§ 4.16 p.m.
§ THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)
My Lords, I beg to move that the Welfare Food (Extension of Definition) Order 1971, which was laid before this House on February 3, be approved. This is a simple amending Order, subject to Affirmative Resolution by both Houses. It seeks to extend the definition of "welfare food" as defined in Section 4(2) of the Emergency Laws (Re-enactments and Repeals) Act 1964. It has been laid before both Houses of Parliament in accordance with Section 61(1) of the Heath Services and Public Health Act 1968.
The primary object of the new Order is simply to extend the existing definition of "welfare food" to enable Secretaries of State concerned with health in England, in Scotland and in Wales to supply a new vitamin preparation in liquid form for babies and very young children. This is a particularly vulnerable age group, and the need to maintain their medical and dental health at the highest level justifies the new provision. My right honourable friend the Secretary of State for Social Services, in a Written Answer on December 16 last, announced that it was proposed to replace concentrated orange juice as a source of vitamin C, and cod liver oil as a source of vitamins A and D, in the welfare foods scheme with a new liquid vitamin preparation for children containing all three vitamins A, D and C. This decision was taken following a Report by a Panel on Cariogenic Foods which was set up by the Chief Medical Officer's Committee on Medical Aspects of Food Policy. The Panel concluded that the misuse of undiluted fruit syrups, including welfare orange juice, was conducive to rampant dental caries. A Panel on Child Nutrition set up by the Committee had previously recommended that a palatable alternative to cod liver oil as a source of vitamins A and D should be found. The Committee agreed that in order to remove the dental hazard presented by welfare orange juice and to overcome the unpalatability of cod liver oil to some children, both products should be with 198 drawn from the welfare food scheme and be replaced by a single preparation containing the three vitamins, A, D and C.
As a result, formulation trials were put in hand and a new preparation for children, to be administered in the form of liquid drops, was developed. The new preparation will provide adequate amounts of vitamins A, D and C to children so as to meet the recommendations of the Committee on Medical Aspects of Food Policy in a convenient, safe and palatable way. The existing definition of "welfare food" in the Emergency Laws Act is restrictive to the extent that it provides, inter alia, for vitamin tablets and not for vitamins combined in liquid form. The age group principally at risk here is the child between six months and two years. Administration of necessary vitamins in tablet or capsule form would present obvious hazards to the very young child who might well inhale the tablet or capsule and suffocate. For this reason, and on expert medical advice, the Secretary of State decided to introduce a new vitamin preparation in liquid form. In order to include the new preparation in a revised Welfare Food Order it is necessary to extend the definition in this way.
In announcing his decision to introduce the new preparation, my right honourable friend pointed out that it was the misuse of undiluted fruit syrups that gave rise to the main dental hazard. The Panel on Cariogenic Foods found evidence that some mothers were in the habit of using undiluted fruit concentrates in children's reservoir feeders and feeding bottles and on dummies, and concluded that this practice was conducive to rampant caries since the syrup remained in contact with the teeth for long periods of time. Following the report, the formulation of welfare orange juice was altered so that both the acidity and the sugar content were reduced, and the bottle label and official leaflet were amended to draw attention to the risk. However, it was not possible to remove the dental hazard entirely without making the orange juice unpalatable or changing its nature.
My Lords, it is important to emphasise that these risks do not arise with the normal consumption of diluted fruit juices nor with non-concentrated juices or whole fruits. It was the misuse of 199 welfare orange juice in the way I have described that concerned the Secretary of State, and has led to the introduction of the new vitamin preparation.
It is proposed to make the new preparation available from April 4 at all child health clinics and local health authority distribution centres. It will be available in a 10 millilitre bottle which will be sufficient for at least seven weeks' supply. Children in low income families will be entitled to two bottles every 13 weeks free of charge. The selling price will be 5p per bottle, and this price covers the cost to the Exchequer. As to the cost to beneficiaries, the new preparation which contains all three vitamins can save families more than 50p on a 13 weeks' supply as against the cost of both orange juice and cod liver oil. Thirteen weeks' supply of welfare orange juice and cod liver oil at full dosage costs 62½p; thirteen weeks' supply of the new drops will cost mothers 10p.
