The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)
I beg to move,
That this House has considered folic acid fortification.
This week is Spina Bifida and Hydrocephalus Awareness Week, so it seems fitting to be having this debate today. The House will have heard the Minister with responsibility for public health, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), announce during Health questions on Tuesday that the Government are launching a public consultation in early 2019 on the proposal to add folic acid to flour. This issue has attracted wide interest from a large group of stakeholders, and it is important that we properly consult on the proposal, to ensure that all people have an opportunity to register their views. We will be encouraging people to take part in the consultation.
Sir Greg Knight (East Yorkshire) (Con)
During his speech, will the Minister tell the House why the Government have apparently ruled out a publicity campaign to encourage those who are at risk to take folic acid supplements and are instead proposing this mass medication?
Nigel Adams
We will be encouraging all stakeholders, as well as the public, to take part in the consultation. I will certainly look into the matter that my right hon. Friend has raised and ensure that someone writes to him.
Owen Smith (Pontypridd) (Lab)
Given the evidence that neural tube defects such as spina bifida emerge between the 18th and the 28th day after conception and that most women are not taking folic acid supplements in accordance with the Government’s guidelines before conception or during their first trimester, does the Minister agree that supplementation alone does not work?
Nigel Adams
The hon. Gentleman takes a keen interest in this matter and has done some extraordinary work on it. He makes an important point. This is why awareness is crucial for all women of childbearing age, including those who are not pregnant but might be considering becoming pregnant.
Will Quince (Colchester) (Con)
I recall that we did not know our first child was on the way until 22 weeks; we were not particularly planning to have a baby. It is not always easy to foresee these eventualities. Will the Minister take into consideration the fact that not everyone can prepare for eventualities that they are not expecting?
Nigel Adams
My hon. Friend makes a perfectly plausible point from personal experience. Not everyone can see into the future and plan accordingly. A large number of pregnancies are unplanned, so I understand his point.
Rebecca Pow
When I was pregnant with my third child, I took folic acid supplements and ate lots of green vegetables, which contain folic acid. However, as colleagues have said, many people do not know that they are pregnant early enough to start doing that. Also, they might not have received the right advice from the medical profession. This consultation is important on those grounds, but will my hon. Friend also ensure that it is very wide ranging so that consideration can be given to all aspects, including the appropriate safeguarding of voluntary fortification by the food industry? Will consideration be given to coeliacs, who use gluten-free flour? This has to be a very comprehensive consultation if it is to be effective.
Nigel Adams
It does; my hon. Friend makes an incredibly important point. A number of foods already contain folic acid, and the consultation will have to take that into consideration. It will also look into what a safe upper limit is in that regard. This is why we want to ensure that the consultation is as thorough as possible.
Anna Turley (Redcar) (Lab/Co-op)
The Minister is being extremely generous in giving way; we are not allowing him to make much progress. May I take it from his last assertion about an upper limit that the consultation, which we welcome, is not so much about whether folic acid will be included in flour but about what the upper limit will be?
Nigel Adams
I do not want to prejudge the outcome of the consultation, and I am sure that the hon. Lady would not expect me do so. It will have to take an upper limit into consideration; indeed, that will be an incredibly important part of the consultation. We want to ensure that the consultation is properly done, that it is thorough and that it can advise Ministers. We will be coming back to the House to report back on it.
I shall move on, if that is okay with colleagues. I think from the tone of the debate thus far that the announcement has been well received. We will be properly consulting on and considering all aspects of this very important issue. I note that many colleagues are well informed about it and that they are aware of the reason behind the calls for mandatory fortification, but it might be helpful to summarise again what we are trying to prevent. Neural tube defects are birth defects of the brain, spine or spinal cord. They happen in the first few weeks of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. These are devastating conditions, and the Government are fully aware of their effect on the individuals themselves and their families. We have already heard the acute interest and strength of feeling on this issue from Members of this House and in the other place, including on what can be done to ensure that pregnant women have healthy pregnancies and give their unborn babies the best protection during the crucial early weeks of development.
Unless someone is pregnant or thinking of having a baby, they should be able to get all the folate they need by eating a varied and balanced diet. Existing pregnancy advice to women who are trying to conceive or who are likely to become pregnant is that they should take a daily supplement of 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods, to which my hon. Friend the Member for Taunton Deane (Rebecca Pow) referred. Examples are spinach and broccoli, as well as foods voluntarily fortified with folic acid, including a wide range of breakfast cereals.
