Folic Acid Fortification

Bill Presented – in the House of Commons at 12:59 pm on 25th October 2018.

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Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government) 12:59 pm, 25th October 2018

I beg to move,

That this House
has considered folic acid fortification.

This week is Spina Bifida and Hydrocephalus Awareness Week, so it seems fitting to be having this debate today. The House will have heard the Minister with responsibility for public health, the Under-Secretary of State for Health and Social Care, my hon. Friend Steve Brine, announce during Health questions on Tuesday that the Government are launching a public consultation in early 2019 on the proposal to add folic acid to flour. This issue has attracted wide interest from a large group of stakeholders, and it is important that we properly consult on the proposal, to ensure that all people have an opportunity to register their views. We will be encouraging people to take part in the consultation.

Photo of Greg Knight Greg Knight Conservative, East Yorkshire

During his speech, will the Minister tell the House why the Government have apparently ruled out a publicity campaign to encourage those who are at risk to take folic acid supplements and are instead proposing this mass medication?

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

We will be encouraging all stakeholders, as well as the public, to take part in the consultation. I will certainly look into the matter that my right hon. Friend has raised and ensure that someone writes to him.

Photo of Owen Smith Owen Smith Labour, Pontypridd

Given the evidence that neural tube defects such as spina bifida emerge between the 18th and the 28th day after conception and that most women are not taking folic acid supplements in accordance with the Government’s guidelines before conception or during their first trimester, does the Minister agree that supplementation alone does not work?

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

The hon. Gentleman takes a keen interest in this matter and has done some extraordinary work on it. He makes an important point. This is why awareness is crucial for all women of childbearing age, including those who are not pregnant but might be considering becoming pregnant.

Photo of Will Quince Will Quince Conservative, Colchester

I recall that we did not know our first child was on the way until 22 weeks; we were not particularly planning to have a baby. It is not always easy to foresee these eventualities. Will the Minister take into consideration the fact that not everyone can prepare for eventualities that they are not expecting?

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

My hon. Friend makes a perfectly plausible point from personal experience. Not everyone can see into the future and plan accordingly. A large number of pregnancies are unplanned, so I understand his point.

Photo of Rebecca Pow Rebecca Pow Conservative, Taunton Deane

When I was pregnant with my third child, I took folic acid supplements and ate lots of green vegetables, which contain folic acid. However, as colleagues have said, many people do not know that they are pregnant early enough to start doing that. Also, they might not have received the right advice from the medical profession. This consultation is important on those grounds, but will my hon. Friend also ensure that it is very wide ranging so that consideration can be given to all aspects, including the appropriate safeguarding of voluntary fortification by the food industry? Will consideration be given to coeliacs, who use gluten-free flour? This has to be a very comprehensive consultation if it is to be effective.

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

It does; my hon. Friend makes an incredibly important point. A number of foods already contain folic acid, and the consultation will have to take that into consideration. It will also look into what a safe upper limit is in that regard. This is why we want to ensure that the consultation is as thorough as possible.

Photo of Anna Turley Anna Turley Labour/Co-operative, Redcar

The Minister is being extremely generous in giving way; we are not allowing him to make much progress. May I take it from his last assertion about an upper limit that the consultation, which we welcome, is not so much about whether folic acid will be included in flour but about what the upper limit will be?

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

I do not want to prejudge the outcome of the consultation, and I am sure that the hon. Lady would not expect me do so. It will have to take an upper limit into consideration; indeed, that will be an incredibly important part of the consultation. We want to ensure that the consultation is properly done, that it is thorough and that it can advise Ministers. We will be coming back to the House to report back on it.

I shall move on, if that is okay with colleagues. I think from the tone of the debate thus far that the announcement has been well received. We will be properly consulting on and considering all aspects of this very important issue. I note that many colleagues are well informed about it and that they are aware of the reason behind the calls for mandatory fortification, but it might be helpful to summarise again what we are trying to prevent. Neural tube defects are birth defects of the brain, spine or spinal cord. They happen in the first few weeks of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. These are devastating conditions, and the Government are fully aware of their effect on the individuals themselves and their families. We have already heard the acute interest and strength of feeling on this issue from Members of this House and in the other place, including on what can be done to ensure that pregnant women have healthy pregnancies and give their unborn babies the best protection during the crucial early weeks of development.

