HC Deb 26 November 1962 vol 668 cc167-78

Motion made, and Question proposed, That this House do now adjourn.—[Mr. F. Pearson.]

10.25 p.m.

Dr. J. Dickson Mabon (Greenock)

Tonight, I want to speak about what I think would be one of the greatest advances of medicine that we will see in this century, the question of the fluoridation of water, provided that we apply it in time. Toothache is an awful business. It is an exquisite form of physical torture which almost every one of us, alas, has endured. We in Scotland have a poet who recited its agonies very well in a memorable poem. But not only is toothache an agony. It is also a cause of a great deal of physical ill-health. Because of that, there arises the question whether we can prevent the dental decay that is taking place.

It has been estimated that about 1 million working days a year are lost by dental ill-health and that in the first ten years of the National Health Service about £150 million has been spent by the State in providing dentures for the people. The Government ought to show more consideration about the growth of dental decay. Some dentists believe that it has reached almost epidemic proportions. That is not my language, but the language of the British Dental Association.

The current issue of the British Dental Journal, speaking about the Ministry of Health Report for 1961, makes the comment that nowhere in the section on dentistry or in the introduction is any indication given about the present state of the public dental health. In none of the dental services mentioned does there appear to be any estimation of whether or not the services, for the organisation of which the Ministry of Health is responsible, are affecting an improvement in the dental health of the public. Pious phrases abound … there is, however, throughout this whole chapter no sign that the Ministry is aware of what the present state of child dental health is, and whether it is improving or deteriorating. The dental profession has no doubts on this point: the teeth of the children of this country are in an appalling condition. I examined chapter VII of the English Report as clearly as I could and I agree with that comment. The figures are not given.

Naturally, therefore, I turned to the Scottish Report for assistance. The only comment I can find is in a brief chapter on page 25 of the current Report of the Department of Health. It states: The typical five-year-old Scottish child starting school has seven of his twenty temporary teeth decayed, filled or already extracted. Even at that early age very few children are found to be completely free of dental defects. The position is probably getting worse. Inquiries have shown that the average 14-year-old has four more decayed, missing or filled teeth than was the case a few years ago. I draw attention to these comments. The Report states that the position is "probably getting worse." Therefore, we are not sure. It states that "Inquiries have shown". Not a survey, but inquiries have shown; and so I could go on. This indeterminate assessment of what is becoming a major problem is far too lighthearted a way of dealing with the subject. I hope that in the reports to come something will be done to correct that position and show us the exact size of the problem. We are in for a chapter of, I hope, not partisan argument, but, no doubt, of political and public argument about this necessary measure before we are able to get it universally accepted.

I should not like the Government, suddenly and without explanation or preparation, to descend on the country and say, "This is to be done everywhere. Let us do it now. We will not listen to any objections." I should not like that to happen. I am convinced that this is an important and essential thing to be done. There is hardly a medical man anywhere with any worth-while reputation who is not an active proponent of this advance. Nevertheless, we want to do these things by persuasion.

One of my complaints tonight is that the Government are failing They are allowing the case to go by default. Up to now, the Government have had a reasonable alibi in saying that they could not decide about anything because they were awaiting the Report. But the Report on the Conduct of the Fluoridation Studies in the United Kingdom and the Results Achieved after Five Years has now been published as Public Health Paper No. 105.

I mention that because, in my opinion, every local authority councillor should have a copy of that Report and should have read it. If the Government really want to save money, one way of doing so is to send every councillor a copy of the Report and to ask him to read it before he starts accepting the hand-outs of various organisations, some of which are exceedingly ill-informed and some of them containing arguments which have been refuted by medical science time and time again. Apparently repetition is of little effect in meeting some of these strange arguments which come before us.

There are, none the less, genuine anxieties to be met, and to be met by reasonable arguments. The Standing Dental Advisory Committee, when it saw the Report, advised the Minister in England and Wales to take action to promote the general adoption of fluoridation as soon as possible. That was in June. In Scotland, the Scottish Standing Dental Advisory Committee advised the Secretary of State that the extension of this preventive measure would be of major benefit to the dental health of children in Scotland. So it would appear that there is not resistance in the Government Departments on this count. It appears that well-informed men and women who serve dentistry and medicine in the Departments of State are wholeheartedly convinced of the need for this major advance in preventive medicine. It is not fair that we should leave the country, as we have done for the last six months, bewildered by the publication of this Report, without the Minister having said anything, and I believe that the time is drawing close when a statement of Government policy on this matter must be made. I am an optimistic person by nature, and I imagine that the Parliamentary Secretary may be able to give us good news tonight, but, if not tonight, I hope that very soon Parliament will be told that the Government intend to accept responsibility in this matter.

