General Food Law (Amendment etc.) (EU Exit) Regulations 2019
Lord Rooker Excerpts(5 years, 2 months ago)
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Baroness Walmsley (LD)
My Lords, I thank the Minister for introducing these SIs, which replace references to the EU in regulations with references to the UK, and as such are relatively innocuous. The first question I want to ask was raised in Grand Committee last Wednesday by the noble Lord, Lord Rooker, who is in his place. Is the Minister satisfied that all relevant regulations on these important food safety matters have been copied over into the SIs we are discussing today? The noble Lord found some SIs where some important matters had not been copied over. Perhaps he has spotted something which I have not in these regulations, and we will hear from him in due course.
Secondly, the general food law SI, the general food hygiene SI and the contaminants in food SI allow only one hour for a single officer in a local authority to familiarise himself or herself with the new regulations and disseminate the information to staff and stakeholders. I wonder whether it is a coincidence that they will have to do it on April Fools’ Day, the first working day after Brexit. The problem is that cuts to local authority funding have meant that some authorities no longer have any full-time food and feed officers to take charge on this issue, so who is going to do it, and who is going to pay for it? How can they do it in only one hour? Is this not just a covert way of ensuring that an impact assessment does not need to be produced? All those who responded to the consultation claimed that this cannot be done in so short a time and will certainly cost more than the Government estimate, and the Government have not offered to cover these costs. How did the Government reach the conclusion that the implementation time for businesses would be so staggeringly short?
The food hygiene SI allows a 21-month implementation period for food labelling changes from EU to GB or UK, but even here, the industry has concerns that some small businesses may struggle to comply. Other respondents to the consultation raised concerns that a common framework across the whole of the UK has not been properly addressed. The NFU pointed out that some farm holdings cross borders and animal feed moves across the Welsh and Scottish borders frequently. Is the Minister satisfied that devolution issues have been settled to the satisfaction of the Welsh and Scottish Governments?
Thirdly, can the FSA and its Scottish equivalent, the FSS, fulfil their additional responsibilities? Do they have enough staff and resources? Can the Minister respond to these concerns? Other respondents are concerned about how the Government intend to provide a suitable replacement for the risk-management function for food safety currently undertaken by the European Food Safety Authority. Can the Minister say what is being done about this? The whole of the food safety regime is based on risk management, and it is far from clear who will be responsible for this after Brexit and whether they have adequate resources. The National Pig Association is keen to retain a close working relationship with the EFSA to ensure that we in the UK receive food problem alerts in good time to take effective protective action against livestock diseases coming to us from the continent. This will also be a concern for other livestock producers. Can the Minister say what arrangements for this have been put in place?
I hope I will be forgiven for straying slightly beyond these SIs to some relevant matters, and I hope the Minister will find my comments useful for the future. If we are to leave the EU, the Government have always said that there is no danger of reducing our food standards and that, on the contrary, it gives us an opportunity to improve them. That is why I am surprised we have heard nothing yet of the Government’s plans to do that. One thing I would have wanted to improve in the common agricultural policy is to link food production and trade policies to the better dietary health of the European population. So here is a challenge for the British Government. They can start with two things, which I put down as markers for the future. First, they should ban the use of nitrites in processed meats, such as bacon and ham, in favour of other processes which have not been designated as carcinogenic by the World Health Organization, as nitrites have been, but which preserve meat just as well and protect it from botulism just as effectively.
Secondly, they should introduce supply-side regulations to reduce the UK population’s intake of free sugars by two-thirds to comply with the Scientific Advisory Committee on Nutrition’s recommendations, which make clear that overconsumption of sugar is responsible for the crisis of obesity, diabetes and all their associated preventable diseases, and for tooth decay in children, which is responsible for most of their hospital stays. Agricultural and trade policy are central to the supply of sugar, and amendments could be effective in changing the market for sugar before it even reaches the consumer. Reformulation programmes, sugary drinks tax and nudges towards behaviour change have their place, but we could make a greater and faster change if we addressed the supply side.