Unless someone is pregnant or thinking of having a baby, they should be able to get all the folate they need by eating a varied and balanced diet. Existing pregnancy advice to women who are trying to conceive or who are likely to become pregnant is that they should take a daily supplement of 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods, to which my hon. Friend Rebecca Pow referred. Examples are spinach and broccoli, as well as foods voluntarily fortified with folic acid, including a wide range of breakfast cereals.

We know, however, that around half the pregnancies in the UK are unplanned. In those that are planned, it has been estimated that only half of all mothers took folic acid supplements or modified their diet to increase folate intake. This has led to calls for the mandatory fortification of flour with folic acid so that women can get it from dietary sources other than foods that naturally contain it. Successive Governments have not considered that mandatory fortification of flour with folic acid to be the best way to protect public health and have instead promoted the use of folic acid supplements as a part of a wide range of pre-conception and post-conception advice to women of childbearing age. However, we are now taking the opportunity that this consultation presents to seek the public’s opinion on this proposed important change.

My colleague the Minister with responsibility for public health responded to a Westminster Hall debate in May 2018 that was secured by Owen Smith, who has campaigned tirelessly on this issue. In his response, the Minister confirmed that the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—I shall refer to it as COT from now on—had agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT published its interim conclusions in July 2018, but it has yet to finalise its detailed review. In summary, COT concluded that the potential masking of pernicious anaemia was still an appropriate and relevant endpoint on which to base a tolerable upper level, but that the level at which this effect started to occur was unclear. It concluded that further analysis of the data was necessary, but that the upper level would not decrease—that is, it would stay at 1 microgram a day or could be increased—as there was no convincing evidence that masking occurred at levels of intake below 1 microgram a day.

COT has discussed this again at this week’s meeting, and as soon as the outcome of its consideration becomes available, it will inform Ministers’ thinking in respect of the Scientific Advisory Committee on Nutrition’s recommendations on the mandatory fortification of flour and about folic acid advice generally. We will reflect that outcome in the consultation document, together with whether we need to take any other action, such as discussions with the industry on removing folic acid from products that are currently voluntarily fortified, such as breakfast cereal. We will also be working closely with colleagues in the Department for Environment, Food and Rural Affairs on the consultation, its responses and any resulting conclusions.

Photo of Rebecca Pow Rebecca Pow Conservative, Taunton Deane

It goes without saying that it would be worth examining the results of tackling anaemia by fortifying flour with iron and of tackling tooth decay by putting fluoride in toothpaste. Similar things have been influenced by approaches to general health, and we could learn great lessons from such examples.

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

My hon. Friend is absolutely right. There is be research and evidence in these areas from around the world, and we hope that it will feature in the consultation. We certainly need to learn from the approaches taken elsewhere.

Photo of Nigel Dodds Nigel Dodds Shadow DUP Spokesperson (Reform and Constitutional Issues), Shadow DUP Spokesperson (Foreign Affairs), Shadow DUP Spokesperson (Brexit), DUP Westminster Leader

I am grateful to the Minister for what he is saying and warmly welcome the announcement made by the Under-Secretary of State for Health and Social Care, Steve Brine, on Tuesday. It is a tremendous step forward. As for looking at what has happened across the world, well over 85 countries, including the United States, have mandatory fortification of flour, so there is an awful lot of evidence out there, and clearly it should be taken into account.

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government)

It certainly will. The right hon. Gentleman takes a keen in this area, and other countries such as the United States, as he mentioned, Canada and Australia have introduced mandatory fortification. We need to learn from all that, but we also need to understand the dietary habits of the United Kingdom. It is worth mentioning that no EU country currently has mandatory folic acid fortification, but he is right and we will certainly be learning from the experiences elsewhere.