We have already seen in Kilmarnock a serious reverse of this process of public enlightenment. Here was a town and a very sensible Scottish town it is, represented by a very excellent Member, as we all know—which willingly accepted its rôle in the five-year scheme; and then, on publication of the Report, and by their agitation, a few well-intentioned but badly informed individuals succeeded in reversing the decision of the town council to continue to take part in this scheme.

I say this quite sincerely, that if any citizen of Kilmarnock wants to see the foolishness of this decision all he has to do is read the Report of the five-year comparison between the health of the teeth of the children in Kilmarnock, and that of the teeth of the children in the neighbouring town of Ayr, and then he will see there is a complete answer to all his worries and a completely convincing case to show that this is a measure which, as it is in my opinion, is the only measure which can reduce spectacularly dental caries among our children. The Report shows that rotten teeth in children were reduced in number by over half in those five years, compared with the children in the neighbouring town. It is a spectacular advance, and it compares equally with the findings in other countries.

This is the strange thing, in a way, about this matter, that throughout the whole world, wherever surveys have been done, the conclusion is inescapable that this particular public health measure is of enormous benefit, and, at the same time, has been shown to have no harmful effects. There are a number of objections. I have, in fact, heard arguments that fluoride is another thalidomide. This seems to me to be the most mischievous thing to say about it.

The difference between fluoride and thalidomide, in one respect, is this, that thalidomide trials were confined to animals and extended at the very best for three years, and that fluoride has been among 43 million human beings and for many over a period of twenty-five years, and not a single adverse effect has been reported and substantiated by scientific investigators all over the world. I hope that this kind of proliferation of the thalidomide scare-mongering cries will be stopped, because they are growing. We saw this in Kilmarnock. We saw the Press filled with the most rubbishy lies from people who, as I say, are well-intentioned, but, at the same time, very ill-informed.

I blame the Ministry of Health and the Department of Health in Scotland for this. It is important that the Government, when trying to put forward preventive measures of public health, should be the main protagonists in convincing the people before they make the law. My own local authority is very progressive—I use the term in its correct sense and not in the party sense. The Corporation of Greenock has been asked to consider fluoridation to the recommended optimum dose of one part to a million. But the authority has hesitated because it has been bombarded with literature from all sorts of people, including the National Pure Water Association—whatever that may be—and others who want to turn the clock back a century.

One notable argument in all this appeals particularly to town clerks. It is the question of whether anyone can sue a local authority which fluoridates the water. There seems some doubt about that. Perhaps the Joint Parliamentary Secretary could enlighten us as to the law on this matter. Is there at present protection for local authorities who add fluoride to the water supply to the recommended degree?

I would prefer local authorities not to take this step on their own just now, however. The Government should bring forward, if necessary, amending legislation to allow it to be done. Someone has suggested a local veto system in relation to this question, but I would not like that. It would mean that the Government had failed to convince the people of the wisdom of fluoridation, and the children, in those areas which said "No", would be the sufferers.

In Kilmarnock, after I had addressed a meeting recently, a young man came up to me and said he had seen the improvement in his own children's teeth during the five years of the experiment. He said that had he not seen this for himself he would not have agreed to fluoridation.

It is important that the Government should lead the campaign. The British Waterworks Association, which has important influence on many local authorities, has advised its water engineers and professional men not to get involved in the controversy until the Government make up their mind. This information has been received with alarm by some local authorities. They say, "The water engineers have been told not to do anything because the Government are not sure." This increasing wave of doubt is casting question on this proposal. Yet not a single medical advance in this century has been so thoroughly analysed, vetted or inquired into to see whether there is any conceivable way in which there could be any real harm.

We all admit that in every medical advance a certain price has to be paid, yet the unusual thing is that in this case the price to be paid is very small. The money price is certainly very little. The cost to the community would be about £2 million, which, compared with the consequent reduction in the expenditure on dental health, would be a drop in the bucket.

Let the Government pledge tonight that they will make an early decision, and that, if they come out in favour of a national scheme for fluoridation of water supplies, the Minister of Health and the Secretary of State for Scotland will lead the campaign to inform the people of this worthwhile advance, and that they will introduce, if necessary, amending legislation to make this possible. I suggest that, at the same time, the Government should offer, if not all the money, at least half the money which the local authorities will be obliged to spend if this comes into being. That would be a considerable gesture of good will and endorsement of the scheme.

I should like the Parliamentary Secretary, if he can, to take up some of the points that I have raised. I have no doubt that this is one of many shots that will be fired in this campaign, and I hope that those of us who believe profoundly in this will be successful in the end.

