Bread and Flour Regulations (Folic Acid) Bill [HL]

Lord Hughes of Woodside Excerpts

Friday 8th July 2016 Lords Chamber

[Lord Hughes of Woodside (Lab)]

My Lords, I join the noble Baroness, Lady Hayman, in paying tribute to our mutual friend, the noble Lord, Lord Rooker, for bringing forward this Bill and I certainly hope he succeeds. The three of us, the noble Baroness, Lady Hayman, the noble Lord, Lord Rooker and I, were in the other place for some years together. I can testify to the noble Lord’s capacity for identifying a public policy that needs to be taken up and his tenacity in seeing it through. He is perhaps best known, at least among the three of us, for the so-called Rooker-Wise amendment—an unlikely duo—which was successfully introduced to a Finance Bill to make national allowances subject to the rate of inflation. He annoyed the then Chancellor of the Exchequer, Denis Healey, no end. Such tenacity is worth having and it certainly makes us in your Lordships’ House proud.

The issue of adding folic acid to flour has been around for a long time, because we share knowledge of the suffering of families who have had children aborted, who have lost children early or who have had children born with defects that last for years of their lifetime. The question must be asked: why are the Government so reluctant to move in the face of such indisputable evidence about the efficacy of adding folic acid to bread when there are certainly no signs at all of any detrimental effects in doing so? I do not know and I hope the Minister can answer that question.

At Question Time in the House—I say this without malice—the Answers given by the Minister for not doing so have been rather flimsy. He has cited the fact that health problems are improving in women, and there is no doubt about that. But beyond that, there is no reason why the Government cannot move. As my noble friend Lord Rooker said, many countries in the world already do this. The Scottish Government are considering moving on their own and have the power to do so as health is a devolved matter. It would be a great shame if that were to be the case.

Why is there such opposition? I know from personal experience how difficult it is to argue against those who, possibly for genuine reasons, are opposed to vaccination or fluoridisation of the water. I still have the scars on my back from trying to persuade Aberdeen Town Council to adopt that when I was the convener on the welfare committee there. I do not know whether it is a matter of prejudice. It cannot be ignorance because the facts are very well known. But the fact is there is huge opposition to any move to what is called public health medicine. The worst example of that is adding fluoride to the water. I emphasise absolutely what my noble friend said. Adding folic acid is not mass medication. That argument might be made in the case of putting fluoride in the water but this is a different matter altogether. This is a simple and straightforward measure that has been well documented as being successful and safe and for making people’s lives much better.

As my noble friend said, this is not a panacea. It will not eradicate NTDs, but the fact that 50% of women may be beneficially affected by this is a prize that makes it worth doing. The only slight disagreement I might have, although I may have misheard what my noble friend Lady Hayman said, is whether this is the right way to go about getting the legislation. I may have misunderstood what she was saying. But in the face of a Government unwilling to move on their own account through lack of time—and goodness knows what the Government will face in terms of time in the coming months and years—it is absolutely essential that those who have the opportunity to bring forward a Private Member’s Bill should do so.

[Baroness Hayman]

I would be more than content were the Minister to say today that the Bill in the name of the noble Lord, Lord Rooker, be taken forward with all speed and support by the Government in another place.

[Lord Hughes of Woodside]

Hear, hear to that. But in the event of that not being the case, it is the duty of this House to pass this legislation through all its stages and send it to the other place to deal with. That is imperative and essential and I am pleased to give my support to my noble friend Lord Rooker.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

I, too, congratulate the noble Lord, Lord Rooker. I think he has raised this issue in the House—I wrote this down—10 times in the past three years, as well as in a great many Written Questions. I have been a Minister for just over a year, and he has certainly raised it three times with me. You could say he hopes that doing so will be a triumph of hope over expectation, but it reflects his real passion and genuine heartfelt concern about such tragedies. He mentioned a letter he had received from a colleague whose mother had lost three children from spina bifida, and other noble Lords have brought home to the House what the impact can be. We can sometimes have rather arcane debates in this House, but that impact is very profound not just on the children but on the parents and families of those children. Far from being an irritation to those of us on this side of the House, his single-minded determination to keep this issue before the House has won him a great deal of admiration and respect in all parts of the House.

