HL Deb 18 April 1985 vol 462 cc813-93

4 p.m.

Baroness Trumpington

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—(Baroness Trumpington.)

On Question, Motion agreed to.

House in Committee accordingly.

[The LORD ABERDARE in the Chair.]

Clause 1 [Fluoridation of water supplies at request of health authorities]:

Lord Aberdare

I have to point out that if Amendment No. 1 is agreed to, I cannot call Amendments Nos. 2 or 3.

[Amendment No. 1 not moved.]

Lord Nugent of Guildford moved Amendment No. 2: Page 1, line 8, leave out ("may") and insert ("shall").

The noble Lord said: This is a very brief amendment and I shall be very brief in speaking to it. Clause 1(1) as drafted leaves the water undertaker, whether a water authority or a water company, free either to conform with a health authority's request to fluoridate the water supply or to refuse to do so. In other words, the water authority or water company is required to make a judgment on this issue. The responsibility of water authorities and water companies is to provide a sufficient supply of pure water and to use their expert technical judgment in deciding how to do this best and most economically. On the other hand, a decision to fluoridate is a judgment based on medical and ethical considerations, and a health authority by its nature is competent to take such a decision and make such a judgment.

My amendment will do no more than to clarify this position so that if a health authority in their wisdom decide that it would be beneficial for a particular area to have fluoridated water and they then make a request to the water authority or company concerned, then the water authority or company will be required to do it, and that will be the end of it. I beg to move.

Baroness Trumpington

I shall, alas, be less brief than my noble friend Lord Nugent. I must say at the outset that acceptance of my noble friend's amendment would not be in keeping with the fundamental principle of this Bill, and for reasons I shall explain would be likely to require radical alteration to the financial arrangements for water fluoridation in a manner which would I believe be unsatisfactory for the water industry.

The prime intention of this Bill is to restore the legal position to what it was understood to be prior to the judgment of Lord Jauncey in the Strathclyde case; that is to say, that fluoridation can proceed only with the agreement at local level of both the health and water authorities. The Bill is above all an enabling Bill which leaves decisions to be taken locally and does not oblige either health or water undertakers to undertake any action with regard to fluoridation against their will. While this Government, like previous Administrations, support and encourage the adoption of fluoridation, we are equally conscious of the sensitivity of decisions on fluoridation and the strength of feeling to which it gives rise.

For this reason we have done nothing in this Bill which would tip the balance of the established decision-making process in favour of fluoridation. Yet I have to tell the Committee that this will be the effect if the amendment of my noble friend Lord Nugent is accepted. I must also warn that acceptance of this amendment will render the financial provisons of the Bill wholly inadequate, and it is by no means clear that the Bill could be further amended to meet the legitimate interests of the water industry on this.

At present the financial arrangements are governed by contracts between health and water authorities which set out in detail the expenses which will be charged to the health authority. These contracts vary from one scheme to another, and each water authority can and does insist on its own particular conditions. As part of these arrangements water authorities receive an indemnity against legal action on certain grounds from the Secretary of State for Social Services. These indemnities are periodically revised in consultation with the water industry and indeed they will need to be further revised after enactment of the Bill.

The Bill as drafted, because it does not oblige a statutory water undertaker to fluoridate at the request of the health authority, will allow all these arrangements to continue unchanged. Under the amendment, however, the statutory water undertaker will be obliged to fluoridate when requested by a health authority, provided a self-contained fluoridation scheme is technically feasible. There would be no obligation at all on the health authority to pay a penny for fluoridation. The Government would be able to withdraw their indemnity without the statutory water undertakers being able to have any right of redress. The statutory water undertakers would similarly have no basis for reviewing arrangements for fluoridation schemes as the provisions for termination of fluoridation contracts by either side would no longer exist.

I appreciate of course that this situation is not the intention of the water industry; nor is it that of the Government. It is, however, very clearly our view that the present freedom of statutory water undertakers to negotiate contractual arrangements for fluoridation would be severely and undesirably constrained if the amendment of my noble friend Lord Nugent is accepted.

Lord Nugent of Guildford

I must confess that that is not a very satisfactory answer. It is not very different as the noble Baroness will know from the answer that was given in the other place. The point which she has made—that if my amendment were accepted the water authority or the water company would then be liable for the financial cost of the process, and much more seriously would be liable for a possible indemnification if a legal action were taken—is not entirely clear to me. That surely depends on how the rest of the Bill is drafted.

The Bill could perfectly well be drafted in order to cater for both those provisions. In the past, water authorities and water companies have been extremely anxious about their possible liability for a legal case and indemnification, because the answer had always been before the Bill appeared that the indemnity was not going to be underwritten by anybody. Therefore the water company or the water authority was in a very anxious position.

As I said on Second Reading, during my days as chairman of the National Water Council I was in fairly constant communication with Ministers asking for a more satisfactory position so that water authorities would have some confidence if they continued to fluoridate water as required, as had been established for some years, and that if legal action were brought against them they would be indemnified by the Government.

My noble friend tells me that if my amendment is accepted this indemnification will be lost. I just do not follow her argument. If it is the Government's intention that the water companies and the water authorities should now be indemnified, presumably that provision would go in anyhow. The only point of my amendment, which is a very simple one, is that the body that can most properly decide whether an area should have a fluoridated supply or not is undoubtedly the health authority. I am sure that my noble friend would agree with me on that. It does not, it seems to me, make an awful lot of sense to ask the water authority to take a judgment on it as well.

My point is a very simple one. I am discouraged by what the noble Baroness has already said. I hope that she will clear up this point of the indemnification because that seems to me a very major point for the water authorities and water companies which are—and have been for years—supplying fluoridated water. There should be no uncertainty about that.

Lord Prys-Davies

I would not wish it to be thought that the noble Lord, Lord Nugent, was the sole voice on this issue. He has dealt very forcefully with the technical arguments. The point I would wish to make is that, if the decision whether or not to introduce fluoridation is to be vested either in the health authority or in the water authority, then it should be entrusted to the health authority for the reasons which the noble Lord has given in support of his argument.

The fluoridation of the water supply relates directly to preventive health measures and not to the volume of supply of water. The health authority knows a great deal about health matters, whereas the water authority is probably a monument of ignorance on such matters. There are no health grounds whatsoever to justify this amendment. There may be other grounds for shifting the responsibility from the water authority and the health authority to the local authority, and we shall come to that at a later stage. At this stage, do we entrust the decision to the health authority or to the water authority? I should have thought that it ought to be vested in the health authority.

As I understand it, all the water authorities—apart from one or two exceptions—would welcome this amendment because they have no wish to be drawn into this debate because they feel that they are not competent to decide the issue; they wish to be neutral. I should therefore very much like to support the case which Lord Nugent has made out.

Lord Boyd-Carpenter

I find myself in support of my noble friend on the Front Bench, sadly, for once in opposition to my noble friend beside me, basically for two reasons. The indemnification point, which my noble friend the Minister has made—if one accepts some of the medical views which have been expressed—may be of considerable import. If the view is sustained that the ingestion of fluoridated water over the years can produce disease—and it is held by a good deal of medical opinion—then indemnification may be of a very serious financial nature.