10.40 p.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

I am sure that we are all grateful to the hon Member for Greenock (Dr. Dickson Mabon) for providing us with an opportunity to have a short discussion on the fluoridation of water supplies. I appreciate very much the clear, lucid and characteristically vigorous way in which he has advanced his arguments. I found myself in broad sympathy with practically everything he said.

I do not, however, agree with his view that the Government are allowing the matter to go by default. It is quite the contrary, and I hope to be able to show why. It might be helpful if I gave something of the background to the matter.

It is perhaps not sufficiently appreciated that fluoride occurs naturally in almost all water supplies. This is a basic fact which we must remember in all our discussions of the matter. In different parts of the world the concentration is as much as 14 parts per million. The highest natural concentration in our own country is about six parts per million.

As the hon. Gentleman rightly said, it has been known for a great many years that there is a correlation between the level of fluoride naturally present in water supplies and the incidence of dental caries or dental decay. Extensive investigations in the United States have shown that children brought up in an area with about one part per million of fluoride occurring naturally in the water supplies have only half the dental decay of children brought up in areas where the water has only a trace of fluoride. In addition, where there is this quantity of fluoride about 30 per cent. of the children between the ages of 12 and 14 have completely sound teeth. Independent investigations in many parts of the world have supported the American findings with remarkable uniformity.

Studies were inaugurated in North America in 1945 to find out whether similar results would follow if enough fluoride were added to the water supply to raise the content to one part per million. In 1952, on the recommendation of the Medical Research Council the British Government sent a mission to North America to study fluoridation in operation and to advise whether fluoride should be added to water supplies here. That mission reported favourably to fluoridation. Its Report stated that the results emerging in those areas where the water was being fluoridated were similar to those where fluoride occurred naturally, and there was no scientific evidence of danger to health from prolonged consumption of water containing fluoride in low concentrations. Everything that the hon. Member said on that subject is correct.

The mission recommended that before general fluoridation in this country was considered fluoride should be added to the water supplies in selected study areas. On the advice of the Minister's standing Dental Advisory Committee, the Government accepted the recommendation. Accordingly, from 1955 onwards studies were carried out in three areas, each being paired for study purposes with a control area. These areas were: Watford, in Hertfordshire; Kilmarnock, in Ayrshire; and part of the county of Anglesey.

Fluoridation began, and a full report on the conduct of the studies and the results achieved by 1961 was published in July of this year, four months ago—not six months. The main conclusions were that after five years of fluoridation in the study areas dental decay in young children had been reduced by half and twice as many children as normal had 'completely sound teeth. Also, there was no evidence of harm from fluoridation despite continuous vigilance.

I endorse everything that the hon. Gentleman said about the state of our children's teeth, and these findings, therefore, are of enormous importance and significance for all who care far proper dental health. These findings were also in line with American experience and showed that fluoridation brought about substantial improvements in the dental condition of the deciduous teeth of children in the study areas. Since the results are in line with those already achieved in America, there is good reason to expect that the long-term effect of fluoridation in this country will be similar.

The Report of the studies was published in the series of reports on public health and medical subjects. In Scotland, these, of course, are automatically distributed to all local authorities. The Report was widely publicised in the national and principal provincial newspapers. It was extensively reviewed in professional local authority journals. The B.B.C. sound news bulletins gave coverage to it. Both the B.B.C. television and I.T.V. news contained full reports on the fluoridation system at Watford and interviews with the medical officer of health. So far, over 6,000 copies have been sold and there has been one reprint.

The Report was considered by my right hon. Friend's Standing Dental and Medical Advisory Committees and by the Central Health Services Council, and similar action was taken in Scotland. None of the bodies consulted made any comments which were otherwise than favourable to fluoridation. Since the publication of the Report my right hon. Friend has received representations in favour of fluoridation from the British Dental Association, the Society of Medical Officers of Health, the County Councils Association, and the Executive Councils Association. In addition, the General Dental Council, the Association of Municipal Corporations and the British Medical Association have written expressing views favourable to fluoridation.

The hon. Gentleman asked me for an indication of the Government's policy. My right hon. Friend said in answer to a Question from the hon. Gentleman last July that he is considering the Report and the advice that he has received on it, and, as he indicated as recently as 12th November, he has not yet completed his consideration.

Mr. William Baxter (West Stirlingshire)

Why not?

Mr. Braine

Because this is an enormously weighty matter, and if the hon. Gentleman has not grasped that he has not grasped anything.

At the moment it is not possible for me to add anything to my right hon. Friend's statement except that it cannot be held that there has been any unnecessary delay. It is a weighty matter. Many issues are involved, and their consideration is bound to take time.

I share the regret of the hon. Gentleman that Kilmarnock decided to discontinue fluoridation last month. The change of attitude on the part of the council was brought about by pressure exerted by a group of persons whose main line of attack was to sow doubts about the safety of fluoridation. Unfortunately, it is a fact that those who oppose fluoridation do so on the basis of a misunderstanding of the nature of what is proposed.

