§ Question again proposed.
§ Mr. Pavitt
As hon. Members will know from previous debates on the subject, every drop of water that is drunk in the House, including tea and coffee made with it, has already been through the human body six times. If hon. Members feel that there is some way in which then-individual liberty is being threatened by having that water cleaned before they drink it for the sixth time, I cannot follow that line of argument.
Hartlepool, Derbyshire and a number of other areas where there is a high concentration of naturally occurring fluoride in the water have been discussed. The anti-fluoridation lobby has never suggested that the Government should take action to remove that fluoride content.
Let us consider the economic basis of the Government's policy towards the NHS in trying to get the best value for public expenditure. There has been a great increase in the amount of public expenditure on the treatment of dental disease. In 1975,27.2 million treatments were paid for by the NHS. There have been, of course, the unfortunate charges that Governments have imposed upon patients since that time. By 1982 that had risen to 31.7 million. In 1975 £169 million was spent on dental services out of the total Health Service budget and in 1982 that had risen to £401 million.
A good deal of evidence has emerged from recent research being undertaken, particularly in the London hospital and by the dental working party established by the Labour party. It shows the way in which Coca Cola, ice cream and so on are injurious to children's health. But the fact remains that fluoridation is the most effective first step in dental care, despite the possibility for further action by Government.
The Royal Commission has already been quoted. Its recommendation 5.31 on page 49 says:There are major areas where Government action could produce rapid and certain results: a much tougher attitude towards smoking, towards preventing road accidents and mitigating their results, a clear commitment to Fluoridation".That clear commitment is not coming from the Government tonight, but at least the Government have made it possible for local health and water authorities to proceed without being threatened with an injunction or High Court action which would prevent them from taking the necessary steps.
We are in favour of topical applications where fluoridation does not exist. We are in favour of the use of fluoride in milk, as happens in some southern counties in Britain. Nevertheless, everybody drinks water. There is no way in which one millionth of a part of fluoride added can in any way be injurious to health, and that has been proved time and again. This is a first step. I urge the Government to follow it through by accepting the other recommendations of the Royal Commission most of which were adopted as part of Labour party policy at the 1978 annual conference. The Government must, apart from this enablement, look into what is being done for school dentistry, examine the whole question of oral hygiene and consider the amount of expenditure that can be made so as to improve prevention rather than treatment.
We appreciate the difficulty faced by the Minister in that no Chancellor of the Exchequer is prepared to spend a penny today to save £10 in 10 years' time. Nevertheless, 105 if the Minister will carry out a follow-through policy of prevention, not only in this but in other spheres, we shall enter the next century with more healthy people and with fewer claimants on the National Health Service, enabling us to speak of the number of people who no longer need to be treated. It will mean people being able to go through their lives without oral diseases, without dental caries and without suffering the disastrous pain of toothache, so enabling the dental profession to concentrate on other areas. I pay tribute to the dentists, who are strongly in favour of the measure, although it might eventually put them out of work.
§ 10.6 pm
§ Mrs. Edwina Currie (Derbyshire, South)
I support the Bill, which is both fair and proper. From 1975 I was privileged to be a member of the Birmingham area health authority and subsequently, on reorganisation, to be chairman of the central Birmingham health authority. I was, therefore, close to and ultimately responsible for Birmingham dental hospital, the main teaching hospital outside the London area and a hospital of great renown; I was also a patient of that hospital for three years; and, like others, I am a parent, having two young children.
I tried during those years to come to this question with a completely open mind. Birmingham fluoridated its water more than 20 years ago and the results have proved extremely interesting. I will not quote the statistics because they have been mentioned by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) and the hon. Members for Oldham, West (Mr. Meacher) and for Leeds, West (Mr. Meadowcroft).
We also had some interesting statistics from my hon. and learned Friend the Member for Perth and Kinross (Mr. Fairbairn). His seemed to be the opposite way round to most other statistics produced in the debate, suggesting that he was quoting from the wrong years. If he will do me the courtesy of sending me a copy of the figures he has, I shall examine them.
All other figures have shown that there has been a sharp drop in the number of dental caries; a great drop in the number of children without teeth or with dentures; a great reduction in the number of children who have had to be treated under general anaethesia, so enabling us in Birmingham to close a clinic; a sharp drop in expenditure on the removal of teeth; and an increase in expenditure on orthodentistry and conservation.
Those improvements have affected not just children, but adults, too. Indeed, we had problems with students because we ran out of people on whom they could practise and had to bus in children who were in need of treatment from other parts of the country. We were thereby able to pay much more attention to the dental care of the elderly, an area which had been greatly neglected.
If I had any doubts on this issue, the care of my two girls has proved to me the rightness of what the Government propose. My elder daughter was the result of a pregnancy carried in London, where the water is unfluoridated, although she was born in Birmingham. She had no end of trouble with her baby teeth, though her adult teeth are fine. My younger daughter, who was carried and born in Birmingham, where the water was fluoridated, has needed no dental treatment of any kind and has no fillings, even though she is coming up to her eighth birthday and eats sweets at a rate that makes me envious and, more important, eats them at the same rate as her sister.
106 Anyone who puts forward the argument that dental disease is trivial has never sat time and again in a dentist's waiting room with a terrified child. For children, fluoridation has been nothing but good.
§ Dr. M. S. Miller
I accept what the hon. Lady says. Does she accept, however, that sepsis in teeth, when it develops as the result of caries, can produce all sorts of conditions? The fluoride does not produce the conditions, but the septic organisms can cause rheumatic fever and many other diseases in children?
§ Mrs. Currie
I accept the hon. Gentleman's professional opinion on that.
The arguments on medical grounds that I have heard will not wash—the argument, for example, that fluoride is a poison. Anything is a poison if we take enough of it. My hon. and learned Friend the Member for Perth and Kinross has rejoined us in the Chamber. Were we to spreadeagle him on the Floor of the House and pour absolutely pure H2O into him, it would kill him or anyone else subjected to that treatment in hours. That would be the result of ingesting any commodity, be it a vitamin, good food, bad food, fluoride sodium chloride or anything else. Anything is poisonous if we subject ourselves to enough of it. No one is suggesting that we do any more than put one part per million of fluoride in the water.
§ Mrs. Currie
I shall give way to my hon. and learned Friend in a moment.
Most of the medical issues which have been raised have been introduced by those who have other objections to the adding of fluoride to our water. That does not absolve us from continuing to be vigilant when dealing with health matters. We must not be complacent.
§ Mr. Fairbairn
All the poison that my hon. Friend suggested I would happily take rather than be spreadeagled on the Floor of the House by her.
§ Mrs. Currie
We have heard other arguments that are much more serious—for example that people can obtain fluoride in other ways. The trouble is that they do not. The families who need help most, whose diet is the most deficient and who take no notice of health education, are exactly those who need the assistance of passive medication, such as the fluoridation of water. It is the simplest, cheapest and safest method that is available to us. It is certainly the cheapest when we take into account the cost of doing nothing. It is the safest when we take into account that we know that there is control and we know how much fluoride is in the water. We do not know, of course, how much is being taken in other forms.
It is argued that we should not add flouride to our water and that we should drink it in its natural state. My home is on a hill in Derbyshire and there are many pure spring waters in the area. I would not touch any of the water that comes out of the ground in my area with a barge pole. I would not touch it in its natural state. The water is cleaned and purified, especially that from the Trent, which passes through all the local power stations, which have been working overtime recently. We chlorinate the water and we would be remiss if we did not. In London we would all have died of dysentery and cholera a long time ago if 107 we had not treated the water effectively all the time. To fluoridate our water provided that the local people want it, seems to me an extension of public responsibilities.
§ Mr. Robin Maxwell-Hyslop (Tiverton)
Is my hon. Friend saying that fluoride should be introduced only if the local people, who will drink it, are given the opportunity of saying whether they want it, as opposed to the non-elected water authority meeting in secret without the presence of the press? Is that her proposition? That is what she is saying.
§ Mrs. Currie
As I understand it, the main recommendations and decisions will come from the health authority as well as from the water authority. I was a member of a health authority, and I am aware that the authorities are represented by a number of local representatives, who take their duties extremely seriously. They are councillors, who are elected representatives. When I was a member of a health authority, one of its representatives was a member of this place, and that was Miss Sheila Wright, who represented Birmingham, Hands worth.
It is said that we should not go in for mass medication because it is not morally justified. That is the most powerful of all the arguments and I would much rather we did not need to medicate our water. However, it seems that it is necessary to balance two undersirable events. First, there is the undesirable event of attacking people's freedom by medicating for everybody. The alternative is to risk lives, especially the lives of children. Children used to die under general anaesthetic, but it is now generally unknown for a child to die under dental treatment in fluoridated areas. That applies to adults and children. My right hon. and hon. Friends who represent Birmingham constituencies will recall that not long ago there was a scandal in Birmingham when two patients of a dentist died under anaesthetic. I accept that they needed better treatment, but they would not have died if they had not had bad teeth.
Every attempt at medical and dental intervention carries a risk for people. For some it is a high risk. We have a responsibility to reduce that risk, if possible, in much the same way as the House did previously when it agreed to compulsory inoculation against smallpox, which resulted in the eradication of that disease. We can eradicate dental caries as a disease.
My hon. and learned Friend the Member for Perth and Kinross said that a medication should benefit a particular individual. We must balance the cost of treating dental disease, and that cost bears down on all of us. If it is undesirable to reduce freedom, it is undesirable also to spend public money in large quantities unnecessarily. Our freedom is reduced when large amounts of tax are lifted from our pockets and those of our constituents to pay for the treatment of dental disease in other people which is readily avoidable through fluoridation. For those reasons, we should support my right hon. and learned Friend the Minister for Health.
§ Mr. Keith Best (Ynys Môn)
My hon. Friend the Member for Derbyshire, South (Mrs. Currie) speaks with great passion on this subject, as she does on all matters. Although some of those who are against the artificial 108 fluoridation of water supplies are sometimes accused of being emotive in their arguments, I am confident that that criticism will not be levelled exclusively at them but will be levelled against some who are in favour of artificial fluoridation. My hon. Friend is so vivacious an advocate that I am sure would never be in danger of dying under a general anaesthetic or of being rendered unconscious under one.