The more short-term and immediate difficulty on my noble friend's amendment seems to be, that if one inserts "shall" one is undermining the bargaining position of the water authority. If they "may", when so requested, put this substance into the water, that leaves them—as I understand it—free to negotiate the financial terms for so doing. If Parliament says "shall", that would seem to undermine their bargaining position That does not seem to be fair.

Lord Colwyn

I wonder whether my noble friend could also clear up one point for me. I am not quite clear what happens if a water authority is supplying fluoridated water for more than one district health authority, and—as in the case in Yorkshire after 1974, where all the area health authorities agreed positively to accept fluoridation except Barnsley, which was on the end of the line—one veto can effectively negative the fluoridation of an area. I am not quite sure whether, under this part of the Act, a fluoridation decision can be adjusted as decisions are made by the water authority.

Baroness Trumpington

First of all, in answer to my noble friend Lord Nugent on the question of indemnity, it would be very difficult to draft the Bill to allow for variation in the arrangements which were mutually desired by the Government and the water industry—for instance, change to indemnity and payment arrangements. Of course, the noble Lord, Lord Boyd-Carpenter, hit the nail on the head when he talked about undermining the situation for the water authorities.

Of course I recognise entirely the laudable motives which lie behind the amendment. We all know the depth of experience of my noble friend Lord Nugent. Nevertheless, I still have to advise most strongly against acceptance. I do not think it right to change the status of the Bill from that of a purely enabling measure. I do not think it right to change the balance of the decision-making process in favour of fluoridation. I do not believe that we should place in jeopardy the current system of detailed contractual arrangements between health and water authorities over the running of fluoridation schemes. For all those reasons, it is essential that the amendment should not be accepted.

With regard to the point of my noble friend Lord Colwyn, I think he will find that the provision is already contained within the Bill.

4.15 p.m.

Lord Nugent of Guildford

I must thank my noble friend for trying to satisfy me, although I confess that I do not feel very satisfied.

I do have to take the point made by my noble friend Lord Boyd-Carpenter, that the bargaining position of the water authority would be weakened if they had this mandatory duty laid upon them. I still feel that logic is on the side of my amendment, that the right body for the decision is the health authority. However, I see that I am not making much impression on my noble friend on the Front Bench.

The point made by my noble friend Lord Colwyn is a good one: that there will be some cases where an individual health authority wants to have a fluoridated supply and because its neighbour does not it may technically be impossible for the water authority concerned to get a supply, the lay-out of the main supply being such that it would be impossible to differentiate the supplies. Of course, the Bill allows for a certain amount of flexibility, especially in emergencies where supplies have to be switched. There are certain limitations in the organisation of supply which would affect particular applications. However, that has nothing to do with the amendment.

I must thank my noble friend for trying, though unsuccessfully, to satisfy me. Nevertheless, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

Baroness Trumpington moved Amendment No. 3: Page 1, line 9, leave out from ("area") to end of line 13.

The noble Baroness said: This amendment seeks to clarify the meaning of the first subsection of the Bill. My right honourable friend the Minister for Health and my honourable friend the Parliamentary Under-Secretary of State for Health accepted in another place an amendment moved by Sir John Page, MP on behalf of the water industry which added to Section 1(1) the words that this amendment now seeks to delete. At the time my right honourable and honourable friends made it clear that they considered the amendment to be essentially unnecessary and that they could only accept it on the understanding that the amendment itself would have to be substantially redrafted and amended at a later stage.

However, the amendment is unnecessary and would render legally ambiguous a Bill which is designed to clarify legal powers. The basic reason why the amendment is unnecessary is that a statutory water undertaker already has unqualified discretion in considering a request from a health authority for fluoridation. This is provided for by the use of the word "may" rather than "shall" in this subsection. No water undertaker could rationally exercise its discretion in favour of a fluoridation scheme unless it were already satisfied that such a scheme were technically feasible. It is not necessary, therefore, to provide for that in the statute.

Similarly, water undertakers cannot supply fluoridation under the existing terms of the Bill to a non-requesting area, except in emergency circumstances. The final part of subsection (1) in Clause 1 is therefore superfluous and I commend its deletion to the Committee. I beg to move.

Lord Nugent of Guildford

When this amendment appeared it caused some surprise to my friends in the water industry, who thought that they had done rather well when they managed to get this part of the Bill amended in another place. However, I acknowledge that there is weight in what my noble friend has just told us. I suspect that the original concept of this amendment was linked to the amendment I have just unsuccessfully moved, to leave out the word "may" and insert "shall". Had that amendment been made to the Bill, the existing provision in Clause 1 would have related to it, to provide the flexibility needed. However, I see that my noble friend has provided all the flexibility needed in a later amendment on the Marshalled List, and so I acknowledge that the wording she seeks to delete is not necessary and would cause problems. So far as I am concerned, I am happy to accept her amendment.

On Question, amendment agreed to.

Lord Sandys moved Amendment No. 4: Page 1, line 13, at end insert— ("( ) There shall be no increase in the fluoride content of the water supplied by a water undertaker in England and Wales unless approval is given for such action by a majority in favour of it in a county council or councils, or in each district council, in the area to be affected.").

The noble Lord said: In introducing this amendment I shall preface my remarks by saying how strongly I support the water authorities and those who work very hard to supply us with water. The remarks I intend to make will relate to those people to some extent, but I hope they will in no way be construed as being hostile to their very hard work on our behalf.

I believe that this amendment will help the Government considerably because it will introduce an entirely new look and provide a fresh context in which the decision whether or not to fluoridate is taken. Let us set this matter out very clearly. At present the water authorities take the decision to fluoridate upon the advice of area health authorities, and in a large number of cases the wishes of the locally-elected councils are not taken into consideration.

It is very sad, when one looks around the country, to see the way in which opinion has been expressed, but the water authorities concerned have been unable or unwilling—and I regret to say that in certain cases they have been unwilling—to accede to the wishes of consumers. Let me describe in a little more detail what has happened. It is significant because in a number of cases the authorities I shall name previously had quite a long-standing opinion in favour of fluoridation.

Let me take first the situation in Surrey, the county with which the noble Lord, Lord Nugent of Guildford, has such a close affiliation. In November 1976 the council voted by 33 votes to 17, reversing the previous long-standing decision to fluoridate. In the same month Northamptonshire voted by 43 votes to 10 against fluoridation and asked most particularly the area health authority not to proceed with its intention to fluoridate. Sheffield City Council voted by 42 votes to 32 votes against, reversing the council's long-held position in favour of fluoridation.

When it comes to my own local authority—about which I know more, for obvious reasons—Hereford and Worcester voted in November 1978 by a very large majority against fluoridation. It was supported by both district councils in its area and by a very large number of consumers. What happened? Subsequently the Severn-Trent River Authority took a decision, not on 19th February 1981, but almost three years later, not to take into account the wishes of locally-elected representatives and local councils.

That was a matter for considerable regret because the Severn-Trent authority's initial decision was taken by a casting vote in 1978. The casting vote won; 19 votes in favour, 18 votes against. For the authority only a few years later to reject entirely the views of the locally-elected representatives—parish councils, district councils and county council—and to say that others know nothing about this subject and that the water authority alone knows about it is the very negation of democracy.