Fluoride is a natural constituent of water. It occurs in many foods and beverages. As a matter of fact, cheese, chicken, fish, tea and beer are all particularly rich in fluoride, and it occurs naturally in greater or lesser amounts in most of the water we drink. In some areas the amount of fluoride in drinking water is greater than the recommended one part per million. In my own County of Essex, certain districts have five to six times that amount.

Thus, the choice is not between fluoride and no fluoride in the water we drink, but between fluoride in a greater or lesser degree. I want to emphasise this point, and am grateful to the hon. Gentleman for making it possible for me to do so. Fluoridation is simply an adjustment of the fluoride content of the water supply to the optimum level necessary for the dental health of the community. Nevertheless, I think that I should say that the extra precaution was taken during the studies—and this is why time had to be taken over this—of asking doctors in the study areas for any evidence of any harm arising out of fluoridation. In spite of this, no cases were reported—

Mr. Eric Lubbock (Orpington) rose—

Mr. Braine

This is an important subject, and I want to give as full an account as I can. In spite of asking for that information no cases were reported of harm being caused to anyone.

Some people argue that it is morally wrong to interfere with the water supply, and that everyone has a right to receive pure water, but water occurring in nature is never pure and nearly always needs to undergo extensive chemical treatment at the waterworks before it can emerge from our taps as clean and wholesome. The only water which is pure is distilled water, which, I understand, is very unpleasant to drink.

The hon. Member has asked me to make it clear that local authorities are adequately safeguarded against any legal action conducted by an individual against an authority which puts fluoride in its water supply. He will appreciate that neither I nor my right hon. Friend—nor anyone else in Parliament—can give a final and authoritative indication of what is strictly a point of law under existing legislation, but he may like to know that the studies of fluoridation so far have been financed by my right hon. Friend under his powers to promote research in general under section 16 of the National Health Service Act, 1946. The Secretary of State for Scotland has similar powers under Section 17 of the Scottish Act.

General fluoridation, of course, would not be assisted in any way under the provisions of a Clause relating to research. Here, as I have already said, my right hon. Friend the Minister of Health and the Secretary of State for Scotland, and my right hon. Friend the Minister of Housing and Local Government, who also has an interest, are still considering the matter and are not yet ready to make a statement of policy. What has been said tonight by the hon. Member with great force and clarity is something which my right hon. Friends will read tomorrow and take very much into account.

The hon. Member also asked me whether the Government will, in the event of general fluoridation being introduced, meet part of the cost as a token of their good will towards the scheme. This, again, is a matter which must await the outcome of the general consideration, but I understand that the cost of fluoridation, in the experience of the study areas anyway, is low, amounting to not more than about 10d. per annum per head of the population supplied.

We are well aware that many local authorities are anxious to begin fluoridation, for all the reasons which the hon. Member advanced so eloquently tonight. But we advised them to await the outcome of the studies, which were providing valuable information. After all, the mission which went to North America ten years ago recommended that these studies should be concluded first. The Report on them was published only four months ago, with the holiday season intervening, and I do not think that in those circumstances we can be accused of dragging our feet.

Once again, I want to emphasise that there has been a great deal of misconception about this matter. Fluoridation of water has been described as mass medication. That is complete and arrant nonsense. Fluoride is neither a drug nor a medicine; it is naturally present in the water we drink, in concentrations either less or greater than one part per million. In the case of fluoridation, nothing is added to the water which is not already there. All that we have is an adjustment of the optimum level of the fluoride in the water in order to promote general dental health, and not only that of the children of today. They will certainly benefit as the result of fluoridation, and will go into adult life with sounder teeth. This is something which is of immediate benefit to children, but it is also something which will be of benefit to the population in general, in the years ahead.

I do not want to argue the case any further. My right hon. Friend has been closely concerned with the matter; he is studying it now, and I hope that it will not be long before he is able to make an announcement to the House. We have had a most interesting and useful debate, and, once again, I would like to thank the hon. Member, whose interest in this matter is now well established, for the way in which he has raised it tonight.

Mr. Kenneth Robinson (St. Pancras, North)

This is a fantastic situation. Here is a medico-social advance in which all the evidence is on one side, to a quite unprecedented degree. The Minister's predecessor started the investigations ten years ago. He had the Report in July of this year, and is not yet in a position to make even a statement of policy or intentions, let alone Propose a plan of action—and the Parliamentary Secretary says that the Minister is not dragging, his feet. If this is not dragging his feet, I do not know what is.

Question put and agreed to.

Adjourned accordingly at six minutes to Eleven o'clock.