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Mr. Deputy Speaker (Sir Alan Haselhurst): I would like from the Chair to reciprocate the many good wishes that have been expressed in the course of the debate and to wish a happy Christmas to all hon. Members and the staff who serve us.
Mr. David Amess (Southend, West): In the early hours of the morning of 26 August this year, a fatal car accident happened on the A127 just outside Southend in which three young boys were killed. Mark Baker, aged 18, Glen Dineen, aged 18, and Gary Dineen, aged 16, were all killed. One of the parents feels very strongly that there should be a change in the law for those who have recently passed their driving test.
And the Petitioners remain, etc.
Mrs. Helen Clark (Peterborough): I am very glad to have obtained this opportunity to speak on this long- running and important issue. I have to tell the House that it is not a festive topic. I must also say that the reason why I have sought this debate is that I am very unhappy about the long delay and Government inaction that I shall be forced to detail.
The headquarters of the Association for Spina Bifida and HydrocephalusASBAHis situated in my constituency. Since I was elected in 1997, I have sought to advance the case for the fortification of flour with folic acid, on which the association had already been campaigning for several years. In its view, the Government's delay is "inordinate" and the failures by the Department of Health even to reply to correspondence are "unprecedented".
Spina bifida is one of the most common congenital malformations. It occurs very early in pregnancy, at about four weeks, when the spine and brain are being formed. It is a fault in the development of the spine, which fails to close properly, and it often results in paralysis below the fault. A major secondary complication is hydrocephalusexcess fluid in the brainwhich, if it is not treated properly, can cause brain damage. Neural tube defects, or NTD, affect about 1,000 pregnancies a year, and the numbers of births of severely handicapped children have mainly decreased because of terminations of pregnancy. At present, NTD affects about 0.13 live births out of every thousand. It is only abortion that prevents the number from being 10 times higher.
There is a direct relation to the intake by mothers of folates, of which I understand that folic acid is the most easily ingested. Poor diet certainly increases the risk and probably accounts for the higher incidence of NTD among poorer womenperhaps those who are socially excluded. Even with a good diet, however, it is virtually impossible to obtain sufficient quantities of naturally occurring folate. The average daily intake is 200 micrograms.
In 1991, an international study led by our own Medical Research Council found that if all pregnant women who had had a previous spina bifida pregnancy took four milligrams of folic acid a day from three months before conception to the end of the third week of pregnancy, the incidence of NTD could be reduced by 75 per cent. That finding was accepted by many authorities, including the then Government. A subsequent health campaign in 1996 increased knowledge among women about folic acid, with the result that 91 per cent. said that they had heard about it, compared with 9 per cent. before that. However, as we know, 35 to 50 per cent. of pregnancies are unplanned. A survey carried out in 1996 found that only one in 10 mothers took a supplement before conception, so that is not the answer either.
In 1996, the United States centre for disease control recognised that health education and tablets would never lead to a significant reduction in NTDs. The United States legislated to make fortification of flour and some other staple foods compulsory. Of course, the United Kingdom must make its own decisions, but our rates of NTD
Representatives of ASBAH met Ministers from the previous Administration more than once. They were told that increased intake of folic acid should be a matter for the individual, not public action. The new Labour Government immediately and rightly put public health at the top of their agenda, and appointed a public health Minister. We have made great strides in recognising the link between social and geographical circumstances and health conditions, and in taking measures to tackle that.
In 1996, ASBAH met the Labour Opposition health spokesperson, who gave an undertaking that the Committee on Medical Aspects of Food and NutritionCOMAwould investigate the fortification of flour with folic acid, should a Labour Government be elected. In September 1997, as the newly elected Member for Peterborough, I met Andrew Russell, executive director of ASBAH, Professor Nicholas Wald and a member of COMA for a briefing on the matter. I was impressed by the strength of the case in general, including the claim that no other single public health measure could prevent as many serious birth defects, and especially by arguments against concerns about the health of the rest of the population if fortification were introduced.
There were two such anxieties. First, folic acid might interfere with the diagnosis of vitamin B12 deficiency. Secondly, people with epilepsy would risk their condition becoming uncontrolled. The evidence showed that folic acid might improve the anaemia associated with B12 deficiency and thus mask its symptoms. However, it does not cause the deficiency, which can be diagnosed by means other than anaemia. Even higher amounts of folic acid than the target 0.4 milligrams would not affect existing epileptics.