If the Government give serious consideration to this amendment, it will enable democracy to enter into the whole process of decision making in an area which is extremely contentious and about which we now know a great deal more than we did a few years ago. I beg to move.

The Earl of Kinnoull

I should like to support most strongly my noble friend. I believe that this is the most vital amendment that will be moved this afternoon because it strikes at the heart of the argument which went through all the stages in another place, so ably led by Mr. Ivan Lawrence, QC, who got the better of the Government's arguments on this issue. In fact, one sees today that the Government have moved a little distance by suggesting an amendment later on the Marshalled List which implies some measure of consultation.

If one examines the Government amendment which we shall be debating later, one sees that it does not go nearly far enough. It does not leave the decision, as it should be left, with local government and with the elected representatives of local electors. I myself wonder whether the Government did not get the decision-making structure entirely wrong from the very start. This is a very sensitive subject and the Government know that it is a sensitive subject. Surely it should be left to local councils to make the necessary decision, which is what this amendment would allow them to do.

Lord Houghton of Sowerby

I, too, wish to support this amendment. It is possible that Amendment No. 16 may be preferable; that is a matter for consideration. Certainly there has to be some consultation with those who represent the consumers. One reads in the Explanatory and Financial Memorandum that: The Bill provides specific powers for a statutory water undertaker to increase the fluoride content of the water supply to a particular area when requested to do so by the appropriate Health Authority or Health Board". That is rather a startling description of how water can be medicated at the request of a health authority.

I ought to make it clear that I am against this Bill on principle. I believe that this House has a very special responsibility for dealing with this matter because it comes very close indeed to the question of the liberty of the subject. I am no more in favour of medicating the water to take care of the teeth of children than I am of medicating the water to cure the nation's constipation or to render the nation's women sterile, or to do anything else to the community which a health authority might think was good and proper. I would bar such action entirely, even with the consent of the district council.

This is a terribly important step we are taking. I realise that the possibility is that were we starting afresh, we might not embark upon this course of action at all. But some authorities have already taken advantage of the law as it seemed then to stand to introduce a fluoridated water supply. To some extent—probably to a large extent—this Bill is intended to regularise the statutory position, so that all local health authorities may know where they are.

4.30 p.m.

Surely the consumer should have something to say before the water authority, at the request of the health authority, begins to pour down his throat liquid that he does not want. Who knows what effect medicated water may have on particular individuals? I agree that water should be brought up to the standard which renders it fit to drink, even though it may need some additive or some treatment.

Years ago I went to a sewage plant belonging to the London County Council. We looked at the sewage going in at one end and we saw the water coming out at the other end. We were told that the water coming out at the other end was fit to drink and we were all challenged to have a glass of it. The look on the faces of those who accepted the challenge was quite a study because it reflected not the taste of the water but the fear that it had something in it that they did not know about. I mention this only to show that in order to make water fit to drink you can take sewage and make it drinkable; and it is done by various chemical processes.

One might say to the consumer, "If you don't want your water done this way, you probably will not have any water at all because this is the supply you must have." It may come from the Thames or other rivers and it may be from polluted sources. The nation must have water fit to drink but beyond that point there is no case whatever for beginning to tamper with the health of the nation by the use of our water supplies. Nothing should be done anywhere along those lines without the firmest democratic assent. I would settle for the decisions of the district and other councils because they try to be representative, although I think that on a matter of this kind—especially on a matter of this kind—the citizen ought to be able to vote directly on whether or not he wants this to be done.

I urge the Committee to regard this as a very important matter. It caused a lot of contention in another place and for once the so-called filibuster was not from the politically opposite side, which shows how strongly some Conservative Members in the other place feel about this subject. It is not a party matter. I am surprised that the present Government are introducing it. They stand for the liberty of the subject. They do not want all this fussiness of the state taking care of the citizen; they believe the citizens should stand on their own feet and use their own intelligence.

The way to get rid of caries in children is to put Rowntrees' sweets out of business and let children have a decent diet. But your Lordhips know jolly well that people are not interested in prevention in their personal habits; they want cures. That is why the pharmaceutical industry does so well as compared with the Health Education Council. Cures are dramatic and people are looking for some way of safeguarding themselves from the folly of their own behaviour or their own indifference to what they drink or eat.

I shall not make this kind of speech again, but we are not always able to register our dissent from the Second Reading of a Bill in your Lordships' House, unless there is a Division. Nearly always in another place there is a Division so that those who are in favour and those who are not have been counted to start with; but in your Lordships' House unless you put your name down with 55 others to register your opinion on a Bill you cannot do so until we come to the Committee stage. Therefore, I am taking the first opportunity of doing so.

Lord Winstanley

I have no wish to prolong the proceedings but, unlike the noble Lord, Lord Houghton, I am in favour of the Bill and should like to see it enacted, unamended, and speedily. Perhaps I may say to the noble Lord, Lord Houghton, that we may be in danger of having a Second Reading debate. I understand very clearly the point he has made that there are certain inhibitions on noble Lords with regard to Second Readings and that sometimes other means must be found to register general disapproval of a Bill. But I should like to say most earnestly to the noble Lord, Lord Houghton, and to other noble Lords who take the same view—which is a very different view from mine—that I hope they will not seek to make Second Reading speeches on each and every one of the amendments which have been tabled for the Committee stage.

Lord Houghton of Sowerby

I am grateful to the noble Lord for giving way. I did promise that I would not do it again.

Lord Winstanley

There are others who have not yet made such an undertaking.

As I am on my feet, perhaps I may be permitted to say a few words on what the noble Lord said. This is not mass medication. It is merely a matter of adjusting the concentration of a normal constituent of normal water to an optimum level where that water happens to be deficient in that particular component. It is not mass medication and it has nothing to do with medication. As we have said, those in favour of fluoridation have never suggested that it cures dental caries. What we have said is that it prevents it, which is a very different matter.

On the particular matter raised on an earlier amendment by the noble Lord, Lord Boyd-Carpenter, who said there might well be serious implications as regards indemnities, and so on, if the medical evidence is to be believed, I must say that there is no medical evidence—reputable medical evidence—that fluoride in water, in the concentration which is recommended in the Bill, has ever done any harm of any kind to anybody, anywhere, ever.

Lord Sandys

This raises such a contentious issue that I am perhaps constrained to make a Second Reading speech, but will the noble Lord accept that there are widely held opinions in this House which are the opposite of what he has expressed?

Lord Winstanley

I readily accept that, and have accepted for years that many people hold a contrary opinion. I regret that and I hope that, as a result of full debates of this kind, people will in the end gradually become more informed as to the full facts and become a little more knowledgeable.

With regard to the important point concerning democracy which was raised by the noble Lord, Lord Houghton, personally I should like to see the health authorities democratically elected. To have that would be a very different matter. But to introduce an element here whereby other bodies repeatedly have to go into this matter so that the kind of discussions which we have had here and in another place go on and on, over and over again, and the same kind of fears—almost paranoid fears—are repeatedly expressed so that people's anxieties are aroused even further, is regrettable.

