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Folic Acid

Volume 794: debated on Wednesday 9 January 2019


Asked by

To ask Her Majesty’s Government when they will commence their consultation on the mandatory fortification of flour with folic acid to prevent foetal abnormalities.

My Lords, the House will understand that this is not a straightforward matter. It requires a robust impact assessment to accompany the consultation to meet our obligations under the public sector equality duty. That work is under way and we will announce soon when in 2019 we expect the consultation to launch. I am sorry that I cannot be more precise today, but we hope to be in a position to announce this shortly.

The Minister knows that the average consultation lasts about 12 weeks. The Government made a very welcome and positive statement on 22 October, but that was 12 weeks ago. Bearing in mind that she cannot answer the Question about the date, the key question that also needs to be answered is: will it be a UK-wide consultation? Two years ago, the Scottish Government decided not to go it alone—and they have a better case than England on the blood-level issue—because of the impracticalities of the integration of the bread and flour industries. Therefore, the consultation has to be UK-wide, and I understand that the devolved Governments have requested that it be such.

My Lords, I pay tribute to the noble Lord, Lord Rooker, for raising this issue. I am delighted that the consultation will take place, so there has been movement, as he rightly said. I place on record that I had a meeting with the Secretary of State this morning to raise this issue with him personally. Like me, he is passionate to ensure that the consultation happens as soon as possible, but it is important that we undertake the impact assessment. On the question that the noble Lord just put to me, due to the milling process it is of course important that we have a UK-wide consultation.

My Lords, the Minister said that this is not a straightforward matter, but actually it is. If noble Lords read the paper by Dr Crider from the United States, they would see that folic acid compounds had been given prophylactically in this way for 40 years. That has shown a reduction in neural tube defects of up to 30%. What is also important is that at least four other papers show that the worst cases are where underprivileged people are not taking these supplements. So far, no side-effects of any seriousness have been noted. Is it not about time that the Government took responsibility for the pain and suffering of these families?

Of course the Government are taking responsibility, and I have just said that we are having this consultation. When I say it is not a straightforward matter, I mean in relation to the impact assessment. I agree that a number of countries—I think around 40—are putting folic acid on a mandatory basis. However, the noble Lord will appreciate that SACN and COT have issued guidelines that we will need to take into consideration in the consultation, and the Secretary of State has assured me today that we will make a decision as soon as possible.

Can the noble Baroness include in the consultation a clear examination of the 11 different additives in standard white flour? Britain has a huge variety of flours and wonderful breads but, on the other hand, we retain those additives. The Netherlands is the next down on the EU list and includes only six additives, while France has only two. Do we honestly need all these additives?

My noble friend highlights our problem and it is therefore important to have the impact assessment. At the moment, additives are only put into white flour, as things are removed through the milling process. Therefore, with folic acid increasingly put into breakfast cereals and a large quantity of other products, we need to look at the upper tolerance level before decisions can be made on moving forward.

The Bread and Flour Regulations currently apply only to wheat flour, which contains gluten and is therefore unsuitable for people with coeliac disease. In the consultation, will the Government consider extending the regulations to apply to gluten-free breads, to ensure that those people have equivalent access to fortified breads?

That is an important point and we need to ensure that the consultation captures as wide a group of people as possible. If we move into mandatory fortification of flour, it should be done on a basis consistent with addressing all issues, including that.

A lot of medical professionals wonder why, after such a long time asking for this to happen, the Government are doing a consultation—whatever that means—only now. It is quite ridiculous and they should be ashamed that it has been delayed for so long. People are suffering because this is not happening. Will the Government please get on with it or tell us the real reason for not doing it before?

I agree with the noble Baroness that the issue has been on the agenda for some time. I am an optimist. There is a consultation, which will be sharp and rapid. She is raising her eyes but the reality is that we have to take into consideration all the issues. It is about responsibility, and choice too. People can go on the NHS website Change4Life, which talks about healthy lifestyles. There is a positive and proactive campaign to ensure that women of childbearing age take folic acid. Young women—and all those of childbearing age—need to ensure that they have a well-balanced diet that includes things such as broccoli, spinach, pulses and so on. That is their responsibility as well as a matter of government accountability.

My Lords, we have had two supplementary questions from the Labour Benches and only one from the Conservative Benches, so would my noble friend like to continue?

My Lords, I draw attention to my interests as set out in the register. Every week that goes by there are more medical tragedies which could be avoided, so there has to be a sense of urgency. I hope this consultation is about how to implement the procedure, not about whether or not, as I think that question has been answered. I ask my noble friend the Minister to assure us that the consultation will be about operationalising the addition of folic acid, not about another way of looking at evidence which has already been thoroughly examined.

I do not know what is going to be in the consultation because I have not had sight of it, but it will take into consideration a wide range of issues to ensure that we are able to move forward in the positive way which I know noble Lords across the House want.