Folic Acid Fortification

Lord Kamall Excerpts

Wednesday 6th April 2022 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government when they intend to introduce draft legislation to replace the Bread and Flour Regulations, following their decision to implement folic acid fortification announced in September 2021.

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

I pay tribute to the noble Lord for his tireless advocacy of this important policy. Substantial progress has been made since September 2021, including working with the devolved Administrations to establish a cross-industry Bread and Flour Technical Working Group engaging stakeholders to move forward to the regulatory review. Proposed changes are being finalised and impacts assessed by a whole-UK working group for a consultation once the Northern Ireland Assembly elections have concluded.

[Lord Rooker (Lab)]

I thank the Minister. This is taking a long time. I have only one question for him. Given that it is now more than 30 years since the medical research councils connected up the difficulties of neural tube defects and that more than 80 countries have operated the policy, will he commit to using the best possible science? People have spent decades on this, and scientists tell me this can prevent up to 80% of neural tube defects. It has advanced since the original science 30 years ago.

[Lord Kamall (Con)]

The noble Lord is absolutely right: our scientific knowledge increases as scientists challenge each other and come to other conclusions. We have to be aware that there is no off-the-shelf solution. For example, I am sure the noble Lord will be aware that in Australia they can divide the flour and fortify only flour used to make bread. That cannot be done in this country, which is why we are working with stakeholders including heritage millers, for example, to make sure that we have the right solution. It has all been delayed due to a number of elections.

[Lord Patel (CB)]

My Lords, the United Kingdom has a high incidence of babies born with neural tube defects. What evidence have the Government collected as to the decrease in the incidence of neural tube defects in babies that would occur if an appropriate daily amount of folic acid was available in the nutrition of United Kingdom citizens?

[Lord Kamall (Con)]

I think the noble Lord will be aware that pregnant women are advised to take 400 micrograms of folic acid. That high level cannot be put into other foods because there are some unintended consequences. For example, it disguises some other traits and conditions in the older population. Therefore, one needs to get the right balance and proportion for the wider population.

[Lord Cunningham of Felling (Lab)]

My Lords, why did the Minister not say—or give some indication—as to when this working group will report, first to the Government and secondly to this House? It has had long enough since my noble friend succeeded in moving this policy change. When does the Minister expect the report, and when can we see some action?

[Lord Kamall (Con)]

I understand the complete frustration with the delays. When I asked the departmental officials about them, they said, “Funnily enough, usually we are people who support democracy, but democratic elections have got in the way.” Delays are due, for example, to the 2019 general election, the Scottish and Welsh parliamentary elections and the Northern Ireland elections.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

It is not fair to have a go at officials over this. Once the Northern Ireland Assembly election period is out of the way, they can get on with it.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, I too commend the noble Lord, Lord Rooker, for his tireless campaign. The continuing consequences of Ministers not introducing the new legislation are that around 430 children in the UK will be born with spina bifida each year until folic acid is added to bread flour. What will the Minister—not his officials—say to the families of these babies to explain why this was just not urgent enough to put into legislation, despite the Government’s decision to do so and despite elections? Officials are not always side-tracked by elections. What will the Minister say given that those children will need continuing health support for life?

[Lord Kamall (Con)]

I think the noble Baroness is being a little unfair. It is quite clear that some of the delay has been due to elections, particularly when it has been necessary to consult across the devolved Administrations. Let there be no doubt. The Government are not against this; we are in favour of it. We are having to cover a number of issues—for example, the level of folic acid fortification to ensure that we add an appropriate amount without the side-effects that have been found in older people. We need to standardise the minimum levels of the existing four fortifications—calcium, iron, niacin and thiamine—and to consider exemptions from fortification for products that have minimal amounts of flour. Provisions have to be made for flour used to manufacture ingredients. We have to consider potential exemptions, for example, for micro-businesses and heritage millers. This consultation will start in earnest once the Northern Ireland elections are out of the way.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that the early MRC trial and all subsequent trials have shown that folic acid must be taken before a woman becomes pregnant? Giving supplementation once someone is pregnant is too late because of the formation of the neural tube. Now, with modern haematological techniques, the problem of pernicious anaemia and the confusion with B12 deficiency does not apply nearly as much, because it is easy to measure the levels.