Once they have got all the relevant SIs about retained EU law through Parliament, will the Government look at these two opportunities as a matter of urgency? Has the Minister had any discussions or made any representations from her department to the rest of Government about such measures, as we move into the years after Brexit?
Lord Rooker (Lab)
My Lords, this is my first opportunity to welcome the Minister and congratulate her on her government appointment. I sincerely wish her well for the future.
As for interests to declare, I recently chaired an egg summit for the largest retailer in the country, which is in the register, and of course at one time, along with the noble Lord, Lord Krebs, who is in his place, I was chair of the Food Standards Agency. Before that, I was one of the last food safety Ministers, so I go back a little bit. This is my guest appearance only, at the personal invitation of my noble friends Lady Jones and Lady Smith; if the party leadership find out about it I will be in real trouble, although I can say that I am speaking for myself today since there is nobody else here from the Labour Party. I serve on Sub-Committee B of the Lords process for Brexit. We deal with all the FSA SIs as they come through. That was agreed simply because the chair is my noble friend Lord Cunningham, who was the Minister at the MAFF when we started work on setting up the FSA. I also sit on the Lords environment sub-committee. This morning we had the pleasure of having the chair of the Food Standards Agency and the Minister’s colleague, the Minister for Public Health and Primary Care, with us for an hour to discuss risk assessment and risk management post Brexit.
We are at one with these regulations. I am not going to waste the time of the Minister or of officials with details on the regulations. They provide continuity for people in terms of public health, the legal framework stays the same and there should be no problem with businesses. We were given quite good commitments in public this morning in terms of resources both for the Scottish end and the FSA, dealing with the rest of Great Britain and Northern Ireland, and therefore I do not want to duplicate everything.
There is one area which the Minister and officials might want to take away for the future. There is a lot of concern about local authority performance, and in terms of inspections there is no question about that. Environmental health officers are the unsung heroes of food safety. They do the takeaways and all the bits that people do not normally think about, but that is not politically sexy for councillors, to be honest, and therefore it is one of the first things they will go for chopping. Of course, without them, in terms of managing the situation, the FSA is powerless, because of lack of information.
Health: Contraceptive Services
Lord Rooker Excerpts(5 years, 7 months ago)
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Lord O’Shaughnessy
I concur with the noble Baroness about the importance and benefits of contraception. It is a success of sexual health services that the use of long-acting reversible contraceptives has risen over the past 10 years. She is right that there have been pressures on public health budgets which have affected services, but it is important to note that many outcomes are improving. The annual number of sexually transmitted infections is stable, and the number of teenage pregnancies is down. In fact, it has fallen by 45% since 2010 to its lowest recorded level. I take her point about the importance of these services and that they are under pressure; nevertheless, they are performing admirably.
Lord Rooker (Lab)
Given that half our pregnancies are unplanned, and that the department’s policy in respect of limiting neural tube defects is to tell women of child-bearing age to take folic acid supplements, what is the Government’s response to the research published two days ago that shows, once again, a reduction in the use of folic supplements by young women of child-bearing age?
Brexit: Food Standards Regulations
Lord Rooker Excerpts(5 years, 8 months ago)
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Lord O'Shaughnessy
There are no suggestions that there should be lower food standards. Obviously, after we leave the European Union, the Food Standards Agency will carry out any risk assessments. There are no proposals to change these rules; we will continue with them. Of course, there would be a proper scientific and evidence-based assessment if there were such suggestions.
Lord Rooker (Lab)
Will the Minister give an assurance that, after we leave, Ministers will play no role in food safety risk assessment? Will a mechanism be found to transfer what takes place in the European field to some independent body, maybe with the Chinese walls of the existing Food Standards Agency? It should not go back to Ministers because they are there to promote the food industry—a role that is in conflict with securing safety for consumers.
