Folic Acid Fortification

Lord Markham Excerpts

Tuesday 25th July 2023 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government whether it remains their policy to reduce the number of pregnancies affected by neural tube defects through mandatory folic fortification of bread flour.

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

My Lords, the Government remain firmly committed to proceeding with a policy of mandatory fortification of non-wholemeal wheat flour with folic acid to help prevent neural tube defects in foetuses. As I have previously updated noble Lords, this policy is being delivered as part of the wider review of the Bread and Flour Regulations. Having consulted, we are finalising policy decisions; we expect to publish a response this summer and lay new legislation early in 2024, subject to clearances.

[Lord Rooker (Lab)]

I remind the Minister that it is now 35 weeks since the consultation on the Bread and Flour Regulations closed. The last time they were reviewed, in 2013, the Government’s decision was announced within 20 weeks of the closure. It is now four years since the Government consulted on fortification of bread flour with folic acid, and it will be two years this September since they made their seminal decision actually to do it. So, we have just lost another two years, which means another 300 babies born with lifelong illnesses, and 1,600 terminations.

When will we get some action? We have lost two years since the previous decision, when it was announced that we were going forward. The Minister has already indicated—he was clever to do so—in answer to the previous Question that he has a problem with Northern Ireland. It is a pity that the noble Lord, Lord Dodds, is not here, because then we would get the facts on Northern Ireland. If that is the excuse, it will not be good enough.

[Lord Markham (Con)]

I first thank the noble Lord, Lord Rooker, for his tireless and passionate campaigning on this issue, which he is right to do. As I have learned, the situation is complex. We had 369 consultation responses, and more than 13,000 different SKU items—products containing flour—will be affected. We are not just talking about bread; pizza, lasagne, cakes and sauces are all affected, so you have to change the labelling of all those. We are trying to bring them all on board in a sensible manner, and to get this right quickly. We believe that a lot of people will voluntarily take this up much quicker. When you are talking about changing labels on the 22 billion items that are sold each year, you obviously need to look at how to do that practically and within a reasonable timeframe.

[Lord Cormack (Con)]

My Lords, my noble friend was right to acknowledge the indefatigable campaigning of the noble Lord, Lord Rooker, but will he please not rely upon these government phrases “shortly”, “in due course” and “soon”? Perhaps he could tell us which of those comes first. We feel that we are being fobbed off and that the delay is inordinate. He talked about early 2024, but will it really be early 2024? According to me, January is early 2024.

[Lord Markham (Con)]

I thank my noble friend, and I agree. I hate the words “in due course” because they mean “whenever”. While I freely admit to using words such as “soon” and “imminent”, “in due course” is not a term I use, and I understand the point being made. The consultation will be published late in the summer. It is a complex area, and I have said that I want to get personally involved now; I want to make sure that we get the balance right between the many competing interests. The legislation is planned for early 2024. All I can do on my side is to undertake to push that forward as much as possible.

[Lord Allan of Hallam (LD)]

My Lords, the Minister said in reply to a previous question that a lot of the industry is already voluntarily adding folic acid to bread and other foodstuffs. Of course, “a lot” is a well-known scientific term for “more than a little”. I invite the Minister to offer us a more precise figure. Does the department know what percentage of bread and similar products are currently fortified on a voluntary basis? If not, could it carry out a survey so that we can have that number?

[Lord Markham (Con)]

Probably the best thing to do is for me to give the noble Lord the detailed information we do have and try to find out more. I am told that “a lot” means the majority of bread products, but I will give the noble Lord a more precise answer.

[Baroness Hayman (CB)]

I ask the Minister not to be too downhearted about the complexities he faces, according to the department. In the more than 30 years since the MRC’s ground-breaking research on this subject, more than 80 countries have managed to fortify their flour. Not one has reported adverse effects; not one has withdrawn that fortification. As I have said before, I had four young children when this evidence first came out; I now have four grandchildren the same age and, honestly, I do not want to stay here until I have great-grandchildren. So can we have some action soon?

[Lord Markham (Con)]

Yes, the noble Baroness is correct, and the point made by the noble Lord, Lord Rooker—that each year’s delay involves another 200 or so babies—was very well made. The beauty of this process is that it makes me shine a light on this issue, so I will be working on quite hard on it.

[Baroness Merron (Lab)]

My Lords, the last time this issue was raised in the Chamber, the Minister put delays down to co-ordination with the devolved Administrations and consultation with the EU due to Northern Ireland—which he referred to in the previous Question—before allowing industry to get on board. Just yesterday, noble Lords debated two statutory instruments that apply to the devolved Administrations, including one specific to Northern Ireland. Can the Minister explain why timely co-ordination across the nations has been possible on tobacco products and pharmacies but not on folic acid in flour, in respect of which time is obviously of the essence, given the importance of the neural health of babies?

[Lord Markham (Con)]

I thank the noble Baroness for that question; as I am rapidly learning, this is a complicated area. For the benefit of noble Lords who were not present yesterday, the tobacco arrangements are part of the Windsor agreement, so we passed primary legislation to allow us to make those changes. On the items before us, which involve secondary legislation, my understanding—if I am wrong, I will make a correction in writing—is that the co-operation of each of the devolved authorities is needed. That is why we are not able to proceed in Northern Ireland without its involvement. The plan is that we will go forward with GB-only measures if we have to. For obvious reasons, we would prefer not to do that; we want Northern Ireland to benefit from these changes as well but, as I have learned, it is a complex area.

[Lord Balfe (Con)]

My Lords, when I became president of the British Dietetic Association—the dieticians’ trade union—this was one of its priorities. When I stood down five years later it was still a priority. My noble friend Lord Rooker has pursued this relentlessly, but what we are overlooking, I am afraid, is that every year more and more babies are born with this defect. Some 80 countries have managed it; what has impeded us for such a long time? I echo my noble friend Lord Cormack’s question: will “early” next year really be early?

[Lord Markham (Con)]

As I have said, there are complications. The MHRA, for instance, has raised concerns about the side-effects of certain folic acid levels in respect of anti-epilepsy drugs. We are going through various medical areas and checking that we do not have unintended consequences, and these are some of the issues that have been taking time to deal with. I am not trying to give excuses, but to allow noble Lords to understand some of the complexities involved. As I have mentioned, the plan is very much to lay legislation in early 2024. We then have to give notice periods to the EU and the World Trade Organization, so, in order to achieve complete transparency for noble Lords, I am afraid there will be a two-year implementation timeframe from then. But rest assured that I will be pushing hard on this.

[Baroness Walmsley (LD)]

My Lords, we have heard that there are millions of products, but also that some manufacturers have implemented this policy voluntarily. Industry has had years of notice that this is going to happen. Surely it is for the Government to legislate and industry to comply.

[Lord Markham (Con)]

Yes, and as I have said, a lot of companies are doing that. What we are really talking about is a backstop for “edge” products that are not fast-moving. There are a lot of products out there already, so relabelling takes some time. I would hope and expect to see most of this implemented pretty quickly, as soon as we get into the new year.

As I am out of time and this will probably be the last thing I say, I wish everyone a happy Summer Recess.