We know, however, that around half the pregnancies in the UK are unplanned. In those that are planned, it has been estimated that only half of all mothers took folic acid supplements or modified their diet to increase folate intake. This has led to calls for the mandatory fortification of flour with folic acid so that women can get it from dietary sources other than foods that naturally contain it. Successive Governments have not considered that mandatory fortification of flour with folic acid to be the best way to protect public health and have instead promoted the use of folic acid supplements as a part of a wide range of pre-conception and post-conception advice to women of childbearing age. However, we are now taking the opportunity that this consultation presents to seek the public’s opinion on this proposed important change.
My colleague the Minister with responsibility for public health responded to a Westminster Hall debate in May 2018 that was secured by the hon. Member for Pontypridd (Owen Smith), who has campaigned tirelessly on this issue. In his response, the Minister confirmed that the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—I shall refer to it as COT from now on—had agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT published its interim conclusions in July 2018, but it has yet to finalise its detailed review. In summary, COT concluded that the potential masking of pernicious anaemia was still an appropriate and relevant endpoint on which to base a tolerable upper level, but that the level at which this effect started to occur was unclear. It concluded that further analysis of the data was necessary, but that the upper level would not decrease—that is, it would stay at 1 microgram a day or could be increased—as there was no convincing evidence that masking occurred at levels of intake below 1 microgram a day.
COT has discussed this again at this week’s meeting, and as soon as the outcome of its consideration becomes available, it will inform Ministers’ thinking in respect of the Scientific Advisory Committee on Nutrition’s recommendations on the mandatory fortification of flour and about folic acid advice generally. We will reflect that outcome in the consultation document, together with whether we need to take any other action, such as discussions with the industry on removing folic acid from products that are currently voluntarily fortified, such as breakfast cereal. We will also be working closely with colleagues in the Department for Environment, Food and Rural Affairs on the consultation, its responses and any resulting conclusions.
Rebecca Pow
It goes without saying that it would be worth examining the results of tackling anaemia by fortifying flour with iron and of tackling tooth decay by putting fluoride in toothpaste. Similar things have been influenced by approaches to general health, and we could learn great lessons from such examples.
Nigel Adams
My hon. Friend is absolutely right. There is be research and evidence in these areas from around the world, and we hope that it will feature in the consultation. We certainly need to learn from the approaches taken elsewhere.
Nigel Dodds (Belfast North) (DUP)
I am grateful to the Minister for what he is saying and warmly welcome the announcement made by the Under-Secretary of State for Health and Social Care, the hon. Member for Winchester (Steve Brine), on Tuesday. It is a tremendous step forward. As for looking at what has happened across the world, well over 85 countries, including the United States, have mandatory fortification of flour, so there is an awful lot of evidence out there, and clearly it should be taken into account.
Nigel Adams
It certainly will. The right hon. Gentleman takes a keen in this area, and other countries such as the United States, as he mentioned, Canada and Australia have introduced mandatory fortification. We need to learn from all that, but we also need to understand the dietary habits of the United Kingdom. It is worth mentioning that no EU country currently has mandatory folic acid fortification, but he is right and we will certainly be learning from the experiences elsewhere.
I assure the House that Ministers have always taken the issue of pre and post-conception advice seriously, and the public consultation will allow us to fully explore the fortification of flour. This is the start of a detailed dialogue with the industry, the general public, relevant charities—I thank Shine, which has done so much campaigning in this area—and members of the scientific community. This Government will ensure that the decisions we take will come after the full consideration of all views. It is my pleasure to introduce this important debate, and I look forward to hearing the contributions and views of Members.
Nigel Adams
With the leave of the House, I echo the hon. Member for Washington and Sunderland West (Mrs Hodgson) in saying that we have had a fantastically well-informed debate. It is good to see the House coming together. I am sure that everyone will agree that the tone of the debate has been extremely welcome. We have heard Members’ views about the proposal to fortify flour with folic acid, and I thank all of them for their contributions and interventions. This will ensure that the consultation document reflects both the scientific evidence base and the very personal impacts of the consequences for families dealing with an NTD birth. What has been clear from the debate is that we must move forward on this issue as soon as possible.
