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Folic Acid

Volume 796: debated on Tuesday 19 March 2019


Asked by

To ask Her Majesty’s Government, further to the reply from Baroness Manzoor on 9 January (HL Deb, col 2212), when they will commence the consultation announced on 22 October 2018 regarding the mandatory fortification of flour with folic acid to help prevent foetal abnormalities.

My Lords, I have good news, I hope. The Government have now received advice on tolerable upper limits of folate from the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Other work streams are also progressing well. We therefore expect the consultation documents to be published within the next month.

My Lords, I am sure that we are all delighted that my noble friend Lord Rooker has at last had some success, given how many Questions he has asked on this subject, and I congratulate him. The Minister might like to know that I tabled a Parliamentary Question in January asking,

“how many babies have been born in England with neural tube defects, such as spina bifida, in the last five years for which figures are available”.

The Answer said that the total number of cases was 889. There were 150 live births, 26 foetal deaths and 713 terminations of pregnancy—that is, 889 families traumatised by something which is entirely avoidable. Can the Minister promise us that this consultation will not be interminable?

I certainly can promise the noble Baroness that the consultation will not be interminable. We believe that it will run for around 12 weeks. Once we have had the opportunity to ask the various stakeholders who we hope will take part—people from the scientific community, the manufacturers of bread, whether large or small, and the public—how they feel about the fortification of bread, we will look at the evidence and revert as soon as we can.

My Lords, I add my congratulations to the noble Lord, Lord Rooker, and I thank the Government for giving us good news. However, will they be working with the devolved Administrations during the consultation, recognising the burden of spina bifida that has occurred in south Wales in particular?

I thank the noble Baroness for raising that issue. This is a devolved matter, and obviously we are mindful of the practical aspects of the proposals, given the amount of trade that occurs within the United Kingdom’s single market. We are working very closely with officials in the devolved Administrations and, although it is not quite there yet, we anticipate that it will be a UK-wide consultation.

It seemed to be a Question that came up every day, and I am very pleased that finally there seems to be some resolution. However, I should like to ask the Minister about the problems that could occur with flour bought from abroad. A lot of artisan bakers now buy their flour from abroad, so how will we deal with fortification in that regard?

My noble friend is quite right, and that is why the consultation is so important. A number of bakers buy their flour abroad. Noble Lords will be aware that, in many—in fact, in all—European countries, there is no fortification of flour at all; they are not in favour of fortification. We have also to consider the smaller-volume producers, for example, who might find fortification difficult as they try to combine folic acid with smaller quantities of dough for bread.

My Lords, first, will the Minister come clean and tell the House why exactly it has taken so many years to get this measure introduced in this country? Secondly, it is very good news that the consultation paper will be produced in a month’s time, but can she tell us whether that will be a short month or a long month?

I am happy to “come clean”, as the noble Baroness suggests. It was important to the Government to make sure that we had the right scientific evidence and advice from the advisory committees to get to the stage where we could have a consultation. The Scientific Advisory Committee on Nutrition, which reported in July 2017, said it would support fortification only if there were restrictions in place on voluntary fortification—lots of manufacturers already put folic acid in, for example, breakfast cereals. This is not as simple as it may at first appear. As I mentioned earlier, we then had the report from the Committee on Toxicity, which looked at the upper levels of folic acid and whether it would be tolerable for people. To a certain extent, if we did not have that, there could possibly be problems with the diagnosis of pernicious anaemia.

Can the Minister tell the House whether the consultation will take on board compelling international evidence about the use of folic acid? Research has already been done, and there is compelling evidence about the efficacy of folic acid. Can the Minister also tell us how long the consultation will last? I am anticipating the next set of Questions from my noble friend Lord Rooker, when the consultation ends and we are waiting for its findings to be enacted.

I cannot wait for those Questions from the noble Lord, Lord Rooker, either. As I said, the consultation would probably be 12 weeks, which is a normal consultation period. The noble Baroness raises an important point about what has happened internationally. As I mentioned earlier, EU countries have not fortified their flour. However, many countries have done so—some have been doing so for quite a long time. One quite important issue to cover here is that fortification is not intended to completely replace the taking of supplements by those who need them. For example, if we were to fortify at the same rates as the US, in terms of receiving the same amount of folic acid, a childbearing lady would need to eat eight pieces of toast. So it is not a complete panacea. We must recognise that a folate-rich diet is also important, as are supplements.

Three years ago, in this House, the then Health Minister acknowledged that the link between folic and reducing neural tube defects was fairly well proven. As it has taken so long to act on that, and on decades of evidence in the United States and elsewhere, once we have finished this 12-week consultation period—in which all professional bodies and royal colleges are unanimously of the opinion that we should act to add folic acid to flour—how long will it take the Government to act?

As I have tried to point out to noble Lords, we are certainly looking to act as soon as we can when we have had the opportunity to review all the evidence presented. Certainly, the scientific evidence in this area is very strong, but there are two other factors that we must consider: the operability of any changes we impose—because we would not want to get that wrong—and public opinion. In other countries, there is public opinion against the mass medication of foods, and we need to make sure that the public are behind this as well.