Folic Acid

Lord Bethell Excerpts

Monday 26th April 2021 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government, further to the reply from Lord Bethell on 23 March (HL Deb, cols 717-20), whether they have reached a conclusion on the findings of their consultation on the proposal to add folic acid to flour which closed on 9 September 2019.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I thank the noble Lord, Lord Rooker, for keeping this issue live. Noble Lords will appreciate that we are in the pre-election period for the Welsh and Scottish parliamentary elections and, as this is a UK-wide consultation, we cannot make any policy announcements at this time. But I can advise that, since my last reply, Ministers have looked at this extremely closely and hope to discuss it promptly with the devolved Administrations after 6 May.

[Lord Rooker (Lab)]

For my 16th Oral Question, may I ask about value for money? Why can the UK Government not use their own estimate in the impact statement for the consultation, which said:

“Preventing an NTD carries a lifetime benefit of up to £3m”


per person with spina bifida? It said that fortification presents

“a significant reduction in NTDs, possibly … equivalent to 150-200 NTDs per year”.

This is every year, not a one-off, so the savings from fortification amount to hundreds of millions of pounds. The work in the United States on the CDC website confirms massive financial savings. Why are the Government so reluctant to save this money?

[Lord Bethell (Con)]

My Lords, I would be glad to take the noble Lord’s recommendation back to the department; he puts it extremely persuasively. As I said, we have looked at the substantial point closely and it is extremely persuasive, as the noble Lord rightly put it. We hope to come forward with recommendations as soon as the elections are over.

[Baroness Thornton (Lab)]

I reinforce what my noble friend Lord Rooker said. I may be addressing this with my third or fourth Minister. I am not certain whether the noble Earl, Lord Howe, dealt with it when I was opposite, but he may have done, which would make the noble Lord my fourth Minister on this issue. It is even more irritating that it was research in the UK that led the United States and other parts of the world to adopt this policy. I think The Minister has run out of road on this one, and I would like to hear what the timetable to implement this policy is.

[Lord Bethell (Con)]

I completely endorse the tribute of the noble Baroness to those who have worked on this policy. She is right: the science that has gone into this has been persuasive around the world. I thank those in industry who worked with us on our pilot, which proved extremely successful. We are in good shape when it comes to thinking through the implementation of such a policy. My hands are tied at the moment, because of purdah, but I hope to return and fulfil the noble Baroness’s wishes.

[Lord Dodds of Duncairn (DUP) [V]]

I congratulate the noble Lord, Lord Rooker, and other noble Lords on their tireless work on this issue. As former co-chair of the all-party group on folic acid fortification of flour in the other place, I remember the campaign to bring about the consultation well. As the parent of a son born with a neural tube defect, I am keen to see the Government act as quickly as possible to prevent avoidable births of children with such a condition. For the sake of the unborn and their families, can the Minister give a categoric guarantee that, after 6 May, when the elections are out the way, we will finally get definitive action and definite proposals?

[Lord Bethell (Con)]

My Lords, I join the noble Lord in paying tribute to all those who have worked so hard, particularly the noble Lord, Lord Rooker, who has delivered a playbook campaign on this. Being on the receiving end, I pay tribute to the grace, persuasiveness and energy with which he has conducted that campaign. He is not the only one, and I pay tribute to the personal testimony of the noble Lord, Lord Dodds— what a moving story he has just told. All who have been involved in these sorts of conditions would have been touched by that. I cannot deliver the categoric guarantee that he asks for but, as I said, we are looking at it extremely carefully and I hope to return soon.

[Baroness Wyld (Con)]

I join my noble friend in paying tribute to the noble Lord, Lord Rooker, for his campaign. I urge him to keep up the pace. While the Government are looking at that, we surely need more creative public information campaigns to raise awareness of the importance of folic acid, particularly when communications around health have, under- standably, focused on the pandemic. What work have the Government done with HCPs, in practice, to make sure that women are fully informed?