Perhaps I may start with the science, although frankly my argument will not be with the science. The noble Lord and others have argued that the science is absolutely black and white; I would say that it is clearly strong but there are still some residual issues.

The SACN has advised that the fortification of white bread flour with folic acid should be introduced only if it is accompanied by a number of preconditions: for example, action to reduce folic acid intakes from voluntary fortified foods, to ensure that individuals do not substantially exceed their safe maximum daily intake of folic acid. The noble Lord, Lord Turnberg, addressed that in his speech so it is perhaps questionable how strong that argument is. It also told us that there is inconclusive evidence on several possible adverse health effects of the mandatory fortification of flour with folic acid. For example, for people aged 65 and over, folate fortification of flour may result in cases of vitamin B12 deficiency not being diagnosed and treated.

However, there is no doubt, certainly in my mind, that the scientific evidence is strong. Regarding other countries, the noble Lord, Lord Rooker, mentioned the huge controlled experiment in America. I certainly would not feel comfortable standing here today and arguing with him on the science. Mine is a different argument: fundamentally, it is not a scientific dispute but more of a philosophical dispute. The science is to inform policy but not to determine it. For policy, we must look more to philosophers than scientists, more to moral choice than scientific experiment, and of course to Parliament and not the laboratory.

The nub of the question is this balance between state and individual responsibility. I know that when we bring it down to this issue, it may be felt to be beside the point but that balance is important because it is fundamental to the kind of society that we choose to live in. It is perhaps especially important now, when lifestyle behaviour is becoming such a big driver of healthcare demand. It is such a big driver that unless it is addressed, there is a serious risk that no healthcare system anywhere in the world will be able to afford the level of healthcare that we expect. I know that a special committee of the House of Lords is looking at this now.

[Lord Hughes of Woodside]

My Lords, can the Minister explain whether his argument on philosophy applies only to this measure? Does it apply to the treatment of water for safety purposes or to vaccination? It is equivalent to saying that vaccination should not be compulsory in any sense of the word. Where does the line fall as to where the philosophy overcomes the practicality of the matter?

[Lord Prior of Brampton]

The noble Lord makes a very good point and I hope to address that issue as I go through this, because where the line is drawn is critical to the debate that we should be having.

The ways in which we live our lives—what we eat or drink, how much exercise we should take and how we should look after ourselves and one another—all directly impact on the likelihood of getting cancer, a stroke or diabetes, or premature death. In this case it directly affects the health of children, so prevention has never been more important. I am sure everyone in this House would agree. The question, as raised by the noble Lord, is then: what are this Government or any Government to do? At one extreme, the answer is to do nothing and, at the other, it is to be highly prescriptive: to determine how we should all live and what we should eat and drink.

The noble Lord, Lord Hunt, referred to alcohol, which I will take as an example. The Government could have washed their hands entirely of that issue and left it to individuals—the classic, John Galt, libertarian approach, which he may have read about in Atlas Shrugged in his youth. Alternatively, they could have opted for some form of prohibition, as tried in the USA and as we do with certain drugs today—although with profound unintended consequences, I might add.

In the UK, as in most democracies, the balance as to where responsibility lies has shifted over the years. It has not shifted seismically or even consistently—there have been ebbs and flows of where that line should be drawn over the years—but it has shifted away from government intervention towards the individual. That is not surprising: you would expect that shift as the population becomes better educated, better informed and better able to make good decisions.

Health: Red Cell Folate

Lord Hughes of Woodside Excerpts

Tuesday 19th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think we are still quite early in the new year. I do not go back to 1991 but the noble Baroness is right: for many years now there has been a large body of scientific opinion in favour of increasing the uptake of folic acid. There is no dispute about that—I do not think there is much science to dispute. The issue is one of balancing the scientific and medical arguments with issues around choice and whether or not it is right to medicate the entire population for the benefit of a fairly small part of it.