The noble Baroness, Lady Gardner, who is herself a dentist of some renown, said on Second Reading—I know she is not present at the moment—that she rather wished the Bill was mandatory. I am inclined to agree with her. I think that after nearly 40 years of discussions on this subject the time has perhaps come for someone to take a decision. The noble Lord, Lord Houghton, said the time has come for lots of other people to take a decision, not once but over and over again. I am not against the democratic procedure. I want people's voices to be heard and their opinions to be heard, but, on an issue which has been argued about for 40 years and on which all scientific opinion is united, the time has come to make up our minds rather than to say that we will not make up our minds but will leave it to a lot of other people to make up their minds.

Lord Boyd-Carpenter

The noble Lord almost challenged me to make a Second Reading speech which, as I did not speak on Second Reading, is a temptation to which I might be peculiarly susceptible; but I shall resist it. However, I do not resist the temptation to come back to him on two points.

First, he said that no medical opinion supported the view that the administration of fluoride in water could do any harm. He rather hastily corrected that to no "reputable" medical opinion. With all respect to his profession, those who take one view on a matter are apt to regard the opinions of others as not being reputable. Sometimes we do the same in this House. There have been quite a number of men with medical qualifications who have indicated that they see dangers in the ingestion of fluoride with drinking water. It is a fact that people do feel that way and have their doubts about it. This is an argument for having this democratic procedure which my noble friend's amendment would provide.

When the noble Lord says that there is no reputable medical opinion I am not wholly convinced, both for the reason I have given, and also because, as he knows better than anybody, current medical opinion at any one time has very often over the years been proved to be wrong. The noble Lord may remember that for years all the leaders of the medical profession prescribed thalidomide to pregnant women and the noble Lord knows the disaster which their error created and the number of maimed and mutilated people who have been about for many years because in its belief that thalidomide was harmless the medical profession was wrong.

That makes those of us who do not belong to that profession a little sceptical as to whether there is such absolute truth and reliability in medical opinion as the noble Lord seemed to think. I shall listen to what my noble friend the Minister says, but it seems to me that there is something to be said for not leaving it just to the health authority to decide these matters, but introducing some element of democratic choice before this chemical is put into the water.

I nearly forbore from adding that, of course, it is about the most uneconomic method of medicating people that one could imagine, because I understand that under 4 per cent. of water is drunk, and yet it is proposed to put this chemical into all the other water which goes into factories or baths or which is used to clean the streets. It is a somewhat uneconomic medical procedure to do all this for the sake of the 4 per cent. which is actually drunk. I again wonder, therefore, whether a democratic procedure, under which people in an area can decide whether they want to spend their money in that way, is not altogether a bad idea. As I say, I shall listen with the greatest interest to my noble friend, but I would say to her that I think she has quite a heavy task in front of her.

Lord Moyne

Perhaps I may add that of the 4 per cent. a very much smaller percentage still are the children who alone could benefit.

Lord Boyd-Carpenter

I am much obliged to my noble friend for that reminder. With regard to the 4 per cent. of water that is drunk, I suppose that those who could be described as children must be well under 2 per cent. and that makes the position even more absurd. As my noble friend intervened, he will recall, because he has raised it, the great battle of Andover 20 years ago, when a very distinguished physician in the country—who happened to be my own doctor—led the opposition which caused the local authority in Andover to obtain an injunction to stop fluoride being introduced. Your Lordships' Committee might be entertained by the Australian's splendid comment. He asked, "Where is this going to stop? If you go on like this, it will be Enos in the morning and gin at night."

Lord Paget of Northampton

I find the speech of the noble Lord, Lord Boyd-Carpenter, astonishing in introducing the thalidomide question here. Thalidomide was an artificial drug, insufficiently tested by a Swiss firm, which, without any regard to our medical authorities, people exercised their democratic right to use, with disastrous results. It seems to me just about the worst argument that you could possibly put up on this issue. We are talking about the exact opposite. I should like to congratulate the noble Lord, Lord Winstanley, on speaking the truth. I have now been in Parliament for nearly 60 years. Throughout that time I have had this problem going on. In my time I must have received up to 50 delegations with obscurantist claptrap about the use of this drug. It goes on and on. As the noble Lord says, in the whole of that time not one bit of real or solid evidence of any sort, kind, or description has ever been produced anywhere or by anybody to show that water so treated has done any harm to anybody. That is the fact. But there is an obscurantist type of witchcraft which has taken on this nonsense and has gone on parading it for my lifetime. I really think it is time it stopped.

4.45 p.m.

Lord Campbell of Croy

My noble friend Lord Boyd-Carpenter raised the question of costs and I feel that I must make a brief intervention, because had he attended the Second Reading debate on this Bill, he would have heard that the cost, even though the amount of water that will be drunk is quite small, is insignificant. That is because it is a very easy operation, whereas the money saved by the National Health Service will be millions, and that money could be put to another use within the National Health Service.

Lord Boyd-Carpenter

Will my noble friend allow me to point out that that is a very unfair comparison? It is not a comparison between putting thalidomide into the water and the damage to the National Health Service—I should have said putting fluoride into the water, but it is all the same, is it not?—and the cost of dealing with dental caries which nobody underrates. It is a question of the choice between putting fluoride into the water, of which, as we discovered, only about 2 per cent. actually goes into children's mouths, and administering it direct to children through toothpaste.

Lord Campbell of Croy

I was interrupted by my noble friend. I would simply add—I do not intend to repeat any Second Reading speeches—that I was referring to the money which would be saved in the attendances at dental surgeries by numbers of children who do not need to have fillings and do not need to have the attention to their teeth which they now have and suffer from. It is the savings in expense there, which not only the dental profession but others have estimated, which must be taken into account when one is considering costs.

Lord Boyd-Carpenter

My noble friend has not followed the point. As I understand it, everybody favours dealing with children's teeth, but not necessarily by putting fluoride in the water. It is perfectly possible to administer it by way of toothpaste or pills.

Lord Campbell of Croy

I must again return to the Second Reading. The noble Lord, Lord Harris, speaking from the Cross-Benches against fluoride, was absolutely against pills and tablets as an effective method of using fluoride. There is no doubt that hard-pressed mothers and those who have to look after small children—because this is something which you have to begin at about the age of one, or even earlier—would find it extremely difficult to administer fluoride in that way. I am glad to say that my noble friend corrected his reference to thalidomide, because clearly that was a slip. However, fluoride is very difficult to administer in the way in which he suggests.

Baroness Trumpington

Perhaps I may end this private argument before it moves any further away from the amendment on the Marshalled List. With regard to the toothpaste point that my noble friend Lord Boyd-Carpenter raised, it is too late by the time they are using toothpaste.

Lord Winstanley

I was going to tell the noble Lord, Lord Boyd-Carpenter, if he will allow me, that he has convinced me of one thing, which is that I was extremely unwise to intervene at all at that particular time. I fully accept that doctors can be wrong and often have been wrong. I accept that contrary opinions have from time to time been expressed. But on every occasion those contrary opinions have been rejected by orthodox medical opinion. The Royal College of Physicians, the Royal College of General Practitioners, the British Dental Association and all other academic bodies in the end have come out with the view which I express.