Orange juice is made available under the welfare food scheme not only for young children but also for expectant and nursing mothers. The new liquid preparation will not be suitable for the mothers since it will not contain other constituents which they need and currently receive in the vitamin A and D tablets supplied for their use alone. A new combined A, D and C tablet is accordingly being formulated, and the intention is to introduce it for mothers only by the end of the year when orange juice will be withdrawn from the welfare food scheme. Cod liver oil will be withdrawn from the scheme on April 30.
As I have explained to your Lordships, the Secretary of State's decision to introduce the new liquid vitamin preparation for these young children is entirely in accord with expert medical and dental opinion, and will constitute a more convenient and a safer vehicle for administering under the welfare foods scheme vitamins essential to their health and wellbeing. To achieve this, it is necessary to extend the definition of welfare foods in the Emergency Laws Act in the manner proposed in the draft Order now before the House. I beg to move.
§ Moved, That the Draft Welfare Food (Extension of Definition) Order 1971, laid before the House on February 3, be approved.—(Lord Aberdare.)200
§ 4.26 p.m.
§ BARONESS SEROTA
My Lords, I am sure the House will be grateful to the noble Lord, Lord Aberdare, for his usual clear and courteous explanation of the purpose of this Order which will extend the existing definition of welfare foods to include the new liquid preparation. We shall always, I am sure, welcome any steps that are designed to improve the standard and the balance of nutrition among the 4 million expectant mothers, infants and very young children up to the age of five who are the beneficiaries of the present range of welfare foods, which have done so much over the years to improve the standards of health and wellbeing of our children, and indeed of the nation as a whole.
Having listened to the statement I doubt whether the mothers of this country will weep if cod liver oil disappears. Quite apart from the difficulty of administering it to very young breast-fed infants, in my experience it stains clothing very heavily and therefore adds to the mountain of washing which young infants inevitably produce. I myself eventually had to resort to the procedure of giving the children their cod liver oil in the bath to avoid this particular hazard.
But I must express my great concern at that part of the statement which appeared to indicate that the supplies of orange juice concentrate, both for children and, eventually, for mothers, are to be withdrawn so precipitately from our welfare clinics. We know that these are popular welfare foods. Some 12.16 million bottles were used last year by expectant mothers and by infants and children at a time when the uptake of certain other welfare foods was declining. We know that according to the research carried out there were a small minority of mothers who were wrongly using orange juice by, as the noble Lord, Lord Aberdare, told us, putting it on dummies and into feeding bottles and therefore creating hazards to the dental health of their children. But in my view that is not sufficient reason for withdrawing orange juice altogether, and I am deeply concerned at its total withdrawal by the end of the year because of the major effect that such withdrawal could have on the economy of, in particular, British 201 Honduras, our major Commonwealth supplier.
Yesterday afternoon we heard my noble friend Lord Greenwood of Rossendale refer to the heavy dependence of the economy of British Honduras on sugar. Citrus fruit and citrus concentrates, including the orange juice exported to this country, come second in the British Honduras export table, and I must ask the noble Lord, Lord Aberdare, whether Her Majesty's Government have considered the effect that this decision will have on the economy of British Honduras. I accept that we should always be concerned to develop better methods of providing for the nutrition of our expectant mothers and young children, and I accept that the new liquid form of vitamin concentrate, providing vitamins A, C and D, is a valuable advance, particularly in the case, as I said earlier, of certain young children. But I would have hoped that in the special circumstance of our Commonwealth interests, as well as in the interests of the health of our mothers and young children, the Government, while introducing the new concentrate, would have agreed at the same time to continue making supplies of orange juice available in our clinics, thereby providing a choice until the uptake of the new substance is known.
I am deeply concerned at what I understand to be the impact of this statement; namely, that as from the end of the year all supplies will be stopped. I must therefore ask the noble Lord what discussions have taken place with the British Honduras Government and what notice we have given to terminate the long-term citrus concentrate contracts that are in existence, and what we intend to do to offset the very severe effects which this action is bound to have on their economy.
§ LORD BURNTWOOD
My Lords, the noble Baroness, Lady Serota, has covered many of the aspects of this question that I had intended to raise. I am concerned that the Government may not have appreciated fully the educational possibilities of getting mothers to use medicines properly. The cariogenic properties of a concentrated fruit juice are of course beyond dispute. At the same time, we know that in other materials that have been on offer to the public generally it has been possible so to educate people 202 that abuses are not practised I therefore hope that, more especially in the light of the effect on British Honduras—and in my time I have received delegations on this matter from that country—some effort will be made to offer at least a limited supply under proper control with adequate warning to the public. I think the public is getting a little restive about the continual replacement of natural vitamin-containing material by synthesised material. Pharmacological research is not so far advanced that we can say quite clearly that cod liver oil, for instance, can be replaced absolutely, dosage for dosage, by a synthesised material. We do know that natural medicines have effects on children which the synthesised product has not as yet proved itself equal to.
