PROHIBITION OF ARTIFICIAL FLUORIDATION OF WATER SUPPLIES

HC Deb 10 November 2003 vol 413 cc90-127

'(1) The WIA is amended as follows.

For section 87 (fluoridation of water supplies at request of health authorities) there is substituted— 87 Prohibition of artificial fluoridation of water supplies Water undertakers shall be prohibited from artificially increasing the fluoride content of the water supplied by them.

(3) Section 88 (power to vary permitted fluoridation agents) shall cease to have effect.

(4) Section 89 (publicity and consultation) shall cease to have effect.

(5) In section 90 (indemnities in respect of fluoridation), at the end there is added— (2) But no indemnity under this section shall apply in respect of any liability, costs, expenses or expenditure incurred in relation to artificial increases in the fluoride content of water after the coming into force of section [prohibition of artificial fluoridation of water supplies](2) of the Water Act 2003.

(6) Section 91 (pre1985 fluoridation schemes) shall cease to have effect.

(7) Schedule 7 (pre 1985 fluoridation schemes) shall cease to have effect.'.—[Mr. Simon Thomas.]

Brought up, and read the First time.

Mr. Simon Thomas

I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker

With this it will be convenient to discuss the following:

Amendment No. 1, in page 75, line 7, leave out clause 58.

Amendment No. 28, in clause 58, page 75, line 20, at end insert— '(2A) With regard to Wales, neither shall a water undertaker be authorised by subsection (1) above unless and until a referendum on increasing levels of fluoridation has been held in accordance with the provisions of Part 7 of the Political Parties, Elections and Referendums Act 2000 seeking approval of the arrangements from the population residing in the area proposed to be affected.'.

Amendment No. 8, in page 75, line 23, leave out from 'a' to end of line 25 and insert 'local authority'.

Amendment No. 34, in page 76, line 2, at end insert 'or the water undertaker'.

Amendment No. 35, in page 76, line 16, after 'authority', insert 'or a water undertaker'.

Amendment No. 36, in page 76, line 23, leave out from '(9)' to end of line and insert'—

1. (a) a combined reference may be made by the relevant authorities; or
2. (b) a reference may be made by the water undertaker.'.

Amendment No. 37, in page 76, line 42, after 'authority', insert 'or the water undertaker'.

Amendment No. 38, in page 77, line 26, after 'authority', insert 'or the water undertaker'.

Amendment No. 39, in page 77, line 30, after 'authority', insert 'or the water undertaker'.

Amendment No. 40, in page 77, line 41, leave out from 'Assembly' to end of line 47 and insert— 'or the water undertaker may refer the matter for determination by such person as the Assembly may appoint; and (b) the determination of that person shall be final.'.

Amendment No. 41, in page 78, line 6, at end insert— '(4A) In making any determination under this section, the person making the determination—

1. (a) shall secure that the arrangements, their variation or termination (as the case may be) are effected in an operable and efficient manner; or
2. (b) if this cannot be achieved, shall refuse to require the entry into, variation of, or termination of, the arrangements.'.

Amendment No. 42, in page 78, line 9, leave out from beginning to 'undertaker' in line 11 and insert—

1. '(a) the person who made the determination shall give notice of his determination to the relevant authority or authorities and the water undertaker in question; and
2. (b) except when there has been a refusal under subsection (4A)(b) above, such relevant authority or authorities and the water'.

Amendment No. 45, in page 78, line 35, leave out 'or'.

Amendment No. 46, in page 78, line 40, at end insert— 'or for accommodating any other operational circumstance which necessitates variation of the source of the water being supplied to the area the water supply to which is required to be fluoridated.'.

Amendment No. 6, in page 79, line 44, after 'consult', insert 'all households'.

Amendment No. 23, in page 80, line 34, at end insert—

'(5A) After section 89 there is inserted—

"89A Assessment and analysis of effects on human health of fluoridated water

(1) Following an increase of the fluoride content of water as a result of arrangements entered into under section 87, a relevant authority shall—

1. (a) undertake an ongoing assessment of the correlation between fluoride consumption and changes in the dental health of the affected population;
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2. (b) undertake an ongoing assessment of the correlation between fluoride consumption and the incidence of any known or suspected adverse effects of fluoride consumption in the affected population;
3. (c) place all data obtained for the purposes of paragraphs (a) and (b) above in the public domain; and
4. (d) periodically publish an analysis of the data obtained for the purposes of paragraphs (a) and (b) above.

(2) The Secretary of State shall by regulations make provisions about the requirements which must be satisfied by relevant authorities for the purposes of subsection (1) above.".'.

Amendment No. 47, in page 80, line 34, at end insert—

'(5A) After section 89 there is inserted—

"89A Fluoridation arrangements: technical guidance

(1) Without prejudice to Chapter 3 of this Part and the Health and Safety at Work etc. Act 1974, the Secretary of State and the Assembly shall jointly prepare and issue a code of practice containing guidance on the technical standards that must be met by water undertakers in relation to the fluoridation of water supplies.

(2) Such a code of practice shall—

1. (a) include such provisions, and
2. (b) be prepared and made in such manner,

as shall be prescribed by regulations made by the Secretary of State.".'.

Amendment No. 48, in page 80, line 37, leave out from 'State' to end of line 48 and insert— 'shall indemnify every water undertaker which enters into arrangements under section 87(1) above against all liabilities that any such undertaker may incur in complying with such arrangements, other than liabilities arising from the undertaker's own fault or negligence.

(2) The Secretary of State shall indemnify every licensed water supplier against all liabilities that any such supplier may incur—

1. (a) in supplying water to which fluoride has been added by a water undertaker by virtue of any such arrangements; and
2. (b) (if the licensee is introducing water into the water undertaker's supply system) in complying with any obligation imposed on it by the undertaker in consequence of the arrangements,

other than liabilities arising from the licensee's own fault or negligence.

(2A) Subject to the preceding provisions of this section, each indemnity shall be on such terms as (with the consent of the Treasury) may be agreed between the Secretary of State and (as the case may be) the undertaker or the licensee.'.

Amendment No. 7, in page 80, line 37, leave out from 'State' to end of line 40 and insert— 'shall indemnify every water undertaker which enters into arrangements under section 87(1) above against all liabilities that any such undertaker may incur in complying with such arrangements, other than liabilities arising from the undertaker's own fault or negligence. (1A) Subject to subsection (1) above, each indemnity shall be on such terms as (with the consent of the Treasury) may be agreed between the Secretary of State and the undertaker.'.

Government amendment No. 91.

Amendment No. 49, in page 81, line 13, after 'authority', insert 'or the water undertaker'.

Amendment No. 50, in page 81, line 23, leave out from first 'the' to 'to' in line 24 and insert— 'person who has made the determination shall give notice of his determination to the relevant authority and'.

Government amendments Nos. 92 and 93.

Government amendment No. 102.

Government amendment No. 122.

Amendment No. 2, in schedule 9, page 227, line 10, at end insert— 'Sections 88 and 89.Section 91.'.

Government amendment No. 125.

Government amendment No. 114.

Mr. Thomas

To date, the Bill has been disagreed with in detail, but not in principle. Now, we come to the part of the Bill with which there is disagreement in principle—a disagreement that crosses the House and runs throughout the parties. The amendments deal directly with whether we should fluoridate our water supplies, whether we should continue the fluoridation of water supplies that are already fluoridated and, if we are to fluoridate further water supplies, how we should consult local populations. New clause 1 and amendment No. 1, which stand in my name, and amendment No. 8, which stands in the name of the hon. Member for Llanllienni—or Leominster (Mr. Wiggin), although in view of his appointment, we should refer to his constituency by its Welsh name—go to the heart of the debate on fluoridation.

In the next hour and a half or so, I hope to hear the views of hon. Members on both sides of the House on how the House wants to come to a view—whether it wants to make a firm ruling on the principle of fluoridation, or whether it wants to make a more practical ruling on whether to extend fluoridation by means of the Bill. Given that this is, for the most part, a free vote—hon. Members on both sides have already expressed different ideas on how we should proceed—I hope that the House will be able, by means of the necessary votes, to make a firm declaration on fluoridation, and I hope that that declaration will be no: we do not have the evidence, the public support or the confidence at this stage, in this Bill, to pass such an important public health measure.

Stephen Hesford (Wirral, West)

The hon. Gentleman is making an interesting, if very backward-looking, point. Does he seek to examine the principle of current law, as I understand it, and to remove it? What has been wrong with that for the past 15 or 16 years?

Mr. Thomas

I am sure that the hon. Gentleman wants to hear precisely that argument, and I promise him that he will hear it from me, if he gives me a little time. To pick up one of his points, two views are reflected and two ways forward are offered. It is for the House to decide what it wants to do. A new clause and an amendment stand in my name—I have given the House a choice.

Let us examine the practical grounds for fluoridation first. I shall discuss the civil liberties aspects and whether we should compulsorily medicate the population later. I have no doubt that putting the measure into the Bill has been justified on public health grounds. That justification is based on the York review, a Government-commissioned review of all the science, the studies, and the peer-reviewed investigations to date on the effect of fluoridation on the population. That review found several important facts, which I want to put on the record.

7.15 pm

The review found that fluoridation appeared to reduce caries by 14 to 15 per cent.—that is, 0.4 per cent. of a tooth—but in the same context, it found that the science was poor and not without bias. The review also found that 48 per cent. of people living in fluoridated areas have dental fluorosis—a brown mottling of the teeth, which is medically accepted as a sign of fluoride overdose. We must not have too much fluoride in the water, and the Bill, by setting a limit on the amount of fluoride that may be put in the water, implicitly accepts that too much fluoride is possible, although it purports that there is an effective level.

Andy Burnham (Leigh)

The hon. Gentleman says that fluorosis affects 48 per cent. of the population and results in brown mottling. Is he not aware that the most common appearance of fluorosis is a pearly appearance of the teeth, not brown mottling?

Mr. Thomas

I do not know about the hon. Gentleman's pearly gnashers, but as he knows, the 48 per cent. examined in the York review identified that as the effect on their teeth. It is the York review that says that, not me, and it is for individuals to judge for themselves. Fluorosis is fluorosis: it is evidence of too much fluoride in the body, and that is the end of it.

Mr. Kevin Hughes (Doncaster, North)

Did not the York review find that there was a 15 per cent. increase in fluorosis? If there is a 14 or 15 per cent. improvement in the quality of teeth and a 15 per cent. decrease in the quality of teeth, especially children's teeth, because of fluorosis, does not the one cancel out the other? Is not the pro-fluoridation proposal an absolute nonsense?

Mr. Thomas

I tend to agree with the hon. Gentleman, except to say that I do not think that one cancels out the other. However, the two pieces of information are evidence that we should use when taking decisions as Members of Parliament. We should not simply swallow one line or another, but try to work out what we should do.

It is clear that the effects of fluorosis include not only the chalky or pearly appearance to which the hon. Member for Leigh (Andy Burnham) referred, but brown staining and pitting of teeth. Those are fairly severe effects. Are we proposing to put something in the water that will have that effect on 48 per cent. of the population? That serious question must be answered.

Mr. Andrew Robathan (Blaby)

Did the hon. Gentleman receive, as I did a couple of days ago, a document from the British Dental Association and the British Medical Association in favour of introducing fluoride into water? It stated that in some areas that are fluoridated the incidence of caries in children was twice as bad as in areas that are not. What conclusion does he draw from that?