Brexit: Food Standards Agency
Lord Rooker Excerpts(6 years ago)
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Lord O’Shaughnessy
I reassure my noble friend that not only are we taking 95% of legislation that derives from the EU regarding food standards and hygiene into UK law through the withdrawal Bill but we are also undertaking work to ensure that we have the right statutory instruments in place in a timely way so that we are prepared for all circumstances when we leave the European Union on 29 March.
Lord Rooker (Lab)
If today is an average day, eight notices will be issued around Europe under the Rapid Alert System for Food and Feed. The only countries that get those notices are members of the EU and the European Economic Area. We will be outside those. This is an integral part of the single market and the customs union; the system did not exist before we joined the Common Market. How can the FSA operate on day one? If this area cannot be transferred over, how will we get those 3,000 notices a year warning of potential hazards? Collectively they provide security and safety for our population.
Lord O’Shaughnessy
The noble Lord is quite right to say that we get those alert systems now, and I can reassure him that we will continue to get them during the implementation period up to the end of December 2020. As all noble Lords will know, we are seeking to negotiate a deep and special relationship with the European Union when the implementation period ends—
Bread and Flour Regulations (Folic Acid) Bill [HL]
Lord Rooker Excerpts(7 years, 10 months ago)
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Lord Rooker (Lab)
My Lords, my Bill concerns a measure of preventative medicine designed to reduce the number of children born with a lifelong serious disability and reduce the high level of terminations of affected pregnancies following antenatal screening and diagnosis. Some may think the number is small. We are talking about approximately 1,000 pregnancies per year in the UK, of which 80% are terminated. We can do something about this, and in my view we should act.
In 1991, UK research by a Medical Research Council team discovered that a deficiency of vitamin B9, folic acid, is the cause of neural tube defects. The defect is that, just after conception, the neural tube does not close as it should. This leads to defects of the brain, spine and spinal cord leading to spina bifida and other serious, lifelong disabilities. The neural tube closes at 27 days, which for most women is before they know they are pregnant.
In all health matters, it is wise for Parliament and government to take expert advice. Following the 1991 ground-breaking UK research, in 2000 the then Committee on Medical Aspects of Food and Nutrition Policy gave advice to government to improve the blood folate status of the UK population through the mandatory fortification of flour with vitamin B9, folic acid. This advice was repeated by the Scientific Advisory Committee on Nutrition in 2006 and in 2009. The Food Standards Agency gave similar advice in 2007 and 2009.
Further research was requested by one or more of the Chief Medical Officers, and it was conducted by various scientists. Several aspects were looked at, including a possible male colon cancer rise due to folic fortification, but a peer-reviewed study of 50,000 cases published in 2013 found no evidence. The National Diet and Nutrition Survey was requested in particular to check the blood folate levels in the whole population, especially among women of child-bearing age. This took some years and the results were published in March 2015. The results showed that the blood folate levels for UK women are below the WHO thresholds.
By October 2015, the Scientific Advisory Committee on Nutrition had collated all the latest evidence, and on 20 October wrote to all four Health Ministers in England, Scotland, Wales and Northern Ireland. Its eight-paragraph letter alerted Ministers to the recent information, the WHO studies, evidence from the USA and the blood folate levels, as well as concerns that the UK food industry was actually reducing amounts of voluntary folic acid in its products. In summary, the letter repeated the advice of 2006 to go for the mandatory fortification of flour.
My Bill would effectively put that advice into legislation. Drafting a Bill like this was easy. As the UK already fortifies flour on health grounds, vitamin B9, folic acid, can simply be added to the list.
To date, the policy in the UK has been that women planning pregnancy should take folic supplements. Health is of course a devolved matter, but there are two problems here. First, the UK has the second-highest number of unplanned pregnancies after the USA. Secondly, the use of supplements is in decline. Taking supplements after becoming aware of pregnancy is too late, as this will be after 27 days. A preventative medicine strategy to cut the numbers of affected pregnancies has to take these facts into account. It cannot be that 80% of terminations after the 20-week scan is a preventative strategy.
