable benefits due to stakeholder participation in pDHM policy-setting Objective: Assess if scope to increase co-production exists, and if so its potential benefits Question-2 How might changes in policy and public attitudes influence supply and demand and the quality of life of recipient families? Objective: Understand characteristics of donor supply-side (to milk banks) and determine the correlation between donation rates and pDHM provision Objective: Establish the donor supply-side constraints vs. potential increased demand Question-3. Is the milk banking system in the UK operationally efficient and robust? Objective: Build a model with stakeholder engagement, allowing exploration of the operational aspects and robustness of milk banking in the UK.