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Folic Acid

Volume 811: debated on Tuesday 23 March 2021


Asked by

To ask Her Majesty’s Government, further to the reply from Lord Bethell on 3 September 2020 (HL Deb, cols 444–5), whether they have reached a conclusion on the findings of their consultation on the proposal to add folic acid to flour which closed on 9 September 2019.

My Lords, I pay tribute to the noble Lord, Lord Rooker, for his stamina on this important issue. Since the consultation on folic acid in flour closed, there has been considerable progress on this policy work, although this has been hampered by Covid. I commit to bringing an update to the House as soon as I reasonably can.

I thank the Minister for his Answer but, as he will expect, it is not good enough. Notwithstanding the Covid pressure on the health department, it found time and resources to produce an NHS reform White Paper, so the priority was organisation, not preventive health. Since the Minister answered the previous Question on this in September, on average there will have been 500 pregnancies affected by neural tube defects, resulting in more than 400 terminations, and around 80 live births of babies with a lifelong disability. Fortification can cut these figures by up to 50%. My last question is: how will Ministers face the Daily Mail, which for 15 years has supported the scientists advising that this policy be adopted? I shall be back next month, I give notice.

My Lords, I pay tribute to both the stamina and the passion with which the noble Lord puts his case. He puts it extremely persuasively. We have worked hard to engage with policymakers on this, meeting mill owners, including artisanal mill owners, and those who are engaged in the supply of food. The supply of food has been a difficult area in the last year. It is difficult to lay this extra burden on the trade. It is extremely open to the option and we remain optimistic that this is a route we can walk down. There has simply not been an opportunity to make that commitment as yet, but I will update the House as soon as I possibly can.

My Lords, yesterday, the Minister said that the health of the nation had to change emphatically. The recent NHS White Paper, to which my noble friend Lord Rooker referred, actually promised a more direct government role in improving people’s health. For instance, as president of the British Fluoridation Society, I was delighted that the Government are now committed to fluoridating water supplies. Given that, would it not be a very important indicator if the Government were to announce very shortly that they are going to go ahead with this?

My Lords, the noble Lord blows my own words in my face very effectively indeed. He is entirely right—we are committed to preventive medicine in the round. Fluoridation is one graphic example of that and the use of folic acid to address neural tube defects is another good example. That is why we did the consultation in 2019 and are considering the responses, and it is why I have made the commitment to return to the House once we are able to give an update.

My Lords, while I wholly support measures for larger commercial millers to minimise the risks associated with folic acid deficiency in vulnerable groups in society, I ask that the Government exempt smaller, traditional artisan mills from having to have to mix folate into flour. These mills represent only 0.1% of flour production and it would be prohibitively expensive for them to purchase the necessary machinery and to adapt what are often listed buildings for this change. Also, some customers deliberately seek out traditional flour, free from additives.

My noble friend makes the case extremely well. I reassure him that, in February 2020, officials from the DHSC and Defra met representatives from the Society for the Protection of Ancient Buildings’ Mills Section and the Traditional Cornmillers Guild and visited windmills and watermills to understand at first hand the practicalities around fortification for those premises. The commitments made on those visits will, I think, build a policy that takes into account the very special needs of those important artisanal trades.

My Lords, I commend the noble Lord, Lord Rooker, for his tenacity on this issue, and fail to understand why successive Governments have not recommended the addition of folic acid to flour, as well as fluoride to water, following many western Governments. For those who live on junk food, folate deficiency can turn into a serious disorder and, if left unchecked, can be fatal. In addition, the possible damaging effects to the foetus during pregnancy make this a no-brainer. The consultation closed 18 months ago, so when will the Minister bring the update to the House?

The noble Baroness puts the case well. It is an issue that I feel personally committed to; a cousin of mine was born with a neural tube defect many years ago, and the effects of that hit my family extremely hard. I recognise the problem of unplanned pregnancies and the need to find a way to get folic acid to people who were perhaps not intending to have a pregnancy. We take this matter extremely seriously, and I commit to returning to the House when we have an update on it.

I encourage my noble friend to accelerate this initiative of folic acid supplementation, which the House can see clearly he would very much welcome. But can he also comment on other preventive measures to improve the nation’s wider health?

My Lords, I think my noble friend alludes to the rollout of the vaccine, which has been the consummate preventive medicine programme that the country has ever seen. It is, I hope, an inflection point in the whole country’s approach to its healthcare. We have for too long emphasised late-stage, heavy- duty interventions, and we have not focused enough on preventive early-stage interventions. Folic acid is a really good example, as are the vaccine and fluoridation, and the kinds of population health measures we hope to bring in will address all of those.

I too commend the noble Lord, Lord Rooker, for his tenacity on this important aspect. Do the Government recognise that 90% of women of childbearing age have low folate levels? If these were corrected by the dietary addition of folate to flour, we could see up to a 58% decrease in neural tube defects. These are massive numbers and cannot be ignored. The clock is still ticking and there are women getting pregnant today who have low folate levels.

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

My Lords, last year, a year after the consultation deadline closed, the Minister repeated his promise that, despite seriously delayed government decision-making, major efforts were being made to step up the raising of awareness of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20. Can the Minister tell the House what actions have been taken? What measurable impact has awareness raising had among these at-risk groups and on ensuring that women whose pregnancies are unplanned—as we have heard—are not missing out on these vital nutrients in the early stages of their pregnancy?

I am grateful to the noble Baroness for reminding me of my words on that matter. I will endeavour to find an answer to her very particular question. I worry that the very large amount of engagement we have had to do on Covid, particularly around marketing, has drowned out some of the messages that we have put through to people on these very specialist issues. I will find out from the department what progress has been made and will be glad to update her.

My Lords, Britain has a relatively high rate of preventable birth defects linked to low folic acid—around 1,000 pregnancies are affected every year. The Government are aware of this but do nothing, and it is scandalous that this tragedy could be prevented by the mandatory fortification of flour with folates. The burden on mill owners appears to be more important to the Government. When are the Government going to stop letting women down in this way at one of the most vulnerable times of their life?

My Lords, I accept the passion with which the noble Baroness has made her case, but it is not fair to say that we have done nothing. The consultation is in place, policy-making is being undertaken and the engagement with mill owners is well progressed. I am hopeful that we can make progress in this area.

My Lords, since I entered this House at the end of October 2013, there have been 14 Oral Questions on this subject. I had four years as the president of the British Dietetic Association, which came and went with us pressing for government action. On 3 September last year, the Minister said that

“I am not in a position to give him”—

that is, the noble Lord, Lord Rooker—

“the date he wishes, but we will come back to the House and answer his Question in due time.”—[Official Report, 3/9/20; col. 445.]

When on earth is “due time” going to arrive?

My Lords, I accept the challenge from my noble friend, who articulates his point extremely well. I can see in front of me the timeline on this issue. I can only say that we are trying to approach this in a way that creates a durable, long-lasting solution that is endorsed by mill owners, paediatricians and all the relevant stakeholders. It takes time to build that sort of consensus but we totally recognise the importance of this issue—1,000 NTD deaths a year is far too many. I undertake to put pressure on the department to ensure that this issue makes progress as soon as possible.