I assure the House that Ministers have always taken the issue of pre and post-conception advice seriously, and the public consultation will allow us to fully explore the fortification of flour. This is the start of a detailed dialogue with the industry, the general public, relevant charities—I thank Shine, which has done so much campaigning in this area—and members of the scientific community. This Government will ensure that the decisions we take will come after the full consideration of all views. It is my pleasure to introduce this important debate, and I look forward to hearing the contributions and views of Members.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 1:12 pm, 25th October 2018

I thank the Government for allowing time for this important and very timely debate. It is a pleasure to be here responding on behalf of the Opposition on World Spina Bifida and Hydrocephalus Awareness Day, as the Minister pointed out, to speak about folic acid fortification, particularly after the announcement by the Under-Secretary of State for Health and Social Care, Steve Brine, earlier this week that the Government will be consulting on fortifying flour with folic acid. After decades of campaigning, I know that the announcement has been welcomed by campaigners and their families, and I thank my hon. Friend Owen Smith and Nigel Dodds for their tireless campaigning on this issue. I too welcome the announcement although I have some further questions, and I would appreciate it if the Minister could elaborate on them later.

As early as 1991, the Medical Research Council published a report recommending that white flour in the UK should be fortified with folic acid, which had been shown in other countries to prevent neural tube defects in foetuses. Similarly, mandatory fortification, with limits on voluntary supplementation, was backed by the Scientific Advisory Committee on Nutrition in 2006 and again in 2017. Why, then, has it taken successive Governments so long to get to this point? The latest national diet and nutrition survey statistics state that 91% of women of childbearing age have a red blood cell folate level below the level estimated to lower the risk of NTDs. It is therefore clear that more needs to be done. In fact, the Public Health and Primary Care Minister said during Health and Social Care questions this week that he was

“convinced that the evidence shows overwhelmingly that this is something we should be doing.”—[Official Report, 23 October 2018;
Vol. 648, c. 135.]

I therefore wonder about the purpose of the consultation.

The Minister may have already answered some of my questions, but is the consultation about seeing whether flour should be fortified with folic acid or is it just about establishing what the upper limit for folate levels should be? Modelling undertaken by Food Standards Scotland in 2017 indicated that fortification at the recommended levels, with a capping of voluntary fortification and supplements, can achieve the reductions in NTD risk without increasing the number of people consuming the upper recommended limit. Is this a scenario that the consultation will consider? Up until now, the Government have continued their policy of voluntary folic acid supplementation for women of childbearing age. Does the Minister expect that advice to continue throughout the consultation and evaluation period?

The press release published this week by the Department of Health and Social Care says that the consultation

“will launch in early 2019”.

Is the Minister able to tell the House exactly when the consultation will launch and how long it is expected to last? The evidence has been available for decades, and people have been campaigning on this issue for many years, so it seems only right that the consultation should conclude as quickly as possible. With that in mind, does the Minister have any expectations of when we will have the results of the consultation? Finally, as the Minister will know, not everyone eats bread or is able to eat wheat flour, so will the consultation make any assessment of how we reach those who do not eat bread or wheat flour? Will the fortification include only wheat flour, or will it extend to other flours, such as corn, rice and gluten-free flour?

That is a lot of questions for the Minister to answer, especially as it is not his brief—he is doing a fabulous job of stepping into various areas across Government—and I am sure that colleagues across the House will have further questions for him, but as this change has been such a long time coming, we are very keen to get an answer to the key question: when will flour be fortified with folic acid in the UK? I look forward to this debate and to hearing the Minister’s answers at the end.

Photo of Patrick Grady Patrick Grady SNP Chief Whip 1:17 pm, 25th October 2018

It seems that a lot of us are substituting for other people today, but it is nice to speak in a debate on a topic on which there is a little consensus and agreement for a change, so I welcome the Government making time for this debate and the announcement about the fortification of flour with folic acid. It is particularly appropriate, as the Minister said, to be holding this debate on World Spina Bifida and Hydrocephalus Awareness Day. As the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, this change has been a long time coming—the Medical Research Council first called for it in 1991—so I hope that the consultation will be concluded as quickly as possible so that we can move to an implementation phase.