I rose because the noble Lord, Lord Boyd-Carpenter, raised a very important point. It was a point which was raised at Second Reading by the noble Lord, Lord Moyne, with regard to the events in Andover. I know that the noble Baroness who is to reply has the full information about precisely what happened in that case. But since the matter has been raised again, I think that it might be helpful if in her reply she put the record straight with regard to those events in Andover.

Lady Saltoun

I must give a little support to this amendment, which has my name to it, among others. I entirely agree with what the noble Lord, Lord Houghton of Sowerby, said, and, with great respect, I entirely disagree with practically every word the noble Lord, Lord Winstanley, said.

The supporters of fluoridation say that there is no difference between adding fluoride to the water and adding chlorine. I am very sorry, but there is. Chlorine is added purely and simply to make the water safe to drink, but fluorine is added to have a specific physical effect on a certain sector of the population. That is quite different, and it is creating a dangerous precedent that that should be done without the consent of consumers, many of whom strongly object.

It is also a very different matter from adding vitamins and minerals to bread. That is another analogy which I have heard used by the supporters of fluoridation. We have a choice of what bread to buy, or we usually do, or we can bake our own, or we need not eat bread. We have to have water. Very few people in this country have their own private water supply. Even if they have, they cannot normally consume nothing but their own private water. Most people rely on the public water supply, and I really cannot agree to that supply being tinkered about with for any other reason but to make it safe to drink. That is one reason why I support this amendment.

May I just add this? The noble Lord, Lord Winstanley, said that all the scientific evidence is that it is perfectly safe to add fluorine to water. With very great respect, I have heard and read scientific evidence which indicates quite the contrary. It seems to me that there is not a consensus on that. I think therefore that we should be very chary of foisting fluorine onto an unsuspecting and possibly ignorant public.

Lord Maude of Stratford-upon-Avon

In supporting this amendment I should like to say how strongly I agree with my noble friend Lord Boyd-Carpenter. The noble Lord, Lord Paget, objected strongly when my noble friend mentioned thalidomide in this context, but there have been innumerable other cases over the years in which accepted medical and scientific opinions about various drugs have been reversed in the fullness of time. A number of commonly used analgesics, the use of ergotamine for migraines and various things of that kind which are freely prescribed lost their popularity because they were held to be dangerous. One does not have to go too far back to remember that the Government's economic advisers were advising Prime Ministers that uncontrolled atmospheric tests of nuclear weapons were perfectly safe and would harm nobody. A year later they were saying that the amount of Strontium 90 deposited on the grass would kill babies within a year. There has been no certainty that the best scientific opinion will not be changed over the years.

The noble Lord, Lord Winstanley, said one very revealing thing when he said that all the Bill sought to do was to bring the fluoride content in water everywhere up to the optimum level. That is a most subjective and highly tendentious remark to make. Who says what is the optimum level, and the optimum level for numbers of different kinds of people?

I think that this amendment ought to be supported and I hope that your Lordships will support it.

Lord Energlyn

I support this amendment, but before I say why, may I refer to the Second Reading speech of the noble Lord, Lord Winstanley? I say this. We are dealing with a form of chemotherapy, and in chemotherapy you have to make two decisions about a substance you are going to use. The first is, is it harmless? The second is, is it useful? Against that you have to ask, if the substance is harmless, is it also useless?

Having said that, I turn to the amendment. I like this amendment because not only does it break down the decision-making problem into smaller units than those which would have to be dealt with by the local health authority or by the water undertaker but it also takes into account the great variation that there is in the composition of water. By composition, I mean not only its chemical composition but its physical composition.

I am most grateful to my noble friend for raising those doubts about the future prophecies of scientists in one field or another. In this case I suggest that we should look at this amendment from a practical point of view and support it. It breaks the problem down into areas where the decisions will never get out of control.

Lord Burton

The noble Lord, Lord Winstantly, said that there was no medical evidence, but I believe there is veterinary evidence. Some years ago there was an escape of this nasty poison from the aluminium works at Fort William. It killed a large area of vegetation, in particular, Ponticum rhododendron, which, as your Lordships will know, is very difficult to kill. Now, many years later, the local farmers tell me that it is still impossible to graze stock over large areas in that locality as the bones of the animals crumble and their teeth drop out. It is not clear whether the teeth have already deteriorated prior to falling out, but there is no use in having extra enamel if the teeth are going to drop out anyway.

After all the experiments carried out to ascertain that one part per million would not be injurous to humans—what my noble friend Lord Glenarthur described on Second Reading as, "the recommended concentration"—clearly there should be little risk, but the fluoridation of water will involve the use of 11,000 tonnes per annum of that poison. Who is to say that all water authorities are so infallible that there will be no mistakes? We must all have smelt the heavy infestation of chlorine in our water supplies from time to time, so the treatment with chlorine varies. How can we then say that we shall always have the same amount of fluorine added to our water? I feel that the treatment of water, rather than milk, can scarcely guarantee safety. If there is an accident, and throughout any area people's teeth start to drop out, this Bill will be responsible.

Lord Prys-Davies

I wish to support the amendment. I did not speak in the Second Reading debate and therefore I should make my position clear. I have very little doubt in my mind that it is for the good of children's teeth that fluoride be introduced to the domestic water supply. I also accept that there is the possibility that all the time other groups will be more at risk. I live with the consciousness that the medical evidence may not be as overwhelming as it appears to be in 1985.

The Second Reading debate showed clearly that there are a series of objections to the Bill as it is drawn. I shall not labour the objections, but I may perhaps be allowed to say this. It appears to me that, the medical evidence not being overwhelming, the central problem is that certain moral limits should be placed upon the extent to which people can be forced to accept treatment which is not necessarily for their own benefit and indeed may all the time expose them to risk. That is the heart of the moral dilemma. Once it is conceded, as it must be conceded, that there are ethical grounds for questioning the decision to fluoridate the domestic supply, the case for the Bill as drawn begins to break down.

The point has been made by the noble Lord, Lord Winstanley, that it has not gone unnoticed that the Government, who are themselves accountable to Parliament, are not confident enough of the strength of the medical arguments or of the irrelevancy of the ethical arguments to enable them to offer a definite lead to the country. They adopt a neutral stance. As I see it, their position is one of disengagement. It is left to the communities to make up their own minds.

5 p.m.

Really it is not left up to the community, either, because the Government hive off the decision to the water authority, which may be remote—far removed—from any of the districts. I should have thought that it would be equally inappropriate to hive it off to the health authority. Certainly I would trust the health authority on medical issues. But I would not trust the health authority on ethical decisions involving the whole of the community. Therefore, having regard to the ethical issues presented by the Bill, it appears to me that the decision whether or not to introduce this substance to the domestic water supply should be taken by a body which has a responsibility and an accountability to the people who live in the district to be affected by the decision. It seems to me that unless we move in that direction, we shall not meet the disquiet which has been expressed in the Chamber on Second Reading and, indeed, this afternoon.