[Lord Bethell (Con)]

My noble friend is right: with half of pregnancies unplanned or unexpected, it is entirely right that we should seek to raise issues such as folic acid. The Government are committed to the preventive agenda, and folic acid is just one among many examples where we hope to mobilise public interest in looking after their own health to avoid these kinds of conditions. Her point is extremely well made.

[Baroness Jolly (LD) [V]]

My Lords, the department’s website states:

“More than 60 countries worldwide now add folic acid to their flour, including Australia, Canada and the US.”


It goes on to say:

“In Australia, neural tube defects fell 14%”.


This would save 400 babies a year in the UK. The department has spent the last year making Covid-related decisions in our best interests. Given the Minister’s comments, can we expect an announcement by the end of June?

[Lord Bethell (Con)]

The noble Baroness puts the statistics persuasively. The numbers I have are slightly different, but her gist is right. I hope to return after purdah to revisit this important subject.

[Lord Moynihan (Con) [V]]

As the noble Baroness, Lady Jolly, just said, does the Minister agree that it is high time that we followed Australia, which mandated the addition of folic acid to wheat flour for making bread? As long ago as 1988, folic acid fortification of all enriched grain product flour was fully implemented in the United States and Canada. It is time to say yes to the long-running campaign of the noble Lord, Lord Rooker; it should be a departmental priority on 7 May.

[Lord Bethell (Con)]

I reassure the noble Lord and others who have pressed this point that it is a departmental priority. There has of course been a pandemic and that has slowed things down. I cannot avoid that fact, but we are very much returning to the prevention agenda in the round and the issue of folic acid in particular.

[Baroness Hayman (CB) [V]]

My Lords, the Minister will understand the frustration in the House at the repeated delays in implementing a policy that has the opportunity substantially to reduce the scale of suffering that goes on, because of our failure to implement the implications of research that, I remember and as has been said, showed the benefits of fortification in the 1980s. It is desperately dispiriting to know that that research has been taken up by other countries, but not the UK. I press the Minister and suggest that it would be extremely helpful if the meetings that he has said need to take place with the devolved Administrations could be arranged now. Perhaps he could write to the noble Lord, Lord Rooker, copying the letter to other noble Lords, to tell us exactly when the meetings that he has described are scheduled.

[Lord Bethell (Con)]

I hear the frustration loud and clear and reassure the noble Baroness that we are working on this at pace.

[Lord Rennard (LD)]

My Lords, in response to numerous questions and debates on this subject over the years, no Minister has ever produced a satisfactory explanation of why we do not add folic acid to flour. Would it have made any difference if the folic acid suppliers had had the Prime Minister’s mobile phone number?

[Lord Bethell (Con)]

No.

[Baroness Altmann (Con)]

My Lords, I too congratulate the noble Lord, Lord Rooker, on his relentless campaigning on this issue and join others in encouraging my noble friend to, as soon as possible, ensure that manufacturers are mandated to add folic acid, so that we can prevent the misery and heartache of dealing with neural tube defects. I also ask my noble friend whether we can make sure that this applies to all kinds of flour, including gluten-free flour, for those mothers-to-be who are not able to have normal bread.

[Lord Bethell (Con)]

My Lords, I understand that considerable efforts have gone into ensuring that folic acid is put into flours of all kinds, and I pay tribute to the industry for trying to deliver a comprehensive service. I am happy to write to the noble Baroness to confirm that.

[Lord McColl of Dulwich (Con)]

My Lords, as fluoride has been added to drinking water to reduce dental caries, surely the Minister agrees that preventing spina bifida is more important, as a former colleague of mine, Professor Richard Smithells, pointed out nearly 60 years ago. Is it not time to act?

[Lord Bethell (Con)]

My Lords, I take on board the point that it is time to act. That is why we are working hard on the matter. As I said, I hope to return to the House on this soon.

[The Lord Speaker (Lord Fowler)]

My Lords, all supplementary questions have been asked; congratulations to the Minister. We now move to the third Oral Question.