[Lord Hughes of Woodside (Lab)]

My Lords, when the Minister says that other views have been taken into account, will he lay to rest today and for ever the idea that the Government will be swayed by those who say, spuriously and nonsensically, that this is mass medication?

[Lord Prior of Brampton]

The proposal is that bread should be fortified with folic acid. The point of doing it through bread is that most people eat bread and that it would reach the widest number of people. It would be fortifying a product that most people eat; that is the purpose of it.

Health and Social Care Act 2012: Risk Register

Lord Hughes of Woodside Excerpts

Wednesday 4th December 2013 Lords Chamber

[Earl Howe]

The noble Baroness would have cause to complain if, in accordance with the debates that we had in this House on accountability, my right honourable friend did not hold the NHS to account on some of the areas of its activities where there were concerns. That is exactly what he does, and he does it quite properly.

[Lord Hughes of Woodside (Lab)]

Is it not the case, in relation to the Chilcot report, that it is not the Government who are holding it up but something else? Will the Minister not hide behind red herrings like that? It is he and his Government who are refusing to publish the risk register, and they surely must do so.

[Earl Howe]

My Lords, over the passage of time a view can be taken about the sensitivity of the Department of Health risk register. That is what we have undertaken to do and what we will do. Next spring, we will reach one of the regular review points for the risk register. I can tell the noble Lord that work to review the register has already started in anticipation of that date.

Health: HIV

Lord Hughes of Woodside Excerpts

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My Lords, yes. We believe that the complex needs of people with HIV will be best served by the work being done by the HIV national clinical reference group of the NHS Commissioning Board. The board will commission these services in the future, and that will drive greater consistency and quality throughout the system.

[Lord Hughes of Woodside]

My Lords—

[Baroness Trumpington]

Our turn. I am not sure whether I am in order but I should like to congratulate, through this House, the Minister on his award yesterday as Minister of the Year in the Lords.

[Earl Howe]

I am exceedingly grateful to my noble friend for that and for not asking me a question that I was unable to answer.

[Lord Hughes of Woodside]

My Lords, I am grateful that I gave way. In view of the reports of an alarming increase in the incidence of HIV, is not the old adage that prevention is better than cure even more important? Is this significant rise in HIV incidence caused by less use of condoms, or what?

[Earl Howe]

In fact, the numbers are more or less stable if one compares this year to last. However, the noble Lord is right: we cannot drop our guard in this area. There is a pressing need to reduce undiagnosed HIV. It is estimated that about 23,000 people are undiagnosed and 47% of those newly diagnosed with HIV are diagnosed late—that was the figure for last year. That is why the prevention campaign through local authorities will be so critical in this area.

Health and Social Care Bill

Lord Hughes of Woodside Excerpts

Monday 12th March 2012 Lords Chamber

[Earl Howe]

We have a Motion before us in the name of the noble Lord, Lord Owen. That question will be addressed then.

[Lord Hughes of Woodside]

My Lords, the Minister said that the details of the risks had been well canvassed in this House. If that is the case then in the absence of proper information, with the best will in the world, the discussions must be based on hearsay. That cannot be the right way to go about discussing business.

[Earl Howe]

My Lords, I think back to numerous debates that we have had in this House, which of course are recorded in Hansard. Many of the risks that I articulated on 28 November last have been gone through by your Lordships almost ad nauseam.

Organ Transplantation

Lord Hughes of Woodside Excerpts

Monday 27th February 2012 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right. The record in Spain is particularly interesting because the rate of donation is about twice what it is in this country. It is interesting to observe that Dr Matesanz, who is head of the transplantation effort in Spain, observed that this was not, in his opinion, due to the opt-out system which Spain employed in 1979. It is much more to do with the organisation of the service which came in about 10 years later. That is what we are trying to replicate in this country.

[Lord Hughes of Woodside]

My Lords, is it not the case that despite the great advances that have been made there is still a problem, whereby if someone carries a donor card the relatives still have to be consulted, and very often they say no? Can we do something to speed that up, if we cannot go for the proper opt-out system?