[Lord Kamall (Con)]

In the brief which I received yesterday the recommendation is for a daily supplement of 400 micrograms of folic acid during the first 12 weeks of pregnancy. I am told that this advice will remain. Certain women with a higher risk of an NTD-affected pregnancy are advised to take a higher, 5-milligram supplement. This is why we have to get the right level. Increasing folic acid in flour alone will not solve the issue.

[Lord Dodds of Duncairn (DUP)]

My Lords, I commend the Government for reaching this position and for being the Government who have brought this matter to this stage. On a couple of occasions, the Minister mentioned the Northern Ireland elections. We know that there are some concerns about what might happen after those elections in terms of a Government being formed. This is a UK-wide matter. Can the Minister assure me that it will progress regardless of the state of devolution in Northern Ireland?

[Lord Kamall (Con)]

Call me old-fashioned, but I anticipated that there would be questions about further delays. When I asked the officials about this, I was advised that once the Northern Ireland elections were out of the way, they could get on with the consultation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to come back to the level of fortification. There are rumours that the Government are going for a minimal level which will not be very effective. My understanding is that the most up-to-date research shows that folic acid is not at all harmful. Therefore, will he assure me that the technical working group that he is going to take forward at some point will look to implement a level that is going to be effective?

[Lord Kamall (Con)]

I understand the noble Lord’s question but the expert Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has advised on the level of fortification needed to prevent neural tube defects. It wants a level that is not considered to pose a risk to health. The advice it has at the moment is that supplementation of folic acid can mask underlying vitamin B12 deficiencies, particularly in older adults. If noble Lords with medical experience disagree, I will be very happy to facilitate a meeting with my officials.

[Baroness Hayman (CB)]

My Lords, I think the House would be grateful for such a meeting. Perhaps the noble Lord, Lord Patel, could take part. It is extremely depressing to hear the Minister today go backwards in time to the arguments, which have all—one by one—been disproved, against this policy. It would be much more helpful to hear of a timetable going forward for implementing it. Does the Minister accept that it is a matter of embarrassment, shame and distress to many of us that, more than 30 years after UK research did this and with 80 other countries that should be able to help us in getting levels and procedures right, there are still families facing distress and the termination of wanted pregnancies because we have not made progress?

[Lord Kamall (Con)]

I understand the frustration that noble Lords have expressed. The same frustration is shared by officials in the department. When I asked officials, “What are the issues that you really need to get to the bottom of?”, one was the appropriate level of fortification. It is interesting that noble Lords seem to disagree with the department’s advice. Therefore, I will facilitate a conversation. Another issue is how that appears compared to other additions and fortifications put into flour. We want to get the right balance. The Government are committed to doing this and we will start as soon as the Northern Ireland elections are over.

[Baroness Merron (Lab)]

My Lords, all the research on adding folic acid to flour, including that by the Government’s independent Scientific Advisory Committee on Nutrition, shows that it is a completely safe measure with no unintended health consequences. In preparation for going down this route to protect newborn babies—which I really would urge the Minister to progress as soon as possible—what plans do the Government have to communicate the benefits of these measures and to reassure those who may have concerns, including parents, and parents-to-be?

[Lord Kamall (Con)]

This will all be part of the consultation, but once the policy has been decided on and fortification starts, clearly, we will be communicating to parents, families and others. If there is a risk—which noble Lords in their expertise seem to disagree with—we will have to identify that. The history of good intentions is littered with unintended consequences. We must be aware of those in our pursuit of increased folic acid in flour.

[Baroness Walmsley (LD)]

My Lords, over the past two years, the Government have made urgent decisions about Covid-19 to save lives and save sickness. Why can they not, in light of the strength of the evidence we already have, make a similarly urgent decision on this issue to save harm to 400 babies a year?

--- Later in debate ---

[Lord Kamall (Con)]

We all want to save harm to 400 babies a year; indeed, we want to save harm to more babies. The issue is that we have to do it in a proper way. When I speak to the officials, they are quite clear that we all want this to happen—there have been delays, which I have mentioned—but we have to get the right level of folic acid. Noble Lords in their wisdom are saying that all the evidence that the department has been presented with is worthless. If they believe that, they should talk to my officials. I will be happy to facilitate that.