Since 1991, the evidence of the benefits of folic acid fortification has only increased to the point at which there is now clear consensus across the medical community about the importance of this step. Dr Linda de Caestecker, public health director of NHS Greater Glasgow and Clyde, and Dr Jonathan Sher, an independent consultant on preconception health, education and care based in Edinburgh, have both written and campaigned extensively on this issue. In February this year, they published a paper in which they said that folic acid, or vitamin B9, could accurately be described as “vitamin benign” given its strong benefits and lack of significant downsides. They also pointed to the important fact that the lack of fortification has led to a health inequality gap, saying in a recent edition of Holyrood magazine:

“Relatively well-educated, well-informed, well-off women tend to follow the advice”— to take supplements before and during pregnancy—

“while their less advantaged sisters often do not. The gap has also grown between women with well-planned and well-timed pregnancies and the large percentage of Scottish women who become pregnant unintentionally, unexpectedly, or with minimal preparation.”

The challenge is particularly acute in Scotland, which has more live births of babies with spina bifida per head of population than anywhere else in the UK. In turn, as the Minister hinted at, the UK rate is higher than that in many other parts of the world where fortification has already been introduced. Over 70 countries have already adopted this practice and have seen a decline in neural tube defects as a result. That is one of the reasons why last year the Scottish Public Health Minister, my good friend—and now the Cabinet Secretary for Communities and Local GovernmentAileen Campbell, along with her Welsh Assembly counterpart, wrote to ask the then Secretary of State for Health to move forward on fortification.

The Scottish Government have also made it clear that they are prepared to take their own steps on fortification if necessary, but the evidence and research mentioned by Mrs Hodgson shows that fortification will be more effective if it is rolled out at the same time across the whole UK. It is welcome that action is at last being taken. The focus of the consultation must therefore be on how fortification can be delivered effectively, not on whether it should be implemented in the first place. I echo some of the hon. Lady’s questions.

When the announcement was trailed earlier this month, the chief executive of Spina Bifida Hydrocephalus Scotland, Andy Wynd, said that the decision to proceed with fortifying flour with folic acid will have a monumental impact on the health of babies in Scotland. I pay tribute to the work of SBHS and other organisations, such as Shine and the Royal College of Obstetricians and Gynaecologists, which have long campaigned on this issue and which provided helpful briefings in advance of today’s debate.

My hon. Friend Stuart C. McDonald works very closely with SBHS, which is based in his constituency. SBHS does incredible work to raise awareness of spina bifida and to support people and families with the condition to live happy and fulfilling lives. On that note, I wish the best of luck to my friend, and former constituent, Tommy Ga-Ken Wan who, with his dancing partner Piotr Marczak, is taking part in SBHS’s “Strictly Come Prancing” event in Glasgow later this month, which will raise much needed funds and awareness—as does the annual SBHS gala Burns supper, which I had the privilege of attending in 2016.

I attended that Burns supper with another constituent, Jackie Lennox, whose sister Tracy was born with spina bifida. Tracy sadly passed away in 2014—as we have heard, spina bifida is a life-limiting condition—and in her memory Jackie established Tracy’s tree, which has become a new but much loved tradition in Maryhill. The memorial Christmas tree outside the burgh halls is decorated each year with baubles bearing the names of loved ones who have passed away.

It is difficult to know how Tracy’s life, and many others, might have been different if the fortification of flour with folic acid had already been routine, but what we do know is that the introduction of fortification will reduce cases of neural tube defects and complicated pregnancies and will allow more babies and families to live longer and less complicated lives. That is why it is important that the Government now move as quickly as possible to take these last steps towards implementation. We must make sure we take this opportunity to finally make it, and get it, right.

Photo of Owen Smith Owen Smith Labour, Pontypridd 1:22 pm, 25th October 2018

It is a pleasure to speak in this welcome debate on a welcome Government intervention. I start by paying tribute to Steve Brine, the Public Health Minister. He is not here today, but he has been excellent in listening to the evidence on this case in recent months, and he moved decisively to announce the consultation on Tuesday. As the Under-Secretary of State for Housing, Communities and Local Government, Nigel Adams, said, the consultation is welcomed on both sides of the House and, indeed, by the scientific community not just in the UK but across the world.