On modelling, the Government will consider all current dietary habits of women of childbearing age to help to inform the impact of this proposed mandatory fortification of flour to ensure that we are reaching the desired outcome. All dietary patterns will be considered whether they be cultural, religious or just personal preference.
On safety, we will continue to listen to COT’s advice to ensure that a safe upper limit is not exceeded by proposed changes to the folate intake from fortified flour. I hear what the hon. Member for Pontypridd (Owen Smith) says, but we have a duty to listen to COT’s advice. On pre and post-conception advice, we will ensure that a clear public health message is provided so that young women can properly understand what this proposed fortification change means for them having a healthy pregnancy.
Let me refer to some of the contributions to the debate. I thank the hon. Members for Blaenau Gwent (Nick Smith) and for Redcar (Anna Turley) for their interventions, and also the Scottish National party spokesman, the hon. Member for Glasgow North (Patrick Grady), who spoke in such an informed way. I really need to pay tribute to the hon. Member for Pontypridd for his work as co-chair of the all-party group on folic fortification and for highlighting those individual cases that he referenced. In particular, there was that incredibly moving story of the young girl, Nicky, which must have touched everyone here. As a Department, we are incredibly grateful for all the work that he has done. He, like the hon. Member for Washington and Sunderland West, was right to reference the work of Lord Rooker. We are extremely grateful for what he has done in this area and for his campaign on folic fortification.
The right hon. Member for Belfast North (Nigel Dodds) speaks eloquently and brilliantly on all issues in this House. It has been a great privilege to listen to his contributions over the past eight years, but particularly in this debate. To come to this Chamber and to speak on a personal level about his experiences must have been incredibly challenging, and the way in which he talked about his son, Andrew, was incredibly moving. Both he and the hon. Member for Pontypridd, as co-chairs of the all-party group, should be very proud of their work to get the Government to this stage. I am absolutely sure that Andrew would be incredibly proud of his father’s work.
The hon. Member for Leeds North West (Alex Sobel) rightly highlighted the costs—the relatively small costs—involved in this area. That is a great reminder to the Government that this is an issue that is not particularly expensive to deal with. There are not that many flour mills around the country, as he said. I am very grateful to him for his contribution.
I turn now to the comments of my friend, the hon. Member for Washington and Sunderland West, whom I have had the great privilege of working with on various campaigns over the years in this place. She asked exactly when the consultation would be launched and how long it would last. I know that other Members will want to know that as well. We do not have an exact date, but it will be early in the new year. I can assure her that it will happen as soon as we have been able to finalise the impact assessments. There is no fixed time for such an important consultation, but we expect it to last around 12 weeks to ensure that everybody has had a chance to consider the matter and respond. She asked whether there was an expectation of when we would have the results. Well, we will consider the outcome of the consultation as soon as it closes. Again, I cannot give her an exact date today in the House, but I can assure Members that we are committed to no delay and to responding as quickly as possible on this very important matter.
The hon. Lady also asked whether the consultation would consider the fortification of flour, or whether it would just establish an upper limit. I can assure her that the consultation will consider whether the calls to fortify wheat flour will achieve the objective for pregnant women. COT is considering the safe upper levels as part of that and its conclusions will be reflected within the wider consultation. She asked which Department will be responsible for leading the consultation, and I can tell her that it will be the Department of Health and Social Care. She also asked about gluten-free flour and whether fortification will include just wheat flour, or other types of flour such as cornflour for those with coeliac disease. We will consider all food in the modelling to ensure that the policy reaches its objective. We will also discuss with industry the issue of foods that are currently voluntarily fortified, such as breakfast cereal.
Finally, the hon. Lady asked how charities such as Shine can support the Government in ensuring that the announced consultation progresses quickly. We are very grateful to Shine and other charities for their tireless promotion of this important issue. Until we know the outcome of the consultation, it is too soon to consider which legislative vehicle might be needed to give effect to any decision, but the consultation process will allow us to make a decision once we have that outcome.
We very much hope that the consultation will raise public awareness of the need to continue to take the recommended folic acid supplement before conception and up to the 12th week of pregnancy. That is vital, as we have heard, and I really hope that this message can be brought to the attention of women both now and in respect of any future change. I am confident that this public consultation will give a proper channel to allow everyone to make their feelings on this issue known. I am sure that everyone who has participated in the debate will very much look forward to its outcome.
Question put and agreed to.
Resolved,
That this House has considered folic acid fortification.