Health: Neural Tube Defects

Debate between Lord Prior of Brampton and Lord Rooker

Monday 21st March 2016 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government whether they will bring forward measures of preventative medicine to reduce the numbers of stillbirths, abortions and live births of babies with serious lifelong disability due to neural tube defects.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government are looking at all aspects of preconception health and preventive medicine. We currently have no plans to introduce the mandatory fortification of flour with folic acid. We plan shortly to engage with relevant stakeholders to identify other measures that can promote good preconception health, including how to redress the low blood-folate levels of women, which can lead to neural tube defects.

[Lord Rooker (Lab)]

The Minister’s Answer is clearer than some of the others, but we now know that the answer is no; that is what he has told us. English Ministers are knowingly doing nothing, basically. They know that half of all women who become pregnant are taking supplements, and only a small percentage of them actually take the correct amount. Moreover, does the Minister know that some food manufacturers are starting voluntarily to reduce the folic acid in their products, which they were going to do on the basis of mandatory levels being introduced following scientific advice? The Government are therefore relying on 80% of pregnancies being sponsored abortions as a management tool. That is the reality of what we are dealing with in England at present. Is this not like English Ministers having a polio vaccine and refusing to use it?

My final point is this. Does the Minister accept that it has never really been made clear that there is a direct and indisputable link between neural tube defects, lifelong serious disability in babies who are born alive and folate vitamin deficiency? It was the UK that told the world this in 1991, and 83 other countries have thanked us by using the policy to reduce the number of abortions and babies born with lifelong disabilities. The Minister should be ashamed of the situation he has been forced into by his colleagues.

[Lord Prior of Brampton]

My Lords, I am not going to argue the science, because the link between folate levels and neural tube defects is fairly well proven. Although our decisions should be informed by scientists and doctors, I do not think that they should be determined by them. The balance between individual responsibility and state responsibility is best left to political judgment.

NHS: Preventive Medicine

Debate between Lord Prior of Brampton and Lord Rooker

Wednesday 20th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there is clearly a direct legal contractual relationship between a private insurance company and an individual. The NHS cannot interfere directly with that contract. There is no similar legal relationship between the NHS and the citizen, although there is clearly a social and moral contract between the two. As part of that contract the state agrees to provide free, high-quality healthcare. It is only right that the individual should accept personal responsibility for their health and well-being, and that of their family.

[Lord Rooker (Lab)]

Can I make a suggestion to the Minister? If the Government want to take preventive medicine seriously, they should invite Sir Nicholas Wald, Professor of preventive medicine at the Wolfson Institute, to come and talk about his lifetime’s work on things such as the polypill, and, indeed, his leadership in1990 of the Medical Research Council’s work on preventing spina bifida and neural tube defects in babies by the use of folic acid in flour.

[Lord Prior of Brampton]

I thank the noble Lord for raising this issue today. We discussed it yesterday and the Government will give him a full response to the issue of fortifying bread with folic acid in the very near future.

Health: Red Cell Folate

Debate between Lord Prior of Brampton and Lord Rooker

Tuesday 19th January 2016 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government, further to the remarks by Lord Prior of Brampton on 21 December 2015 (HL Deb, col 2308), whether the letter from the Scientific Advisory Committee on Nutrition gave any indication of how many women aged 16 to 49 in the United Kingdom met the recommendations from the World Health Organisation regarding red cell folate concentration.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

The advisory committee’s letter indicates that 14.5% of UK women of childbearing age met the new threshold for red cell folate concentration that has been recommended by the World Health Organization since April 2015. Ministers are reviewing the contents of the letter carefully. They plan to come forward with their response to the committee’s latest advice in due course.

[Lord Rooker (Lab)]

I thank the Minister for that Answer but he has just told the House that 85% of women of childbearing age in the United Kingdom failed to meet a major World Health Organization target. The letter says that UK levels are the same as those in the United States of America before fortification with folic acid. Following fortification, US women are now above the World Health Organization target, there have been fewer avoidable abortions, there have been fewer babies with a serious lifelong disability, and the USA is saving half a billion dollars in healthcare costs. The same story is repeated from Canada to South Africa and from Chile to Australia. Worryingly, the same letter says that blood folate levels have gone down so low, it looks like there has been a 25% increase in terminations in England and Wales in the past few years as a result of the current policy of advice only rather than fortification. I say to the Minister: none of the figures in that letter was new. They were known on 20 March last year. The House recesses on 23 March this year. Will we have a decision before we recess?

[Lord Prior of Brampton]

My Lords, the letter that the noble Lord refers to was received on 20 October last year, so we have had it for a little over three months. It is very important to make the point that it is not that the red cell folate levels of British women have gone down but that the threshold used by the WHO has gone up, from 340 nanomoles per litre to 906 nanomoles per litre. Nevertheless, the noble Lord makes a very strong point. He has made it before, in December. There is a lot of medical and scientific evidence on his side of the argument. There are other arguments that the Government are taking into account.

Pregnancy: Neural Tube Defects

Debate between Lord Prior of Brampton and Lord Rooker

Monday 21st December 2015 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government whether they have any proposals to minimise the risk of neural tube defective pregnancy in women of reproductive age.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government are looking at all aspects of preconception health. This includes the uptake of folic acid, which can reduce the risks of neural tube defects. Women are advised to take a supplement of 400 micrograms of folic acid from several weeks before conception until the 12th week of pregnancy. This information is available on the NHS Choices website.

[Lord Rooker (Lab)]

My Lords, is the Minister aware that on four occasions his predecessor told the House that the Government were awaiting information on blood folate levels? It was published nine months ago yesterday and we have had no statement whatever about it. Has the Minister had the chance to look at the scientific paper published last week showing that, if the UK had adopted white bread flour fortification at the same time as the United States of America, there would have been 2,000 fewer neural tube defect-affected pregnancies in the UK? There is now a spina bifida epidemic in Europe, which there is not in the 80 countries that fortify flour with folic acid. Surely it is time for action.

[Lord Prior of Brampton]

My Lords, I pay tribute to the noble Lord for the extraordinary work that he has done in this field and for giving this very important and tragic issue a greater degree of public awareness. My honourable friend in the other House, Jane Ellison, the Minister for Public Health, is considering her response to the report that the noble Lord referred to and to the report by the SACN, the committee on nutrition, published on 20 October. I expect that she will come to a decision early in the new year.