Unfortunately, I cannot agree with my hon. Friend the Member for Derbyshire, South. My right hon. and learned Friend the Minister for Health rightly said that in this Bill the Government propose to do no more than to restore the position to the status quo. He said also that he is perfectly satisfied that artificial fluoridation of water supplies inhibits dental caries and benefits the general population. I do not doubt that my right hon. and learned Friend generally believes that that is so. I have little doubt that fluoridation of water supplies can play its part in preventing dental caries. All hon. Members would like that to occur. Just because those points are true does not mean that hon. Members are not entitled to offer their views on whether they believe it is right that there should be an artificial mass addition of fluoride to the water supplies.
I shake my head in disbelief when I hear a Conservative Government— some have said, the most Right-wing Conservative Government this century— propose legislation to add to the water supply an industrial poison, as it is described in the 1976 report of the Royal College of Physicians, which comes from industrial wastes and is said to be necessary to sustain life. I shake my head in disbelief also when I hear the Opposition support the judiciary, the Government and the medical professions. I wonder whether the House has gone topsy-turvy.
The Government are satisfied that fluoride is safe. If so, why do the Government offer an indemnity? Why would health authorities not recommend the artificial addition of fluoride to water supplies if there was no indemnity? That is a simple question, but the answer is more complicated. I hope that my hon. Friend the Under-Secretary of State for Health and Social Security will address his mind to that problem. If the Government are certain that fluoridation is safe, there should be no need for an indemnity. If they are not, it should not be added artificially to the water supply. That proposition is wholly true and unchallengeable.
Fluoride is cumulative. What is a safe dose? I challenge any hon. Member to ask any doctor or dentist what a safe dose of fluoride is. There will be no answer because no doctor or dentist would know the total amount of fluoride ingested in a patient. Moreover, fluoride is a noxious substance.
Contrary to what many hon. Members said, fluoride does not occur naturally in water but is picked up by water in its passage through the ground, or down a river, such as the Thames. We then drink it in our tea in the House of Commons Tea Room, as the hon. Member for Brent, South (Mr. Pavitt) vividly explained. We are told that fluoride is beneficial to the population. I hope it is, because everyone in a fluoridated area must drink it. They have no choice. However, I am not aware that it does a great deal of good to pensioners with false teeth— perhaps I shall be told differently— or to patients suffering from a renal complaint. They are told in a cavalier way that it does not matter if they live in a fluoridated area because they can put a filter on the tap.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I have listened to my hon. Friend's remarks with great care, and I am anxious not to cause unnecessary alarm among the many patients who receive renal dialysis. Does my hon. Friend accept that we offer standard advice through the National Health Service to all those charged with maintaining renal dialysis units, which is that they should screen the water for products which would harm those with renal failure, including aluminium, fluoride and other substances? There is a great range of substances in water. My hon. Friend must accept that we ensure that substances which would adversely affect dialysis patients are not present.
§ Mr. Best
I accept unreservedly what my hon. Friend said. He confirms my point that fluoride should not be taken by those who suffer from renal complaints.
Lord Jauncey, in his judgment, said that the addition of fluoride wouldnecessarily involve a restriction on the freedom of choice of the individual, who would have little alternative but to consume the fluoridated water whether he likes it or not.
If hon. Members are so concerned about compelling people to take preventive medicine— I use that term because it seems to be the most neutral term in use during the debate— why do we not ban smoking? Smoking undoubtedly causes lung cancer. No hon. Member would disagree with that. Yet for some extraordinary reason we allow people to go on killing themselves and to die of lung cancer at great cost to the NHS, by not banning smoking. What is the reason for not banning smoking?
§ Mr. Best
My hon. Friend says that people like it. It may not be wholly dissociated from the fact that people should be allowed to smoke if they wish, having had the dangers of it pointed out to them. The alternative is to say that nobody should make a conscious decision about whether to do or not to do something which may be harmful to health. I do not think that anyone in this House would want to live in a society where that choice was removed altogether.
I do not wish to introduce a note of levity into the debate, but many people suffer from indigestion and we do not add antacids to the water supply. It would be wrong to do so, for not everyone suffers from indigestion. But it is also true that not everyone in an artificially fluoridated water area suffers from dental caries. What about the people who do not suffer from dental caries and are not likely to do so?
What are the criteria for the addition of a substance to the water supply which is designed not to make it potable, not to remove poisons which would otherwise be harmful to the body, but deliberately and positively for the purpose of preventive medicine? We are entitled to ask what are the criteria for adding any such substance to the water supply.
Let us restrict the argument to water, as that is the one substance that we must drink to sustain life. I do not believe that the House has addressed itself to that question tonight. I do not believe, with respect, that the Government have addressed their mind to it. I am not for one moment saying that this might be regarded as the thin edge of the wedge, so that someone might suggest that if 110 a tranquilliser could be added to the water supply it would be highly beneficial to society because it would reduce the incidence of violence and other anti-social behaviour. I am not suggesting that that might be regarded as a precedent.
§ Mr. Sydney Chapman (Chipping Barnet)
Surely the answer is that fluoride already exists in water. If my hon. Friend is saying that it should not exist to the extent of more than or up to 1 mg, is he also suggesting that the Government should legislate to take natural fluoride out of the water supply in order to conform with his wishes?
§ Mr. Best
I am grateful to my hon. Friend for his question, because it seems now that the proposition is that anything that exists already in substances that we take must be left in because it is accepted as a matter of history. I do not regard that as either a laudable or a responsible view for this House to take.
§ Mr. Edward Leigh (Gainsborough and Horncastle)
Is not the inference that just because a substance occurs naturally somewhere, it should be imposed on everyone everywhere? Can that be right?
§ Mr. Best
My hon. Friend knows my answer to that question, and he must address it to those who wish the Bill to get a Second Reading.
Much has been said about local choice. An opinion survey in Anglesey, the area that I have the privilege to represent, made on 30 November 1983 by the Gwynedd technical college, demonstrated that 26.5 per cent. of persons questioned were in favour of the artificial addition of fluoride to the water supply, and that 53.6 per cent. were against. My own survey of my constituency showed that 30 per cent. were in favour, but 45 per cent. were against.
I am not a populist. I do not believe that it is the function of hon. Members merely to reflect the whims of the local population, because our job must be to exercise our judgment, but I hope that all hon. Members will understand the sense of frustration that is experienced by the people living in my constituency who, time and again, demonstrate their opposition to having fluoride artificially added to their water supply but who can make no democratic decision about it. That is because there is no capacity within existing legislation for such a decision to be taken.
There is, of course, the referendum. I suggested the idea of a referendum on 21 December 1981. If this is to be a matter of genuine local choice, should not the people of the area make that decision and speak their mind—or, if not them, the directly elected borough or district council? That is no good to those who want fluoride added to the water supply of Anglesey because the local borough council is against the artificial fluoridation of water supplies. What, then, of the consumer watchdog of the National Health Service, set up by legislation to watch over matters in the NHS— the community health council? That is no good, because the community health council is against the artificial fluoridation of water supplies as well.
111 My right hon. and learned Friend the Minister for Health recognises that this is an ethical question. It is not the same as the death penalty, on which I am opposed to a referendum because I believe that the punishment of offenders must remain the prerogative of representatives 112 in the House. I am not sure that even a referendum, which would be binding on a dissenting minority, is the right answer. Ultimately, surely the proposition comes down to this. Preventive medicine must remain a matter of individual choice, of encouragement and exhortation perhaps, but of individual choice, and not compulsion.
§ Mr. Michael McGuire (Makerfield)
I apologise for the fact that I have not heard many of the speeches that have been made.
I am opposed to the Bill. I hope that those who spoke in favour and who want to intervene in what I hope will be a short speech will make the points that they think will convince me. Sometimes we come into the Chamber in one frame of mind and listen to a speech, and it changes our point of view. I am not saying that I have such a tremendous command of language and oratory as would make those in favour of the Bill change their mind, but I hope that those who want to will intervene, and briefly. The hon. Member for Derbyshire, South (Mrs. Currie) did not give way to me in her speech. I hope that hon. Members will intervene to try to convince me that the Bill should go through. I believe that it should not. It is thoroughly bad, and on one sound principle alone.
I cannot pronounce the new name for the constituency that used to be called Anglesey. The fixed points in the House have gone since we changed so many old and well-loved names. I am sorry that I cannot refer to the hon. Gentleman's constituency by name. He dwelt at length on preventive medicine and whether it is the duty of the State to take certain decisions that it believes will make the citizens healthier—in this case, we are concerned with their teeth. I would be in favour if it could be proved that, if fluoride was put in water people who ingested it, especially children, would have a magnificent set of teeth. Nobody is suggesting that, however. The proponents of the Bill say that if flouride is added to water in the suggested proportions young people's teeth will be saved from decay, to the extent that one or two teeth will be saved in their lifetime, and they will not need to have three or four fillings.
§ Dr. M. S. Miller
It is not a matter of one or two teeth. Depending on the age at which it begins to be given, which should preferably be during the mother's pregnancy, 60 per cent. or more of fillings will be avoided and in some instances it will save the person's teeth throughout life.
§ Mr. McGuire
I am interested to hear that, as none of the proponents sending out literature about this has ever made that claim. But even if my hon. Friend's claim were proved, I should still oppose compulsory Fluoridation because it is not for the State to take that decision. Vaccination is not compulsory, although the benefits are far greater. There are advertising campaigns to persuade people to have their children inoculated, but there is still freedom of choice.
Is my hon. Friend suggesting that if people take fluoride they will not have to take care of their teeth?
§ Mr. McGuire
Of course not. If people take fluoride but neglect their teeth, they may delay the onset of caries for a short time, but it will not prevent it. Whether the water is fluoridised naturally, artificially or not at all, if people do not pay attention to dental hygiene they will have bad teeth and they will need fillings and extractions. It is convenient to argue that in some areas fluoride occurs naturally in the water, but has anyone analysed all the other naturally occurring constituents in the water?
I sense that many Conservative Members intend to oppose the Bill and they are right to do so. The soundest 114 principle on which to oppose it is the fact that it is compulsory mass medication. Anyone who argues that that is not so is guilty of sophistry of the worst kind. People are given no choice in the matter.
On a lighter note, if we wished to try to eradicate common complaints by compulsory mass medication we should consider ailments such as constipation. No one has seriously suggested that that should be dealt with nationally, although it affects far more people. The same could be applied to smoking, dieting, and so on. The State would end up acting as nanny to all of us. Nobody wants that.
No case has been made for compulsory Fluoridation beyond the fact that it will delay the onset of caries and the extraction of teeth for a short time. No one has suggested that if people do not pay proper attention to dental hygiene they will not suffer the consequences, whether there is fluoride in the water or not.