Recent peer-reviewed research published in February 2014 by a team led by Sir Nicholas Wald, the leader of the 1991 Medical Research Council study, showed that in a 10-year study of 500,000 women in the UK the policy of advice regarding supplementation was not working. The study showed a decline in women taking supplements from 40% in 1999-2001 to 28% in 2011-12. It showed that women under the age of 20 were five times less likely to take folic supplements than women aged 30 and over. Even among women who had previously had a neural tube defect pregnancy, only half were taking supplements. The conclusion was stark: the current government policy was,
“failing and has led to health inequalities”.
On average, 69% of women of child-bearing age are not taking supplements. Half the pregnancies are unplanned. It cannot be right there is no proper strategy.
In my view, saying that it is individual responsibility is unacceptable. Department of Health officials have been known to say that terminations after the 20-week scan identifies the defect are how the issue is managed, and have stated that dealing with neural tube defects via folic fortification is “not a vote winner”. This was told to a public meeting in Parliament last year, and the Minister is aware of the source.
Based on the 1991 UK research, over 80 countries have introduced the mandatory fortification of white bread flour with folic acid, vitamin B9. There is abundant evidence of efficacy and no suggestion of any harm. It reduces the abnormality by up to 50%, though I have seen some research giving an even higher figure than this. The USA mandated the fortification of flour in 1998, based on the 1991 UK research. Recent American published research showed a significant reduction in neural tube defect births there, and they have a Folic Acid Awareness Week. There has been a large saving in America both in human misery and public expenditure. The US expenditure saving on averted medical costs alone for surviving babies is put at $600 million. It spends $4 million on fortification.
No country which has introduced fortification has reversed the decision. The various countries that have introduced it include America, Australia, Iran, Chile, Iraq, Canada and Saudi Arabia. In July 2015, a report on preventable spina bifida in Europe reached the conclusion that Europe has an epidemic of spina bifida compared to countries that apply mandatory fortification. The prevalence of neural tube defects per 100,000 births in the UK, Denmark, France and Germany is in general twice the level in the United States of America, where flour has been fortified for nearly 20 years.
There is a need for a strategy on neural tube defects rather than a campaign for fortification. It is not mass medication, as only white bread flour has ever been involved, so the argument about mass medication does not apply. Research galore has shown no ill effects on the male population. The principle of flour fortification in the United Kingdom is not at stake. The UK has fortified flour on health grounds since World War II with four substances: two vitamins and two chemicals. That was last reviewed in 2013 and a decision to continue that was made by the coalition Government. Industry pays for the fortification, by the way, so it is not a question of public expenditure. People will say that the numbers are not huge, but they are bound to grow as supplement-taking declines and as industry reduces voluntary fortification.
I am in favour of a woman’s right to choose, but I reject the Department of Health view on managing neural tube defects by termination. That is quite unacceptable. The human tragedy, much of which could be avoided by a science-led policy, should be the reason for a push on policy change. There are too many terminations, and too many babies are born with a serious lifelong disability. Mandation is needed to reduce this human distress and misery, to save lives by avoiding terminations, and to prevent lifelong disability and significant public health costs.
During the many times I have raised this matter over the last few years, I have never used any real-life examples, because the science tells the story. However, yesterday I found a letter from a colleague, who is absent from the House at present due to poor health. Although we knew each other for many years before we joined your Lordships’ House, they have never mentioned their family history to me. Our colleague’s letter said that before our colleague was born,
“my parents lost three children to spina bifida: one was still-born, one lived for a year and another for 6 weeks. The grief caused by these deaths cast a very long shadow over my parents’ lives and indeed over my own—I felt an obligation to live for the three of them. The point is that this degree of suffering is largely avoidable by measures like your proposal”.
We have the means, not for a complete cure but vastly to decrease this harm and misery. I cannot see how we can stand by and do nothing when we have the chance to reduce the human misery caused by neural tube defects. I beg to move.