This amendment invites your Lordships' Committee to vest the decision-making power in the local authorities. I give it my full support. When we come to Amendment No. 16 it may be that we ought to vest it in the people themselves; but I give the amendment my wholehearted support.

Lord Beaumont of Whitley

I should not like the only speech from the Liberal Benches to be that of my noble friend Lord Winstanley, much as I respect his expertise in this particular field. As a member of the party which has long had John Stuart Mill as its guru, I suspect that that great man would be turning in his grave at some of the arguments which are being put forward against this amendment.

If my noble friend Lord Winstanley tells me that medical evidence, indeed, all reputable medical evidence, comes down on one side, I for one, as opposed to some of the other people in favour of this amendment, am quite prepared to believe him. I am also prepared to say that if I was a member of an authority which was dealing with this matter, I would accept his opinion and I might well vote for fluoridation. But what I must vote for in this Committee is the right for people to come to what decision they like on the matter.

My noble friend Lord Winstanley spoke about the question having been discussed over and over again. He said that one of the troubles with this amendment—I think I quote him correctly—was that it would be discussed over and over again. That is what devolution and local government—in which both he and I strongly believe—is all about. I believe that whatever the medical rights and wrongs of this matter, it is something on which the people of this country, who are affected area by area, should have the right to vote. There are different amendments on the Marshalled List, but it seems to me that this, as well as being the first, is, indeed, a representative and a worthy one. I certainly support this amendment.

Lord Paget of Northampton

Will the noble Lord permit me to say just one thing? Would he be in favour of allowing people to have first, thalidomide and, secondly, "pot" if they chose to vote for it?

Lord Beaumont of Whitley

I am not quite certain about the argument about thalidomide. My answer in regard to "pot" is certainly, yes, as Members of the Committee know from my past record in this Chamber.

Lord Somers

I am always rather surprised at the passion which some people seem to show when it comes to the question of being allowed to do exactly what one wants. I think most of the Committee will probably agree that it is impossible to buy any milk in this country that is not pasteurised—and that is a very good thing. However, surely the mere desire to have something that is not pasteurised, that is perfectly natural, is not necessarily a very urgent desire, nor necessarily a very wise one. It seems to me that if the bulk of medical and scientific opinion is in favour of fluoridation and says that it is completely harmless, who are we, who are not scientists or doctors, to question it?

Lord Sandys

Before the noble Baroness replies, perhaps I may list no fewer than five Nobel prizewinners who are against fluoridation. I think it would asist the noble Lord, Lord Winstanley, and, indeed, the noble Lord, Lord Paget, to have these names. The noble Lord, Lord Paget, mentioned the opposition to fluoridation in such disreputable terms as witchcraft and other terms. I think it would benefit the Committee and those outside to know these names. I hope I am not being too tedious in expressing them. They are: Professor Hugo Theorell, Nobel prizewinner and Swedish biochemist, whose work on enzyme chemistry, to which we will come later, is very widely known; Professor Otto Warburg, also a Nobel prizewinner; Professor Butenandt, a Nobel prizewinner of Munich University; Professor Murphy, a Nobel prizewinner and consultant physiologist; and Professor Semenov, a Nobel prizewinner of Leningrad University and a chemist.

Lord Moyne

Before the noble Baroness replies, perhaps I may say this. The noble Lord, Lord Winstanley, incited her to go into Second Reading matters. The noble Baroness very kindly wrote to me. I telephoned the people concerned yesterday. I have an answer. However, if she is not going to take up time on this amendment by raising that, perhaps I need not speak.

Baroness Trumpington

In immediate answer to the noble Lord, Lord Moyne, I wish to say that with regard to the Andover case, as he so rightly said, I have written to him. I shall place a copy of the letter in the Library, if there is not already one there.

It is extremely difficult for me not to make a Second Reading summing-up speech. The noble Lord, Lord Winstanley, was certainly not alone in his possible invitation to me. It seems a long time ago that I was delighted to hear my noble friend Lord Sandys welcome fluoridation at the start of his remarks. Again we have all those noble Lords on one side or the other who all feel passionately. The noble Lord, Lord Houghton of Sowerby, pointed out so succinctly that the water goes round and round, and I shall not continue with that parody.

However, as my noble friend Lord Boyd-Carpenter strayed—though I understood his temptation—from the purpose of the amendment, at this stage I shall resist the temptation to answer him and other noble Lords, including the noble Lord, Lord Prys-Davies, concerning medical opinion and other medical matters because, strictly speaking, this is not the amendment that concerns them. However, in answer to the other point of my noble friend Lord Boyd-Carpenter on the matter of costs, fluoridation has been shown by the World Health Organisation, among others, to be highly cost effective. So I, too, can throw a name around the place. The cost of water fluoridation comes from central Government funds allocated to health authorities, and not from either the rates or water charges. I recognise that this amendment reflects the views of those who feel strongly that fluoridation should not be introduced unless it has the agreement of locally-elected representatives, which is what this amendment is all about.

To answer my noble friend Lord Sandys, I believe that the Severn-Trent Water Authority has behaved entirely properly in its attitude towards water fluoridation. Requests for fluoridation have come from the West Midlands Regional Health Authority, which has itself taken a number of measures to assess local opinion on fluoridation. In addition to the holding of public meetings, the West Midlands Regional Health Authority has conducted opinion polls at both national and local levels in favour of water fluoridation. The results of surveys held in Wolverhampton, Worcester, Mid-Staffordshire and Walsall were that, overall, 64 per cent. of those questioned were in favour of fluoridation, 27 per cent. were against, and 9 per cent. were "Don't knows".

On the basis of consultation action carried out by the West Midlands RHA, I believe the Severn-Trent Water Authority was quite entitled to comply with requests for fluoridation. Indeed since 1979 the Severn-Trent Water Authority has operated a policy of agreeing to fluoridate areas only where a majority of community health councils are in favour. However, I must make the point that, as regards England and Wales, local authorities no longer have any responsibility for either the provision of water or the provision of facilities for preventive health measures, as these were removed under the 1974 reorganisation of the water industry and under the 1973 reorganisation of the Health Service.

For the benefit of noble Lords, equally I wish to make it clear that the Government attach very great importance to health authorities consulting local opinion on fluoridation prior to taking a decision This is why we have agreed to amend the Bill in our new Clause 32, so as to place a specific statutory duty on health authorities to undertake general public consultation before making a request to a water undertaker for fluoridation. This will give local bodies, such as local councils and individuals, the opportunity to make representations to the health authority. In addition, health authorities are already expected to consult their community health councils on fluoridation proposals, and it should be remembered that these bodies have statutory responsibility for representing consumer interests in health matters.

Therefore, as my noble friend can see, the Government are bending over backwards to ensure consultation. However, I must tell the Committee that the Government do not agree that the final decision on fluoridation should rest with other than those bodies which have the statutory responsibility for carrying out the functions inherent in fluoridation. It is manifestly wrong that bodies, whether or not elected, which have no responsibility for either preventive health measures or the provision of water supplies should have a right of veto on water fluoridation. On this basis I hope that my noble friend will not press his amendment.