Mr. Thomas

I think that the hon. Gentleman is referring to the document that I have in my hand, which I did indeed receive recently. It shows that although fluoridated areas tend to have better dental health—I should say better health in terms of caries, not dental health, because there is more to dental health than simply caries; gum disease and cancer and mouth cancer have to be considered as well—there are fluoridated areas that have an above-average incidence of decayed, filled or missing teeth among five-year-olds. The science is unproven.

To return to the York review, following its publication, four eminent members of the NHS centre for reviews and dissemination at York university—Professor Jos Kleijnen, Professor Trevor Sheldon, Sir lain Chalmers and Professor George Davey-Smith—made the following statement in a letter to the then Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears): As far as we are aware, no other review"— they refer to the York review— of this topic is of comparable scientific standard, and we are concerned about some continuing misinterpretations of the evidence which could have implications for public policy. I think that their use of the word "misinterpretations" refers to the Government's attitude, but that is for them to say.

Three points were made in the letter. The first is about the effectiveness of fluoridation in reducing caries—the very point raised in an intervention by the hon. Member for Blaby (Mr. Robathan)—and the letter states: We could discover no reliable, good-quality evidence in the fluoridation literature world-wide. What we found suggested that fluoridation was likely to have a beneficial effect, but in fact the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth. The second point was about the effectiveness of fluoridation in reducing inequalities in dental health across social groups—I understand from our debates in Committee that this will be a strong argument, which the Government will want to advance. The letter stated: The evidence is weak, contradictory and unreliable". Are we to legislate on the basis of weak, contradictory and unreliable evidence?

The third point was on the safety of fluoridation: Apart from an increase in dental fluorosis (mottled teeth)"— it is the scientists, not me, who describe it as mottled teeth— we found no clear pattern among the possible negative effects we examined, and we felt that not enough was known because the quality of the evidence is poor"— a point to which I shall return in a few moments.

Mr. Adrian Bailey (West Bromwich, West)

Did the survey provide any assessment of the number of children who have died under general anaesthetic as a result of tooth decay? I can tell the House that, on the basis of figures released for 1998, three children died. We would all agree that that is a serious and devastating health argument.

Mr. Thomas

That is so irrelevant to this debate—[Interruption.] I shall tell the hon. Gentleman why. It is because modern medical practice is not to give general anaesthetic to children undergoing dental examination and treatment. The hon. Gentleman should know that. It is precisely because of those unfortunate deaths that it is not now general practice to give general anaesthetics to children in dental surgeries on the high street. The hon. Gentleman knows that and he should not adduce that evidence to support his position.

Andy Burnham

rose—

Mr. Bailey

rose—

Mr. Thomas

I am not giving way for the moment, because I want to continue with my speech.

As emphasised in the York review, only high-quality studies can fill the gaps in knowledge about those and other aspects of fluoridation. The question that we must ask is whether the Government have, since the York review, commissioned those high-quality studies. No, they have not. They have not even received the report that they said they would commission from the chief medical officer and the chief dental officer. That report is not yet published; not yet given to Members; not yet available to the public. The one thing that the Government said they would do in response to the York review has not been done. Yet we are being told to rush this Bill through as a great opportunity to improve the dental health of children and our population. It is not. It is too fast and based on too little evidence.

Richard Burden (Birmingham, Northfield)

The hon. Gentleman is describing the York review and I understand that he wants all the facts out. Will he also confirm—he has not said it in his speech so far—that the York review found no evidence to substantiate allegations by anti-fluoride campaigners to the effect that there was a link between fluoridation and bone cancers, thyroid cancers, Down's syndrome and hip fractures?

Mr. Thomas

I am grateful to the hon. Gentleman, who makes a reasonable point. We have all received material from all sides of the argument—particularly perhaps the side to which he refers—about fluoridation. I agree that some of it comes across as rather hysterical, shall we say. However, I would not like the hon. Gentleman to believe that the points made on that side of the argument are completely without validation in the York review, which said that there could be possible negative outcomes such as IQ and congenital defects. They acknowledged that that could not be proved, but argued in favour of further high-quality research. That was the York review's recommendation—we do not know enough about the effects, so may we have further high-quality research, please?

The Government's response, which had unfortunate consequences, was to ask the Medical Research Council to advise on any further priorities for research into water fluoridation. The MRC concluded that research on a number of other possible negative health outcomes—including the IQ and congenital defects mentioned in the York review, to which the hon. Member for Birmingham, Northfield also referred—was of a "low priority".

Thus the York review asked for higher-quality research as a priority, but in response to the Government the Medical Research Council declared that such research was a low priority. I cannot step into that argument. I acknowledge that I do not have the scientific ability to do so, but I do know one thing: if I am to support legislation, I want to be able to examine relevant studies and reviews. I want to be convinced that what we put into our water supply will not have adverse effects.

As I said earlier, much of the publicity and propaganda on the issue verges on the hysterical. Although it remains the case that there is no evidence to prove the negative, as legislators we surely remain in difficulties. We need to be absolutely certain about what we are putting into our public water supply before we make any progress in that respect.

I now want to move on to consider in more detail the Government's view of these matters.

Gareth Thomas (Clwyd, West)

I am inclined to support the hon. Gentleman's viewpoint. For the sake of clarity, however, is he saying that if the medical evidence were stronger, the human rights arguments would effectively be overruled?

Mr. Thomas

The hon. Gentleman makes a good point. From my perspective, I am opposed to compulsory medication. It may be good for me to have a little aspirin for my heart, particularly in debates such as this, but I do not want to be forced to take it. I want to be able to choose whether to take any medication. A little later in my speech, I shall deal with the question of whether fluoridation counts as water treatment or medication, which is at the heart of the hon. Gentleman's question. We must think clearly on these matters. If it is clear that we are trying to achieve a medical result, I would say that civil liberties is an absolute issue. If it is clear that it is a different matter of water treatment, then a rather different argument applies. I hope to persuade hon. Members this evening that what is at stake here is a medical matter and that we should not proceed down those lines.

Stephen Hesford

Having examined the hon. Gentleman's amendment, the logic of his argument seems to be that we should not fluoridate water because there is no proof either that it works or that it is not harmful. However, I have seen no amendments on the amendment paper that require water companies to withdraw fluoridation from the 5 million people who receive fluoridated water and have done so for about 40 years.

Mr. Thomas

The hon. Gentleman is absolutely right that no amendment is designed to achieve that, but new clause 1 would do precisely what he says. I am afraid that the hon. Gentleman misleads the House in going down that road. New clause 1 withdraws fluoridation from those who receive it. I hope that those who believe in civil liberties will support it, as well as those who have a more practical or pragmatic view. It is for hon. Members to decide.

Mr. Alan Williams (Swansea, West)

Is there not an alternative, which goes closer to meeting a point of principle: to refuse to allow clause 58 to stand part of the Bill?

Mr. Thomas

That is amendment No. 1. I would say to the right hon. Gentleman that that at least keeps the status quo, but it will continue to allow fluoridation to be decided by water companies, which is the real problem. We all agree that water companies should not decide that sort of thing, and I want to argue that we should not decide it either.

The Government have usefully copied to members of the Committee their own arguments based on a briefing from the chief dental officer of why we should fluoridate. I understand that we have a free vote tonight, but also that the Government are clearly behind fluoridation as a method of dealing with the problems of NHS dentistry, to which I shall return in a few moments. The review examined alternatives to water fluoridation. Let us accept for a moment that fluoride benefits teeth. I can accept that at a personal level because I use a fluoride toothpaste, but it is my own choice to use it. In a letter to Committee members, the Government said: Dental decay can also be largely prevented on an individual basis by dietary means. However there is no evidence that it is possible to alter people's diet to this extent on a population basis and it is therefore not currently a practical public health option.

That strikes me as a defeatist attitude from the Government. Just today, the Government addressed the issue of obesity in young children. At other times, they have talked about too much salt in our diet and, in an apparently constant stream of initiatives from No. 10, have stressed the need to change our diet. I do not disagree with that. Let us have exhortations from the Government about changing our dietary habits, how we look after our health, not smoking and not drinking too much. But let us not then use the same argument to impose compulsory fluoridation, because—it is claimed—people are too thick to learn how to look after their teeth. That is a ridiculous argument.

The situation is even more ridiculous, because the letter continues: It is also cheaper—water fluoridation costs around 50p per person per year; a year's supply of toothbrushes and toothpaste costs around£10. So there are important reasons to consider water fluoridation as the preferred method of preventing tooth decay. the Government honestly suggesting that we should all drink fluoridated water and throw out our toothbrushes and toothpaste to save £9.50 a year? That would not improve oral health, gum disease or rates of mouth cancer. It would not help us to address the increasing problems of the NHS dental service, with one third of children in Wales not having an NHS dentist. Some 69 per cent. of the population in my county do not have an NHS dentist—

Mr. Redwood

rose—

Mr. Thomas

Here is a man who was partly responsible for that.

Mr. Redwood

I was going to say nice things about the hon. Gentleman, but not after that calumny. Does he agree that it is odd that the Government want to boss us all around to stop us having tooth decay, but they allow smoking? All their medical advice is that smoking causes awful health problems that then need to be remedied by the NHS, but they have not banned it. The Government are being illogical in allowing us to smoke, but making us have fluoride when we do not want it.

7.30 pm

Mr. Thomas

I agree that that is illogical, but I will not be tempted further down that path as it would be outside the scope of the new clause and amendments.

The British Dental Association has written to all hon. Members to ask them to support fluoridation. It makes no bones about wanting fluoridation, and that is fine, but my children have a drink called Ribena ToothKind, which is approved by the British Dental Association. Is the BDA urging legislators to put fluoride in everyone's drinking water, but at the same time willing to take money from a commercial company to say that a sweet soft drink is good for your teeth?

Mr. Morley

There is no sugar in it.

Mr. Thomas

That is true. I do not know whether the Minister has children—

Mr. Morley

indicated assent.

Mr. Thomas

He will know, then, that if one lets children have sweet drinks, they ask for more. When one is out and about, one does not always have access to nice tooth-kind drinks. The children want Coke, lemonade or Fanta. Let us be clear about the facts—the British Dental Association does not have clean hands on the issue. If it is prepared to back sweet drinks, it should not tell us what we should put in our clean, fresh water. We should bear such facts in mind when interest groups tell us how we should legislate.

Mr. John Butterfill (Bournemouth, West)

The hon. Gentleman mentioned the cost of fluoridating the public water supply as opposed to the cost of toothbrushes and toothpaste. We are concentrating on the problems of a small minority of children in deprived areas who are not getting the necessary dental care. Would it not be better and cheaper to concentrate directly on their needs, rather than do something that would affect the whole country?

Mr. Thomas

The hon. Gentleman has put his finger on the heart of the argument. We have in many of our communities a recognised problem of severe tooth decay in young children. That is a feature of poverty, lack of education, culture, bad diet and lack of access to dental services. None of those factors is affected by fluoridation. There is no evidence that a young child in, say, Manchester or Aberystwyth who drinks fluoridated water but continues with those bad health habits will have significantly improved teeth. They might have an improvement of 0.4 per cent. in one tooth, but that is no reason to change our whole water supply. The hon. Gentleman is right—we need to target improvements in dental health directly on those who need it most.

I know that many hon. Members wish to speak, so I shall conclude. Is fluoridation medication? When the hon. Member for Leominster (Mr. Wiggin) pressed the Under-Secretary on the issue in Committee, she said that she did not consider fluorosilicic acid—the substance used to fluoridate water—to be a medicine, and she mentioned the guide to medicinal and health care products. I take it that she was referring to the Medicines and Healthcare Products Regulatory Agency, which has published a guide to what should be considered a medicinal product. It states, on page 4, that medicines include Any substance or combination of substances presented for treating or preventing disease in human beings or animals. According to that, fluoride is a medicine.