It is no part of the duties of the House of Commons to give the green light—which is what the Bill will do—to a proposal that makes it appear necessary to add fluoride to water and to suggest that neglect of the people is involved if it is not added. We should oppose the Bill on the sound principle of opposing mass medication and that it will not help the majority of people. Once past the age when second teeth are formed in childhood, Fluoridation will not help. The case for it has not been made. We should oppose the Bill, and in doing so we shall do a very good job indeed.
§ Mr. Robin Maxwell-Hyslop (Tiverton)
There are two points to the Bill— one of principle and the other of detail. On the point of detail, no one seriously challenges the fact that the presence of fluoride in water has a beneficial effect on dental caries. However, that is not the point at issue.
Certain contraceptive pills were withdrawn not because they were inefficient contraceptives but because they had side-effects that were wholly unexpected by those who originally passed them as safe and recommended them for general use. The reason that Dalkon intra-uterine devices are now not only withdrawn but the manufacturers are desperately trying to find people who still have them in—some women do not know that they still have them—is not because they are inefficient contraceptives but because they have been shown to have harmful side-effects that were not anticipated by those who recommended them. Let us think of the position if they had been fitted—or, with contraceptive pills, administered—compul-sorily, because that is the analogy.
The question is not whether fluoride—either naturally in the water as it percolates through the ground, or artificially added— is an instrument in delay ing or preventing caries. The technical issue is unanswerable except over a much longer period of time than has been allowed to date. What are the side-effects? That is the large question mark. No amount of evidence about the prevention of dental caries gets rid of that question mark.
Arguments about whether elected local bodies should have the right to impose this medication are not ones of substance because the public water supply system is not conterminous with local authority boundaries. Therefore, that is not a practical consideration. It is the right of the 115 individual to know what is being administered to him or her or to their children, and to have the right to control that.
There are peripheral questions. I put my vote where my mouth was when I took the view that water authorities should meet with the press present, but the water authorities that are party to the proposal meet in secret. They are not elected bodies. My hon. Friend the Member for Derbyshire, South (Mrs. Currie), who has now left the Chamber, pretended that because she was a member of an elected body and seconded by it to the health authority, in some way she was elected to the health authority. Of course she was not. Nor are people elected to health authorities today. But, even if they were, it does not overcome the point of principle. I am the first to admit that I have changed my stand on this matter during the past 15 years.
When I was first contacted by members of the dental and medical professions, about 15 years ago, I became convinced of the efficacy of fluoride as an anti-caries agent, and it was on that that I focused. Because I thought that it would be an excellent thing if people did ingest this substance, to reduce dental caries, I took, without conscious decision, the further step of thinking that it should be administered to them by the public supply system. I did so without focusing on the question of principle, which concerns the right of some exterior body to administer in a necessary substance something that may have demonstrated beneficial effects in one sphere, but the full effects of which cannot be known over a limited period. Why in the water? Why not in the air or in trains, now that in many trains one cannot open a window? Why not in public places of many kinds, such as shops and offices? Why not administer gaseous substances in the air?
§ Dr. Miller
Does the hon. Gentleman understand what it is all about? Fluoride cannot be administered in the air. It cannot be controlled in the air. It can be controlled in water to the extent of one part per million. Can you get that into your head? [HON. MEMBERS: "Order."] I am sorry, Mr. Deputy Speaker. The hon. Gentleman cannot understand that one cannot do this in the air.
§ Mr. Maxwell-Hyslop
Perhaps it is a substance that would assist the hon. Gentleman with his hearing, which should be voluntarily taken by him, but I would not recommend that it should be compulsorily administered, whatever public good might follow from such a course of treatment.
Both the chairman and the chief executive of the South-West water authority have assured me, not only verbally but in writing, that there is no conceivable known way by which they can restrict the administration to one part per million. There are so many different sources of water in the south-west— bore holes, extractions from rivers, springs and reservoirs—which feed at different speeds 116 into common mains and sometimes into local mains, that there is no way in which the authority can ensure a low limit such as this.
The explanatory memorandum says:"Effects of the Bill on Public Sector Manpower The Bill has no effect on public sector manpower.Are water authorities not public services? They must be, because their borrowing is being restricted because it counts against the public sector borrowing requirement. Is it suggested that the fluoride administered from 20 or 30 different sources in one water authority should not be monitored? It will have to be monitored, but it is suggested that it will not take extra manpower to do this and to control and correct the level when the intensity gets too high. How can the Bill have no effect on public sector manpower, unless it be that the words on page 2—are they sinister or benign?so far as is reasonably practicablehave the answer. Does that mean that ensuring that the level does not go over 1 mg per litre will happen only as long as no extra manpower is involved?
§ Sir John Page
I have listened with great patience to my hon. Friend trying to make an enormous soufflé from one bad egg. I do not wish to go into this in too much detail, but the reason is that already so many chemicals and processes happen to water before it comes out of the tap that one more tiny drop would be of infinitesimal importance.
§ Mr. Maxwell-Hyslop
My hon. Friend has missed the point. We are talking here about fluoride. Why does the Bill say, only of fluoride, that it must be maintained at 1 mg per litre if it does not matter if it is much more?
§ Mr. Maxwell-Hyslop
It does say that. Clause 1(5) states:Any health authority making arrangements with a statutory water undertaker in pursuance of an application shall ensure that those arrangements include provisions designed to secure that the concentration of fluoride in the water supplied to consumers in the area in question is, so far as is reasonably practicable, maintained at 1 mg per litre.Perhaps my hon. Friend has not read the Bill. Why does it say that if it does not matter whether the level is maintained there?
§ Sir John Page
I know that it was a mistake for me to have interrupted my hon. Friend. I was answering his question about manpower. As to the phrase,so far as is reasonably practicable",there will be pluses and minuses. Control can be maintained, but there must be a tiny plus or minus on either side—[Hon. Members: "How much?"] Perhaps 0.1 per cent. or something like that.
§ Mr. Maxwell-Hyslop
But it does not say 0.1 percent. It says nothing except for the meaningless phrase,so far as is reasonably practicable".That is a point of substance, not of trivia. Ifso far as is reasonably practicablemeans without addition to public service manpower, that is a much wider margin than if one takes on, as one does for many statutory purposes, additional enforcement staff to ensure that the new conditions imposed by statute are adhered to. But when the explanatory memorandum says that there will be no expansion to public service manpower, how does one then read the qualification,so far as is reasonably practicable",117 except as meaning so far as is reasonably practicable without taking on additional manpower to check the concentration, to ensure that water supplies with too high a concentration are cut off, and to take corrective action on the input? Where there are many sources of water supply, especially in conditions of drought, when water is turned off for some hours in a day, which causes many different concentrations in pipes, this is not just a theoretical consideration but a highly practical one.
The point of principle has nothing to do with whether it is a small or large baby—with whether it is 1 mg per litre, one part per million or 100 parts per million. The argument also falls on the point of detail that it cannot be enforced at the level declared in the Bill without a considerable increase in manpower to monitor it and to take corrective action if it goes over the permitted limit, even though the amount by which it can go over the permitted limit is not stated in the Bill, because of the woolly phrase.
On the point of principle and on the point of practicality, the Bill ought not to proceed. The Second Reading of a Bill is not about its detail, but about its principle.
§ Mr. Maxwell-Hyslop
The hon. Gentleman did not listen previously and, as he has not taken medication since then, I have no reason to believe that his hearing has improved.
§ Dr. Miller
The hon. Gentleman must realise that no attempt has been made to mislead the public or the House. The Bill recommends 1 mg per litre, but one can be sure that 2 mg, 3 mg, 5 mg or 10 mg would not do any harm. There is a vast margin of safety. The reason why 1 mg is suggested is that it is sufficient. The substance costs money, and there is no point in adding 10 mg per litre if 1 mg does the job.
§ Mr. Maxwell-Hyslop
Were that the real reason, rather than a spurious reason thought up by the hon. Gentleman on the spur of the moment, the Bill would refer to a minimum of 1 mg. The hon. Gentleman does argue that it does not matter if there is much more, but there must be 1 mg per litre to do what is intended. The principle is unaffected by whether it is 1 mg or 10 mg. The practice is certain: to monitor and enforce limits will require manpower, and it should not be stated that it does not. As it has been stated that no manpower is required, we must read the phraseso far as is reasonably practicableas meaning that the stated quantity is not to be adhered to in practice and is not to be monitored in such a manner that corrective action can be taken to prevent people from receiving excessive doses, as opposed to our knowing that people have taken excessive doses after they have done so.
The point of principle remains and it is as true of air as it is of water. If this is permissible with water, it is permissible with air, and with other things that people necessarily and without choice ingest. That is the point of principle.
Let there be as much health education as would satisfy the most exacting hon. Member; let there be as much exhortation; let supplies of preventive or therapeutic substances be made available at public expense. All that is different from administering compulsorily substances 118 that people do not wish to ingest—for reasons that may be good or bad, but which are decisions that they are at liberty to make about their own bodies and persons.
§ Mr. Gerald Howarth (Cannock and Burntwood)
It is a pleasure to follow my hon. Friend the Member for Tiverton (Mr. Maxwell-Hyslop), who is a master of detail in these matters. I am pleased to have him as an ally rather than as a foe.
We all agree that the Government were right to allow a free vote. We have had an interesting, stimulating and informed debate— at least, the opponents of the Bill have been informed. It has been an interesting debate on the other side too.
This is a matter of great concern to my constituents. The Cannock Chase district council is an elected body, although there are regrettably not too many Conservatives on it at present. It has declared itself hostile to the compulsory fluoridation of the water supply. I share its concern. I also have a particular interest in this subject, as a sufferer. I have been a patient at the Eastman dental hospital for the past two years, as I suffer from periodontitis. It is not caries, but is a dental disease. Therefore, I may have more interest than usual in this issue, and can speak with some authority on it.
If the hon. Member for Makerfield (Mr. McGuire) did not regard his speech as an oration, many of us certainly did, and we look forward to hearing more from him in the spirit in which he has approached this subject. He rightly identified the question of principle involved, or the philosophical arguments, but there are also medical arguments. I shall deal with them first. Medical opinion has differed for years over whether the addition of fluoride to water supplies is a good way of reducing the incidence of dental decay, particularly among children. I understand that the idea of giving children supplementary fluoride to prevent dental caries dates from the 19th century, and was conceived after the discovery of fluoride in a mammoth tooth in 1803.
