Health: Birth Defects

Lord Hunt of Kings Heath Excerpts

Wednesday 6th November 2013 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am delighted again to applaud my noble friend for raising this matter and I hope that we can look forward to a positive response from the Minister. My noble friend Lord Turnberg explained the science and it is clear that there is very credible support for my noble friend’s position. The Scientific Advisory Committee on Nutrition’s 2006 report recommended mandatory fortification of flour to the Government. That was endorsed in 2007 by the Food Standards Agency board. More recently we have all, I think, had a briefing from the British Medical Association which also supports folic acid fortification of flour. I thought that the BMA was very much to the point when it argued that the current guidance to women to take folic acid supplements has a number of limitations. As the noble Countess, Lady Mar, said it does not take account of unplanned pregnancies and, given that almost half of all pregnancies in the UK are unplanned, it is clearly an inadequate response. It is also a fact that poor compliance with the advice to take supplements means that women planning a pregnancy only marginally increase their compliance with folic acid supplement use. The noble Baroness, Lady Grey-Thompson, made some very powerful points about this and about the very hard decisions parents subsequently have to make.

Noble Lords have already dealt very effectively with the concerns that have been raised about the links between folic acid and cancer. The Scientific Advisory Committee on Nutrition, which advises the Food Standards Agency, said that the evidence in relation to bowel cancer was insubstantial and that any increase in cases could be down to improved screening. It recommended that those deemed to be at greater risk of colon cancer should receive precautionary advice on taking extra supplements containing folic acid and that the situation should be monitored. The Chief Medical Officer then requested further investigation by the Scientific Advisory Committee on Nutrition into the potential link between folic acid and colorectal cancer. The committee upheld its previous recommendation, with an amended recommendation to clarify the advice on supplement use for particular population groups.

We roll forward to January 2013, when the noble Earl, Lord Howe, told the House:

“Additional advice on folic acid and cancer risk was requested by the then Chief Medical Officer and provided by SACN in 2009. The papers underpinning the advice from SACN have not yet all been peer-reviewed and published in a scientific journal. Ministers need to very carefully consider this complicated issue and would like to see all information in the public domain before making any decision”.—[Official Report, 8/1/13; col. WA 44.]

I am a great admirer of the Department of Health, having enjoyed many happy years there, but I recognise long-grass briefing when I see it and that is the kiss of death. I hope that the Minister, if she cannot say that the Government are going to go down this route, will at least give a timetable for when the Government will make a definitive decision, or must we wait, month after month, for every single paper to be peer-reviewed? I think that that would be a great pity.

In conclusion, I shall ask the Minister a rather more general question coming back to the issue of advice given by health visitors and midwives in relation to vitamins and minerals generally. The reason I do so is that in September 2012 in another place my honourable friend Kate Green secured a Westminster Hall debate about the rise in the incidence of rickets. She talked about vitamin D deficiency across large sections of the population and quoted a study by the Clinical Effectiveness Unit at Stockport which found a surprising lack of awareness among health professionals about vitamin D across eight acute and six primary care trusts in the north-west. Only 24% of health visitors and just 11% of midwives reported having had training in vitamin D supplementation. I realise that this is a little distant from folic acid, but since the Government now put such reliance on advice given to women, does the Minister think that, as part of a wider response to the issues raised by my noble friend tonight, more needs to be done to ensure that midwives and health visitors are adequately trained in providing advice in relation to vitamins and minerals in pregnancy and before?

That is not a substitute for the action that my noble friend wants, and I very much hope that the Government will recognise that this would be the right thing to do. I hope that the Minister will be able to make a happy announcement.

--- Later in debate ---

[Baroness Jolly]

My Lords, I am telling noble Lords what I have been briefed. I am more than happy to write to noble Lords and, if they are happy for me to do so, leave the letter in the Library for everyone to check. I will also need to respond to the noble Lord, Lord Rooker, on his question regarding terminations.

The noble Countess, Lady Mar, asked about the risks and benefits, and assessing impacts, of fortification, giving due consideration to the implications of additional recommendations by SACN. We will take into account the views of the Chief Medical Officer, who raised the issue in her annual report, and of the devolved Administrations. The other point raised by the noble Countess was on ensuring that NTDs are avoided in pregnancy and on preventing vitamin B12 masking. We need to get this right. SACN considered the amount of folic acid to recommend and also recommended developing guidance on supplement use for particular population groups, along with implementing measures to monitor evidence of long-term exposure to intakes of folic acid. We are carefully weighing the benefits and risks of SACN’s recommendations and will take account of all views.

The noble Baroness, Lady Grey-Thompson, asked what foods would be considered for fortification. Currently, breakfast cereals are voluntarily fortified with folic acid in the UK. The FSA considered other foods, including soft drinks, fruit juice, milk and chewing gum, when it made that recommendation, but the consumption rate of these products is not considered to be universal across women of child-bearing age and would therefore not be suitable for fortification. Other foods were also considered. Bread was finally decided upon as the universal food as—to answer a point raised by both noble Baronesses—it is universally consumed across the population and all socioeconomic groups: more than 90% of households eat bread. Fortification of wheat flour would also include other wheat-based products such as pizzas, pastries and biscuits.

I think I have replied to several points that were raised.

[Lord Hunt of Kings Heath]

My Lords, will the Minister write to noble Lords—clearly the Government will have to consider this—and set out a timetable on when they will come back to Parliament with an answer?

[Baroness Jolly]

That sounds eminently sensible. I am happy to write to noble Lords to give them that information. I hope that I have provided reassurance—I am not convinced that I have—that the Government are committed to reaching the right decision on the fortification of flour with folic acid, doing proper justice to the work of SACN and others and ensuring that, while seeking to deliver the benefits, we minimise the potential risks. In the mean time the Government will continue to raise awareness of the need to take folic acid supplements and are supportive of all those who are raising awareness of this issue. I thank the noble Lord for securing the debate.