Folic Acid Fortification

Debate between Owen Smith and Nick Smith

Thursday 25th October 2018 Commons Chamber

[Owen Smith]

From memory, I believe that just 6% of women aged under 20 supplement their diet prior to or, indeed, during pregnancy. It is clear that this particularly affects younger women, perhaps because they have not yet read the literature, gone to classes or otherwise been informed. The other reality is that there is a much lower level of folate among women from working-class and black and ethnic minority backgrounds, which is another fundamental reason for addressing this in the manner proposed.

Shine estimates that the cost of caring for people with spina bifida and other neural tube defects is around £500,000 over their lifetime, but the point is not the financial cost to the NHS or to the taxpayer; the human cost to families and individuals is what counts. In this awareness week for spina bifida and hydrocephaly, Shine has been highlighting some of those human examples.

One example is of a young woman called Nicky, who had spina bifida. She could walk a little, but she used a wheelchair most of the time. She loved animals, and she volunteered at a local animal sanctuary and rode at weekends. At 18, before she intended to start a university degree in animal care, the shunt that controlled her hydrocephalus needed replacing. It went wrong, and she had three dreadful years of ill health during which she was largely housebound or hospitalised. She obviously could not continue with her education, and she died at 21.

That is not an uncommon case; unfortunately, it is all too common. There is no certainty, of course, that had Nicky’s mother supplemented her diet prior to conception, or indeed during pregnancy, Nicky would not have been born with spina bifida. However, we have known for almost 30 years of the clear evidence that there is a dramatically greater likelihood that Nicky would have been born without a neural tube defect had her mother had the requisite levels of folate in her system. As my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) said, it was in 1991 that the Medical Research Council first published the evidence showing a 72% reduction in the likelihood of conceiving a child with a neural tube defect if the mother supplements her diet with folic acid.

The history is interesting, because successive Governments have not responded to the evidence with fortification, on which this Government are now consulting. I make it clear that I think the last Labour Government should have done so. We did a huge amount through bold public health interventions. Smoking cessation is the best example, but there are myriad examples. The last Labour Government were very good at addressing public health needs. However, this is one area where they did not undertake to act and they should have done. The position our Government and successive Governments took was to move towards advice that diets should be supplemented with 400 micrograms of folic acid during and prior to pregnancy. As many people have said, the problem is that 40% of pregnancies are unplanned; only 30% of women take the right dose of folic acid even if they are supplementing; young women tend not to supplement at all, as my hon. Friend the Member for Redcar (Anna Turley) said; and working-class women and women from black and ethnic minority backgrounds have lower levels of folate because they do not supplement very often. Across the whole population, irrespective of demography, about 75% of women do not have the right levels of folate and therefore are at increased risk of giving birth to a child with a neural tube defect.

Other countries have been bolder than us. As the right hon. Member for Belfast North said, about 85 countries have chosen to introduce mandatory fortification, including America, Canada, South Africa and lots of countries in South America. It has not happened in Europe, but this will be another example of Britain leading the way in Europe.

[Nick Smith (Blaenau Gwent) (Lab)]

My hon. Friend has shown great leadership on this issue, and Shine has been a fantastic help to campaigners across the country on this issue. Does he agree that families in south Wales are glad the Government are moving on this but that they want this consultation to be completed much more quickly—as quickly as possible—because they think this important public health initiative should be brought in sooner rather than later?

[Owen Smith]

That is right. I understand why the Government need to consult. There has been a debate about the upper level of folate. As I may discuss briefly later, the evidence suggests that there is not necessarily any issue associated with an upper tolerable limit. A recent paper in January last year by Professor Sir Nicholas Wald, who did the original research in the early 1990s, very effectively debunked the notion that there is an upper tolerable level of folate. Other studies have done the same, but I am confident that that will come out in the consultation. The point my hon. Friend makes about families in his south Wales constituency and mine is well made. To illustrate that, using the 72% statistic, let me say that had the Labour Government introduced this measure in 1998, at the same time as the United States did, 3,000 babies would have been saved from being born with spina bifida or anencephaly.

There is no evidence from countries across the world that have undertaken this measure of ill effects in the population. There is lots of evidence to show that there are other ancillary benefits; one study in Norway has shown a diminution in the volume of autism in the population. There is huge scientific support for this measure, including from the Royal College of Obstetricians and Gynaecologists; the Royal College of Paediatrics and Child Health; the Royal College of Midwives; the British Maternal and Fetal Medicine Society; the Faculty of Sexual and Reproductive Healthcare; the British Dietetic Association; the Governments of Wales, Northern Ireland and Scotland; the chief medical officers in Wales, Scotland, England and Northern Ireland; Public Health England; Public Health Wales; the Food Standards Agency; and Professor Sir Colin Blakemore. The list goes on and on. Crucially, the Government’s own Scientific Advisory Committee on Nutrition has advocated this measure for the best part of 20 years. So it is a measure whose time has come. It will be enormously beneficial for our population, and if we in this House undertake to do it, we will contribute to saving hundreds of lives each year and thousands of lives over the years to come. I commend the Government for having the bravery and foresight to do it.