Lord Rooker
My Lords, I do not propose to make a windup speech, but I thank all colleagues who have spoken—I am very grateful. I am grateful to the Minister as well, because we have had a little more time today than we get in Question Time exchanges. I understand where he is coming from. I do not accept it, but at least he has put things on the record about the philosophy argument that will be useful for the future.
It is a bit like somebody in South America at the moment finding a real cure for the Zika virus and not using it. We are standing by with a 100% cure and not using it. I used the example of the United States of America. They do not just do fortification, they have a disability child awareness month and a folic acid awareness week as well—we do not even do that; that is refused as well in Parliamentary Answers—that is voluntary, but they see the benefit of it. Basically, you are on your own, girls. That is a summation of where we are. The Government refuse to accept the fact that half of pregnancies are unplanned. Despite any pre-conception advice, half of pregnancies are unplanned. People will not be listening. That is one of the problems.
I tried to keep my speech devoid of all the scientific quotes, but the issue about the industry is important. I fully accept that the advice to industry from the Scientific Advisory Committee on Nutrition on mandatory fortification was, “Be careful what you do voluntarily”. Since its warning letter last October, industry has taken steps to reduce its voluntary folic acid fortification on the basis that the advice of 2006 would be implemented at some time—that is, there would be mandatory fortification. We have a problem. The industry is reducing voluntary fortification and we are not introducing mandatory fortification, so the position will be even worse. The blood levels will be even lower as a result. That is a cause for concern and I have not heard a solution to it.
I also avoided any reference to devolution. The English Government, for whom the Minister speaks—he does not claim to speak for anyone else—could well be faced, in the next couple of years, because these things take a while, with Scotland, Wales and Northern Ireland legislating for white bread flour fortification. The mills are in the wrong place when one looks at the borders. Industry wants a UK solution. As I said, during the general election, I wasted time knocking on doors, but I also spent time with Sir Nicholas Wald and Sir Colin Blakemore visiting the supplement manufacturers and others. It is quite clear that they want a UK-wide solution.
In September, the Cabinet Secretary for Health and Sport in Scotland and the Chief Medical Officer in Scotland had a meeting with myself, Sir Nicholas Wald and Sir Colin Blakemore to listen to the argument. They do not have all the solutions, and do not profess to have all the answers. Scientists do ask the question, which is why, when I left the Food Standards Agency, I said I would pursue this. The independent scientists were saying on this and on other issues that Government never pronounce about the advice. In this case, the Government have pronounced; they said no. I fully accept that; there is no doubt about that any more. We know where we stand, but I am not going away, and I beg to move the Bill be read a second time.
Health: Neural Tube Defects
Lord Rooker Excerpts(8 years, 1 month ago)
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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
Lord Rooker Excerpts(8 years, 3 months ago)
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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
Lord Rooker Excerpts(8 years, 3 months ago)
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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
Lord Rooker Excerpts(8 years, 4 months ago)
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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.
Mental Health: Parity of Esteem
Lord Rooker Excerpts(9 years, 10 months ago)
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Lord Rooker (Lab)
My Lords, will the Minister do what he can in government to lock in the policy of the programme that he has announced today? I remind him that—I think it was in 2004—the former Social Exclusion Unit published a seminal report on mental health and social exclusion, with 27 action programme recommendations. As Ministers come and go and as civil servants get recycled, things go off the boil and we have to start doing it all over again. That does not serve the citizens of the country on an issue such as this, which transcends all our other divisions. We need to concentrate on it so that we do not lose it as people come and go.
Earl Howe
The noble Lord is right and I can say to him that the coalition Government have tried as far as possible to continue the good work on mental health of the previous Administration. One has to keep renewing the momentum on this. Situations do not stand still, and that is why our new mental health action plan Closing the Gap reminds everyone in the system of the most important gains to be made in 25 areas where people can expect to see and experience the fastest changes. I am glad to say that that document has been well received by all stakeholders.