Lord Sandys

I have listened with interest to what my noble friend Lady Trumpington has said, and I have come to the following conclusion. I appreciate the Government's good intentions as expressed in Amendment No. 32. However, together with a number of my colleagues I have thought very carefully about that amendment. It expresses a willingness to enter into consultation, but at the heart of it is the present situation: consultation can take place, as, indeed, it did take place—and the noble Baroness described what took place in the West Midlands.

I had no quarrel whatever with the Severn-Trent Water Authority until it made the decision not to take the wishes of locally-elected representatives into account. It is at that point that Amendment No. 32 becomes somewhat vacuous, because all these opinions can be gathered in the most careful and beneficial manner, but at the heart of it is the dilemma so well put forward by my noble friend Lord Nugent, that it is not the water authority which should be responsible for taking the decisions.

Having listened to my noble friend Lady Trumpington, I believe that all those who have supported this amendment would wish to dispute the matter, and I wish to test the opinion of the Committee. I beg to move.

Baroness Trumpington

Before my noble friend sits down, perhaps I may add a further comment. Although I realise that people hold pretty entrenched positions over this matter, has it occurred to my noble friend that every time a county or district council changes its political complexion, or every time a vast body of councillors changes at election time, great expense will be incurred due to this stop-go possibility?

Lord Sandys

We have considered that point. The various decisions which I took the trouble to quote to your Lordships were taken as long ago as 1976. Since then there have been a number of elections. I am not aware that there has been a reversal of that. Therefore, I believe it is somewhat unlikely that this would take place.

Lord Houghton of Sowerby

The noble Baroness—

The Earl of Caithness

My noble friend has moved his amendment.

5.17 p.m.

On Question, Whether the said amendment (No. 4) shall be agreed to?

Their Lordships divided: Contents, 64; Not-Contents, 90.

Airedale, L. Kinnoull, E.
Alexander of Tunis, L. Leatherland, L.
Bauer, L. Listowel, E.
Beaumont of Whitley, L. McNair, L.
Beswick, L. Maude of Stratford-upon-Avon, L.
Birk, L.
Boothby, L. Merrivale, L.
Boyd-Carpenter, L. Milverton, L.
Buckmaster, V. Monson, L.
Burton, L. Mottistone, L.
Cathcart, E. Moyne, L.
Cledwyn of Penrhos, L. Munster, E.
Cross, V. Nicol, B.
Dacre of Glanton, L. Phillips, B.
David, B. Platt of Writtle, B.
Elwyn-Jones, L. Ponsonby of Shulbrede, L.
Energlyn, L. Porritt, L.
Ennals, L. Prys-Davies, L.
Enniskillen, E. Rankeillour, L.
Ewart-Biggs, B. Rawlinson of Ewell, L.
Gainford, L. Ritchie of Dundee, L.
Gladwyn, L. Rugby, L.
Graham of Edmonton, L. Saltoun, Ly. [Teller.]
Greenway, L. Sandys, L. [Teller.]
Gregson, L. Seebohm, L.
Grimond, L. Stoddart of Swindon, L.
Houghton of Sowerby, L. Strathspey, L.
Hylton-Foster, B. Terrington, L.
Jacobson, L. Thurlow, L.
Jacques, L. Wallace of Coslany, L.
Kearton, L. Wells-Pestell, L.
Kilbracken, L. Yarborough, E.
Kings Norton, L.
Ailesbury, M. Halsbury, E.
Amherst, E. Hardinge of Penshurst, L.
Attlee, E. Hayter, L.
Auckland, L. Hemphill, L.
Aylestone, L. Henderson of Brompton, L.
Belhaven and Stenton, L. Hooson, L.
Beloff, L. Hornsby-Smith, B.
Belstead, L. Ilchester, E.
Bottomley, L. Jenkins of Putney, L.
Brabazon of Tara, L. Kilmarnock, L.
Broxbourne, L. Lane-Fox, B.
Bruce-Gardyne, L. Lindsey and Abingdon, E.
Burton of Coventry, B. Lloyd of Kilgerran, L.
Caithness, E. Longford, E.
Cameron of Lochbroom, L. Lyell, L.
Campbell of Alloway, L. McAlpine of West Green, L.
Campbell of Croy, L. Malmesbury, E.
Chitnis, L. Marley, L.
Colwyn, L. Marsh, L.
Craigavon, V. Massereene and Ferrard, V.
Cullen of Ashbourne, L. Mayhew, L.
Davidson, V. Mersey, V.
Dean of Beswick, L. Nugent of Guildford, L.
Denham, L. [Teller.] Onslow, E.
Diamond, L. Orkney, E.
Ebbisham, L. Orr-Ewing, L.
Elles, B. Paget of Northampton, L.
Elliot of Harwood, B. Pitt of Hampstead, L.
Elton, L. Portland, D.
Faithfull, B. Reay, L.
Falkland, V. Renton, L.
Fanshawe of Richmond, L. St. Aldwyn, E.
Ferrier, L. Seear, B.
Fraser of Kilmorack, L. Shinwell, L.
Gardner of Parkes, B. Skelmersdale, L.
Glenarthur, L. Stamp, L.
Gridley, L. Stewart of Fulham, L.
Haig, E. Strabolgi, L.
Hailsham of Saint Marylebone, L. Sudeley, L.
Swinton, E. [Teller.]
Teviot, L. Vivian, L.
Tordoff, L. Whitelaw, V.
Trumpington, B. Willis, L.
Vaux of Harrowden, L. Winstanley, L.
Vickers, B. Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

5.26 p.m.

The Earl of Kinnoull moved Amendment No. 5: Page 2, line 10, at end insert ("and that a device for removing safely all fluoride from the water supply is available to be supplied free of charge to the householders on request.").

The noble Earl said: I beg to move the amendment standing in my name. Perhaps I may start by saying that I think the Committee has been rather discourteous not to have congratulated my noble friend on her recent appointment and leadership of her first Bill in her present position. I remember her standing here when she first spoke on the Sunday Trading Bill and then the Barking dogs "pooper-scooper", about which she spoke with tremendous eloquence. Now she is moving forward. She is certainly no lightweight when it comes to logical thought, and I hope that this amendment, which is a simple one, will appeal to her.

If this amendment were accepted it would take a lot of the heat out of this contentious Bill. The purpose of the amendment is for the water authority to provide upon request a device for each householder to take the fluoride out of the water as it enters the premises. I am told that this is perfectly possible, and that it would not cost very much. This comes back to the question of the freedom of choice, and if this could be achieved it would be of great benefit and indeed assistance to all those who feel passionately against fluoridation. I beg to move.

Lord Campbell of Croy

I should be grateful if my noble friend could give some explanation of his intentions in moving this amendment. It reads: and that a device for removing safely all fluoride from the water supply is available". Fluoride exists in some percentage in all the water for drinking in this country. I should like to ask him the question on two heads.

First, there are fortunate areas of the country where there is already a percentage of fluoride in the water which is at the one part per million—which is the recommended amount for this Bill—or above it, and they are, for example, parts of Essex, the Hartlepools, and South Shields. There is no need for any fluoride ever to be added to the water in areas where it is already at one part per million or above; but is it the intention in my noble friend's amendment that the device to be supplied is to take all that natural fluoride out?