Mr. Bill Etherington (Sunderland, North)

The hon. Gentleman will be aware that fluoride is not a registered medicine. It is, however, a registered poison.

Mr. Thomas

The hon. Gentleman is right. Under the Poisons Act 1972, it is registered as a part II poison, alongside arsenic and paraquat. I do not think that there are many useful benefits of arsenic.

Mr. Gordon Prentice (Pendle)

Are those people who live in areas that have naturally fluoridated water being poisoned?

Mr. Thomas

Those individuals who live in areas that are naturally high in radon are being poisoned. Many areas have natural features that have an impact on our bodies—such as fluoride and radon. The hon. Gentleman cannot wriggle out of that one. If it is a poison, we should not add it to our water supply.

It is illegal to add fluoride to the water supply as a treatment. In other words, fluoride is not regulated as a water treatment agent. The Water Supply (Water Quality) Regulations 2000 list those substances that may be added to our water, and fluoride is not one of them. It is curious that fluoride is not regulated as a medicine, it has never been tested on the population as a medicine, it cannot be bought over the counter and it is even banned in Belgium as a treatment for teeth, yet we seek to achieve a medicinal effect by putting it in our water. I know that many hon. Members represent the 5 million people in England who already have fluoride in their water and they will not be happy to hear that argument, but we have to look at the hard evidence. The York review and other evidence make it clear that insufficient evidence is available to decide to add fluoride to our water. There is insufficient evidence of the effects that the Minister will no doubt claim.

There are better alternatives, such as improving access to NHS dentistry and increasing education on personal dental care—including cutting down on sugar in the diet—which could achieve similar effects to water fluoridation, but without as much controversy or the potential negative health effects, even if those stop at fluorosis. Fluorides are not the way forward for the NHS dental service. Fluorides are not the way forward to treat the population as a whole. I urge the House to reject mass medication and to support the important principle of individual choice in how we look after our own bodies and teeth, how we take medicines and how we interact with the rest of society. This is not a matter for this House.

Mr. James Wray (Glasgow, Baillieston)

May I ask, Mr. Deputy Speaker, for a Division on amendment No. 8? There is cross-party support for the amendment. Quite a number of people have added their names to it; I did not table it, but I have added my name.

Stephen Hesford

Will my hon. Friend give way?

Mr. Wray

Give me a chance to get started.

I have watched this matter over the years. From 1983, the Water (Scotland) Act 1946 was taken up in the Court of Session, and one of the reasons was that the Government wanted to fluoridate water supplies in my country of Scotland—part of the United Kingdom. The people were against that, and the case ended up taking five years to be settled in the Court of Session. That was the reason for the Water (Fluoridation) Act 1985. The Government produced a Bill in 1983 because they found that it was ultra vires and outwith the remit of a water engineer to "treat" the people who drink water. All the additives that have been mentioned as being in the water are there to make it wholesome. It was important in the early 1980s to keep additions under strict control by local authorities, which are the democratic authorities accountable to the electorate. They consult the people and listen to their views. At that time, they certainly did listen. Lord Jauncey decided the case. Three or four items were put to him, including the medical, moral and legal aspects.

Local authorities all over England and Scotland were not really interested in fluoridating public water supplies, but an organisation called the British Fluoridation Society has spent money to the tune of £185,000 to brainwash the whole of Britain to try to get fluoride into all the waters in all the local authority areas. The Government have been dishonest.

Stephen Hesford

My hon. Friend talks about dishonesty. On representation in the House, is he aware that two early-day motions were tabled and that one, in favour of fluoridation, was signed by more than 150 Members? Of the two EDMs, one was an amendment against anti-fluoridation moves and the other was anti-fluoridation in itself. Only 21 Members signed for the anti position.

Mr. Wray

That does not really matter.

Mr. Butterfill

On a point of order, Mr. Deputy Speaker. The hon. Member for Wirral, West (Stephen Hesford) is misleading the House—

Mr. Deputy Speaker

Order. I am sure that the hon. Gentleman, with his experience, would not wish to use that expression and accuse another hon. Member of misleading the House.

Mr. Butterfill

I am sure that the hon. Gentleman did not intend to mislead the House, but he certainly had that effect.

Mr. Deputy Speaker

Order. The hon. Gentleman has great experience of chairing proceedings in the House, and he should know that he is trying to pursue on a point of order what is really a point of argument.

Mr. Wray

Many early-day motions are tabled. Some get hundreds of signatures, but they never go anywhere. Neither will that one.

The jewel in the crown was Birmingham, which has been fluoridated for 30 years—[HON. MEMBERS: "For 40 years."] That is even worse. The Government never reported back on the professor who went into five primary schools and found that 34 per cent. of the children had dental fluorosis—caused by chronic fluorine poisoning. That is where the disease comes from—a poisonous waste. No one from the medical profession ever discovered that fluoride was attracted to bones and teeth; they knew nothing about it. Cattle were found down in England with skeletal fluorosis, which came from people dumping fluoride, which was very expensive to dump. People wanted to find a cheap way of getting rid of that, so they sent an agent to have a look. It was him who discovered that it was attracted to bones and teeth. That is where chronic fluorine poisoning and skeletal fluorosis came from. I think that the company at the time may have been Fisons.

7.45 pm

Under the 1926 food and drugs legislation, it is a crime to add any kind of fluoride to foodstuffs. The Medicines Act 1968 clearly states what is a medicinal product. Why would a Government who believe in democracy want to transfer a non-medicinal product to a health authority and take away the democratic right of a local authority?

Mr. Gerald Kaufman (Manchester, Gorton)

I am interested in amendment No. 8, but I would be grateful if my hon. Friend could clarify one point. I understand entirely that he recommends that the requirement should come from a democratically elected local authority. What would be the basis on which such an authority would make such a request?

Mr. Wray

The reason for wanting to take the decision away from local authorities is that local authorities up and down the country refused to fluoridate. It was then put in the hand of water authorities, but they cannot do it because of the Water (Scotland) Act 1946, so the Government have to try to persuade the water authorities. Because of indemnification, the water authorities will not like that because they have heard public complaints about the fluoridation of public water supplies and dental fluorosis. They will not implement fluoridation. In fact, an attempt was made to force authorities in the north of England, and that case was lost because the judge said that the water authority had a responsibility to its shareholders and customers.

Mr. David Marshall (Glasgow, Shettleston)

In the event of fluoridated water being eventually proven harmful to the health of human beings, who does my hon. Friend think will be liable if the victims sue? Would it be the manufacturers of fluoride, the water companies, the strategic health authorities or even the Government?

Mr. Wray

If any of my children get dental fluorosis or chronic fluorine poisoning, I will sue everybody until I get the right one—the Government, the fluoride company, whoever. One reason why fluoride is said not to be a medicinal product is that a product licence would be needed to procure the fluoride. That licence would state clearly what the product is—a fluorosilicate, under European Union directives, and something that is certainly not on the approved medicines list. I have heard Ministers speak about fluorspar and natural fluoride. Natural fluoride comes from fluorspar. It is insoluble. With fluorosilicates, as soon as they hit the water, they dissolve. With fluorspar, the actual fluoride comes from the fluorspar and is insoluble. There is a very big difference.

I do not care who takes fluoride. Give it to your sons, give it to your daughters—in toothpaste or in tablets, as long as it is self-administered. Once we start to use water as a panacea, as mass medication for the whole population, half of whom do not even have teeth, we might as well put the fluoride into buckets.

We have a socialist Government and they should never medicate people against their will. It is illegal in English law to medicate someone against their will. It is as though a doctor diagnosed all his patients and prescribed them fluoride without seeing them. We have never done that in this country. That is what bothers me—the fact that a Labour Government who believe in democracy want such demagoguery and want to fluoridate public water supplies.

The Government know the moral aspects and the medical aspects; they certainly know the legal aspects. Why are fluorides forbidden and criminal under the Poisons Act 1972? Why are the human rights of the individual being taken away by a few Members of Parliament who are not even taking the time to read exactly what will be going into our water? Why do they not find out what fluoride is and where it comes from?

Out in the commercial world somebody will be making big bucks. That is what this is all about. If the whole UK water supply is fluoridated, somebody will get their palm greased. They will be ready when the Government decide to put fluoride in the water.

There will be no way of really measuring one part per million. How will the Government know how many children are already taking fluoride tablets at school? How will they know how many people already brush their teeth with fluoridated toothpaste? If a baby ate a tube of toothpaste she would die. There is enough fluoride in a tube of toothpaste to kill a child.

Mr. Etherington

Earlier my hon. Friend was asked about the democratic processes that might be used by local authorities to ascertain the wishes of the public. Does he share my view that whatever the system is I would have more confidence in it than if the matter were left to a strategic health authority?

Mr. Wray

I certainly do.

What worries me is that the Minister is misleading the House. The chairman of the York university review committee, Professor Trevor Sheldon, sent a letter to the press about the statements—

Mr. Deputy Speaker

Order. Did I hear the hon. Gentleman accuse the Minister of misleading the House? If I did, I hope that he will very quickly withdraw that statement.

Mr. Wray

Yes, Mr. Deputy Speaker, I withdraw it.

Trevor Sheldon wrote an open letter that stated:

The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken providing more definitive evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation. Why does the Minister not promote the comments of the director of the Medical Research Council, Dr. Paul Harrison? He said: But there is a lack of research on some important aspects, which is why we're highlighting the need for more research…Because of the wide use of toothpastes and other dental health care products containing fluoride, we need a better understanding of how much fluoride we're all absorbing. Everybody else is worried, so why does the Minister say that it is safe to take fluoride? All those bodies have looked at the evidence and considered the studies.

In 1997, Wolverhampton fluoridated its water supply, so why did dental costs rise by 112 per cent? Should not those costs have been lower after fluoridation? We are not getting the right facts in this case.

I hope that hon. Members will vote for the democratic right of local authorities to retain control under amendment No. 8 and that they will vote against the fluoridation of public water supplies. That is a criminal act and it is illegal under various Acts passed by the Government.

Several hon. Members

rose—

Mr. Deputy Speaker

Order. May I appeal to the House? It is obvious that only a short time is left for this debate so I hope that in future contributions, including those from the Front Benches, Members will bear in mind the fact that there is a great deal of interest in taking part.

Mr. Wiggin

I shall try to keep my comments as brief as possible, Mr. Deputy Speaker, but I want to address a large number of amendments.

Members on both sides of the House feel very strongly about amendment No. 8, which the hon. Member for Glasgow, Baillieston (Mr. Wray) has just discussed. We shall certainly press it to a vote and on the Opposition Benches it will be a free vote.

Mr. Greg Knight (East Yorkshire)

Some time ago when we held a debate on the composition of the other place there was a series of genuine free votes. To indicate that they were genuinely free votes, the Government Whips Office put in Tellers for both sides. Has my hon. Friend received any notification from the Treasury Bench that Government Whips will be telling on both sides when we vote on this group?

Mr. Nick Ainger (West Carmarthen and South Pembrokeshire)

indicated assent.

Mr. Wiggin

I see that the Government Whip is nodding. I am grateful to my right hon. Friend the Member for East Yorkshire (Mr. Knight) for making that vital point; if we are to have a free vote, free it must be.

Currently, the Bill gives strategic health authorities the role of consultation with local communities to determine whether fluoride should be added to their water supply. We want that to be undertaken by local authorities. The Minister has insisted that any decision to fluoridate water will be determined by "local" people after "local" consultation. Strategic health authorities are not local. The SHA for my constituency is in Coventry, which is a long way from Herefordshire so it is not local in any sense of the word.

