Lord Rooker
To ask His Majesty’s Government when they expect to announce a decision following the consultation on the Bread and Flour Regulations 1988 which closed on 23 November 2022.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government will publish an interim response within 12 weeks of the consultation closing, on 14 February, with a fuller government response later this summer. We received 369 responses, and UK officials are currently reviewing them in detail with a review to finalising policy decisions. Following that, the Government expect to lay new legislation early in 2024 subject to clearing parliamentary process. Discussions with industry on the practicalities of folic acid fortification of flour are also ongoing.
Lord Rooker (Lab)
I have to say that is the first time the Minister has answered one of my Questions on this, and I am very grateful to him. He gave some positive dates, which we can hold him accountable to, and it looks as though there is some progress. I will make just one point. It is already three months since the end of the consultation. That is another 250 neural tube defect pregnancies, 80% of which will be terminated, and close to 50 live births of children who will have lifelong disabilities. It really needs to speed up. I fully accept what the Minister said, and I am very grateful for that—it would be churlish to be otherwise. However, the fact is that time is of the essence on this. We have a cure for 80% of the issue, but we are not using it at the present time.
Lord Markham (Con)
I thank the noble Lord, who has been a tireless campaigner on this issue. Again, a benefit of this position is getting to learn new subjects, and this is one of them. I can see why he campaigns so hard on it. I am delighted to say that we are getting there, albeit that it could be argued that maybe it could be quicker. At the same time, industry is seeing that, and the good news is that it is already adjusting. The majority of breakfast cereals are now fortified and a lot of the rest of the industry is responding. We are making a difference, and I thank the noble Lord again for his campaigning.
Baroness Walmsley (LD)
My Lords, does the Minister consider that too low a dose would leave people believing that fortification does not work? Is he aware that the Royal College of Obstetricians and Gynaecologists believes that the proposed level of folic acid fortification will prevent only about 20% of neural tube defects? It recommends that fortification be set at a level that is sufficient to prevent four out of five neural tube defects, which is 1 milligram per 100 grams. Will the Minister consider that?
Lord Markham (Con)
I am very aware of the range of scientific advice on this. I am also aware that the official results of the consultation, which will come out, are not clear cut. A sizeable number of people, 40%, are anti-fortification. As ever, it is about trying to get that balance right. We completely agree on the direction of travel. There is some scientific advice that at too high a level there is a potential masking of pernicious anaemia in the elderly. This is the first step. Let us get all the evidence. The critical thing is getting that first step right.
Lord McColl of Dulwich (Con)
My Lords, can my noble friend the Minister find out exactly how many people are involved in the decision-making on this subject? How often do they meet?
Lord Markham (Con)
I do not know the precise number; I know there are many stakeholders in this. The devolved Administrations have been involved in all of this. Part of the delay is because, once we go ahead, we have to notify the EU, because of the Northern Ireland elements of it, and that is a six-month notification. We also have to notify the World Trade Organization. All these aspects mean that this is not as quick as we would want, and then we need to let the industry have time to adjust. It is a process involving many people, but we are getting there.
Baroness Wheeler (Lab)
My Lords, despite their seriously delayed decision-making, the Government promised nearly two years ago that major efforts would be made to step up awareness raising of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20 years old. Can the Minister tell us what actions have been taken, and what measurable impact awareness raising has had among these risk groups and on ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?
Lord Markham (Con)
The noble Baroness is correct. Key to all these things is awareness that the best advice is to take folic acid supplements, as suggested. I am happy to provide precise figures of how that has moved in recent years. I completely agree that, as ever, education and awareness are key to this.
Lord Jackson of Peterborough (Con)
My Lords, I welcome my noble friend the Minister’s very positive tone. I first campaigned on this issue as a constituency MP 18 years ago, but it is 32 years since the Medical Research Council established the causal link between the ingestion of folic acid and the reduction of neural tube defects such as spina bifida and hydrocephalus. Scores of countries have pursued this policy and it has had a significant impact on reducing the tragedy of lifetime disability that has affected many families. Can the Minister ensure that the review is concluded expeditiously so that we can erode these terrible medical conditions as soon as possible?
Lord Markham (Con)
Yes, I am very happy to do so. It has been quite a process, as my noble friend says, but we are getting there. As I said, the good news is that the industry is seeing the direction of travel and is responding as well. That is always better when done voluntarily. We are seeing more foods with levels of fortification. We will get there in terms of it being mandated as well.
Lord Patel (CB)
My Lords, there has to be some progress. I think the noble Lord, Lord Markham, is the seventh or eighth Minister to answer this Question, the first being the noble Earl, Lord Howe. To get the scientific facts right, the advice given by the Royal College of Obstetricians and Gynaecologists of 1 milligram is based on the surmise that higher doses do not cause any harm. It is wrong science, for which there is no proof, to say that doses as high as 1 milligram mask B12 deficiency. It is completely false and we must not use that. The chief scientific officer of the Department of Health confirmed that at our last meeting, which the noble Lord, Lord Rooker, may well remember.
Lord Markham (Con)
To be clear, I was referring to scientific advice I received today about the potential risk of masking, as I said. It is a concern but, as ever, one of the wonders of this House is the expertise available on tap. I will go back to consult on that and write to the noble Lord.
Lord Cunningham of Felling (Lab)
My Lords, between 80 and 90 countries now add folic acid to flour, with no known side-effects. What are the Government waiting for? All the evidence is there, all the science is there and this is all well known. I do not know, speaking for myself, what the delay is about.
Lord Markham (Con)
As I say, there is a process involving co-ordination with the devolved Administrations. We have to consult the EU, as mentioned, because of Northern Ireland is part of it all, and then allow the industry to get on board. Again, we are all in favour, without a doubt, but 40% of the respondents were anti. So we need to be careful to do this in the right way. I hope and believe this to be the first step but, as ever, the first step is often the hardest. We are getting there and this will make a difference.
Lord Dodds of Duncairn (DUP)
My Lords, I join the noble Lord, Lord Rooker, in welcoming the Government’s firm announcement on dates. The delay has been as frustrating as it has been inexplicable for many people. Can I seek an assurance that, when this measure is finally adopted legislatively, it will apply across the entire United Kingdom equally and at the same time?
Lord Markham (Con)
Yes, that is my understanding. One of the aspects that has taken time is getting the devolved Administrations on board and the complications of the Northern Ireland situation with the EU.
Baroness Jolly (LD)
My Lords, many countries put folic acid into bread to prevent neural tube defects. When it was added to flours in Australia, the number of these defects reduced by 14%. More folic acid in more bread products could save 800 babies a year in the UK from developing birth defects such as spina bifida. The Minister gave your Lordships positive news, but when can we expect it to bear fruit?
Lord Markham (Con)
As mentioned, there is a process that we are going through. As I said in my first Answer, we will be laying the legislation early in 2024, but it is happening. More importantly, in the meantime a lot of the industry are voluntarily adopting it.