I refer the Hon Member to the answer provided on 18 August 2026 in response to Question 18253.

Folic acid fortification was recommended by the Committee on Medical Aspects of Food and Nutrition Policy in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid. The tolerable upper limit was also re-considered by the Committee on Toxicity (COT) in 2018.

In its 2006 report on folate and disease prevention, the SACN considered data from hospital discharge surveys in the United States of America, where mandatory fortification of enriched cereal grain products with folic acid was authorised in 1996 and fully implemented in 1998. The data suggested that the number of cases of pernicious anaemia or subacute combined degeneration of the spinal cord had not increased post-fortification. This suggests that mandatory fortification had not led to a delay in the detection of vitamin B12 deficiency by masking the diagnosis of pernicious anaemia.

In the SACN’s extensive review of the evidence on folate and health it considered other medical conditions for whom folic acid supplementation may not be appropriate including epileptic patients on phenytoin, an epileptic drug, pregnant women in the context of multiple births and embryo selection and anti-folate chemotherapy. For each, the SACN noted that there is no evidence or no substantive evidence to suggest that folic acid fortification would cause adverse health outcomes.

The policy was developed with Government’s public consultations on both the impact assessment and legislation. This issue was considered as part of the consultation and impact assessment process.

The level of folic acid chosen for fortification, 250 micro grams per 100 grams of flour, was based on modelling carried out by Food Standards Scotland. The level of fortification has been chosen in order to minimise the risk of the population exceeding the tolerable upper intake level and therefore the risk of masking the diagnosis of pernicious anaemia. COT concluded in 2018 that “Further work is needed to identify the maximum level of folic acid intake at which masking would not occur. However, it is very unlikely that this would be such that the [upper limit] for intake would be less than 1 mg/day, as at present.”

The Government is planning an evaluation on the impact of the policy to assess the effectiveness of the level of mandatory folic acid fortification for both the prevention of neural tube defect affected pregnancies but also to check that the population are not routinely exceeding a tolerable intake and identify any further unintended consequences.

No such assessment has been made. The majority of the treatment pathway for aplastic anaemia is an integrated care board commissioning responsibility and data is not held centrally. Hematopoietic stem cell transplant (HSCT) is a curative treatment option for aplastic anaemia. NHS England does not directly collect data on long-term outcomes and quality of life for patients with aplastic anaemia who have received a stem cell transplant. Instead, the British Society of Blood and Marrow Transplantation and Cellular Therapy collects data on transplants performed by United Kingdom transplant centres, and reports this back to the NHS England Blood and Marrow Transplantation Clinical Reference Group (CRG). This includes individual centre annual summary reports. These reports are reviewed by the CRG and insights from the analysis are shared with local commissioners so that they can address any issues with providers. However, HSCT is performed for a number of conditions and the CRG does not routinely review long-term outcomes for individual conditions at a granular level.

The Department funds research on health and social care through the National Institute for Health and Care Research (NIHR). The NIHR welcomes funding applications for research into any aspect of human health and care including aplastic anaemia.

Applications to the NIHR are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money, and scientific quality. Topics for new research can be proposed to the NIHR at the following link:

https://www.nihr.ac.uk/get-involved/suggest-a-research-topic

The NIHR has not allocated funding to research on aplastic anaemia in the last five years, neither directly nor through its research programmes or career development awards, because no applications were received that were deemed fundable by the NIHR.

The NIHR also works closely with other Government funders, including UK Research and Innovation, which is funded by the Department for Science, Innovation and Technology and includes the Medical Research Council, to fund research into a range of conditions, including aplastic anaemia.

The UK Rare Diseases Framework sets out four priorities collaboratively developed with the rare disease community, which includes increasing awareness of rare diseases among healthcare professionals. With over 7,000 rare diseases, it is not possible for healthcare professionals to receive comprehensive training on every condition. It is therefore important that they are aware of rare diseases more broadly and are alert to considering them. The 2025 England Rare Diseases Action Plan updates on progress to increase awareness of rare diseases among healthcare professionals. This includes launching new resources on the innovative digital educational resource GeNotes and developing a range of training and educational resources on rare diseases to include rare diseases in UK health professional education and training frameworks.

Working under the United Kingdom Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as aplastic anaemia.

Collaboration at all levels across England, Northern Ireland, Scotland and Wales remains an underpinning priority. The Department works closely with colleagues across the devolved nations to ensure policy on rare disease is aligned across the UK, and that we share best practice and areas of learning.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as aplastic anaemia.

There are over 7,000 rare diseases often needing highly specialised input, and so the National Health Service website is not always the most appropriate platform to disseminate such information. We receive many requests for new topics, including aplastic anaemia, and each one is assessed and prioritised according to a set of criteria. The factors considered when making these decisions include demand for the topic, how well it aligns to achieving strategic priorities, whether it will provide a cost saving for the NHS, suitability for a national audience, prevalence of the condition/symptom and whether other healthcare information providers are better placed to host the information than us, for example, charities. At this stage there are no plans to add aplastic anaemia to the NHS website.

However, we continue to add further information on rare diseases to the resources provided by the NHS Genomics Education Programme (GEP). These resources are designed for all healthcare professionals and include information on rare diseases for non-specialists through ‘bitesize’ genomics content. The GEP has a ‘just in time’ resource called ‘GeNotes’ and has developed a two-week Massive Open Online Course to support clinicians in a general approach to rare disease. NHS England has an established patient advisory group for genomics education to ensure lived experience and patient voices are an integral part of the GEP resources and to determine the direction of travel for the programme aligned to their priorities. Additionally, work continues in partnership with Medics For Rare Disease to expand the programme’s remit into non-genetic rare disease.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as aplastic anaemia.