Strategic health authorities are neither democratically elected nor accountable. Their accountability comes only through the Secretary of State, which is not a direct local mechanism. They do not match up with the Government's insistence on local consultation and I should prefer an element of democratic decision making with elected and accountable local authorities having that power.

Mr. Drew

I shall be voting with the hon. Gentleman on the amendment. Not only am I unhappy about the level at which the decision will be taken, but I have received two letters, one from the Greater Manchester SHA and one from my SHA, Avon, Gloucestershire and Wiltshire, urging me to support the provisions on the basis that we should have a fluoridated water supply. How can those authorities carry out open, honest and democratic consultations when they are telling us which way to vote?

Mr. Wiggin

The hon. Gentleman makes an extremely important point. We want not only democratic accountability, but at least proper information to be provided to all people, so that they can decide how they would like their water supplies to be treated. Of course, that is difficult if the strategic health authority has already made that decision.

8 pm

Andy Burnham

The hon. Gentleman makes a point about the decision being in the hands of the wrong body. Why did the then Conservative Government leave the decision in the hands of the health authorities when they passed the Water (Fluoridation) Act 1985?

Mr. Wiggin

I do not think that they left the decision in the hands of the health authorities. [HON. MEMBERS: "They did."] I thought that the decision was left in the hands of the water authorities. [HON. MEMBERS: "No."] I thought that that was what the Government were seeking to change. Anyway, like the hon. Gentleman, I was probably at school at the time, so I was not privy to the full debate.

Andy Burnham

rose—

Mr. Wiggin

Hang on; let me answer the first question. The important point that the hon. Gentleman is trying to make is that the then Government probably acted—I am sure that they did—on the best scientific evidence at the time. One of the biggest criticisms of the Bill is that the York report has requested further research, but the Government have not carried it out. I can see that the hon. Gentleman is highly exercised, so I shall give way.

Andy Burnham

The hon. Gentleman asks me to explain further. The original Conservative legislation said that the health authorities would undertake the consultation, but that the water companies may choose to fluoridate on the back of the health authorities' request. The word, "may" is the loophole in the 1985 Act that people are exploiting to open a debate on the question per se, but the hon. Member responsible for that legislation—the right hon. and learned Member for Rushcliffe (Mr. Clarke)—is wholly in favour of the change that other hon. Members and I are proposing tonight.

Mr. Wiggin

rose—

Mr. Butterfill

May I just make it clear that the previous legislation left it free to health authorities to recommend fluoridation, but that it was up to the water authorities to decide whether to go ahead and, since most of them were worried about getting sued, they did not do so?

Mr. Wiggin

I shall make some progress not only because it is important that hon. Members have the chance to make their own speeches, but because we have moved on about 20 years, and there seems little advantage in debating what happened 20 years ago.

Mr. Kevin Hughes

Water authorities will not take the decision because they are not convinced that it is safe and they fear they will be sued if they do so. That is what they fail to say.

Mr. Wiggin

I am grateful to hon. Members for all their interventions. One of the Bill's fundamental flaws is that it does not give us the decision on fluoridation, but the rights and wrongs of what has happened in the past are not for us to debate. I would prefer it if they were, but that is not the case, so I must make progress.

I would prefer to see democratic decision making, so it is right that such powers should be in the hands of local authorises, as elected and accountable bodies. Strategic health authorities have an overwhelming bias in favour of fluoridation. Such an issue needs neutrality—the point made by the hon. Member for Stroud (Mr. Drew)—with each local community given an equal amount of information from both sides of the debate, so they can make up their own minds.

The right hon. Member for Manchester, Gorton (Mr. Kaufman) asked in an earlier intervention why local authorities should take that decision. The answer is that it must be in their interests to ask their electorate and, when they get the answer, to act accordingly.

Mr. Kaufman

My question was not why. I find it very attractive that local authorities should take the decision. What I am interested in having elucidated to me is by what process the local authority would make its decision.

Mr. Wiggin

I shall come to my amendments slightly later on, but I would prefer a proper referendum to be conducted—every household should be consulted. We are talking about mass medication, whether we want to call it that or not, so we must have mass consultation to go with it. That is the least that we can do.

Mr. Simon Thomas

The right hon. Member for Manchester, Gorton (Mr. Kaufman) makes an important point, but it is also important to note that the Bill does not specify what the current consultation with the strategic health authorities—or, indeed, in Wales, with the National Assembly—should involve, so that criticism should be channelled at the Bill as well.

Mr. Wiggin

I agree with the hon. Gentleman, and I shall come to that in speaking to my amendments.

Richard Burden

The hon. Gentleman sees this as a health issue. Does he think that any other health issue should be decided by local authorities, rather than by part of the health service?

Mr. Wiggin

The hon. Gentleman puts his finger on the real misunderstanding. He talks about a decision being made by a local authority or by a strategic health authority; I am talking about local people being able to take that decision. That is why I would prefer local authorities to make the decision. They start from an unbiased position, so they can undertake proper consultation without pursuing their own agenda, and they are elected and accountable. None of those things applies to strategic health authorities, so we need to move on from whether they should make the decision or whether local people should make it. That is why the hon. Gentleman and I will not agree, but he can now understand why his comments are not the same as mine and are not relevant. It does not matter what other health decisions are made by local authorities because they are not covered by the Bill.

Mr. Bailey

The hon. Gentleman has not said what would happen if there were different types of local authority in an area—a county council, a district council or even a district council and a parish council—and they were at odds with each other.

Mr. Wiggin

The hon. Gentleman makes an important point. We have referred to local authorities, but I imagine that the county council would be involved in my area, for example. I have a unitary authority in Herefordshire, but a county council and a district council in Worcestershire, both of which are in my constituency. There are difficulties, but why would strategic health authorities do a better job? They are not accountable and not elected. [Interruption.] I will not ask the hon. Gentleman to respond, but I am sure that he will comment on that in his speech. In answer to his question, my feeling is that, so long as an authority conducts proper consultation, it will be able to make the decision. As the Minister said in Committee, the majority of people must be in favour of fluoridation before it takes place.

Mr. Alan Williams

Will the hon. Gentleman give way?

Mr. Wiggin

I will. I have been very generous; I do not see why I should stop now.

Mr. Williams

I appreciate that fact, and I am grateful to him for giving way. Does he not understand that he is giving the argument away? Either we believe in compulsory medication or we do not. If we do not believe in compulsory medication, it does not matter whether it is done by the Government, by a quango or by a local authority, it is still wrong. I believe that compulsory medication is wrong in all circumstances.

Mr. Wiggin

I am grateful to the right hon. Gentleman for that intervention, but it is wrong to say that I am giving the game away or behaving in any way like that. That is not what I seeking to do with my amendments. I want to ensure that the Bill, which only deals with whether fluoridation may or may not take place, guarantees accountability—that is the bit that is missing.

Mr. Kaufman

Will the hon. Gentleman clarify whether, regardless of the fate of any other amendment, he will nevertheless press amendment No. 6 to a Division, because that amendment refers to consulting all households?

Mr. Wiggin

I would love to press amendment No. 6 to a Division. I cannot confirm whether I will do so because we will be under a lot of time pressure; otherwise, the Bill will not receive a Third Reading. If we are successful with amendment No. 8, however, perhaps it will be possible to press amendment No. 6 to a Division. That is an important point, and I am grateful to the right hon. Gentleman for making it.

Amendments Nos. 34, 35, 36, 37, 38, 39, 40, 42 and 46 all relate to the same purpose: including the water undertaker in the decision-making process. The Bill only takes account of the health authority in such decisions, and those amendments would enable water companies, as well as health authorities, to initiate variations in arrangements to accommodate changes in circumstances, including operational emergencies. Under the Bill, only health authorities can request changed arrangements, but it is only fair that water undertakers should also apply the same provisions. There should be statutory provision for water undertakers to make arrangements for changes in their obligations to take on operational contingencies. Those amendments would ensure that the water company, as well as the health authority, could request such a provision.

Amendment No. 37 would ensure that the decision on the level of fluoridation concentration could be taken by the water company, as well as the health authority. It is only fair that water companies have an input into what concentration of fluoride should be added.

Amendments Nos. 36, 38, 39, 40 and 42 would place the water companies on the same footing as health authorities in a disagreement over a requested variation. Water undertakers should be able to appeal to the Secretary of State and relevant authorities when the terms of a requested variation cannot be agreed. Again, that relates to the point made in amendments Nos. 34. 35 and 37 that express statutory provision should be made whereby water companies can request variation of their obligations to accommodate operational contingencies.

Amendment No. 41 would require that in the references of disputes under section 87B, the Secretary of State or the Welsh Assembly should be empowered to ensure that new or revised fluoridation schemes are operable and efficient. If a scheme failed to be so, entry into the arrangements would be refused.

Amendment No. 46 would add to the circumstances under which suspension of, or variation of, fluoridation takes place, and suggests the addition of necessary changes to source of supply. The boundaries of operational supply zones often have to be varied to accommodate seasonal changes in weather patterns and other operational exigencies.

Amendment No. 6 is very important. It seeks to ensure that every person affected by the proposed fluoridation scheme must be consulted, or at least invited to participate in the consultations. I had to concede that invitation because the Government do not intend to hold the proper referendum that I would have preferred. Consultation literature must be sent to every household in the affected area. In Committee, the Under-Secretary said: That is the sort of thing that we have in mind. I welcome that comment. Furthermore, she added that we believe that some sort of door-to-door consultation must be part of the overall consultation."—[Official Report, Standing Committee D, 23 October 2003; c. 461.] Is she therefore proposing that the Government will ensure that every door of every household in every area will be knocked on to discuss fluoridation? I find that highly unlikely. Equally, we must ensure that all households in an affected area receive neutral, unbiased information from both sides of the debate, and that the information is understood by all. Will that happen? I should like to see a referendum on a topic as controversial as fluoridation. Given its health effects—to say nothing of the civil liberties factor, to which reference was made—it is all the more vital to ensure that everyone has their say after a fully informed debate. We have still not had an answer as to what democratic result the Government consider right in order to fluoridate water supplies. Fluoridation will affect individual freedom, because people have to drink water. Their choice and right to drink non-fluoridated water—indeed, fluoride can even be absorbed through the skin when in the bath—will effectively be eliminated, unless the Government are going to give every opponent to fluoridation the money to buy bottled natural drinking water if they live in a fluoridated area, which, of course they are not. It is important that all households be consulted on whether they want fluoridation to take place, and if the Government are serious about their promise to let local communities decide, my amendment should be included.

On amendment No. 47, Water UK believes that, in relation to fluoridation of water supplies, there should be statutory provision by the Secretary of State for specifying construction and operational standards. This code of practice, prepared by the Secretary of State for water undertakers, is in the interests of safety and of the avoidance of arguments over the standards that have to be met and paid for. The amendment would provide clear assurances in that regard.

Amendment No. 48 is very similar to amendment No. 7, except that it adds a subsection (2) to accommodate licensed water suppliers in indemnity arrangements against all liabilities incurred in fluoridation. Amendment No. 7 would ensure that the Secretary of State grants indemnities to water suppliers that agree to fluoridate a water supply under clause 58; we should surely welcome that. In Committee, the Minister stressed that a water supplier that agrees to fluoridate should not incur any additional liabilities, compared with a water supplier with no fluoridation scheme. She is right, but my amendment seeks to be sure of exactly what liabilities are covered in the indemnity, what is excluded, and the costs. It should be expressly provided that the Secretary of State must indemnify water companies against all liabilities that they may incur as a consequence of fluoridation, other than those arising from their own fault or negligence. We want proper protection for consumers in all areas.