Sadly, history does not relate which toothpaste the mammoth used or whether it was alive when it was discovered. But since then medical opinion has remained divided on how best to emulate the mammoth. Fluoride, as has been mentioned, is a poison, and we are talking about adding a poison to the water supply in quantities that exceed those already existing. Although many scientists and dentists believe that it can help to reduce dental decay, there are clearly those who do not agree with them.
It is argued that although fluoride may help children for a limited period of their growth, it is injurious to the body and is a possible contributory cause of certain diseases, including— it has been suggested in some quarters— cancer. Indeed, dentists warn that there are positive dangers to young children from the excessive use of fluoride toothpaste. I think that those dangers will be exacerbated if fluoride is also to be added to the water supply.
Mr. Winter, of the department of children's dentistry at the Eastman dental hospital, has made the following point:Recent concern has been expressed about the possibility of young children ingesting sufficient fluoride toothpaste to result in dental mottling"—which we have already heard is a disease in itself—This could happen by over-enthusiastic loading of the toothbrush by parents, or by young children gaining access to119toothpaste which they eat freely. While there is no direct evidence of dental fluorosis from the ingestion of fluoride toothpaste alone, it may contribute to the problem, especially if children have been given fluoride supplements since infancy.Mr. Winter goes on to say:Further research is certainly required to clarify this matter.That is at the heart of the point made by those of us who oppose the measure. Further research is still required. We do not believe that the subject has been fully explored.
In this debate Lord Jauncey seems to have been used much like the Bible. He has been quoted by all sides. But among other things, on page 79 he said:Counsel for the Petitioner submitted that I could only reject the epidemiological case if I were satisfied that there was no possibility of fluoride causing cancer. I could not be so satisfied on the evidence in this case, and indeed proof of such a negative would be very difficult if not impossible.Another argument which he advanced was that fluoridation would probably cause dental fluorosis and mottling of the teeth, the first sign of fluoride poisoning. This is a medical opinion and proves that the weight of evidence is not wholly on one side.
Fluoridation can also render water too impure for use in kidney machines. On that Lord Jauncey said:I am not going so far as to state that no chronic renal failure patients with a kidney function reduced to 20 per cent. or less will ever suffer any harm from drinking fluoridated water. This is a possibility.He did not say that it was likely, but he did say that it was a possibility.
Lord Jauncey continued:I consider that the Petitioner is well-founded in submitting that drinking water fluoridated to one part per million can, in some circumstances, cause enzyme inhibition.Enzymes are vital to life's process, particularly for young children and the unborn. The inhibition of enzymes can cause birth defects, infant mortality and genetic damage. One of the major causes of cot deaths is a deficiency of oxygen-carrying enzymes. These are inhibited by fluoride. This is a possibility and no one knows definitely whether it is not so. The highest incidence of cot deaths in the world is in Australia, which is completely fluoridated. There is a possible connection.
I do not argue that evidence exists that fluoride causes damage. I argue that there is evidence that the case is not proven, as my hon. and learned Friend the Member for Perth and Kinross (Mr. Fairbairn) said.
In 1977, Chile ceased fluoridation because of the clear increase in infant mortality in areas subjected to fluoride in the water. Sir Arthur Amies, emeritus professor of dental medicine and surgery at the University of Melbourne, said:The case against fluoridation medically requires only such evidence as is necessary to support a reasonable doubt. Where the public is concerned, no reasonable doubt can be ignored, and the doubt about fluoridation is more than reasonable, it is considerable.I am not a medical expert in these matters. I might benefit from further advances in dental medicine. However, the duty of the House is to examine the evidence worldwide. I do not believe that the case is proven. I do not believe that we have reached total certainty in medicine.
§ The Parliamentary Under-Secretary of State for Scotland (Mr. John MacKay)
The law of Scotland would have allowed Lord Jauncey to return a verdict of not proven, but he did not do that. I shall not bore my hon.
120 Friend by reading out his conclusions, but there is no doubt about them. My hon. Friend does Lord Jauncey a disservice in relation to his judgment.
§ Mr. Howarth
I am grateful to my hon. Friend. The House will be grateful for the fact that he does not intend to read out the whole judgment by Lord Jauncey. I am aware of Lord Jauncey's conclusions, but we must take cognisance of the points that emerge from those conclusions. The case is not 100 per cent. proven.
§ Mr. John Patten
My hon. Friend has drawn heavily on supposed evidence from Australia. Will he recognise that the supposed link between cot deaths and fluoride was closely examined by the health and medical research council in Australia, which in 1979 definitely found that there was no such link? Secondly, will my hon. Friend recognise that Sydney, which has had fluoridated water since 1968, has the lowest incidence of cot deaths anywhere in that continent?
§ Mr. Howarth
I am grateful to my hon. Friend. The fact is that Australia does have the highest incidence of cot deaths. However, I accept my hon. Friend's point and I am sure that the House will appreciate his having taken that opportunity to make it.
My principal point is that made by the hon. Member for Makerfield and several of my hon. Friends. Even if the medical evidence were completely in favour of the addition of fluoride, there remains a deep-seated philosophical argument against it, as advanced by my hon. Friend the Member for Ynys Môn (Mr. Best). That argument is akin to the seat belts argument, which has also been mentioned. If I had been a Member of the House at the time it considered whether to make the wearing of seat belts compulsory I would have voted resolutely against it. I wear seat belts everywhere I go in a car, but I am resolutely opposed to making people wear them against their wish. That is not part of Conservative philosophy, nor is it part of Conservative philosophy to put medicines in the water supply.
I shall not go further into the arguments about the addition of chlorine, and so on, which is to make water pure, and the addition of something which has been added for one specific purpose only, which is to resolve the problem of dental decay.
Mention has been made already, somewhat unfairly I am sorry to say, of the confirmation that was given some years ago by my hon. Friend the Under-Secretary of State; no doubt he will refer to that when he replies.
§ Dr. M. S. Miller
If, at some time in the future, a group of scientists were to say that for the past 20 or 30 years they had been working on a substance which, if added to water in small quantities, reduced the incidence of coronary thrombosis by 10, 20 or 50 per cent. but which many experiments had shown did not produce any ill-effects, would the hon. Gentleman look favourably on introducing that substance into the water?
§ Mr. Howarth
That is a hypothetical question. It would depend on whether there were other means of treating the ailment or whether the treatment could be taken in some other form.
The fundamental point of principle is that if something were added to the water supply which helped 10 per cent. of those who suffer from coronary thrombosis, one would have to examine the other options. If there were none, I 121 should have to consider that. I hope that I do not have a closed mind on such matters. However, a fundamental principle is about to be breached, and I do not wish to be a party to that.
If the measure goes through, people will not be able to decide for themselves. Henceforth, they will have no choice but to take fluoride in the drinking water and with their cooking.
Moreover, fluoride has side effects, or at least some feel that it does. We do not know how many suffer from side effects caused by fluoride in the water supply. All I know is that one of my constituents feels that he has suffered from fluoridated, contaminated water in Wales. He was ill as a consequence. Others have had similar experiences. I suppose the advice to him would be to move his holiday home from Wales to Northern Ireland which is excluded from the Bill and continues to enjoy a water supply unfettered by the compulsory addition of fluoride.
Those who believe that fluoride helps to reduce caries have plenty of alternative options open to them. They can use a mouth rinse, or toothpaste, 98 per cent. of which contains fluoride. People have a choice. I can still buy toothpaste that does not contain fluoride if I wish. Or they can take the tablets which I have here in my hand. My wife and I gave those to our children because we believed that that was the right thing to do although we have stopped doing so because we now have doubts about the matter. But that decision was up to us as parents with an informed view. Incidentally, if a child took all the tablets in one go, serious danger could result. [Interruption.] Whatever is said, this is a medicament being put in the water supply.
There is the possibility that milk can carry fluoride. The Borro Foundation provides that service, and when I asked the Secretary of State for Education and Science if he thought there was a case for making that service available to school children—from choice, not compulsorily—he replied that he did not have that in mind.
We must not lose sight of the cost. It will cost £500,000 in the west Midlands to fluoridate the water supply. That money could be better spent increasing the amount of money available to dental hygienists. Indeed, a dental hygienist has done more for my teeth than fluoride tablets or any other medicament.
Trouble with children's teeth results from the fact that parents are not teaching then how to brush their teeth and what to eat. Too many parents buy off their children in the supermarket, giving them too many sweets, and we know how bad sweets are for teeth. The hon. Member for Makerfield pointed out that dental hygiene can resolve the problem. If people take all the fluoride in the world—in the appropriate doses, of course—but do not properly maintain their teeth, we shall still have a nation suffering from dental decay.
In my view, the medical case has not been proven beyond all doubt for a gigantic step of this nature, which will result in every person being obliged to consume fluoride, unless the water is taken out of a bottle. This is the thin end of the wedge. We shall be setting a dangerous precedent which we shall rue in the future. I hope, therefore, that hon. Members in all parts of the House will join me in voting against the Second Reading.
§ Mr. Alan Williams (Swansea, West)
Even if fluoridation were proved to be absolutely safe and even if it were claimed to be a treatment for complaints far more 122 serious, I should still insist that the House must address two major issues which overwhelm the poor arguments we have heard in favour of fluoridation.
The first is that of compulsory mass medication versus individual choice. The second is that of democratic decision versus bureaucratic imposition. I am surprised that the occupants of the Government Front Bench, unlike many of those sitting behind them, can have the effrontery to suggest that there is even a question to be answered on the issue of democratic versus quango decision. as they, after all, occupy their present elevated status after fighting two general elections on manifestos opposing quangos, insisting on the need to cut back on them and to diminish their authority. I assume, therefore, that the democratic argument is established.
We come to the argument of democratic choice. There is a major difference between adding substances to water to make it drinkable and adding substances for any other reason. It is difficult to explain why teeth complaints should be treated differently from any other form of medical hazard that faces us. A person can discharge himself from hospital—
§ Dr. M. S. Miller
I ask my right hon. Friend to be more careful about definitions. He has talked about drinking water, but any water is drinkable. He was referring to water that is safe to drink. Any water that is not fluoridated is not safe to drink.
§ Mr. Williams
We are talking about the compulsory and unnecessary adding of fluoride to drinkable water in areas where it is not added now, one of which I represent. I have opposed, successfully until now, the introduction of fluoridation in my constituency. As others have said, we no longer insist on vaccination, even against killer diseases. We do not force feed those who decide that they will allow themselves to die through starvation. We do not impose medication in any form on others unless a special legal process has been undertaken through the courts.