I pay tribute to Nigel Dodds, my co-chair of the all-party parliamentary group on folic acid fortification. He has spoken with great bravery and sincerity about his family’s experiences, and he and many others have played a far more important role than I have in bringing home to Members the importance of this change.

I also pay tribute to Shine, and particularly to its current chief executive Kate Steele. The charity does wonderful work to support individuals and families with spina bifida and neural tube defects, and it has played an excellent role in campaigning for fortification.

Lastly, I thank Lord Rooker. He campaigned on this issue long before I and many others did. In truth, he has been the leading advocate in Parliament for this change over a long period. This is a proud day for him.

Obviously there will be some controversial questions. The Government are proposing a big public health intervention, and it is right that they are consulting, but the Public Health Minister was right to say on Tuesday that the evidence is overwhelming and that he is convinced by the evidence.

I will spell out the scale and gravity of these conditions in the UK to bring it home to Members, and to those who might read or watch this debate. We now all know that neural tube defects are the failure of the spine to close at either end, and they happen early in pregnancy. Neural tube defects can lead either to spina bifida or anencephaly.

Anencephaly occurs in 40% of neural tube defects and is fatal. Children with anencephaly do not survive, and often they die very quickly after birth. Spina bifida is where the spinal cord does not properly form, which obviously leads to poor mobility, poor bladder control, bowel issues, often learning disabilities, mental health problems, physical health problems and lifelong disability. It is an extremely grave condition.

Neural tube defects affect around 1,000 pregnancies each year in our country. In this country, two foetuses a day are aborted following the diagnosis of a neural tube defect, and two children a week are born with such birth defects.

Photo of Anna Turley Anna Turley Labour/Co-operative, Redcar

My hon. Friend is making an extremely powerful case, for which I am grateful. Does he agree that one of the most frightening statistics is that young women under the age of 20 are five times less likely to take folic acid supplements? That strengthens the case for mandatory flour fortification.

Photo of Owen Smith Owen Smith Labour, Pontypridd

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 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 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.

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

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?

Photo of Owen Smith Owen Smith Labour, Pontypridd

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.

Photo of Nigel Dodds Nigel Dodds Shadow DUP Spokesperson (Reform and Constitutional Issues), Shadow DUP Spokesperson (Foreign Affairs), Shadow DUP Spokesperson (Brexit), DUP Westminster Leader 1:34 pm, 25th October 2018

It is a pleasure to follow Owen Smith in this debate because, as has been mentioned, he co-chairs the all-party group and has done a fantastic job in raising awareness of the issue in a relatively short time. It is not that long since the all-party group was set up, so this must be something of a record in getting the Government to move. I thank the Minister for what he has said and pay tribute to Steve Brine, who is the Minister responsible for public health, for what he said on Tuesday and for the speed with which he has moved on the issue. Many, many people have been involved in highlighting it over the years, and I join the tributes that have already been paid to people such as Lord Jeff Rooker, to the scientists who have been involved, to the charities in Scotland and to Shine, which operates in Northern Ireland and across the rest of the UK. They have done tremendous work in campaigning on the issue over many years, in addition to the work they are doing to help families who have someone with spina bifida or hydrocephalus in the family and who have lost someone who had these conditions.

This is a great debate and this measure is a great positive move. Clearly, we would wish that it had happened earlier, but we are delighted it has reached this stage now. I thank the Government for taking it forward now, because it is important that we move ahead and do not lose time, as too much time has been wasted. The approach adopted over many years by the Government has been of not wanting to go down the road of what is described by some people as “mass medication”. All sorts of genuine issues have been raised about the effects, but the science proves clearly and objectively that this is safe and will prevent thousands of people from being born with severe conditions—and that does not take into account the many tens of thousands of terminations that happen as a result of parents learning that their unborn baby may be affected severely by spina bifida or hydrocephalus.