Amendment No. 48 adds to amendment No. 7 by attaching subsection (2) in order to accommodate licensed water suppliers. Of course, the question arises of why indemnities are needed in the first place. Is it because there is a risk associated with mass water fluoridation? And it is because of that risk that water companies must be protected against future action? However, just because we recognise that the Government may know of the dangers of fluoridation—hence the indemnity—does that mean that we can skip over the harmfulness of fluoride? As has been said, fluoride is a class 2 poison. We should not legislate without the necessary high-quality research. The high-quality research that the York review itself requested has not been undertaken; indeed, in Committee the Minister told us that it was marked as "a low priority". We need to assess the proportionality of the risk of tooth decay in children, and the risk posed by fluoride for people of all ages. The scientific research is contradictory, and the satisfactory evidence is non-existent. The safeguards are clearly not in place. The matter is in no way resolved, so the clause in question should not be included. Giving an indemnity to water companies does not detract from the doubt and uncertainty that surrounds the issue; and it certainly is not a reason why we should accept fluoridation.

I want to know how much the proposed indemnities will cost, what legal advice is being taken, and whether the Bill fulfils its human rights obligations.

Mr. David Kidney (Stafford)

On the York review's recommendation for further research and the Medical Research Council's 15 recommendations for such research, the hon. Gentleman points out that we have yet to receive the results. But even if this House were willing to legislate without knowing the results, would he think it odd that we consulted the public without their knowing the results?

8.15 pm

Mr. Wiggin

As I said earlier, it is important that the public be properly informed and consulted.

Mr. Butterfill

Does my hon. Friend accept that although the Government may be indemnifying the water companies, they will not get an indemnity themselves? There is no doubt that they will face legal action if they proceed with the Bill.

Mr. Wiggin

I share my hon. Friend's concern. I, too, have heard that the provision will be tested in law and I am very worried about that, because ultimately the consumers will pick up the bill, whether they wish to or not. For that reason, this part of the measure makes me extremely nervous.

Have the Government received the advice of the chief medical officer and the chief dental officer, commissioned in September 2002? We were promised in Committee that a great deal more information would be available on Report. We all look forward to knowing what that information is. If these amendments were accepted, they would provide assurances for all water undertakers that liabilities are covered by the indemnity arrangements, which would be most helpful.

Amendments Nos. 49 and 50 would enable water companies, as well as health authorities, to initiate changes to pre-1985 fluoridation arrangements, which would be fairer to water companies. Water undertakers should be included in statutory provisions that will affect their industry.

I look forward to hearing the rest of this debate. This is an extremely important issue, and I regret very much the sneaking of this clause into the Bill. It is clear that this issue needed a great deal more time in which to debate it.

Andy Burnham

In fact, the clause has not been snuck into the Bill; 150 Members of this House signed an early-day motion, which I tabled, on this issue. That shows the strength of feeling in this place—on both sides of the House—which the Government recognised by introducing the clause.

Today, we have an opportunity to correct a loophole in the law that has thwarted the will of the House for 20 years, and left health inequalities between rich and poor communities that are wider than they need be or should be. Tooth decay is almost entirely preventable, and water fluoridation has been shown to be a safe and effective way of preventing it. Yet we rarely get the chance—

Mr. Kevin Hughes

Can my hon. Friend justify his statement by saying by whom it has been so shown?

Andy Burnham

The justification is the figures, provided for every constituency, from the British Dental Association. In respect of five-year-olds, the constituencies with the best dental health in the country all have a fluoridated water supply. Those with the worst dental health are the poorest communities, which do not have a fluoridated water supply.

Mr. Lansley

rose—

Mr. Kevin Hughes

rose—

Andy Burnham

I shall make progress as others want to speak.

We have a once-in-a-generation opportunity to pass legislation that will have a rapid effect on the nation's health, particularly in our most deprived communities, and we must seize it. In fact, it was a Bill passed in 1985 by the previous Conservative Government that made water fluoridation legal, although pointing that out will not help me on this side of the House. The Government's proposed change simply gives effect to the spirit of that legislation.

Mr. Drew

I was under the impression that, when the clause was added, it was an all-party move that the Government did not instigate, but which they may have been sympathetic to. If the Government are in favour of fluoridation, let them say so, but they are not saying that. They are sitting on the fence and hoping that this place will vote in favour of fluoridation. Can my hon. Friend clarify that point?

Andy Burnham

I referred to early-day motion 247, which I tabled. It was signed by Members on both sides, including the right hon. and learned Member for Rushcliffe (Mr. Clarke), who introduced the original legislation—a powerful voice—and the hon. Member for Cheadle (Mrs. Calton) among many others. The Government are right because they are giving communities the chance to decide for themselves. I do not believe that a single Member of the House has the right to deny my constituents the ability to make their own decision on this issue.

Mr. Alan Williams

Does my hon. Friend not understand that he is not doing what he says? He is not giving his constituents the right to do what they want. He is taking one minority—a local government minority—and getting that to force-feed fluoride, as opposed to having a regional health authority do that. He is still force-feeding fluoride and compulsory medication.

Andy Burnham

I am not force-feeding anything to anyone. I support the amendment that gives effect to the original water fluoridation legislation that was passed by the Conservative party and incorporated in its privatisation legislation. It said that, on the back of consultation with local communities, health bodies should make a request to fluoridate. That was the spirit of the legislation that the House passed, and on what basis should we deny our communities the chance to choose for themselves in accordance with the spirit of that legislation?

Mr. Wray

When my hon. Friend reads the paper from the British Dental Association, does he not notice that inner London has the best dental care? The water in that area has never been fluoridated.

Andy Burnham

I am grateful to my hon. Friend for making that point. I am looking at the league table for the worst dental health in the country. If he does not mind me saying, Glasgow has the worst children's dental health in the whole country. When we know a safe and effective means of doing something for the children in Glasgow, we should do it.

On my hon. Friend's specific point, I see that Cities of London and Westminster is No. 10 on the list of the worst constituencies for children's dental health. Under-fives there have, on average, almost three missing, filled or decayed teeth. Right below that constituency are Kensington and Chelsea, which is at No. 11 on the list, and Regent's Park and Kensington, North, which is at No. 12. Inner London is right at the top of the league for the worst dental health in the country.

Mr. Wray

Glasgow also has the four most deprived areas in the whole of the United Kingdom.

Andy Burnham

My point is that, as a supporter of a socialist Government and member of the Labour party, I ask my colleagues in my party to vote for water fluoridation. We know that it is the most effective way of improving the dental health and quality of life of children in our poorest communities. We should all take that opportunity as members of the Labour party.

Mr. Kevin Hughes

Will my hon. Friend look at the British Dental Association report? Does he not see that in 19 of the best 20 constituencies for dental health the water is not fluoridated?

Andy Burnham

I have looked in detail at the figures and I point my hon. Friend to the constituency with the best dental health in the country. The best is Tamworth, where the water is fluoridated. Tamworth does not have the social profile of the wealthiest parts of the country, but it has the best children's dental health. I put it to him that that has something to do with water fluoridation.

I shall now attempt to make progress. This is a controversial issue and the Government deserve credit for taking it on and seeking to resolve it. However, I take the view that the issue has been allowed to become controversial not because most people oppose fluoridation—surveys of the public show that they do not—but because a noisy minority send long letters to Members of Parliament. The chief medical officer unequivocally endorses water fluoridation as the most effective means of improving the health of the nation. What Member of the House has more evidence than he does to make such a recommendation?

Mr. Etherington

My hon. Friend suggests that a majority are in favour of fluoridation, and he has already made the point that he is trying to do what he thinks is right for his constituents. A poll carried out by a local newspaper showed that more than 90 per cent. of my constituents were against fluoridation. I hope that he will bear that in mind when he talks about MPs being influenced by noisy minorities. That is not always the case.

Andy Burnham

The latest poll carried out by NOP found that 67 per cent. of people support fluoridation if it can be shown to reduce tooth decay—and it can.

Mr. Hughes

On a point of order, Mr. Deputy Speaker. I wish to apologise to the House and to my hon. Friend. Another hon. Friend has just pointed out that there is another page in the report and that I was looking at the wrong one.

Mr. Deputy Speaker

That was not a point of order for the Chair, but a personal correction. I hope that we can now proceed to allow as many Members as possible to speak before the debate concludes.

Andy Burnham

In my view, the health arguments do not stack up. They are chucked around by people opposed to fluoridation because they know that the civil liberties argument advanced by the hon. Member for Ceredigion (Mr. Thomas) is not strong enough. That is what it comes down to: a choice between the civil liberties of the individual and the common good, and particularly the common good of our most deprived communities.

I readily accept that there may be a cost to the individual's liberties in drinking one part per million of fluoride in water. But what is the benefit? Water fluoridation has been shown to improve the dental health of an entire population, cutting needless suffering and improving people's quality of life. Given that choice and that cost and that benefit, I will always opt for the common good over civil liberties. It is morally wrong for us to know of a safe and effective means of cutting children's suffering and then not give local communities the power to choose it for themselves. But that is what some propose we do tonight.

New clause 1 is a backward-looking piece of nonsense from the Flat Earth Society that deserves rejecting out of hand. It would end water fluoridation in parts of Birmingham and the west midlands without giving those communities any say about it whatsoever. On what basis does the hon. Member for Ceredigion have the right to do that to the communities that currently have water fluoridation?

Mr. Simon Thomas

Will the hon. Gentleman give way?

Andy Burnham

I have given way a lot and Mr. Deputy Speaker wants us to make progress. Just as imposing fluoridation would be wrong, so is any effort to prevent local communities from accessing a proven health intervention used the world over.

Amendment No. 1, tabled by the hon. Member for Ceredigion, seeks to preserve the status quo, with private water companies in charge of the decision. This is an unashamed attempt to maintain a flawed system simply because the deadlock it will bring—and the choice that it denies to local communities—suits the hon. Gentleman's views. Surely the House should, wherever possible, facilitate local people taking their own decisions.

Amendment No. 8 has more to recommend it. If nothing else, by placing the decision in the hands of a local authority, it passes the democracy test. If passed, it would be a significant improvement to the current system, but it is, I think, superficially attractive for two reasons. First, the practicalities dictate that fluoridating a water supply should be a strategic regional decision, not a local matter. Secondly, it is a public health matter and, as such, should rest with those who are expert in public health matters and skilled at informing the public in these difficult areas.

For these reasons, the Government have rightly placed the decision in the hands of strategic health authorities. It is, of course, vital that SHAs conduct extensive and rigorous consultation before taking a decision to proceed with a regional scheme. If the decision were to go to local authorities, differences of opinion between them may render a scheme impractical. If, in an area such as Greater Manchester, there was one objection, that could be sufficient to render the scheme impractical. That could prevent those who voted in favour of water fluoridation from receiving it, which would be neither democratic nor fair. I suspect that the amendment is a wrecking amendment that has been dressed up to appear more attractive, but it should be resisted. Clause 58 should be allowed to remain as drafted.

I make two appeals to hon. Members on both sides of the House: first, choose the common good over civil liberty, especially given that the liberty concerns a negligible particle of fluoride and the good would substantially improve dental health in the most deprived of our communities; and, secondly, even if hon. Members are not persuaded of the case for water fluoridation per se, basic democracy demands that clause 58 remain unamended. I have seen at first hand general anaesthetics being administered week in, week out at Manchester dental hospital on children as young as five. Although the hon. Member for Ceredigion said that such procedures are not used any more, 2,000 such general anaesthetics are administered each year in Greater Manchester, but none is administered in Birmingham, which has fluoridated water. Should any hon. Member deny my constituents the chance to do something for themselves about that dreadful situation?