The hon. Member for Ynys Môn (Mr. Best) made a legitimate point when he asked why we had not banned smoking. It was suggested that we have not banned it because people like to smoke. I ask my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) to pass me a glass of water.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I pass my right hon. Friend a glass of water that is guaranteed fluoride-free—but I have spat in it.
§ Mr. Williams
It has been said that we should not ban smoking because people like to smoke. We have said to those who like to smoke marijuana that we shall not allow them to do so. We have recently imprisoned someone who liked taking cocaine. It seems that it was not his intention to peddle it to others but to take it himself, and we said that he should not do so. That argument is not tenable.
The hon. Member for Ynys Mon advanced legitimate and worrying arguments about precedent. If I had not been worried about the arguments before I heard what he had to say, and if I had not been convinced by his remarks, I would have been convinced of his case by the interjections that he had to face from those who disagreed with him. There were those who referred to antacids and said that we cannot add antacids to water. That is not the issue. The question is whether we would do so if we could. The imputation is that some hon. Members would. Should we 123 accept additives to water for certain heart conditions? There are those who say that they would if it were possible to do so. The list is lengthening.
The hon. Member for Ynys Mon asked about the possibility of adding tranquilisers and there was the interjection "Why not?". When it was suggested that there could be the introduction of certain chemicals via the air, the argument was raised that that would not be controllable. That means by implication that if it were controllable it would be acceptable.
What makes the avoidance of minor problems of the teeth—
§ Mr. Williams
Yes, minor problems. What makes them more important in health terms than any other health consideration? If fluoride is so effective, the duty in a democracy is not to impose it on people but to make people aware of the benefits available to them by using fluoride in some other form. The duty is not to impose fluoride but to allow people to make a choice. I am opposed to the Government's proposal because it does not give people that choice.
§ Sir Ian Percival (Southport)
I have listened to almost the whole of the debate and with great interest, and on occasions I have been impressed by some of the arguments of those in favour of the Bill. However, having listened to it all, I come to the opposite conclusion, and shall vote against this legislation.
The subject with which we are dealing can be reduced to simple propositions. My right hon. and learned Friend the Minister for Health rightly described the process of adding fluoride to water as "preventive medicine" and "a public health measure". The purpose is to prevent damage to health which might be suffered by some people, and it is no good anyone seeking to put that any other way.
It is equally clear that fluoridation is compulsory mass medication. We must all drink water, so if the water in our area is medicated, we must drink it—whether or not it will do us any good and, indeed, in the knowledge that many people cannot possibly obtain any benefit from it. The question we have to face is whether any arm of authority should be given the right to subject all the people in a given area to that medication so that those who might benefit do so?
On the face of it, the most powerful argument was that unless we do fluoridate the water, young people might be denied the opportunity of having less trouble with their teeth. My hon. Friend the Member for Cannock and Burntwood (Mr. Howarth) demolished most of that argument, so that I need refer to it only briefly. There are other ways of obtaining for our young people the benefit of fluoride's value— toothpaste, tablets, and so on. What is really being said is: "Because we do not trust parents or health authorities to do the right thing, we must step in and wet nurse them to ensure that the young people get that fluoride although millions of other people who do not receive any benefit will have to drink the fluoridated water as well." The House must face that issue in deciding whether to pass this legislation.
I have been a Member long enough to pay great attention to the views of the right hon. Member for South 124 Down (Mr. Powell). I was impressed by the fact that, although the points I made are well known to him, he came to a different conclusion. I respect his concern for freedom of the individual. His concern is as great as that of any one else. The right hon. Gentleman nearly, but not quite, persuaded me.
Further, even if the arguments of the right hon. Member for South Down were sufficient to overcome those hurdles, there is one more which is conclusive. If any arm of authority were to be given the right to take this action, it must be a democratically elected body to which the electors can make known their views. If that body acts contrary to the views of the electorate, they can exercise control in the next election. Nothing short of that process will do. Since it is central to the Bill that a health authority is the body to which the right is to be given—and as that is by no stretch of the imagination an "elected body"—that consideration is fatal to the Bill. I shall vote against the Bill, and I urge my right hon. and hon. Friends to do so also.
§ Mr. Edward Leigh (Gainsborough and Horncastle)
I have a few questions to ask the Minister, which I can put in literally two minutes.
First, given that every human being is largely made up of water, has not every individual a right to drink water the treatment of which has been limited to cleaning? Secondly, is the fact that fluoride occurs naturally somewhere, an argument that it should be imposed on everyone everywhere?
Thirdly, accepting that water itself does not cause decay and that people cause decay to their teeth by their eating habits, what is the logic in saying that their eating habits should be exercised according to choice, and their drinking habits according to compulsion? Fourthly, are there not ample opportunities for individuals to apply fluoride to their own teeth?
Fifthly, if it is said that the decision to administer fluoride should be made locally, is it not right that water and health authorities are appointed and not elected? Sixthly, if fluoride is considered desirable, why should not other drugs, substances or chemicals be applied? Why should the line be drawn after fluoride? Where is the logic in that?
Seventhly, is it not a fact that far from fluoride benefiting everyone, it benefits only some, that is, children? Eighthly, is it not true that some doctors and researchers still have doubts about the safety of fluoride? Is it right, therefore, to make it compulsory?
Ninthly, is it not true that whether or not fluoride is dangerous, some people still consider it to be dangerous? Some of my constituents said to me that it affects their health. Why should they be forced to take it, even if their fears are groundless? Tenthly, do not people have the right to choose?
§ Mr. Ivan Lawrence (Burton)
I sense some restlessness in the House and know that all hon. Members wish to draw the debate to a conclusion. I hope that I shall not be criticised if I do not attempt to make the definitive anti-fluoridation speech.
I hope that that is not a misjudgment, because I cannot help feeling that the Government have misjudged the debate. The first misjudgment was that the debate would 125 achieve so little interest that it could begin at 7 o'clock and be expected to end at 10 o'clock. That may show that the Government are not with it regarding public feeling about the fluoridation issue. The second misjudgment relates to my hon. Friend the Parliamentary Under-Secretary who, at one stage, so misjudged his prospects that he thought he would never become a Minister, still less a Minister in the Department of Health and Social Security, and committed himself to a document supporting the antifluoridation case.
I shall address myself to some points that have recurred during the debate. The first relates to the question of the safety of fluoridation. It is perfectly clear that some people consider fluoride to be absolutely safe. The Minister for Health told us that a massive amount of research was examined by his advisers, whose conclusion, that there is no jot or tittle of reliable evidence to show that fluoridation is safe, and can be relied on. For every expert, scientist or doctor who has committed himself to writing to say that there is no evidence to suppose that fluoridation is unsafe, I can produce a doctor, scientist or expert who has produced a report to say that it is unsafe.
Furthermore, I draw the attention of hon. Gentlemen who support the Bill and say that Lord Jauncey in a lengthy case has come to the conclusion that it is safe, to three judges who have held the contrary view. In May 1982 Judge Ferris, hearing a case in Houston, said that artificial fluoridation of public water suppliesmay cause or may contribute to the cause of cancer, genetic damage, intolerant reaction and chronic toxicity, including dental mottling in man…and may aggravate malnutrition and existing illnesses in man.That is the decision of a judge who heard the same kind of evidence from the same kinds of witnesses as produced the alternative conclusion from Lord Jauncey.
In Illinois, Judge Ronald Niemann said thatthe artificial addition of fluorides to the public water supply may have adverse health effectsand that itexposes the public to a risk, uncertain in its scope, of unhealthy side effects".That was in February 1982, and that is contrary to the conclusion reached by Lord Jauncey.
In Pittsburg. Pennsylvania, in 1978, Judge Flaherty said thatartificial fluoridation of public water supplies is deleterious to human life and health.He was considering precisely the same sorts of witnesses as Lord Jauncey considered.
That is not all, for at the end of a 210-page report, prepared for the Ministry of the Environment in the Province of Quebec in 1979 by an advisory committee which consisted of a number of experts, it was said of the fluoridation of water that itposes serious dangers to health and has not proved to be a very effective deterrent to dental caries".I draw those judgments to the attention of the House, and I shall not weary the House with a long list of research projects throughout the world which indicate that fluoridation is unsafe for all kinds of reasons. I merely make the point that it seems to me that we in this House are not fitted to make judgments of scientific detail and that, where leading scientists cannot agree that fluoridation is safe, there must be a doubt.
The chlorination of water saves people from dying of typhus or some other illness, and one assumes that everyone is in favour of chlorination, but here we are 126 dealing only with the reduction of dental caries in children's teeth. It may be painful. but it can be reduced by a number of other means, as we have heard.
We have heard an argument about whether fluoridation is beneficial. I do not propose to go into that in any great depth. but the figures produced by scientists to show that there has been a beneficial reduction in dental caries in children's teeth since the introduction of fluoride in this, that or the other area, can usually be interpreted in two ways.
Reference has been made to the Birmingham figures. All one can say about those figures is that since fluoridation there has been a threefold increase in the number of temporary fillings, and that in permanent fillings there has been neither an increase nor a decrease, despite many years of fluoridation.
Most of the conclusions that have been drawn in favour of the beneficiality argument have been on the most fallacious of all logical inaccuracies— post hoc ergo propter hoc: that because since the introduction of fluoridation, there has been a fall in caries in children's teeth, therefore that fall is due to fluoridation. The problem with that argument is that in some parts of Britain where there has been a comparable decline in dental caries in children's teeth—I cite particularly the Isle of Wight—there has been no fluoridation of the water supply. That leads one to the conclusion that it may well be that more attention to the brushing of teeth, more attention to diet, and more attention to the consumption by children of sugary substances, may have much more to do with the reduction of dental caries in children's teeth than the fluoridation of water has ever done.
I shall not labour the point, but I do not concede the argument— whether it has been made by my hon. Friends or Opposition Members— that it is beyond peradventure that the fluoridation of the water supply benefits teeth. It is very much a question of doubt whether it does. We know that it hardens the teeth. Whether it improves them or delays the onset of dental caries for longer than two years, which is what one scientific report in Britain said, one does not know, but it has not been proved beyond doubt.
My right hon. and learned Friend the Minister for Health began by telling us that he, his officials and his experts had been into the the question of fluoridation with such great care that we could rely upon them, because no stone had been left unturned and they had investigated every criticism that had been made. The trouble is that they have totally neglected to do any research into the one really important aspect of the effect of fluoridation—how much of a dose anybody will receive.