The approach of Governments previously—to offer advice, education and information on supplementing diet with folic acid—has not worked. That is clear. Over the past 20 to 30 years, it has not made a difference, mainly because of some of the issues we have discussed: the fact that almost half of pregnancies are unplanned; a lot of people in certain demographics and age groups are simply less likely to know about this or come across the information that is out there; and these neural tube defects develop 14 to 28 days into pregnancy—once that has happened, it is too late to start taking folic acid supplements. I have no argument with the advice on taking folic acid in the early stages of pregnancy, but in the vast majority of cases it will be too late—these supplements need to be taken in advance of conception if they are going to make a difference; that is the reality of it. If we continue with the current policy, the problem is simply going to continue.

There is an alternative, it is safe and it has been proved to have worked in more than 85 countries, including Australia and the United States. The scientific consensus is enormous, and the hon. Member for Pontypridd read out the list of scientific bodies, clinicians and others who are all agreed about the need to proceed along this path. Therefore, I, too, join the call that this should not be a long, drawn out consultation, as ample evidence is already available on the issue. The consultation should be proceeded with as quickly as possible to ensure that this is introduced, and I make the plea that it should be introduced across the UK. We had a debate yesterday about Northern Ireland, and I do not want to get into all of that, but on this issue the Government have taken steps to introduce sensible, non-controversial measures where appropriate.

Patrick Grady mentioned the high incidence in Scotland and we have a high incidence in Northern Ireland. He is absolutely right to make that point and I congratulate the Scottish Government on what they have done on the issue, but we cannot allow some kind of interregnum in Northern Ireland. This issue is important and I think that there would be absolute consensus across the board in Northern Ireland that any change should happen there alongside the rest of the United Kingdom.

The effects of these conditions on the children who are born with them are extreme. I have spoken previously about my own son, Andrew, who was born in 1990 with spina bifida and hydrocephalus, and about the severe impact that had on his life. As he grew older, there were more severe effects. Of course, that did not just affect him. He was a bright, cheerful boy and a lovely child. The lives of those who came into contact with him were enriched, and our lives were certainly enriched by having him. It had severe effects on him—he was hospitalised many times and had shunt operations and setbacks—and there was also an effect on the wider family. It affected the entire family circle. We had great family back-up and support, but in many cases people do not have that. This is a really massive issue, and that is where charities such as Shine and others come into play, providing such fantastic support, help and assistance.

If it can be prevented, why are we not taking the steps that need to be taken? Andrew had eight years of a wonderful life, in the sense that he was loved and gave out so much love, but the problems that he had and faced throughout that short life were very, very difficult for him and for the rest of his family. We would love to see children being born without having to have these conditions. They do not need to be. We now have to move on with this issue. There is no good reason not to. Some abstract arguments may be advanced and some theoretical arguments made about liberty, mass medication and other things, but they have been clearly disproved—they are a total red herring. Folic acid fortification is something that can be done that is safe and that works. It will not prevent these conditions entirely—some children will still be born with them—but there will be a lot fewer, so we need to move forward.

I welcome what the Government have done. They have listened and responded. Let us now get on with it. I pay tribute to everyone who has been involved in the campaign and got it to this stage. The political agenda is dominated by certain subjects but, if nothing else happens, if we can get this done, it will be a great legacy for this Government and this Parliament.

Photo of Alex Sobel Alex Sobel Labour/Co-operative, Leeds North West 1:43 pm, 25th October 2018

I thank my hon. Friend Owen Smith for initially asking the Backbench Business Committee for this debate. When time could not be allocated, the Government allowed for this time instead, so I thank them, too. I thank my hon. Friend and Nigel Dodds for their tireless campaigning. I was moved to speak in the debate because of my hon. Friend’s presentation at the Backbench Business Committee, of which I am a member. This whole issue seems like such a no-brainer, so I am really pleased that the Government have come forward with a consultation. I echo the comments of Members who want the consultation to happen quickly so that we can get measures in place.

In preparation for this debate, I went to Holland & Barrett to find out the cost of folic acid tablets. Just one jar costs £8.49. Being pregnant is an expensive business, as is having children. As well as folic acid pills—if someone is aware of their pregnancy or intends to become pregnant—there are baby clothes, decorations, cots and car seats to buy, and all that at a time when many people have very little money and are just about managing. Do we really expect those families to spend £8.49 on supplements?