Norman Baker

I have two immediate regrets. First, the proposal should not be in the Bill at all because, irrespective of its merits, it belongs in a health Bill. Secondly, I regret the fact that I am only the fifth speaker, despite the fact that we are an hour and a half into a two-hour debate, which shows that we have had insufficient time. I guarantee hon. Members that my speech will be the shortest of those that we have heard so far.

8.30 pm

I am pleased that the hon. Member for Ceredigion (Mr. Thomas) tabled new clause 1, because we danced around the issue of fluoride for some time on Second Reading and in Committee. Is it appropriate to put fluoride in water? That is the nub of the issue and the question that people want answered, so I hope that we shall have the chance to vote on new clause 1 in half an hour.

Stephen Hesford

Will the hon. Gentleman give way?

Norman Baker

I shall not give way to any hon. Member who has already spoken, although I shall give way to hon. Members who have not spoken, if necessary.

Does fluoride give health benefits? I conclude that it does but that the benefits are limited. Are there health risks from fluoride? Probably not, but there might be risks, so we need to do further work on that. That equation is not sufficient to justify overriding civil liberties and the genuine opposition of at least a minority of the population to the adulteration of water—as they see it—by adding a medical substance. The hon. Member for Leigh (Andy Burnham) talked about choosing the common good over civil liberties, but civil liberties are the common good, so we should not mix up those two concepts.

In Committee, the Minister said with some sophistry—without wishing to be rude—that fluoride is not medication because it is not classed as a medicine. The whole purpose of adding fluoride to water is to derive a medical benefit. Hon. Members clearly have a view of whether that is right or not, but let us not pretend that fluoride is not a medicine. For the purpose of the Bill, it is treated as a medicine. Let us concentrate on whether it is appropriate to use the mass-medication process suggested in the Bill.

Mrs. Patsy Calton (Cheadle)

Will my hon. Friend consider medication a little more? What does he think should be done about the fluoride that occurs naturally in some parts of the country?

Norman Baker

The hon. Member for Ceredigion dealt with that point when he drew a parallel with radon gas, which is naturally present in some parts of the country. We encounter environmental hazards during our lives about which we can do little—they are part of living on this planet. However, we do have the opportunity to decide whether to enhance or minimise those hazards. Some people believe that fluoride, as a man-made addition to water, is unwelcome because of its potential hazards. Adding fluoride to water is not necessary when one considers the ultimate behaviour of man.

Amendment No. 1 is superficially attractive. Although I happen to be against fluoridation, in Committee I voted against removing what was then clause 61—it is now clause 58—because it does not relate to whether it is right or wrong. New clause 1 relates to the principle of whether fluoride should be in water but clause 58 contains mechanistic provisions for the bodies that should decide the matter—the water companies, as is the case at present, or strategic health authorities, as the clause would provide. Hon. Members who want to vote against fluoride should vote in favour of new clause 1 because clause 58 relates only to who should make decisions on the matter. I am clear that it would be better, although not perfect, for the decision to be made by a strategic health authority rather than a water company, which is the basis of clause 58. That is why I favour new clause 1 but oppose removing clause 58.

Having said that it would be preferable for a strategic authority to make the decision, it would not be the best solution. If fluoride is to continue to be added to water, it is better for that to be decided by common consent with popular support. The decision will receive popular support if it is taken independently. However, SHAs are not independent because they have an agenda. They are not democratically elected and there is only a thin line between them and the Secretary of State for Health, which shows their democratic credentials. SHAs would not take a local decision because they are not local. It would be quite wrong to impose a measure that many people would consider to be an infringement of their civil liberties by a mechanism that was not independent, democratic or local, which would be the case if SHAs made the decision. If new clause 1 is unsuccessful and the House accepts the principle of adding fluoride to water, it is important for us all that there is a means of dealing with its addition in a way that commands public support. In that way, even those who do not want it will know that they have had an opportunity to have their say and had an input into the decision. That can be achieved by involving local authorities. They might not be perfect but they are local, democratically elected and accountable, which is more than can be said of strategic health authorities.

The drafting of amendment No. 8, for which I have considerable sympathy, is faulty. It refers to one local authority. There is, of course, no coterminosity between local authority boundaries and water company boundaries or even water supply areas within water companies. South East Water uses several different sources to supply people in my constituency. The direct link between a local authority and the water supply is not necessarily right. A combination of local authorities would be necessary to bring about a decision-making process. I do not pretend that that would be easy. It is better to have a difficult but justifiable situation, however, than an easy but unjustifiable situation, which is the case with the strategic health authorities.

I hope that we will vote on new clause 1 so that we determine the principle of the matter. It is a free vote for my colleagues, as I imagine it is for other parties, although I am not sure about Plaid Cymru. The Government Whip, the hon. Member for West Carmarthen and South Pembrokeshire (Mr. Ainger), shakes his head. Perhaps he has inside knowledge of Plaid Cymru's workings. I also hope that we will vote on amendment No. 8 because the accountability of those who take the decisions is important.

Mr. Alan Williams

I say to my hon. Friend the Member for Leigh (Andy Burnham) that when the subject was first debated on the Floor of the House I was on the Opposition Front Bench, which I left to join the Back Benches so that I could oppose the then Government's proposal. I did so for the same reasons that make me oppose it today. It is a matter not of whether fluoride is good or bad, but of whether compulsory medication is right or wrong. It is a fundamental right of every individual in this country, other than in a major national emergency, to say, "I do not want medication." It does not matter what part of the electorate is chosen to make the decision, whether it is the local authority or people voting in a national referendum, a minority will be forced to accept compulsory medication.

My hon. Friend said that 67 per cent. of people in a poll were in favour of fluoridation. That means that one in three people who replied did not want to be force fed fluoride, but in arrogance people who have just come into this House and do not understand the prime responsibility—[Interruption.]

Mr. Deputy Speaker (Sir Michael Lord)

Order.

Mr. Williams

Those people do not understand that the prime responsibility of the House of Commons cuts across parties to protect the rights and privileges of the people of this country. People have the right to say no to medication. We cannot say no to a water supply, because we must have water. No one can pretend that fluoride is a matter of life or death. Professor Sheldon said that at best it gives an estimated benefit in the order of 15 per cent. Are hon. Members seriously saying that to get a 15 per cent. benefit we will force feed one in three people? It is as simple as that. If hon. Members miss that point, they do not understand what the House of Commons is about.

Sir Paul Beresford (Mole Valley)

I obviously have a declared interest and, as such, will take a slightly different approach. I will not go through the facts and figures. Other hon. Members have the opportunity to do so. I want to touch on the caries aspect of the problem and my experience of fluoride in this country and elsewhere.

The proposal is a little start—a tiny step forward—but it is decades behind the United States, Australia and New Zealand. I was a child in New Zealand and graduated from dentistry there. We have three dental generations in New Zealand: my parents' generation, which has plastic teeth; my generation, which has our own teeth but heavily filled; and the next generation—my children's generation—most of whom have little or no sign of decay and no fluorosis. I speak as someone who has looked through a microscope at the teeth of living patients. The first place in New Zealand where fluoridation was introduced many decades ago was a little town called Hastings. There was a huge scream, and there were allegations of the type that we have heard tonight about cancer and brittle bones. There were even allegations about the process being used by the Nazis for torture, but it all proved to be absolute rubbish.

Research on the subject in the past few decades has been enormous. Fluoride occurs naturally in many water supplies throughout the world, so there has been a great the opportunity to look into its effects. In Hastings, the mayor made a brave decision to add fluoride to the water and there was, as I said, a scream. However, his biggest problem came from a local lady who said that a cup of tea would taste different. On day one, he pulled a lever, and the fluoride went in. There was an enormous number of complaints, but about six weeks later there was a small item in the paper saying that when the mayor had pulled the lever it was not connected to anything. A piece of machinery that was supposed to come from England had not arrived on the boat. However, New Zealand has had fluoride ever since, and it has been of tremendous benefit.

Much has been made of the fact that decay can be prevented by other means, which is true. Much, too, has been made of the fact that there should be expenditure by the Government to teach prevention. The Ministry of Health in New Zealand tried that years ago, and put a huge amount into prevention. There was an advertising campaign, and three special colleges for school dental nurses were set up—the population, I remind hon. Members, was only about 2 million. Those girls did drilling and filling sessions at every single primary school—as kids, we called them "the murder house" because we had an enormous amount of decay.

Once fluoride arrived, decay gradually disappeared and the need for those dental nurses was reduced. The population has more than doubled, as has the school population, but the number of schools for dental nurses has gone down from three to one. The girls are spending two thirds of their time teaching prevention, because they do not need to drill and fill.

When I arrived in Britain about 30 years ago and went to work in east London, I could not believe what I saw. The points made by the hon. Member for Leigh (Andy Burnham) are quite right, as are the points made on the postcards, which, I hope, Members have received. What I saw was disgusting and appalling. I spent a large proportion of my time extracting teeth or refilling teeth when dental decay had eaten around what I had done heroically the previous year to save teeth, not just in children but in adults. Last night, I spoke to an elderly dentist in New Zealand, who told me that before fluoridation, filling teeth heroically was like trying to fill a bath with the plug out—it was hopeless. When fluoride arrived, that changed.

I remember children and adults coming into my clinic with swollen faces and broken-off teeth. They had pus pouring out and were in considerable pain. They had sleepless nights and had to take days and hours off work or school. It was appalling. We used to run a general anaesthetic session every Thursday afternoon. That is not permitted now, because it is done in the hospitals, which have picked up the load that we had to deal with. We would put 18 to 20 patients through a huge series of extractions because there was no clinical alternative. That does not occur in New Zealand, Australia or the United States, where there is fluoride.

I was staggered by the working hours that were lost. On Monday morning, dentists would have queues of patients lining up to see them. That does not happen in areas with fluoride.

Mr. Kevin Hughes

Is the hon. Gentleman trying to say that that is all down to fluoridated water? I do not think that he can make that claim, because not even the York review and the General Medical Council are saying that. He is stretching the point a little.

Sir Paul Beresford

What I am saying to the hon. Gentleman is that, having looked at mouths in one country where there is fluoride in water and in another country where there is none, I believe that, in addition to the benefit of fluoride toothpaste and where decent tuition has been given, we can beat caries with fluoride in the water supply, topped up by other methods. We must recognise, however, that in trying to teach adults and children in a country where there is less than one toothbrush per person, we need fluoride to take the initial step.

8.45 pm

In the past, children who came out of a dental surgery—this often still applies today—would be petrified of dental care thereafter, which contributed to the difficulty. I now run a very specialist and extremely part-time dental practice doing advanced restoration. The only pain is in the white envelope at the end of the day. We are doing high-class work, but it is still vulnerable to decay, and people would be protected from such decay to a considerable degree if fluoride were included in the water supply.

Mr. Butterfill

Will my hon. Friend give way?

Sir Paul Beresford

No; my hon. Friend has been bouncing up and down like a yo-yo, and I shall leave things like that for a moment, as I wish to move on.

I have spent most of my life battling dental caries. I have been to conference after conference and read journal after journal, and I am absolutely convinced of the benefits and safety of a fluoridated water supply. Perhaps the best answer to those with health concerns, especially the hon. Member for Ceredigion (Mr. Thomas), who tabled the new clause, is to remember that almost all the All Blacks will have had fluoridated water all their lives, and they beat Wales.