We do not all drink the same amount of water, at one part per million. We do not all drink beer or tea that has fluoridation. We do not all eat the same food that has been treated or processed with fluoridated water. There is at least one professor in this land who says that the cumulative effect of cooking and processing food in fluoridated water deposits a far higher degree of fluoride in the bones than anybody imagines. It is cumulative, and is not passed out of the system. Nobody knows how much fluoride we ingest through the air when we breathe.
Therefore, since it is conceded that fluoride ingested into the system at two, three, four or five parts per million can be highly poisonous, and since nobody knows or could possibly know how much fluoride there is in the system in any dose, which is an area of research upon which little 127 work has been done, that gives no confidence and should not inspire any confidence in us that a great deal of work has been done on one or two other issues.
We have discussed whether the measure is democratic, undemocratic or does not matter. I can only recount some experiences from my part of the country, where the Severn-Trent water authority and the South Staffordshire water works company decided, on the demand of the area health authorities, to fluoridate the water. The Government said that they would wish it to be fluoridated only with the consent of the local people concerned, but when the democratically elected Staffordshire, Shropshire, Gloucestershire, Herefordshire and Worcestershire county councils said no, that was ignored by the water and health authorities. When the district councils of Newcastle-under-Lyme, Stafford, South Staffordshire, East Staffordshire, Lichfield, Cannock Chase, Tamworth and Stoke-on-Trent in Staffordshire all said no, that was ignored by the water and health authorities, which knew better. Oswestry, North Shropshire, South Shropshire, Shrewsbury and Atcham, The Wrekin, and Bridgnorth in Shropshire all said no. Malvern Hills, Wychavon and Worcester in Hereford all said no. Whenever a responsible public opinion poll has been taken, which refers to matters other than saving the health of people's teeth, and people have been asked whether they want the water to be fluoridated, everybody has said no. There is absolutely no doubt that the overwhelming majority is against fluoridating the water.
There have been all sorts of bogus polls. We are taking the powers away from democratically elected people and giving them to water and health authorities, which not only are not democratically elected, but are removed from the locality. That is no answer. To pretend that that is democratic is bogus. We know perfectly well that representative bodies have been appointed in the USSR, but no one on the Front Bench would call that a democratically elected state. The argument about democratic elections and the will of the people is highly significant and militates against the Bill.
Finally, there is the question of freedom. When I first came to the House I could not have cared less about fluoridation. I then sat on the Select Committee and found that witnesses who assured us that fluoridation was beneficial and safe could not answer simple questions to show that they knew what they were talking about. Only then did I begin to smell a rat and to realise that there was more to this than we had been led to suppose. People who are worried about this are concerned, above all, whether it is an infringement of their freedom. In this context, it was sad to hear the right hon. Member for South Down (Mr. Powell) trying to justify a decision that he made many years ago on the ground that fluoridation was not mass medication. He and I have fought together in various battles, notably with regard to seat belts. I see no significant difference between the interference with individual' liberty in that case and in the individuals decision as to whether he or his children should take a particular medicine.
Others have argued that only a tiny bit of freedom is involved, so it does not really matter. That is exactly the argument that we had in relation to seat belts. There is no such thing as a tiny bit of freedom. There is the principle of freedom or no freedom. It is a seamless web, and degree 128 is irrelevant. What matters is whether we are prepared to stand up for the liberty of the individual, which can so easily be eroded. If Governments are allowed to say, through the medical authorities, not "This is a medicine that we advise you to take "but "This is good for you and you must take it", who can say where that will lead? We should be saying, "This is good for children's teeth and, even though you are not a child, you will take it", and "Even though you have no teeth, you will take it. but that is only a little infringement of liberty because people without any teeth cannot possibly be harmed by it."
John Stuart Mill said that the individual is sovereign over his own body and mind, and I believe that the right hon. Member for South Down has made similar references to the importance of safeguarding small freedoms. If we infringe freedom in this way, where will the process end? Will doctors tell us that because in their view it is good for us to take vitamins— tranquillisers, stimulants, contraceptives or whatever— we shall have to take them? Once we give that kind of licence to administrators, very little of our freedom will be left in a very short time.
That is no doubt why of all the countries of Europe which might be expected to fluoridate their water, if it were as beneficial as we are told, only the United Kingdom and Eire do so. Austria, Greece, Norway, France and Spain do not. Belgium, Holland, Germany and Sweden used to do so, but have stopped, as have hundreds of cities in the United States.
I invite the House to accept the overwhelming strength of the arguments against the Bill and to vote against it. I remind my hon. Friends that it is a free vote. I hope that members of the Government will bear in mind, too, the sensitivities of those in the Government who in the past, on the question of freedom, if on no other issue, have expressed their opposition to the proposition in the Bill.
§ Mr. Ray Powell (Ogmore)
I do not intend to detain the House for long. I have listened to most of the debate and I think that most of the points at issue have been well and truly covered.
When I found myself in agreement with the hon. Member for Ynys Mon (Mr. Best), I thought I had better leave the Chamber and read my notes to determine whether I would be going into the right Lobby. I must say that I share the sentiments that he expressed. Indeed, many Conservative Members have expressed the right and proper view on the Government's introduction of this proposal.
A few questions have been overlooked. One is that the Bill suggests that the public water supply is maintained at 1 mg per litre. The Minister is a past Welsh water authority employee of 10 years' standing. I ask him how it is possible to measure that degree of fluoridation in a reservoir, or in the water supply at the outset, when there is a drought? Recently reservoirs in Wales dropped to 10 per cent. of their normal capacity, and there would have been great difficulty in measuring the degree of fluoridation in such a position.
§ Mr. John Patten
The Department of the Environment regularly checks the fluoride levels in reservoirs. I am advised that there is no danger whatever of adverse levels of fluoride creeping into water supplies either during a drought or at any other time.
§ Mr. Powell
That might be what the Minister says, but it is not my information from chemists within the water industry. There is great difficulty in ensuring that that can be done. The consumers will never have the guarantee that that will be the level of fluoride in the water that will come out of their taps. There are a number of reasons for that, and the matter needs further investigation.
The Bill suggests that no additional public expenditure will be involved. If we add a substance to a water supply, who pays for it? Will it come from public expenditure? If it comes from the water authority budget, that is obviously public expenditure.
The decision whether fluoride should be added to the water supply will he made either by the health authority or by the water authority. I have listened to a number of speeches, especially those of the hon. and learned Member for Burton (Mr. Lawrence), the hon. Member for Ynys Mon and my right hon. Friend the Member for Swansea, West (Mr. Williams). Most Conservative Members were opposed to quangos when the Government took power in 1979. Indeed, in 1979 the area health authorities and the water authority in Wales were far more democratic than they are today. Elected representatives of local authorities served on both bodies in 1979, but some of those positions have now been filled by appointments made by the Secretary of State for Wales. Therefore, it is not elected bodies that are making decisions. The hon. and learned Member for Burton covered a number of points when he asked how many elected councils—borough, district and county—that have opposed the adding of fluoride to the water supply have been overruled by quangos.
I shall vote against the Bill primarily because, as other hon. Members have said, it is the basic individual right of the individual, and the public in general, to determine whether or not to have fluoride in his water. Therefore, all hon. Members should be going into the No Lobby, to show the Government quite forcefully that we have no intention of allowing this measure to be passed.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I have to tell my hon. Friend the Member for Ogmore (Mr. Powell) that I for one will not be going into the No Lobby, because I support this limited measure.
I start by declaring an interest—I do not like going to the dentist. I never did like going to the dentist, and I do not wish the pain and suffering of going to the dentist on anyone else and, above all, on children. I am firmly of the opinion that a vote for this Bill is a vote against a child's toothache. Those hon. Members who wish to vote against it should bear that in mind.
Some hon. Members came to the debate late and said that they had not heard arguments that fluoride in water does helpfully affect children's teeth. If they had listened to the Minister, to my hon. Friend the Member for Oldham, West (Mr. Meacher), or to other right hon. and hon. Members at the beginning of the debate, they would have heard a vast and adequate array of information, which should have convinced anyone who was prepared to be convinced. Although I may be tedious, I have no intention of being repetitious, and I shall not go through points that were made at the beginning of the debate. Those points are wholly convincing, and the evidence from a place as close as Birmingham is especially convincing to me and to anyone who looks objectively at the evidence. There have been massive improvements in 130 the health of children in Birmingham, directly and only as a result of the introduction of fluoride into the water in and around that city. Those who spoke earlier showed that in the quantities proposed, fluoride is not injurious to anyone's health.
Fluoride, it has been said, is available from other sources. It can be applied by a dental technician or a toothbrush. It can be provided by tablets, as waved at us by the hon. Member for Cannock and Burntwood (Mr. Howarth). I note from the Times parliamentary guide that he is listed as an international banker. The well-off and well-informed international bankers of this world may have the information to lead them to give the tablets to their children to make them free from dental caries. The hon. Member for Cannock and Burntwood, and every other hon. Member, has an obligation to the children of the worse-off, and worse-informed, who are likely to get fluoride only through the water system. My hon. Friends should bear in mind the condition of the teeth of the worstoff in their constituencies before they vote against this limited measure.
§ Mr. McGuire
Is my hon. Friend seriously suggesting that if fluoride is added to water, those poorly off children can forget about dental hygiene—[Interruption.] I am asking my hon. Friend whether he believes that there is any benefit in neglecting dental hygiene.
§ Mr. Dobson
For a start, if during pregnancy their mothers drink water with fluoride added to it, their milk teeth will be in a better condition. There is no other way of getting that fluoride into the system. Secondly, we all know— even my hon. Friend the Member for Makerfield (Mr. McGuire) knows—that the worse-off and the worst-informed members of the community have most difficulty in developing eating and cleansing regimes properly to look after their teeth. We must bear that in mind when we discuss this matter.
Some people believe that this is a trivial matter. and that because dental caries does not kill people outright—I understand that it can indirectly lead to death—it is not worth the candle. However, some hon. Members would jib even at the idea put forward by my hon. Friend the Member for East Kilbride (Dr. Miller): that if we discovered an element that was completely safe, and that prevented heart disease or cancer, we should put it in the water. Some hon. Members might change their minds if they heard of such an element, but others would still say that it represented terrible, compulsory mass medication.
