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Folic Acid

Volume 813: debated on Wednesday 23 June 2021


Asked by

To ask Her Majesty’s Government what progress they have made with the response to their consultation about the fortification of flour with folic acid.

My Lords, the administration of folic acid to the bread of the nation to avoid around 500 neural tube defects a year is exactly the sort of preventative health intervention that we are putting at the heart of our health strategy. I am pleased to say that progress is being made, and I thank the devolved Administrations for their engagement in this measure to ensure that we have alignment between the four nations. I reassure noble Lords that this remains a priority for the Government.

My Lords, surely the Government have run out of time and must now announce that they will follow the science and finally act to help to prevent the entirely avoidable numbers of babies born with neural tube defects? Recommendations were to be announced as soon as the recent elections were over, and if we are serious about preventative medicine and health, surely on this issue, where UK research has led the way to many other countries taking action long before now, there really can be no further delay or excuses.

My Lords, I entirely agree with the noble Lord that we are committed to following the science and are totally persuaded by it. However, I cannot avoid the fact that there were elections in devolved nations, which have meant that politicians and Secretaries of State in some of those countries were not available to engage with. I am pleased to report to the House that we have made a lot of progress in engaging with the devolved nations. We could not possibly do this policy without their support, buy-in and alignment. Progress is continuing at great pace, and I look forward to returning to the House and updating it at a future date.

My Lords, in March this year, the noble Lord said that the Government were taking time to create a

“solution that is endorsed by mill owners, paediatricians and all the relevant stakeholders.”—[Official Report, 23/3/21; col. 720.]

Given that the position of UK flour millers is acceptance if the Government decide to introduce mandatory fortification, and given that there is overwhelming support from the medical community, why are the Government dragging their feet and not introducing this measure, when it is proven to reduce neural tube defects in babies? Next month is the 30-year anniversary of when this link was proven. Why are we taking so long to put this measure in place?

My Lords, the noble Baroness is entirely right: medical opinion on this matter has absolutely consolidated around support for it, and the consultation in September 2019 was extremely positive indeed. I am extremely grateful to mill owners, both the large industrial ones, which make a lot of the white flour, and the artisanal mill owners, which had complexities of their own. The engagement with them has been enormously positive, and I cannot see any obstacle on that front. However, there is a machinery of government point that needs to be addressed: we have to work it through the devolved nations and other arm’s-length bodies, and we are doing that at pace.

My Lords, from my noble friend’s responses, the House will be clear that this decision is under way. Could my noble friend give some idea of whether we might expect an announcement before the Summer Recess? We know that hundreds of children being born with spina bifida and anencephaly, which can be so damaging to themselves and their families, could be avoided. The sooner we do this, the sooner we can stop such problems occurring.

I agree with my noble friend; she is right that this is a priority. However, it is not within my gift to simply grant a decision on it; it needs to be worked through both industry and government. We are making progress on this. It is a huge national undertaking for us to put substances literally in the bread of the nation. The public deserve to feel confident that that decision has been made thoughtfully and responsibly, and it is entirely right that we take care to dot the “i”s and cross the “t”s.

My Lords, the Government have had an awfully long time to dot the “i”s and cross the “t”s. When the MRC research first came out, my children were the age that my grandchildren are now. Some 80 other countries have moved more speedily than the UK on the evidence provided by the UK-funded MRC research. As well as the noble Lord making progress on this before the Summer Recess, will the Government look at what the barriers were that made us as a country so slow to come to the decision to fortify flour?

My Lords, this Government’s progress on this really came to a head in the consultation in September 2019, and we have been on course to implement these measures since then. It is unfortunate that the Covid pandemic intervened at that point and we had to put work on this project on hold until April of this year. Since April, we have had to deal with the elections in the devolved Administrations. That, unfortunately, creates an insuperable barrier to taking the measures through all the necessary checks and alignments. I reassure the noble Baroness that we are totally committed to this policy, we are moving at pace and I look forward to further progress shortly.

I very politely remind the Minister—and it is on the record—that the three devolved Governments were in favour of this policy before the English Government were, so there cannot really be any substance of any delay from the devolved Governments. I know this because, with scientists, I discussed it with some of the Ministers. My other point is that, given that we already fortify with three substances, there cannot be any technical difficulties whatever in the flour mills in adding folic. There should not be any long-term delay of a technical nature, should there?

My Lords, I agree with the noble Lord. Can I just take a moment to bear testimony to his patient and determined campaigning on this issue? He has held the Government’s feet to the fire on it, and I am grateful for his focus. He is right that we are hopeful that there should not be any substantive delay with the industry. A huge amount of work has gone on in the consultations and the dialogue we have had, and I am grateful for that. However, the Senedd and Scottish parliamentary elections in May meant that new personnel were at the top of government. We hope that they are as supportive as the noble Lord so rightly pointed out, but there is a process to get the official endorsement that we need to take this forward and we are waiting for that paperwork to come through.

My Lords, is the Minister aware that 50% of pregnancies are not planned? Therefore, while the Government consult and procrastinate, what communication is being planned with women of childbearing age to tell them that they need to take a folic acid supplement before they start a pregnancy to avoid NTDs in their babies?

My Lords, this Minister is very aware—personally extremely aware—of the fact that 50% of pregnancies are not necessarily planned. As the noble Baroness knows very well, that is one of the reasons for this policy and that is why we are so supportive of it. The education that goes to new mums and dads on folic acid is done through GPs, and we are always looking at ways to enhance that. But I think there is no better of way of ensuring that folic acid gets to the right people at the right time than through this measure, and that is why we are supporting it as energetically as we are.

My Lords, can the Minister comment on whether the Government have been working with the health authorities in other countries to review the evidence from the more than 80 other countries where folic acid has been mandatorily added to food products?

My Lords, it is my understanding that both the Department of Health and Defra have been engaged with other countries on this matter. I will be glad to write to the noble Baroness with any details that we may have on record.

My Lords, I listened to the Minister’s answer where he referred to delays as a result of the Covid pandemic and the elections in the devolved Administrations. While they may be recent issues, this delay well precedes both those important events. As my noble friend Lord Rooker and others have so eloquently expressed, patience on this is long exhausted and parents-to-be cannot be expected to continue to carry such risk. Can the Minister tell the House exactly when babies will be protected? Is the delay that we have seen over decades due to any change in the Government’s position?

I absolutely reassure both the noble Baroness and all noble Lords in the Chamber that there is absolutely no equivocation on behalf of the Government in this matter. It is a huge undertaking to put a substance in the food of the nation. It is therefore something that has to be endorsed by all the relevant bodies, including the four nations and other arm’s-length bodies. We have to ensure that we have all the public health sign off and the industry support that we need, and we need to take the public with us. There will be a moment when we need to sell this to the public, and they will have questions and we will need to have a dialogue. When that happens, I would like to have crossed all the “t”s and dotted all the “i”s so that we are in great shape. That is why we are being as thorough as we can. I reassure all noble Lords that there is no question of us going backwards on this.