Once a fortification policy had been implemented, newly diagnosed epileptics would be controlled on already supplemented flour. I accept that a more cautious position was subsequently adopted on the latter. However, in 1998, a study of 60 epileptic women who were given 0.8 milligrams in multivitamin supplements, found no side effects. That remains the case. When COMA reported in January 2000, it reached the same conclusion. However, I shall revert to that point shortly.
After my meeting with ASBAH, I sought and later obtained a meeting with the then public health Minister. That happened in November 1997, although the Minister was unavoidably absent and was represented by her parliamentary private secretary. Again, it was attended by Professor Wald, Andrew Russell, Professor Wiseman of the Department of Health and officials.
In the meantime, I had tabled the first of three cross-party early-day motions on the topic and, with Lord Ashley of Stoke, organised a reception in the House of Lords in December to publicise the issues. At the meeting, we were told that COMA was considering the subject and that
Professor Wald said that he would favour an amount of 0.4 milligrams a day but that less would be acceptable. Professor Wiseman mentioned some other possible benefits of folic acid supplements such as a possible protection against cardiovascular disease. He said that although the research was inconclusive, that should not be a barrier to fortification on the ground of preventing neural tube defects.
The reception in December gained an unexpected boost. In the weeks that immediately preceded it, Bianca, a central character in the popular soap "EastEnders", played by Patsy Palmer, discovered that she was expecting a spina bifida baby. With her partner, Ricky, she agonised about whether to have an abortion. In the end, she did. Patsy Palmer attended our reception.
At that point, we were very optimistic that a favourable Government decision would be taken, and taken soon. We were led to believe that COMA would report within a year or so and expected a subsequent Government decision. We had to wait another year. ASBAH was extremely disappointed, as it expected the Government to take "a more socially inclusive"we always talk about that"and responsible view" than their predecessors. ASBAH and I wrote separately to inquire about progress. We waited several months for a response. COMA reported in January 2000:
On 24 May, I tabled a parliamentary question asking when the consultation document would be published. Again, I was told "shortly". On 25 July, in response to yet another parliamentary question, I learned that the document had been published and that the consultation was to run until 31 October 2000. I am sorry if this is becoming tedious, but it is essential to understand the frustration experienced by those of us who have been involved in the issue for a long time. I am afraid that I have not finished.
For the past year, ASBAH and I have been trying to obtain a response from the Department of Health to the results of the consultation. I shall not list all the dates and I certainly shall not identify the Ministers concerned, but I will say that three ASBAH letters went unanswered and that it was erroneously claimed in a letter to me that a
I also said that I was, as I remain, concerned about the monetary and human costs of the delay, including those of the many avoidable pregnancy terminations that occur each year due to neural tube defects. It is traumatic for a woman to have a termination. The Department of Health letter to ASBAH dated 19 November said that the majority of responses were in favour of fortification, but again raised the issue of B12 deficiency. The good news was that apparently crucial research on the prevalence of that condition had just been completed. Another issue related to the technical aspects of fortification and, apparently, the Food Standards Agency will engage in detailed discussions with industry representatives to see what might be feasible.
In my first meeting with ASBAH in June 1997, I was assured that there were no technical obstacles, but that the industry had naturally said that it required a directive from the Government before implementing fortification. I tabled a third early-day motion on 9 November to draw attention to some of the facts, noting that the Department's deadline for consultation responses had passed more than a year ago and urging an early announcement of its intentions.
I agreed with ASBAH that, if we had heard nothing by spring, we would go ahead with yet another function in the Commons, but that, hopefully, we would not need to do so. I still hope that that may be the case, or that the function will go ahead, but that we shall be celebrating and not endlessly calling for action. I was horrified, therefore, when very shortly afterwards an article appeared in the British Medical Journal calling for further delays on the ground of the masking effects of folic acid on B12 deficiency and yet more research.
As will be apparent from what I said earlier, the article is based on no new evidence. The reservations expressed by its authors, Professors Wharton and Booth, were dismissed by COMA two years ago. Worst of all, the call for field trialsa rather peculiar phrase in itselfis, I understand, a non-starter, as it would involve millions of participants. In any case, the experience of fortification in the United States already provides the necessary evidence. As I have said, flour fortification has been established there since 1998, with full public acceptance. It has involved minimal cost, and no hazards have emerged. We are talking about a population of a quarter of a billion, which strikes me as quite a large field sample on which to base any conclusions.
Surely enough is enough. We have the evidence; the precedents are there; the practical barriers can be surmounted. Please, please, at Christmas time, may I have an assurance that the Government will follow the recommendations of their own Committeeas they promised they would five years agoand recommend the fortification of flour with the suggested and agreed amount very, very soon?