Commission on Devolution in Wales

Debate between Owen Smith and Nick Smith

Thursday 3rd November 2011 Commons Chamber

[Owen Smith]

Several Government Members have talked about what, to put it bluntly, is ancient history now and pointed to the size of the mandate and turnout, but we all know that politics is a precarious, parlous business. The Tory party clearly thought that it had a sufficient mandate at the last election. It did not get a majority, but nevertheless it is the ruling party. We have to bury that argument and move on. Right now, there is clear support for devolution in Wales, as was shown in the recent referendum. That is not in dispute. It ill behoves Government Members, who purport to support devolution, to keep dredging up these ancient concerns and this ancient history, because, frankly, it gives us the suspicion that they still have not quite bought into it.

I have a second concern, which, actually, I share with some Government Members—even, perhaps, the hon. Member for Monmouth (David T. C. Davies)—about the constant, cyclical nature of the interaction between demands and desires, legitimate or otherwise, for additional, incremental powers in Wales, Scotland, Northern Ireland and even, perhaps, England. That is a problem. It leads to perpetual pressure for change and to very few instances in which we—legislators in this place and the devolved Administrations, which have their own particular locus—can put our foot on the ball and contemplate the broader picture, the country’s longer-term trajectory. That is hugely important. The Silk commission ought to consider that wider context.

In particular, however, this House needs to consider that wider context and be the place in our country where we contemplate the aggregate impact of the changes to the particular discrete functions and powers of different parts of the UK and where we think long term about what the benefits and disbenefits might be. That is not to take an anti-devolutionist perspective, however. I am thoroughly committed to devolution and the principle of subsidiarity—pushing down power and democratic accountability as low as we can—which is why I talk in my excellent and recommended article for Compass about reinvigorating local government democracy in England, which would be a jolly good thing. However, I am also British—indeed, proudly so—and I feel that my values and those of the Labour party transcend national boundaries and the identity politics that stem from an obsession with national boundaries. My concern is that the wider picture—the longer-term perspective—is too infrequently considered in this place or, in particular, the devolved Assembly. I do not want Wales to be as politically peripheral in Britain as it is de facto geographically peripheral. I worry that at some point that will be the net consequence—the aggregate impact—of these things.

Let me turn briefly to some of the specificities of what Silk will consider. I will take only one—corporation tax—but for me, they all highlight the risk that we might face. Anyone picking up the Financial Times this morning could have read an article about Peter Robinson, the First Minister of the Northern Ireland Assembly, who has advocated adopting a 10% corporation tax rate to compete with the 12.5% rate in the south. My view is that this would be hugely difficult and dangerous. Although it might be advantageous for Northern Ireland in the short term, we should also consider the risk that it would necessarily lead to arbitrage between the two areas and to different pricing arrangements. If we had variable taxation bands between different parts of the mainland, we would certainly see arbitrage across the borders and we would need internal transfer pricing policy and legislation in this place and the other jurisdictions. Given the difficulties with legislative vehicles to deal with transfer pricing between European countries—the disaster, even—what on earth would they be like within the UK?

Westminster needs to hold the ring. Westminster needs to consider the risks. Westminster needs to be the place where this debate is thought about, in conjunction with the discrete and—from the perspective of the local jurisdictions—eminently reasonably changes that may be wished for. This place also needs to be where the broader economic context is considered, because, bluntly, some of the peripheral changes to taxation that we are talking about and that Holtham talks about—indeed, perhaps even the larger changes too—will not lead to the growth, jobs, wealth and opportunity that would be created by measures that the Government could be implementing right now, such as those in Labour’s five-point plan.

[Nick Smith]

I congratulate my hon. Friend on his support for subsidiarity and decisions being made at the right level. The success of the Welsh Assembly, particularly in the last few months, has been based on its good ideas, such as the Welsh job fund and introducing local police support officers, all because people in Wales are fed up with the horrible attacks that we have seen from the Government.

[Owen Smith]

My hon. Friend is absolutely right. The Welsh Assembly has understood that in order to stimulate our economy we need a stimulus. We cannot sit on our hands and assume, as the Government do, that laissez-faire economics will drive economic progress in our country.