Other hon. Members have talked about this being an invasion of civil liberties. I do not have the document with me, but I can refer hon. Members to it and they can look it up later: in the city records of Nottingham we discover that the self-same arguments that have been mounted tonight against the introduction of limited quantities of fluoride in water were used by the semi-elected lord mayor and several aldermen in the 19th century, when the first medical officer of health said that we needed a decent clean water supply to get rid of typhoid and cholera. Those people talked about it being an invasion of people's rights to provide them with something that would stop them getting sick, but it was a step forward from which we have all benefited.
Most Conservative Members would bow to the right hon. Member for South Down (Mr. Powell) as an ardent 131 champion of civil liberties from a Right-wing point of view. They were rather disappointed when he, in his prophetic mood and reminiscent vein, rose tonight. I wish to reply in kind. The prophet arose and his erstwhile admirers flocked to hear him speak, but they were cast down and sorely disappointed, for verily did he speak in favour of fluoride and made it clear that he intended to pass by on the other side. The right hon. Member for South Down did confess that he was the Minister for Health who helped introduce artificial fluoride into water; he said that he was pleased that he had done it, and he believed it to be justified. That at least is clearly not a matter that he does not wish to be revealed by the operation of the 30-year rule on Government documents.
We have also heard the argument that there is no choice for those who drink water that has had fluoride introduced into it. But in the past, as part of the system of preventive medicine, we have given people no choice. There used to be no choice with some vaccinations. It was decided, rightly, under the powers given by the House, that some diseases could be eradicated only if vaccination were compulsory. Those schemes were successful. Contrary to what was suggested by some Conservative Members, that was not done only to provide protection for the person who was vaccinated. It was also intended to ensure that he or she did not pass on a disease to someone else. Some Conservative Members have claimed that we have had no system of preventive medicine in which there was no element of choice. That has happened; society has insisted that it was right to protect everyone by compulsory vaccination.
None of the opponents of the Bill can deny that a legion of chemicals are introduced into the water supply to make it clean and to stop the water making people sick. All that we are saying is that dental caries will be coped with if limited quantities of fluoride are put in the water.
I support one aspect of the civil libertarian case. I object to the idea of someone in authority introducing a substance into the water supply without public consultation or knowledge. It would be useful if the Government agreed to accept amendments in Committee to provide that if a health authority wished to recommend to its water authority that fluoridation should be introduced, that health authority's debate should take place in public and that the same should apply to water authorities.
§ Mr. Dobson
No. If Conservative Members are so worried about that aspect of water authorities' activities, I hope that they will vote for the Water Authorities (Meetings) Bill which has been introduced by my hon. Friend the Member for St. Helens, South (Mr. Bermingham).
The Bill before us is a limited measure. Many people strongly believe in extending preventive medicine and think that the law should not merely be declared to be what everyone has thought it to be, but should be changed so that if a health authority asks a water authority to put fluoride in the water supply, the water authority should be compelled to comply.
The Bill does not go that far. It simply reasserts what everyone has thought to be the law. If it is not approved, areas such as Birmingham, where people are already 132 benefiting from the introduction of limited quantities of fluoride, will no longer enjoy that benefit. I hope that most of my hon. Friends will join me in voting for the Bill.
§ 12.8 am
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
We have had a long and interesting debate, which Ministers from the DHSS, the Scottish Office, the Welsh Office and the Department of the Environment have followed carefully.
Three threads have run through the debate— the benefits or otherwise to dental health of adding fluoride to the water supply, the safety of adding that mineral to the water supply and the important issues of personal freedom and liberty. I do not underestimate the strength of feeling of many of my hon. Friends on those issues.
I have noted with care what was said by my hon. and learned Friend the Member for Perth and Kinross (Mr. Fairbairn), my right hon. and learned Friend the Member for Southport (Sir I. Percival) and my hon. Friends the Members for Ynys MÔn (Mr. Best), for Tiverton (Mr. Maxwell-Hyslop), for Cannock and Burntwood (Mr. Howarth) and for Gainsborough and Horncastle (Mr. Leigh), though I doubt whether I shall be able to answer all 10 of the points put by my hon. Friend the Member for Gainsborough and Horncastle.
Last but not least I must mention the points so powerfully made in support of the arguments of personal liberty by my hon. and learned Friend the Member for Burton (Mr. Lawrence), who is a powerful advocate of the case against the sort of addition to the water supply that the Bill attempts to establish.
But just as I appreciate the arguments with which I do not agree, I welcome the support given to the Bill by right hon. and hon. Members from all parties, with the exception, I believe, of the SDP whose voice we have not heard. We had detailed support from the right hon. Member for South Down (Mr. Powell), who wound back the clock and told us what made him, as a former Minister for Health, decide in favour of this form of addition to the water supply despite his deeply held views about the doctrines of personal liberty. I also welcome the support given by my hon. Friend the Member for Harrow, West (Sir J. Page), and by the hon. Member for Leeds, West (Mr. Meadowcroft) on behalf of the Liberal party—that party also seems to have a free vote tonight—as well as by my hon. Friends the Members for Bournemouth, East (Mr. Atkinson) and for Derbyshire, South (Mrs. Currie) and by the hon. Member for Brent, South (Mr. Pavitt).
In my brief concluding remarks, I shall deal with each argument in turn. I have not heard any hon. Member advance any argument tonight that would lead me to move one jot or iota from giving my full support to what my right hon. and learned Friend the Minister said in advancing the powerful case in support of dental health. It would be otiose to repeat the arguments that he has already put so well. Those arguments have received support from the hon. Members for Holborn and St. Pancras (Mr. Dobson) and for Oldham, West (Mr. Meacher). I just hope that the general management committee in the constituency of the hon. Member for Oldham, West does not read Hansard and see that he is commended and supported by the right hon. Member for South Down. I do not know how well that would go down in Oldham, West.
I do not quite know what the oft-quoted Lord Jauncey would make of all the ways in which gobbits and bits of 133 his opinions have been used by right hon. and hon. Members, sometimes in favour and sometimes against the Bill. But one fear consistently underlying the debate on dental health was that somehow the addition of fluoride to water—whatever benefits it might have—would lead to dental mottling. In his judgment after the longest legal case in Scottish history lasting 201 days, the learned judge said:there is likely to be a very small increase in the prevalence of mottling of a type which will only be noticeable at very close quarters and which is very unlikely to create any aesthetic problems for the owners of the teeth.The learned judge was absolutely right in his judgment.
I come to the important issue of safety. Again, I stand four square behind everything that my right hon. and learned Friend the Minister had to say. The whole scientific community constantly and rightly keeps any additions to our diet or water supply, and any forms of new or old drugs that are available on the market, under surveillance. Any scientist worth his salt would move very fast to publish any damning evidence that shed light on the safety, or lack of it, of any substance freely available on the NHS, or available privately. No such evidence has been forthcoming from any quarter in this country or abroad.
However, my hon. Friend the Member for Ynys MÔn asked several detailed points, to which I shall respond. He said that Lord Jauncey had suggested in his judgment that perhaps fluoride should fall within the ambit of the Medicines Act 1968. Lord Jauncey did not accept that supply without a products licence would be in breach of the Medicines Act and rejected that part of the petitioner's case based on alleged contravention of the Act. That is made clear in his summing-up.
My hon. Friend the Member for Ynys MÔn also referred to the indemnity of water authority employees if safety is challenged. The indemnity offered in respect of alleged harm to health is primarily to assist water authorities, which cannot be expected to judge safety issues. That is a health question and the offer of indemnity is a clear example of the Government being prepared to put their money where their mouth is.
§ Mr. A. J. Beith (Berwick-upon-Tweed)
The Minister made an odd statement when he said that the safety aspects cannot be left to the water undertakers but must be dealt with by the health authorities. Does he recognise that the addition of fluoride to the water supply is done by water authorities at many separate sites, some of them small and unmanned and which are monitored only from time to time? Surely water authorities and statutory undertakers have a heavy responsibility. If the Minister says otherwise he will seriously mislead them.
§ Mr. Patten
I wish that the hon. Member for Berwick-upon-Tweed (Mr. Beith) had been here earlier to hear the whole argument. I gave way only to ensure that he votes with the Government this evening. The health authority is responsible for deciding whether the addition of fluoride to water is in the public interest. That is the answer to the hon. Gentleman's question.
Safety issues have been tested in courts of first resort, middle resort and last resort round the globe. My hon. and learned Friend the Member for Burton discussed three cases of judges ruling against the safety of fluoride in the United States. None of the cases were in courts of last resort. No court of last resort in the United States has ruled 134 against fluoride. The issue has been taken to the Supreme Court eight times and on each occasion the safety of fluoride has been advocated by the judges involved.
On safety grounds, as on the benefits to dental health, the Government's case is sound and has been carefully composed. My right hon. Friend the Secretary of State and I would be the first to come forward if there were any doubts at all about safety.
I had doubts about the safety of fluoride in the 1970s.—[linterruption ] I think that I have been caught by the 10-year rule. That remark has caused interest among my hon. Friends, so perhaps I should attempt to explain. In the 1970s a report by the Royal College of Physicians exonerated the addition of fluoride to the water supply. I accepted that. Shortly after, the work of Burk and others cast substantial doubt on the safety of fluoride. I was very worried at the time, as were many of my right hon. and hon. Friends. I had my doubts on safety grounds. In the 1980s those doubts were laid to rest by subsequent scientific evidence. After careful consideration of the evidence on safety no hon. Member could conceivably feel that there is any genuine scientific doubt on the safety of fluoride.
That leads me to the third, the last and the most important issue that is being considered tonight, and that is freedom of choice. In that context it is important to understand that in artificially adding fluoride to the water supply we are in no way introducing a substance which is otherwise alien to us. That is the underlying factor which makes any argument against fluoride based on freedom of choice almost impossible to substantiate.
First, freedom can be seen not to be contravened when we consider that fluoride is widely and naturally present in the human diet. It occurs at particularly high levels in tea. Indeed, as has been said, a heavy tea drinker in a fluoridated area will ingest far more fluoride from his tea than he ever will from the water.
Secondly, almost every toothpaste that is on the market today contains a substantial amount of fluoride at the proper safety level and some 95 per cent. of all toothpastes that are marketed and used, I dare say. by most hon. Members, contain fluoride.
Thirdly, fluoride is naturally present in almost every water supply around the globe. In the United States it exists at levels of up to 13.6 mg per litre, in the United Kingdom, in the West Mercia water area, it exists at levels of up to 5.8 mg per litre; in Austria at up to 5.3 mg; in Italy at up to 3 mg, and so on.
§ Mr. Patten
I am sorry, but my hon. and learned Friend was not able to give way to me and I am af-aid that I do not have the time to give way now in attempting to wind up the debate.