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I do not think I shall join that particular controversy.

Hon. Members have made my job of speaking to the Government amendments and winding up the debate difficult. I shall endeavour to address the arguments and not deal with individual amendments, as time will not permit me to do so. First, it is ironic that the hon. Member for Ceredigion (Mr. Thomas), who is in pursuit of liberties, is pursuing them through a whipped vote of his party, whereas many hon. Members are on a genuinely free vote. That is an extreme irony.

Clause 58 is an enabling clause. No one is forcing anyone to do anything here or anywhere else. The point is that the provision is not for the whole country and it is democratic, as we are going to local communities and the Bill enables those communities to decide for themselves. That is very important. While we might want to reduce demand for dentistry, as the hon. Member for Ceredigion said, we also want to improve dental health, as the hon. Member for Mole Valley (Sir Paul Beresford) pointed out, which is why dentists throughout the country support the measure as well. It is not in dentists' interests in terms of their business—let us admit it—to support the measure, but they have done so because of their interest in dental health. And yes, brushing teeth is essential too.

Mr. Brian H. Donohoe (Cunninghame, South)

May I refer my hon. Friend to a letter written by the Secretary of State on 6 November, which states: We are in sympathy with the amendment to the extent that we are resolved that local authorities should play a major part in reaching decisions"? Why does she accept that regional health authorities should undertake consultation but not local authorities, given that local authorities are democratically elected, while health authorities are quangos of this Government?

Miss Johnson

Let me point out that my right hon. Friend the Secretary of State also said: we are equally certain that the overall process should be 'owned' by the Strategic Health Authority". That is the case for just the reason that hon. Members have advanced—strategic health authorities have a strategic role in public health. That is why they are ultimately the right place in that regard. I shall deal with the question in more detail and return to the question of local authorities in a moment.

Several hon. Members

rose—

Miss Johnson

I need to make some progress, as I have but 10 minutes. My hon. Friend the Member for Leigh (Andy Burnham) is right about dental health inequalities. I draw hon. Members' attention to a letter in yesterday's edition of The Times that was signed by my right hon. Friends the Members for Darlington (Mr. Milburn) and for Holborn and St. Pancras (Mr. Dobson), the right hon. and learned Member for Rushcliffe (Mr. Clarke) and Lord Fowler, all of whom were Secretaries of State for Health, and all of whom were supporting the fact that people should be able to choose fluoride under the existing clause. I do not need to point out that that is a very unusual collection of individuals who do not always bat together: in this case, it is important that they are doing so.

Mr. Morley

It is a dream ticket.

Miss Johnson

As my hon. Friend says, it is a dream ticket.

On compulsory medication, the hon. Member for Cheadle (Mrs. Calton) is right to say that as fluoride is a naturally occurring substance, fluoridation is no more medication than is exposure to many other trace elements. We need some fluoride in our diet; many vegetables, among other things, contain trace elements of it, just as water contains many trace elements.

We commissioned the University of York to review the evidence and, in response to its criticism of the quality of some of the evidence, we asked the Medical Research Council how it might be strengthened. It came to the conclusion that many of the suggested areas for further research were very low priorities, because the existence of many of the harms that hon. Members have mentioned could not be proved.

Mr. Kidney

After the MRC's response, the Government commissioned a study on one recommendation and asked the chief medical officer and the chief dental officer to report on the others. Does my hon. Friend have the results of that research, and can she share them with us before we vote?

Miss Johnson

We have provisional advice on the outcome of the research on bio-absorption of fluoride. The results are very encouraging. As they are still being peer reviewed, it would not be appropriate to discuss them now, but all the evidence will be available to local communities when strategic health authorities discuss the matter under the provisions of the Bill, if it is supported by the House.

On international comparisons, 400 million people in 60 countries benefit from optimally fluoridated drinking water, either naturally occurring or adjusted. That includes 64 per cent. of people in the US, 43 per cent. in Canada, 75 per cent. in Israel and 61 per cent. in New Zealand.

Mr. Butterfill

Can the Minister confirm that in certain parts of the United States and, indeed, Europe, fluoride-treated water has been withdrawn?

Miss Johnson

No, I cannot. Indeed, in Los Angeles, fluoridated water was recently introduced to a large additional population. I am not sure to what the hon. Gentleman refers.

The effectiveness of fluoride in reducing tooth decay is not as the hon. Member for Ceredigion suggests. The York study said that fluoridation would result in 15 per cent. more children having no tooth decay, which is better than the 15 per cent. reduction that he describes. In the end, it comes down to a balance of judgment. Hon. Members mentioned the 1,500 to 2,000 children in the Manchester area who have their teeth extracted under general anaesthetic each year and may thereby be placing their lives at unnecessary risk. That could be avoided by going down the path that the clause advocates in enabling those communities to decide for themselves. Six million people in this country drink fluoridated water. New clause I would remove that ability even from those who currently use fluoridated water. I hope that hon. Members of all parties are well aware of that.

There is 40 years' experience of fluoridation.

Mr. Kevin Hughes

If we were to hold a vote on fluoridation in Doncaster in which 40 per cent. voted against it and 60 per cent. in favour of it, what advice would the Minister give to the 40 per cent. who did not want fluoride in their water? What would they do?

Miss Johnson

My hon. Friend knows that we do not propose to hold referendums. However, whenever local opinion is in favour of something, some people will not support it. That is probably true in Birmingham where water is fluoridated.

The York report suggested that approximately 15 per cent. more people in fluoridated areas had fluorosis, not 48 per cent., the figure that I believe that the hon. Member for Ceredigion cited. From his considerable experience of dentistry, the hon. Member for Mole Valley described the way in which the matter is regarded and how minor it often is.

Amendment No. 8 deals with the involvement of local people. The Secretary of State for Health circulated a letter to all hon. Members that stated that we were in sympathy with the amendment to the extent that we are resolved that local authorities should play a major part in reaching decisions about whether an area should fluoridate. The views of local authorities will need to be taken into account at every step of the consultation. We are convinced that decisions should be owned at strategic health authority level.

Mr. Drew

Will the Minister give way?

Miss Johnson

I shall in a moment. As part of our modernisation programme, borough councils, unitary authorities and all the county councils have established overview and scrutiny committees, which have a remit to consider health services. We accept that local authorities have an important role in those matters.

Mr. Colin Challen (Morley and Rothwell)

Will my hon. Friend clarify whether the results of any public consultation would be binding on health authorities under the Bill?

Miss Johnson

We are clear that health authorities should accede to the proposal to ask for fluoridation in their area if consultations ascertain that the local population is in favour of it. I was a local authority member for 16 years and I do not believe that local authorities are the right vehicle for the decision. In many cases, local authorities do not cover large areas. There is already an issue about the coterminosity of water companies with strategic health authority areas. The logistics, the size difference, the potential bureaucracy of bringing authorities together and the problems that some hon. Friends have outlined of local authorities running the process rather than being key components, as we envisage them, mean that the proposal is wrong.

Strategic health authorities are responsible for health decisions and it is therefore right that they are able to pursue the matter as the overall ring holder.

Norman Baker

Does the Minister envisage a one-size-fits-all solution in a strategic health authority or can local communities express their views such as the possibility of different solutions in the same health authority area?

Miss Johnson

That is an interesting point. We believe that the solution should apply to a strategic health authority area, but there will be issues with the water companies about boundaries and the relationships with them.

Mr. Donohoe

Will the Minister give way?

Miss Johnson

I want to move on to make one or two additional points. I have had little time to contribute to the debate.

In Bolton, 70 per cent. of five-year-olds have experienced tooth decay. On average, each child has more than three decayed teeth. There is no fluoridation in the north-west. In the west midlands and Crewe, only 23 per cent. of five-year-olds have experienced tooth decay. I believe that the case has clearly been made for allowing local communities to decide, and we are enabling them to do so.

I would like to draw Members' attention to the comments of the hon. Member for Salisbury (Mr. Key), who said in Committee that he had decided that he was not prepared to pass by on the other side, and that this was a question of balance and judgment. He said: I have decided that, in this instance, child health must take precedence over my scruples, prejudices and personal views on individual liberty and freedom."—[Official Report, Standing Committee D, 23 October 2003; c. 442.] I urge other hon. Members to do likewise.

It being Nine o'clock, MR. DEPUTY SPEAKER put the Question already proposed from the Chair.

The House divided: Ayes 181, Noes 284.

Division No. 357]	[9:00 pm
AYES
Adams, Irene (Paisley N)	Drew, David (Stroud)
Ainsworth, Peter (E Surrey)	Duncan, Alan (Rutland)
Allan, Richard	Etherington, Bill
Ancram, rh Michael	Evans, Nigel
Arbuthnot, rh James	Fabricant, Michael
Austin, John	Fallon, Michael
Bacon, Richard	Flook, Adrian
Baker, Norman	Forth, rh Eric
Barker, Gregory	Foster, Don (Bath)
Barnes, Harry	Fox, Dr. Liam
Baron, John (Billericay)	Francois, Mark
Barrett, John	Garnier, Edward
Beith, rh A. J.	Gibb, Nick (Bognor Regis)
Bellingham, Henry	Goodman, Paul
Benn, rh Hilary	Gray, James (N Wilts)
Bennett, Andrew	Grayling, Chris
Bercow, John	Green, Damian (Ashford)
Brady, Graham	Green, Matthew (Ludlow)
Brake, Tom (Carshalton)	Greenway, John
Brazier, Julian	Grogan, John
Breed, Colin	Gummer, rh John
Brooke, Mrs Annette L.	Harvey, Nick
Burgon, Colin	Heath, David
Burnett, John	Heathcoat-Amory, rh David
Burns, Simon	Hendry, Charles
Burstow, Paul	Hinchliffe, David
Burt, Alistair	Hoey, Kate (Vauxhall)
Butterfill, John	Hood, Jimmy (Clydesdale)
Cable, Dr. Vincent	Howard, rh Michael
Cameron, David	Howarth, Gerald (Aldershot)
Carmichael, Alistair	Hoyle, Lindsay
Cash, William	Hughes, K.evin (Doncaster N)
Chope, Christopher	Hurst, Alan (Braintree)
Clifton-Brown, Geoffrey	Jones, Helen (Warrington N)
Collins, Tim	Jones, Martyn (Clwyd S)
Con way, Derek	Jones, Nigel (Cheltenham)
Cook, Frank (Stockton N)	Kirkwood, Sir Archy
Corbyn, Jeremy	Knight, rh Greg (E Yorkshire)
Cotter, Brian	Laing, Mrs Eleanor
Crausby, David	Lait, Mrs Jacqui
Cryer, John (Hornchurch)	Lamb, Norman
Davies, rh Denzil (Llanelli)	Laws, David (Yeovil)
Davis, rh David (Haltemprice & Howden)	Leigh, Edward
	Letwin, rh Oliver
Djanogly, Jonathan	Lewis, Dr. Julian (New Forest E)
Donohoe, Brian H.	Lewis, Terry (Worsley)
Doran, Frank	Liddell-Grainger, Ian