Although supplements are costly, treating illnesses caused by the lack of folic acid in the diet of expectant mothers costs the NHS far more. Studies show that adding folic acid to food reduces instances of neural tube defects by 72%. That is exceedingly significant when we consider the fact that hundreds of babies are affected by spina bifida every year in the UK. Researchers in Chile compared the annual cost of the rehabilitation and treatment of children with spina bifida with the cost of adding folic acid to flour. The results showed that for every $1 invested in adding folic acid to flour, $12 was saved in medical treatment and care. Adding folic acid to our flour will not only benefit the would-be victims of neural tube defects, but save significant amounts for the NHS and therefore the taxpayer. It is estimated that it would cost only £200,000 a year for us to add folic acid to flour, and there are only 10 major flour mills in the country. It could be done very easily and very quickly.

Of course, there is a small minority of people who do not like mass measures such as the fortification of foods, but food fortification is nothing new and already makes an important contribution to diets in the UK and overseas. In the UK we already fortify white and brown flour with iron, thiamin and niacin after they are removed with the bran during the milling of wheat, so the relevant technology and infrastructure is already in the UK industry. We add other substances to food for flavour, for texture or to increase the speed of production, so why would we not add a harmless ingredient, for which there is no upper limit, that could save hundreds of babies a year from being born in the UK with lifelong birth defects?

Having children is an incredibly exciting time for parents—full of hope and expectation—but it is also fraught with risk and concern. Pregnant women and expectant parents are bombarded with information about diseases and issues that can afflict the mother and the baby. If we can do one simple, cheap and effective thing to reduce the chances of a baby contracting a life-changing illness, surely it is a no-brainer.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 1:47 pm, 25th October 2018

With the leave of the House, I wish to say what an excellent debate this has been. I thank the Members who have taken part: Patrick Grady, my hon. Friend Owen Smith, Nigel Dodds in particular for his very moving speech, and my hon. Friend Alex Sobel. We really have heard excellent and moving speeches. Most Members present were in Westminster Hall for the debate in May when together we called on the Government to look again at this issue. The Under-Secretary of State for Health and Social Care, Steve Brine, did listen. He assured us all when we were lobbying him on the way out that he had listened. He told us to watch this space, so it is really good that within six months we are back, that we are all in agreement that there are benefits to fortifying flour with folic acid, and that we are keen to have that happen as soon as possible.

As we have heard, charities such as Shine, from which I have received very detailed and helpful briefings, have been campaigning on this issue for decades, and I pay tribute to Lord Rooker, who has also shown great leadership on this matter over decades. Will the Minister say whether charities and campaigners will have an opportunity to be involved with and to engage in the consultation? How will they be able to do that? Many of them have not only first-hand experience of why fortification is needed, but the expertise that should be utilised during the consultation. My last question, I promise, is: will the Minister please tell the House, if the information is available, which Department is facilitating the consultation and who it will be led by?

After this issue has been on the table for two and a half decades, we all agree that it is now time for our flour to be fortified with folic acid. I look forward to hearing the Minister outline the timeframe in his closing speech.

Photo of Nigel Adams Nigel Adams Government Whip, Parliamentary Under-Secretary (Housing, Communities and Local Government) 1:49 pm, 25th October 2018

With the leave of the House, I echo Mrs Hodgson in saying that we have had a fantastically well-informed debate. It is good to see the House coming together. I am sure that everyone will agree that the tone of the debate has been extremely welcome. We have heard Members’ views about the proposal to fortify flour with folic acid, and I thank all of them for their contributions and interventions. This will ensure that the consultation document reflects both the scientific evidence base and the very personal impacts of the consequences for families dealing with an NTD birth. What has been clear from the debate is that we must move forward on this issue as soon as possible.

On modelling, the Government will consider all current dietary habits of women of childbearing age to help to inform the impact of this proposed mandatory fortification of flour to ensure that we are reaching the desired outcome. All dietary patterns will be considered whether they be cultural, religious or just personal preference.