We must also be wary of assuming that drinking water supplies that are not fluoridated do not have other additives. In his opinion Lord Jauncey said:There are some 18 different chemicals which are added to different supplies in Strathclyde and whose purpose is to achieve purity.That helps put the argument on the addition of fluoride into perspective. Governments approve the addition of additives to a range of foodstuffs, whether it be iodine to salt or vitamins to bread. Once one looks at the number of areas in which, with Government and all-party support 135 things are added to our diet and drinks, it is difficult on pragmatic logic to separate out fluoride from any of those other additions.
§ Mr. Fairbairn
All the other substances named by Lord Jauncey in his judgment are intended to help the person who ingests them. Fluoride is added not to help the person who ingests it but others. My hon. Friend has said that the Government's purpose is to advise on what is good and what is not, not to make it compulsory. Why has he changed his mind on fluoride?
§ Mr. Patten
I have explained that.
In order to try to erect some form of suitable philosophical background for what I have had to say I reread my distinguished constituent Sir Isaiah Berlin's important work "Two Concepts of Liberty". I came to the House tonight with an argument erected on that important book, but unfortunately my hon. Friend the Member for Bristol, West (Mr. Waldegrave) told me that Sir Isaiah has recently remarketed his book and increased the number of concepts of liberty from two to four. That was inconvenient from the point of view of anyone suggesting an argument based on concepts of liberty about what we do and do not consume for which it is impossible—I am trying to answer the comments made soto voce by my hon. Friend the Member for Ynys MÔn—to lay down a hard and fast barrier beyond which one cannot go before personal liberties are themselves transcended.
I simply cannot find in my mind any line to suit all places, all circumstances, all situations at all times and say, "If I cross that line, personal liberties are transcended. If I do not cross it, everything is all right." In the end one must make a judgment on, the facts and evidence.
I recognise that there will always be those who genuinely feel that water fluoridation constitutes mass medication and, as such, should not be permitted. Set against that, it is the view of the Government that it is for the responsible bodies which take decisions locally to weigh any alleged interference with the liberty of the individual against the undoubted benefits which we believe future generations will gain in their dental health as a result of water fluoridation.
As with any decision which is taken on a community basis, there will inevitably be those who are disappointed whichever way the local decision goes. Nevertheless, in this strictly limited Bill we are doing no more than restoring the situation to what we understood it to be in Britain before the judgment delivered by Lord Jauncey in the Scottish courts.
As has been stressed, this is a short measure designed to give the responsible authorities the legal power to choose, if they wish, to improve dental health by the fluoridation of water supplies. Nothing new— no compulsion—is introduced by the Bill.
I hope that the House will agree, not least in view of the authoritative evidence we have heard on the safety and efficacy of fluoridation, that this choice should continue to be open to health and water authorities on the basis that has been in operation for the last 30 years.
§ Question put, That the Bill be now read a Second time:—
§ The House divided: Ayes 159, Noes 71.137
|Division No. 62]||[12.28 am|
|Alexander, Richard||Macfarlane, Neil|
|Alison, Rt Hon Michael||MacKay, John (Argyll & Bute)|
|Amess, David||Major, John|
|Ancram, Michael||Marland, Paul|
|Arnold, Tom||Mather, Carol|
|Atkinson, David (B'm'th E)||Maude, Hon Francis|
|Baker, Rt Hon K. (Mole Vall'y)||Mawhinney, Dr Brian|
|Baldry, Tony||Maxton, John|
|Banks, Robert (Harrogate)||Mayhew, Sir Patrick|
|Batiste, Spencer||Meacher, Michael|
|Beaumont-Dark, Anthony||Meadowcroft, Michael|
|Bevan, David Gilroy||Meyer, Sir Anthony|
|Biffen, Rt Hon John||Miller, Hal (B'grove)|
|Boscawen, Hon Robert||Miller, Dr M. S. (E Kilbride)|
|Bottomley, Peter||Moore, John|
|Bottomley, Mrs Virginia||Morrison, Hon P. (Chester)|
|Boyson, Dr Rhodes||Moynihan, Hon C.|
|Brittan, Rt Hon Leon||Neubert, Michael|
|Brooke, Hon Peter||Newton, Tony|
|Buchan, Norman||Nicholls, Patrick|
|Buck, Sir Antony||Onslow, Cranley|
|Burt, Alistair||Osborn, Sir John|
|Butcher, John||Page, Sir John (Harrow W)|
|Carlisle, Kenneth (Lincoln)||Page, Richard (Herts SW)|
|Chalker, Mrs Lynda||Patten, John (Oxford)|
|Channon, Rt Hon Paul||Pavitt, Laurie|
|Chapman, Sydney||Pawsey, James|
|Clarke, Rt Hon K. (Rushcliffe)||Pike, Peter|
|Colvin, Michael||Powell, Rt Hon J. E. (S Down)|
|Coombs, Simon||Powley, John|
|Cope, John||Raffan, Keith|
|Couchman, James||Raison, Rt Hon Timothy|
|Currie, Mrs Edwina||Rathbone, Tim|
|Dalyell, Tam||Rees, Rt Hon Peter (Dover)|
|Dobson, Frank||Renton, Tim|
|Dorrell, Stephen||Ridley, Rt Hon Nicholas|
|Douglas-Hamilton, Lord J.||Rifkind, Malcolm|
|Dover, Den||Roberts, Wyn (Conwy)|
|Dunn, Robert||Robertson, George|
|Durant, Tony||Robinson, Mark (N'port W)|
|Edwards, Rt Hon N. (P'broke)||Rumbold, Mrs Angela|
|Eggar, Tim||Ryder, Richard|
|Eyre, Sir Reginald||Sainsbury, Hon Timothy|
|Fatchett, Derek||Shaw, Giles (Pudsey)|
|Fenner, Mrs Peggy||Shepherd, Colin (Hereford)|
|Fletcher, Alexander||Shersby, Michael|
|Foulkes, George||Sims, Roger|
|Fowler, Rt Hon Norman||Smith, Tim (Beaconsfield)|
|Fraser, Peter (Angus East)||Soames, Hon Nicholas|
|Freud, Clement||Speed, Keith|
|George, Bruce||Spencer, Derek|
|Godman, Dr Norman||Squire, Robin|
|Goodlad, Alastair||Stanley, John|
|Gow, Ian||Stevens, Lewis (Nuneaton)|
|Gower, Sir Raymond||Stewart, Allan (Eastwood)|
|Gregory, Conal||Stewart, Ian (N Hertf'dshire)|
|Gummer, John Selwyn||Stradling Thomas, J.|
|Hayhoe, Barney||Taylor, John (Solihull)|
|Hogg, N. (C'nauld & Kilsyth)||Thatcher, Rt Hon Mrs M.|
|Home Robertson, John||Thompson, Donald (Calder V)|
|Howard, Michael||Thompson, Patrick (N'ich N)|
|Howe, Rt Hon Sir Geoffrey||Thorne, Neil (Ilford S)|
|Hunt, David (Wirral)||Thurnham, Peter|
|Jenkin, Rt Hon Patrick||Tracey, Richard|
|Johnson Smith, Sir Geoffrey||Trippier, David|
|Joseph, Rt Hon Sir Keith||Viggers, Peter|
|Key, Robert||Waddington, David|
|Knight, Mrs Jill (Edgbaston)||Waldegrave, Hon William|
|Lamont, Norman||Walden, George|
|Lang, Ian||Wallace, James|
|Lawson, Rt Hon Nigel||Wardle, C. (Bexhill)|
|Lee, John (Pendle)||Watson, John|
|Lennox-Boyd, Hon Mark||Watts, John|
|Lilley, Peter||Wheeler, John|
|Lofthouse, Geoffrey||Whitney, Raymond|
|Lyell, Nicholas||Wiggin, Jerry|
|McCrindle, Robert||Wilson, Gordon|
|McDonald, Dr Oonagh||Wolfson, Mark|
|Wood, Timotny||Tellers for the Ayes:|
|Young, Sir George (Acton)||Mr. Peter Lloyd and|
|Younger, Rt Hon George||Mr. Tristan Garel-Jones.|
|Alton, David||McKay, Allen (Penistone)|
|Ashdown, Paddy||McKelvey, William|
|Beith, A. J.||Maclean, David John|
|Benyon, William||Maxwell-Hyslop, Robin|
|Bermingham. Gerald||Maynard, Miss Joan|
|Best, Keith||Merchant, Piers|
|Biggs-Davison, Sir John||Molyneaux, Rt Hon James|
|Body, Richard||Monro, Sir Hector|
|Bowden, A. (Brighton K'to'n)||Nellist, David|
|Brown, M. (Brigg & Cl'thpes)||Norris, Steven|
|Budgen, Nick||Ottaway, Richard|
|Butterfill, John||Parris, Matthew|
|Carlile, Alexander (Montg'y)||Percival, Rt Hon Sir Ian|
|Carttiss, Michael||Portillo, Michael|
|Cash, William||Powell, Raymond (Ogmore)|
|Chope, Christopher||Proctor, K. Harvey|
|Clegg, Sir Walter||Rhys Williams, Sir Brandon|
|Craigen, J. M.||Shaw, Sir Michael (Scarb')|
|Fairbairn, Nicholas||Skeet, T. H. H.|
|Fallon, Michael||Skinner, Dennis|
|Gardiner, George (Reigate)||Stanbrook, Ivor|
|Golding, John||Stern, Michael|
|Griffiths, Peter (Portsm'th N)||Stevens, Martin (Fulham)|
|Grist, Ian||Stewart, Andrew (Sherwood)|
|Ground, Patrick||Stewart, Rt Hon D. (W Isles)|
|Hancock, Mr. Michael||Sumberg, David|
|Hawkins, C. (High Peak)||Walker, Bill (T'side N)|
|Haynes, Frank||Waller, Gary|
|Higgins, Rt Hon Terence L.||Warren, Kenneth|
|Howarth, Gerald (Cannock)||Wells, Sir John (Maidstone)|
|Howells, Geraint||Wigley, Dafydd|
|Hunter, Andrew||Williams, Rt Hon A.|
|Lawrence, Ivan||Woodall, Alec|
|Leigh, Edward (Gainsbor'gh)|
|Lester, Jim||Tellers for the Noes:|
|Lightbown, David||Mr. Peter Bruinvels and|
|McCartney, Hugh||Mr. Neil Hamilton.|
§ Question accordingly agreed to.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 42 (Committal of Bills).