Lidington, David	Sayeed, Jonathan
Lilley, rh Peter	Selous, Andrew
Llwyd, Elfyn	Shepherd, Richard
Loughton, Tim	Sheridan, Jim
Lyons, John (Strathkelvin)	Simmonds, Mark
McAvoy, Thomas	Simpson, Alan (Nottingham S)
McCafferty, Chris	Skinner, Dennis
McDonnell, John	Smith, Llew (Blaenau Gwent)
MacDougall, John	Smith, Sir Robert (W Ab'd'ns & Kincardine)
McIntosh, Miss Anne
Mackay, rh Andrew	Smyth, Rev. Martin (Belfast S)
Maclean, rh David	Spicer, Sir Michael
McLoughlin, Patrick	Steen' Anthony
McNamara, Kevin	Stewart, David (Inverness E & Lochaber)
Maples, John
Marsden, Paul (Shrewsbury & Atcham)	Straw, rh Jack
	Streeter, Gary
Marshall, David (Glasgow Shettleston)	Swire, Hugo (E Devon)
	Syms, Robert
Maude, rh Francis	Tami, Mark (Alyn)
May, Mrs Theresa	Taylor, Sir Teddy
Mitchell, Andrew (Sutton Coldfield)	Thomas Gareth (Clwyd W>
	Thomas, Simon (Ceredigion)
Moore, Michael	Tipping, Paddy
Moss, Malcolm	Trickett, Jon
Mudie, George	Turner, Andrew (Isle of Wight)
Murrison, Dr. Andrew	Tyler, Paul (N Cornwall)
Norman, Archie	Tyne, Andrew
O'Brien, Mike	Vis, Dr. Rudi
Osborne, George (Tatton)	Walley, Ms Joan
Ottaway, Richard	Waterson, Nigel
Paterson, Owen	Watkinson, Angela
Pickles, Eric	Webb Steve (Nortnavon)
Pope, Greg (Hyndburn)	White, Brian
Price, Adam (E Carmarthen & Dinefwr)	Whittingdale, John
	Wiggin, Bill
Pugh, Dr. John	Willetts, David
Purchase, Ken	Williams, rh Alan (Swansea W)
Randall, John	Williams, Hywel (Caernarfon)
Redwood, rh John	Williams, Roger (Brecon)
Reid, Alan (Argyll & Bute)	Willis Phil
Robathan, Andrew	Winterton, Ann (Congleton)
Robertson, Hugh (Faversham & M-Kent)	Wood Mike (Batley)
	Wray, James (Glasgow Baillieston)
Robertson, Laurence (Tewk'b'ry)	Yeo, Tim (S Suffolk)
Rosindell, Andrew	Younger-Ross, Richard
Ruddock, Joan
Ruffley, David	Tellers for the Ayes:
Russell, Bob (Colchester)	Mr. Jim Murphy and
Sanders, Adrian	Derek Twigg
NOES
Ainger, Nick	Bottomley, Peter (Worthing W)
Ainsworth, Bob (Cov'try NE)	Bradley, rh Keith (Withington)
Allen, Graham	Bradley, Peter (The Wrekin)
Anderson, Janet (Rossendale & Darwen)	Brennan, Kevin
	Brown, rh Nicholas (Newcastle E Wallsend)
Armstrong, rh Ms Hilary
Atkins, Charlotte	Brown, Russell (Dumfries)
Atkinson, Peter (Hexham)	Browne, Desmond
Bailey, Adrian	Bryant, Chris
Baird, Vera	Burden, Richard
Baldry, Tony	Burnham, Andy
Banks, Tony	Byers, rh Stephen
Barron, rh Kevin	Cairns, David
Beard, Nigel	Calton, Mrs Patsy
Bell, Stuart	Campbell, Mrs Anne (C'bridge)
Beresford, Sir Paul	Caplin, Ivor
Berry, Roger	Cawsey, Ian (Brigg)
Betts, Clive	Challen, Colin
Blackman, Liz	Chaytor, David
Blears, Ms Hazel	Chidgey, David
Blizzard, Bob	Clappison, James
Blunt, Crispin	Clark, Dr. Lynda (Edinburgh Pentlands)
Borrow, David

Clark, Paul (Gillingham)	Howells, Dr. Kim
Clarke, rh Charles (Norwich S)	Humble, Mrs Joan
Clarke, rh Kenneth (Rushcliffe)	Hutton, rh John
Clarke, rh Tom (Coatbridge & Chryston)	Iddon, Dr. Brian
	Illsley, Eric
Clelland, David	Ingram, rh Adam
Clwyd, Ann (Cynon V)	Irranca-Davies, Huw
Coffey, Ms Ann	Jack, rh Michael
Colman, Tony	Jackson, Glenda (Hampstead & Highgate)
Cook, rh Robin (Livingston)
Cooper, Yvette	Jamieson, David
Cousins, Jim	Jenkins, Brian
Cox, Tom (Tooting)	Johnson, Alan (Hull W)
Cryer, Ann (Keighley)	Johnson, Miss Melanie (Welwyn Hatfield)
Cummings, John
Cunningham, rh Dr. Jack (Copeland)	Jones, Kevan (N Durham)
	Jones, Lynne (Selly Oak)
Cunningham, Jim (Coventry S)	Jowell, rh Tessa
Cunningham, Tony (Workington)	Joyce, Eric (Falkirk W)
Curry, rh David	Keen, Alan (Feltham)
Darling, rh Alistair	Kelly, Ruth (Bolton W)
Davey, Edward (Kingston)	Kemp, Fraser
Davey, Valerie (Bristol W)	Kennedy, rh Charles (Ross Skye & Inverness)
David, Wayne
Davidson, Ian	Key, Robert (Salisbury)
Davis, rh Terry (B'ham Hodge H)	Khabra, Piara S.
Dawson, Hilton	Kidney, David
Dean, Mrs Janet	Kilfoyle, Peter
Denham, rh John	King, Andy (Rugby)
Dismore, Andrew	King, Ms Oona (Bethnal Green & Bow)
Dobbin, Jim (Heywood)
Dobson, rh Frank	Kirkbride, Miss Julie
Dowd, Jim (Lewisham W)	Knight, Jim (S Dorset)
Eagle, Maria (L'pool Garston)	Kumar, Dr. Ashok
Edwards, Huw	Ladyman, Dr. Stephen
Ellman, Mrs Louise	Lawrence, Mrs Jackie
Ennis, Jeff (Barnsley E)	Laxton, Bob (Derby N)
Farrelly, Paul	Lazarowicz, Mark
Fisher, Mark	Leslie, Christopher
Fitzsimons, Mrs Lorna	Levitt, Tom (High Peak)
Flint, Caroline	Lewis, Ivan (Bury S)
Flynn, Paul (Newport W)	Linton, Martin
Follett, Barbara	Lloyd, Tony (Manchester C)
Foster, rh Derek	Lucas, Ian (Wrexham)
Foster, Michael (Worcester)	Luff, Peter (M-Worcs)
Foster, Michael Jabez (Hastings & Rye)	Luke, lain (Dundee E)
	McCabe, Stephen
Francis, Dr. Hywel	McDonagh, Siobhain
Gardiner, Barry	MacDonald, Calum
George, Andrew (St. Ives)	McFall, John
Gerrard, Neil	McGuire, Mrs Anne
Gibson, Dr. Ian	McIsaac, Shona
Gilroy, Linda	McKechin, Ann
Godsiff, Roger	McKenna, Rosemary
Goggins, Paul	Mackinlay, Andrew
Griffiths, Jane (Reading E)	McNulty, Tony
Griffiths, Nigel (Edinburgh S)	MacShane, Denis
Hammond, Philip	Mactaggart, Fiona
Hanson, David	McWalter, Tony
Harris, Dr. Evan (Oxford W & Abingdon)	McWilliam, John
	Mahmood, Khalid
Harris, Tom (Glasgow Cathcart)	Mallaber, Judy
Hayes, John (S Holland)	Mandelson, rh Peter
Healey, John	Marris, Rob (Wolverh'ton SW)
Henderson, Doug (Newcastle N)	Martlew, Eric
Hendrick, Mark	Mawhinney, rh Sir Brian
Heppell, John	Meale, Alan (Mansfield)
Hesford, Stephen	Michael, rh Alun
Hill, Keith (Streatham)	Milburn, rh Alan
Hodge, Margaret	Miliband, David
Hope, Phil (Corby)	Miller, Andrew
Hopkins, Kelvin	Mitchell, Austin (Gt Grimsby)
Horam, John (Orpington)	Moffatt, Laura
Howarth, rh Alan (Newport E)	Mole, Chris
Howarth, George (Knowsley N & Sefton E)	Moonie, Dr. Lewis
	Moran, Margaret

Morley, Elliot	Spellar, rh John
Mountford, Kali	Squire, Rachel
Mullin, Chris	Starkey, Dr. Phyllis
Munn, Ms Meg	Steinberg, Gerry
Murphy, Denis (Wansbeck)	Stevenson, George
Naysmith, Dr. Doug	Stinchcombe, Paul
Norris, Dan (Wansdyke)	Stoate, Dr. Howard
Olner, Bill	Strang, rh Dr. Gavin
Organ, Diana	Stringer, Graham
Osborne, Sandra (Ayr)	Stuart, Ms Gisela
Page, Richard	Stunell, Andrew
Palmer, Dr. Nick	Sutcliffe, Gerry
Pearson, Ian	Tapsell, Sir Peter
Perham, Linda	Taylor, rh Ann (Dewsbury)
Pickthall, Colin	Taylor, Dari (Stockton S)
Pike, Peter (Burnley)	Taylor, David (NW Leics)
Plaskitt, James	Taylor, Ian (Esher)
Pollard, Kerry	Taylor, John (Solihull)
Pond, Chris (Gravesham)	Taylor, Dr. Richard (Wyre F)
Portillo, rh Michael	Teather, Sarah
Pound, Stephen	Thomas, Gareth (Harrow W)
Prentice, Ms Bridget (Lewisham E)	Todd, Mark (S Derbyshire)
	Tonge, Dr. Jenny
Prentice, Gordon (Pendle)	Touhig, Don (Islwyn)
Primarolo, rh Dawn	Tredinnick, David
Prosser, Gwyn	Truswell, Paul
Purnell, James	Turner, Dennis (Wolverh'ton SE)
Quin, rh Joyce	Turner, Dr. Desmond (Brighton Kermptown)
Quinn, Lawrie
Rammell, Bill	Turner, Neil (Wigan)
Rapson, Syd (Portsmouth N)	Twigg, Stephen (Enfield)
Reed, Andy (Loughborough)	Tynan, Bill (Hamilton S)
Reid, rh Dr. John (Hamilton N & Bellshill)	Walter, Robert
	Ward, Claire
Rendel, David	Wareing, Robert N.
Robertson, John (Glasgow Anniesland)	Watson, Tom (W Bromwich E)
	Watts, David
Robinson, Geoffrey (Coventry NW)	Whitehead, Dr. Alan
	Wicks, Malcolm
Roche, Mrs Barbara	Widdecombe, rh Miss Ann
Ross, Ernie (Dundee W)	Wilkinson, John
Ruane, Chris	Williams, Betty (Conwy)
Russell, Ms Christine (City of Chester)	Winnick, David
	Winterton, Ms Rosie (Doncaster C)
Salter, Martin
Savidge, Malcolm	Woolas, Phil
Sawford, Phil	Worthington, Tony
Sedgemore, Brian	Wright, Anthony D. (Gt Yarmouth)
Shaw, Jonathan
Simon, Siôn (B'ham Erdington)	Wright, Tony (Cannock)
Singh, Marsha	Wyatt, Derek
Smith, rh Andrew (Oxford E)	Young, rh Sir George
Smith, Geraldine (Morecambe & Lunesdale)	Tellers for the Noes:
Smith, Jacqui (Redditch)	Jim Fitzpatrick and
Soley, Clive	Joan Ryan

Question accordingly negatived.

MR. DEPUTY SPEAKER then proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Order [5 November].