UK Human Milk Banks Stretched Thin, Warn Experts After Emergency Planning Workshop

Human milk banks in the United Kingdom are operating on goodwill, thin staffing and fragile logistics, and without urgent investment the network may be unable to withstand future shocks such as infant formula shortages, according to the proceedings of a workshop held in London on 11 November 2022. The meeting, organised by the Human Milk Foundation and now published as a meeting report in BMC Proceedings, brought together milk bank leaders, academics and emergency planners from across the UK and Ireland to define the pressures facing the sector and to build a collaborative network capable of strategic, evidence-based responses.

Human milk banks provide safe, screened donor human milk to clinically vulnerable infants, most commonly those born preterm, and play a secondary role that participants argued is just as important: enabling mothers to establish their own milk supply. The World Health Organization recommends donor milk from non-profit milk banks for vulnerable infants when supplementation is needed or breastfeeding is impossible, as part of a package of lactation support. Milk banks operate much like a blood transfusion service, screening donors with health questionnaires and blood tests, collecting milk, pasteurising it, storing it and supporting donors throughout. Human milk protects infants from life-threatening complications including necrotising enterocolitis and bronchopulmonary dysplasia.

Despite this clinical role, the workshop heard that no national funding or milk bank strategy has existed in the UK for over 40 years. As a consequence, donor milk has largely been rationed to the most premature infants, who face the highest risk of gut complications. Yet recent research points to broader benefits: donor milk availability alongside high-quality lactation support has shown marked positive impacts in late preterm and full-term infants on the postnatal ward and in situations where maternal health affects the ability to lactate. Parental psychological wellbeing improves, anxiety and depression scores normalise, and preliminary findings suggest that over 65 percent of mothers go on to establish breastfeeding who might otherwise have stopped.

The workshop’s structure was deliberately practical. After scene-setting talks on the history of milk banking and current UK provision, participants split into four brainstorming groups, three in person and one online with ten virtual attendees, mixing milk bank staff, emergency planners and academics with interests spanning supply chains, operational management, microbiology, psychology and infant feeding in emergencies. Recorded sessions were later analysed to extract key vulnerabilities and opportunities, and all participants contributed to the final manuscript through a shared drafting platform.

The picture of service vulnerability that emerged was stark. Staff described frustration at chronic underfunding, exhaustion from regularly working beyond paid hours to maintain basic provision, and signs of burnout after years of working with limited support. Staffing levels varied greatly across the country, with some milk banks operating on less than one full-time equivalent member of staff. When one team member was unwell or away, capacity was reduced or removed entirely. NHS milk bank staff were sometimes reallocated to other clinical duties, and there was often no continuity planning for retirements; one milk bank manager returned after retiring to prevent her service from closing.

Equipment and supply chains added further fragility. Under-resourcing meant equipment levels were often minimal, so a single key machine failing or needing servicing could halt a milk bank, and some services reduced output even when a printer broke. Since 2020, external supply problems had worsened: three milk banks reported shortages of single-use jugs and blood testing vials needed for donor serology screening. A lack of a culture of sharing problems between UK milk banks meant other banks were unaware of these difficulties and unable to offer help. Communication with hospitals, neonatal operational delivery networks and the public was also weak, particularly for smaller banks producing less than 1,000 litres a year, and most milk banks relied on paper or spreadsheet tracking rather than the bespoke tracking systems recommended by NICE Clinical Guideline 93, a gap that may exclude some families from donating or receiving milk due to cultural or religious concerns around milk kinship.

Logistics compounded the problem. With only 13 functional milk banks in the UK, collecting donated milk from homes and hospitals and distributing it to end users is complex. Much of the transport relies on networks of volunteer blood bike couriers who deliver for the NHS free of charge, but banks reported difficulties from a shortage of volunteers, adverse weather and frequent small deliveries caused by a lack of storage space at hospitals, milk banks and donor homes. The Hearts Milk Bank has trained its own volunteers to provide cover, but participants questioned whether the training and management resources exist to roll this out nationally, and noted the inherent risk of depending on unpaid volunteers for such a critical role.

The proposed responses were concrete. Participants called for every NHS milk bank to develop its own risk register with local emergency preparedness teams, noting that although engagement with the NHS Emergency Preparedness, Resilience and Response framework is a statutory obligation on individual trusts, UK milk banks appear to sit entirely outside it. The Hearts Milk Bank, embedded in a standalone charity, has maintained a risk register since January 2020. Other recommendations included expanded public awareness through media, school education and antenatal services; improved cohesion between milk banks, which currently lack unified meetings, training pathways, accreditation or regulatory oversight; investment in staffing, training and IT; and a national milk bank risk register. Participants also framed milk banks through the lens of food security: during the recent formula shortages in the United States, local milk banks increased capacity four-fold to help vulnerable infants, though they were limited by capacity themselves, and the workshop concluded the UK would currently lack the milk bank capacity to respond to a similar shortage.

The demand-side numbers underline the stakes. Current output from NHS-funded milk banks is estimated at less than 10,000 litres of donor milk a year, while the Hearts Milk Bank, founded as a charity in 2017, has a capacity of 5,000 litres annually with only 40 percent of its provision funded through cost recovery from neonatal services. Modelling suggests approximately 25,000 litres a year would be needed to meet the needs of preterm infants born at up to 34 weeks cared for in hospital, according to unpublished data from the Staff and colleagues team cited in the report. A 2022 survey of UK neonatal units, with a 56 percent response rate, found 87 percent expected their donor milk provision to expand or start within two years, and recent WHO guidance recommends donor milk as the first-line nutrition option in the absence of maternal milk for all preterm infants, not just the very low birthweight population to which it has largely been restricted for four decades.

The report’s conclusions are blunt: milk banking in the UK is a stressed and stretched service reliant on one or two staff per bank, with minimal service continuity, resilience support or succession planning, pressures exacerbated by the COVID-19 pandemic as donor milk shortages grew in 2021 and 2022. National emergency planning guidance fails to mention infants or infant feeding, and only 29 local resilience forums in England and Wales even briefly mention infants and feeding supplies in evacuation guidance. The authors argue that with appropriate investment, UK milk banking could rapidly coalesce into a standardised national service providing equitable access, evidence-based delivery and an active research programme, but that without intervention the network will lack the ability to respond to future internal and external stressors, including significantly increased demand or UK-based shortages in formula or other specialist infant feeds.

Subject of Research: Resilience and emergency planning in UK human milk banking services

Article Title: Improving resilience in human milk banking: workshop proceedings, 11th November, London UK

Article References: Shenker, N., Hatia, A., Griffin, S., Chandler-Maini, G., Bailie, L., Barnett, D., Savage, E., D’Souza, A., Dowling, C., Gane, T., Stroud, S., Wood, A., Holder, G., Crawley, H., Sibson, V., Gray, H., Fallon, N., Brackley, M., Hinds, H., … Easthope, L. (2026). Improving resilience in human milk banking: workshop proceedings, 11th November, London UK. BMC Proceedings, 20(S31), Article 33. https://doi.org/10.1186/s12919-026-00390-4

Image Credits: AI Generated

DOI: 10.1186/s12919-026-00390-4

Keywords: human milk banks, donor human milk, emergency planning, service resilience, neonatal care, breastfeeding, NHS, risk register, infant formula shortage, staffing, COVID-19, BMC Proceedings