§ LORD ABERDARE
My Lords, I am very grateful to have had a warm welcome to the end of cod liver oil, even though the welcome to the end of concentrated orange juice has not been quite so warm. May I first of all deal with the question of our suppliers in British Honduras and Jamaica. They have over many years been urged by us to diversify and not rely entirely on this market. We gave them notice in October, 1970, that we should not be requiring any more orange juice concentrate after the end of this year. We have sent a representative to British Honduras and Jamaica, and I myself have had two conversations with the Minister for Trade and Industry from Jamaica and I have tried to be of assistance to him. We have also asked my right honourable friend at the Foreign and Commonwealth Office to consider favourably any possible help that they might be able to give in phasing out this contract.
So far as the withdrawal of orange juice concentrate is concerned. I cannot really add anything very useful to what I said in my statement. The fact is that it has been misused. The Committee on the Medical Aspects of Food Policy advised us strongly against continuing with it if we could find another way of getting the same vitamins taken by the children, and of course combining them with the vitamins that replace cod liver oil in a simple and also a much cheaper way. I take the point made by the noble Lord, Lord Burntwood, about possibly educating mothers into not misusing the 203 concentrated orange juice. This would have been, I suppose, an alternative, but I doubt whether it would have been very effective. It might have been very expensive without any certainty that it would be effective. I hope, therefore, that your Lordships will agree to this Motion.
§ BARONESS SEROTA
My Lords, at the very end of my remarks I mentioned the question of phasing and allowing orange juice concentrate to be available for a period in the clinics at the same time as the new substance. I am very concerned that notice was given in October, 1970, leaving British Honduras just less than a year and a half, which is one or at most two crops to find alternative markets. Could the noble Lord tell us what quantities of orange juice we have been buying and what this is going to mean to British Honduras?
§ LORD ABERDARE
My Lords, I also said that we had been urging producers to diversify for a very long time. October, 1970, was the date when we gave notice of termination of the contract. As I say, I have been in touch with the Jamaican Minister and we have tried to help him. However, I do not think he is as concerned as the noble Baroness is.
§ LORD SHEPHERD
My Lords, I am sorry to intervene, particularly as the Minister has replied, but this is a very serious matter. Yesterday, we had a debate on the effect on the Commonwealth of our negotiations to go into the Common Market. Noble Lords speaking from the Benches opposite spoke in very clear terms of this country's responsibility to help developing countries. The decision that the Government have taken is one that was presented to a previous Administration, and we took a different view. I do not think that the decision the Government have taken to-day has anything to do with the effect on young women and children. I think it is a question of economy. The noble Lord himself made this point at the end of his remarks. The noble Lord suggests that some fourteen months' notice—that is, notice to the growers—is sufficient for these countries to diversify their economy. If the noble Lord has any knowledge of these territories, he will know that it 204 is, I will not say impossible, but nearly impossible for them to diversify. The noble Lord has, I think, struck a very severe blow to our friends in British Honduras and Jamaica, and I shall look at any further protestations from the Benches opposite about their attitude to the developing countries with a good deal more suspicion than I have done in the past.
§ LORD ABERDARE
My Lords, I should like to reply to the noble Lord on one point. This decision was made on medical grounds; not at all on the question of economy. We were advised by the Committee on the Medical Aspects of Food Policy, which is the Committee which advises the Secretary of State, that the misuse of this concentrated orange juice was affecting our children's teeth, and it was for that reason the decision was taken. We went to a very great deal of trouble to make the decision as easy as possible for Jamaica and British Honduras.
§ BARONESS SEROTA
My Lords, I would only point out that clearly this has been going on for nearly thirty years, during which time we have been pushing orange juice into children. It is a very tiny minority of people who have been using it wrongly. I think the least the Government could have done was to insulate British Honduras and Jamaica from the worst effects of this change by a careful phasing out of the orange juice supplied to mothers and babies.
§ On Question, Motion agreed to.