NHS England’s flagship GeNotes resource, developed by NHS England's Genomics Education Programme, is aimed at healthcare professionals in order to continue their growth, and has more than 500 resources featured across nine specialties. Aplastic anaemia is not currently included in GeNotes. The Genomics Education Programme is also developing a range of training and educational resources on rare diseases, to include rare diseases in United Kingdom health professional education and training frameworks. Work continues to expand the programme’s coverage.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as aplastic anaemia.

There are over 7,000 rare diseases, often needing highly specialised input, and so the National Health Service website is not always the most appropriate platform to disseminate such information. At this stage there are no plans to add aplastic anaemia to the website.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as aplastic anaemia.

The majority of the treatment pathway for aplastic anaemia is an integrated care board commissioning responsibility. Hematopoietic stem cell transplant (HSCT) is an NHS England specialised commissioned service that covers aplastic anaemia, and NHS England has published two national service specifications, one for adults and one for children. The HSCT specifications set out the standards that the providers of the service must meet, which includes access to a range of multidisciplinary staff, including psychological support and nurse specialists trained in communication and counselling.

The Department funds health and care research through the National Institute for Health and Care Research (NIHR). The NIHR funds clinical, public health, and social care research and works in partnership with the National Health Service, charities, universities, local government, other research funders, patients, and the public.

The NIHR welcomes funding applications for research into any aspect of human health, including anaemia, through its research programmes. From 2019/20 to 2023/24, the NIHR funded £10.7 million of research into anaemia.

The NIHR also provides research support by funding facilities, expertise, training, and recruitment support, which includes approximately 176 studies from 2019/20 to 2023/24 on anaemia research supported across NIHR infrastructure.

The National Institute for Health and Care Excellence (NICE) has produced a clinical knowledge summary on anaemia which provides guidance on testing and treatment of all types of anaemia. It was last updated in September 2023. The clinical knowledge summary states that, in all people, serum ferritin levels of less than 30 micrograms per litre confirms a diagnosis of iron deficiency. NICE guidelines are not mandatory and, whilst clinicians and health and care commissioners are expected to take them into account, it is important for a proper diagnosis and treatment plan to be in place that address the specific needs of the individual.

The Medicines and Healthcare Products Regulatory Agency has authorised a number of intravenous iron products for use by patients with anaemia in the United Kingdom, including iron dextran, iron sucrose, ferric carboxymaltose, and ferric derisomaltose.

The Government is committed to improving the lives of those living with rare diseases, such as aplastic anaemia. The UK Rare Diseases Framework sets out four priorities collaboratively developed with the rare disease community. These include: helping patients get a final diagnosis faster; increasing awareness of rare diseases among healthcare professionals; better coordination of care; and improving access to specialist care, treatments, and drugs.  We remain committed to delivering under the framework and will publish an annual England action plan in 2025.

There are over 7,000 rare diseases often needing highly specialised input, and so the National Health Service’s website is not always the most appropriate platform to disseminate such information. At this stage there are no plans to add aplastic anaemia to the NHS website, but we will re-review the position in the future, should things change.

The majority of the treatment pathway for aplastic anaemia is an integrated care board commissioning responsibility. Hematopoietic stem cell transplant (HSCT) is an NHS England specialised commissioned service that covers aplastic anaemia, and NHS England has published two national service specifications, one for adults and one for children. The HSCT specifications set out the standards that providers of the service must meet, which includes access to a range of multidisciplinary staff, including psychological support and nurse specialists trained in communication and counselling. Specifically for children, there should be access to appropriately trained paediatric dieticians, physiotherapists, occupational therapists, speech and language therapists, psychologists, social workers, and Child and Adolescent Mental Health Services, within nationally defined access standards.

The Competition and Markets Authority (CMA) is the UK's independent competition authority, and its consultations, including the live consultation relating to commitments offered by Vifor Pharma (https://www.gov.uk/government/consultations/consultation-on-proposed-commitments-in-respect-of-vifor-pharmas-supply-of-intravenous-iron), are therefore independent of Government. Any questions relating to consultations carried out by the CMA should be sent directly to the CMA.

There is information available from NHS Choices to support the identification of symptoms related to anaemia, which advises individuals to seek general practitioner (GP) advice should they experience those symptoms.

GPs exercise their clinical judgement with support from relevant guidance to arrange appropriate tests and investigations that may lead to a diagnosis, such as blood tests to assess the full blood count, which may highlight indicators of anaemia. The National Institute for Health and Care Excellence’s Clinical Knowledge Summaries website also provides guidance on testing and treatment of all types of anaemia.

No assessment has been made on the link between iron anaemia and colorectal cancer for national screening purposes. Colorectal cancer is more common in people over the age of 50, but it can affect people of any age. To identify patients who have symptoms that do not align to a particular type of tumour, including for non-specific symptoms of colorectal cancer, the National Health Service has implemented ‘non-specific symptom pathways’. There are 103 pathways currently in place with the aim to have national coverage by March 2024.

To encourage people to see their general practitioner if they notice symptoms that could be cancer, NHS England runs the ‘Help Us, Help You’ campaigns, which address the barriers that deter patients from accessing the NHS.

This information is not held centrally.

While we have no specific plans to do so, the Government’s advice on a healthy, balanced diet for children is shown in the Eatwell Guide. The Eatwell Guide is a visual representation of the types and proportions of foods needed for a healthy balanced diet, including variety of iron rich foods essential in preventing anaemia.

The information is not held in the format requested. Data on admissions do not record the type of ward or unit where a patient was treated and does not represent the number of incidences treated.

The information requested is not collected centrally.

The National Institute for Health and Care Excellence is in the early stages of developing a guideline on pernicious anaemia and expects to publish its final guidance in March 2023.