On safety, we will continue to listen to COT’s advice to ensure that a safe upper limit is not exceeded by proposed changes to the folate intake from fortified flour. I hear what Owen Smith says, but we have a duty to listen to COT’s advice. On pre and post-conception advice, we will ensure that a clear public health message is provided so that young women can properly understand what this proposed fortification change means for them having a healthy pregnancy.

Let me refer to some of the contributions from the debate. I thank the hon. Members for Blaenau Gwent (Nick Smith) and for Redcar (Anna Turley) for their interventions, and also the Scottish National party spokesman, Patrick Grady, who spoke in such an informed way. I really need to pay tribute to the hon. Member for Pontypridd for his work as co-chair of the all-party group on folic fortification and for highlighting those individual cases that he referenced. In particular, there was that incredibly moving story of the young girl, Nicky, which must have touched everyone here. As a Department, we are incredibly grateful for all the work that he has done. He, like the hon. Member for Washington and Sunderland West, was right to reference the work of Lord Rooker. We are extremely grateful for what he has done in this area and for his campaign on folic fortification.

Nigel Dodds speaks eloquently and brilliantly on all issues in this House. It has been a great privilege to listen to his contributions over the past eight years, but particularly in this debate. To come to this Chamber and to speak on a personal level about his experiences must have been incredibly challenging, and the way in which he talked about his son, Andrew, was incredibly moving. Both he and the hon. Member for Pontypridd, as co-chairs of the all-party group, should be very proud of their work to get the Government to this stage. I am absolutely sure that Andrew would be incredibly proud of his father’s work.

Alex Sobel rightly highlighted the costs—the relatively small costs—involved in this area. That is a great reminder to the Government that this is an issue that is not particularly expensive to deal with. There are not that many flour mills around the country, as he said. I am very grateful to him for his contribution.

I turn now to the comments of my friend, the hon. Member for Washington and Sunderland West, whom I have had the great privilege of working with on various campaigns over the years in this place. She asked exactly when the consultation would be launched and how long it would last. I know that other Members will want to know that as well. We do not have an exact date, but it will be early in the new year. I can assure her that it will happen as soon as we have been able to finalise the impact assessments. There is no fixed time for such an important consultation, but we expect it to last around 12 weeks to ensure that everybody has had a chance to consider the matter and respond. She asked whether there was an expectation of when we would have the results. Well, we will consider the outcome of the consultation as soon as it closes. Again, I cannot give her an exact date today in the House, but I can assure Members that we are committed to no delay and to responding as quickly as possible on this very important matter.

The hon. Lady also asked whether the consultation would consider the fortification of flour, or whether it would just establish an upper limit. I can assure her that the consultation will consider whether the calls to fortify wheat flour will achieve the objective for pregnant women. COT is considering the safe upper levels as part of that and its conclusions will be reflected within the wider consultation. She asked which Department will be responsible for leading the consultation, and I can tell her that it will be the Department of Health and Social Care. She also asked about gluten-free flour and whether fortification will include just wheat flour, or other types of flour such as cornflour for those with coeliac disease. We will consider all food in the modelling to ensure that the policy reaches its objective. We will also discuss with industry the issue of foods that are currently voluntarily fortified, such as breakfast cereal.

Finally, the hon. Lady asked how charities such as Shine can support the Government in ensuring that the announced consultation progresses quickly. We are very grateful to Shine and other charities for their tireless promotion of this important issue. Until we know the outcome of the consultation, it is too soon to consider which legislative vehicle might be needed to give effect to any decision, but the consultation process will allow us to make a decision once we have that outcome.

We very much hope that the consultation will raise public awareness of the need to continue to take the recommended folic acid supplement before conception and up to the 12th week of pregnancy. That is vital, as we have heard, and I really hope that this message can be brought to the attention of women both now and in respect of any future change. I am confident that this public consultation will give a proper channel to allow everyone to make their feelings on this issue known. I am sure that everyone who has participated in the debate will very much look forward to its outcome.

Question put and agreed to.

Resolved,

That this House
has considered folic acid fortification.