[Earl Howe]

The noble Lord makes a good point. It is generally the practice that the relatives are consulted even where someone has expressed a wish to donate an organ after death. Doctors will normally respect the wishes of the relatives; however, it is equally true that that person’s wishes will be emphasised to the relatives. There is a delicate balance to be struck here. The moment that action by medical teams is seen to be high-handed, it risks damaging the credibility of the transplant service.

NHS: Management Consultants

Lord Hughes of Woodside Excerpts

Monday 13th February 2012 Lords Chamber

[Earl Howe]

My noble friend is quite right. As I said earlier, the use of consultants—provided that that use is judicious and they are engaged in open competition processes—can be very cost-effective. It is a very flexible way of obtaining high-class advice without incurring long-term costs.

[Lord Hughes of Woodside]

Has McKinsey been given access to the risk assessment studies, which have been subject to some controversy in this House?

[Earl Howe]

I am not aware that it has or that it would need to have been.

Health: Early Diagnosis

Lord Hughes of Woodside Excerpts

Monday 21st November 2011 Lords Chamber

[Earl Howe]

The noble Baroness draws attention to an issue which we have been debating in various forms under this Bill, which is how we join up services and make the whole system hang together in the way that we all wish to see. The short answer to her question is that, at local authority level, the health and well-being boards will be responsible for co-ordinating that kind of information. However, we will also want to make sure that this takes place at a national level too. The outcomes data that we get from secondary care providers will in time, I am confident, produce information that will feed into public health campaigns.

[Lord Hughes of Woodside]

My Lords, I welcome the emphasis on and campaigns for early diagnosis, but will the Minister recognise that equally important is early treatment, and therefore not abandon targets for ensuring that people get early intervention of the highest quality?

[Earl Howe]

Yes, my Lords, we recognise fully that waiting times are important, and in particular diagnostic waiting times. I am certain that the noble Lord will be reassured to know that waiting times in both respects remain low, and we intend that they should remain that way.

Health: Breast Cancer

Lord Hughes of Woodside Excerpts

Monday 3rd October 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend is right that we have historically targeted women in a certain age group for breast cancer screening. We are looking to see whether that age group should be widened but it is generally true to say that screening is more cost-effective in older women. It has certainly been the case that the breast screening programme over the past number of years has increased the detection of cancer and saved an estimated 1,400 lives a year.

[Lord Hughes of Woodside]

My Lords, can the Minister confirm that there is something in the NHS called the two-week procedure whereby GPs can refer patients to a hospital and they are therefore seen by that hospital within those two weeks? If I am right in that, will that be more widely used and advertised so that patients know what they can ask of their GP?

[Earl Howe]

The noble Lord is right. We are not changing that target, which we believe is clinically well founded. It is largely up to GPs to make sure that, if cancer is suspected, that referral pathway should be followed.

Smoking

Lord Hughes of Woodside Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

My noble friend speaks with great authority on this subject, and I find little to disagree with in anything that he has said. He is absolutely right that children are particularly vulnerable to the harms of second-hand smoke: more than 300,000 children in the UK present passive smoking-related illnesses to their GP every year. We have to take this matter seriously, and we are. However, despite the evidence my noble friend cites from Canada, it is still early days to judge how effective that legislation has been, over and above voluntary measures. The second issue that poses problems is enforcement. However, we continue to look at these questions very closely.

[Lord Hughes of Woodside]

My Lords, as a former heavy smoker, I still have a guilty conscience over what I must have done to my own children. I fully support every effort to attack passive smoking. But did the Minister see in a report in today’s press that a council somewhere in England has refused to allow an adoption because the male of the family had once smoked a cigar at a wedding and had once smoked a cigar at a party? Is this not taking things to a totally ridiculous level?

[Earl Howe]

My Lords, I did not see that report, but what the noble Lord says disturbs me. I think we all want to see an increase in adoption rates and we do not want to see potentially good adopters turned aside for what may appear to be trivial reasons.