There is nothing in his amendment to indicate that the device should not be made available to take out the optimum amount of fluoride already existing naturally in the water supply in those parts of the country. That needs to be made clear. I have a feeling that his intention is that it should be a device only in the areas where fluoridation has taken place. If that is so, that brings me to my second question.

Suppose that there exists naturally half a part per million, and then, in carrying out the purpose of this Bill after the necessary processes have been gone through another half part were added. There would be half a part existing naturally in the water supply which has been there for centuries and has been drunk by people who in that area had rather good teeth, though not as good teeth as those with one part per million. They had quite good teeth on half a part per million; then another half is added to make it one part.

Is it the intention that the device which my noble friend suggests should not only take out the half part which has been added by fluoridation but also the other half part which exists naturally in the water supply already? The word "all" in the amendment makes that look like the intention. I should like that clarification before making further comment.

5.30 p.m.

The Earl of Kinnoull

I welcome this chance to give my noble friend clarification because I think that I can answer both his questions with one answer. Basically one is talking about those areas where fluoride has been injected into the water supply where the devices will be fitted free. The devices, which are technically very clever, will only take out what has been put in and would not take out or lower any natural fluoride already in the water.

Lord Campbell of Croy

I am grateful to my noble friend. It would be difficult to take out the exact percentage in the second case, and I would also suggest that the amendment would have to be seriously redrafted for I do not believe it would carry out the purpose that my noble friend has just described.

Lord Houghton of Sowerby

This amendment raises the question of what are the rights of the conscientious objector? There is room for a little private enterprise, which will recommend itself to noble Lords opposite, and that is that there should be an encouragement to private enterprise to put fluoride extractors on to the market at a reasonable cost so that they can be installed by the householder and that will enable him to get rid of the fluoride.

More seriously, is there to be no right of contracting out of something that can be regarded as an unacceptable imposition upon the liberty of the subject? When I was a boy vaccination against smallpox became compulsory. It would not be made compulsory today, but it was then. There was room for conscientious objection. I need not tell your Lordships that my father was one of the first to claim exemption from vaccination of his children on the grounds that he had a deep personal conviction against it. What are similar fathers to feel about this? How can they have any remedy against the onrush of the state with its doctored water, polluted—if one likes to call it that; and it is a pollution—at the behest of the local health authority. The Committee has just denied the right of the local authority, as the elected representative of public opinion, to have some firm say in whether the application of the health authority should be made or accepted. There is a serious point because having embarked upon this course of action, all sorts of implications follow and it is difficult to be rid of them. If a proposal is made to get rid of them, it becomes almost laughable. First something is imposed on the public that they do not want. If one tries to find a remedy for those who want to contract out, it becomes a matter of ridicule. This is a serious matter.

There is only one other fundamental remedy and I wonder why that has not been suggested. If we privatise water, which will probably be done anyway, that will encourage alternative supplies and bring the consumer freedom of choice. That is conservative doctrine. "If you drink our water, it is pure and undefiled. It is cheaper than the other lot". We can begin to look at water as a commodity about which we are free to make a choice. There could be lemonade in some water; whisky in others. And one can draw some amusing pictures of what might happen in Britain in those circumstances. We shall have a few more serious points yet.

Lord Auckland

The Committee is being asked to consider an interesting amendment but one which raises a number of problems. We are asked to agree that the device—we do not know what the device is—should be supplied free of charge. Will it be supplied by the local water authority or by the local authority? Who will supply it? Most people complain these days about high rates and high water rates. If these devices are to be supplied (we know not to how many people) will some benefit from a free supply and possibly reduced water rates while others do not? I believe there is a danger here of discrimination. While there is originality in the amendment I believe that the enforcement of it will present enormous problems for local authorities and certain water undertakings.

Lord Monson

I should like to support this amendment, particularly in view of the unfortunate defeat of the previous amendment which would have allowed the electorate a degree of democratic control over whether the water supply should be artificially fluoridated or not. It may be opportune to mention to the noble Lord, Lord Winstanley—perhaps somebody should have pointed this out earlier—that the last amendment was a precise replica of an amendment moved in another place by three Liberals: Mr. Alan Beith, Mr. Michael Meadowcroft and one other honourable Member whose name escapes me. It seems that Liberal principles are infinitely elastic.

However, it is not just a question of the feelings of consumers and the deeply-held convictions mentioned by the noble Lord, Lord Houghton, although I certainly should not wish to minimise these. A more practical aspect is concerned. Even if we discard the possibility of causal link between fluoridation and cancer and other diseases—I am not sure one can do this—it is estimated that 500,000 people in this country are allergic to fluoride in the water, however consumed. Research in Lanarkshire and in the Netherlands has established a link between fluoride and certain allergic reactions. I must point out to the Committee that allergic reactions can be every bit as unpleasant as dental caries. For this reason alone I commend the amendment proposed by the noble Earl.

Lord Sandys

I should also like to support the amendment of my noble friend. There is an obvious intention in his proposal that would greatly assist those kidney sufferers who have to receive non-fluoridated water if their complaint is sufficiently advanced. The device which he names is a difficult one to envisage being constructed. Nevertheless, I believe the problem centres upon the fact that the fluoride ion is difficult to remove from the water once it has been put in. I understand that such a device is available in Australia for particular cases; and for those who wish to remove fluoride from their water supply, whether wholly subsidised as suggested in the amendment or in some other form, there should be something available to remove fluoride from the supply.

Lord Campbell of Croy

May I ask my noble friend Lord Sandys, arising from my previous exchange with my noble friend, whether he does not agree that the amendment as it now reads about removing all fluoride from the water is defective? It is clear from what my noble friend who moved the amendment said that the correct words should perhaps be: the fluoride which has been added". It must be in the exact percentage as was added.

Lord Sandys

We are entering into what I understand is a deep scientific argument. The process by which fluoride is removed is a system of reverse osmosis. It is complicated. I am no scientist but in its natural form fluoride is normally balanced by both calcium and magnesium in the water supply and this should and would remain in it under the system as it is practised in Australia.

Lord Campbell of Croy

My noble friend has misunderstood the point that I put to him. It is not a question of how it is done. I am talking about the drafting of this amendment. The amendment is defective because it says "all fluoride"; whereas it was perfectly clear from my noble friend when he answered my question that it is not intended to remove all the fluoride.

The Earl of Caithness

The answer that I was about to give has already been given by my noble friend Lord Campbell of Croy. Also, I do not think that my noble friend Lord Kinnoull actually made any argument for wanting to get rid of fluoride. He did not say anything about that. He said that he wanted to get rid of fluoride but for no particular reason. He has not made a case for it. I would rest my case there. I hope that my noble friend will withdraw his amendment and if he wants to come back with a more salient amendment later we could consider it then.

The Earl of Kinnoull

I am not sure that I received quite the courtesy that I expected from the Government, but there it is. Perhaps it is a long, hot afternoon. My noble friend Lord Campbell seemed to be answering on behalf of the Government much more intelligently. He is absolutely right. The amendment is defective and I shall withdraw it. I shall not waste the time of the Committee in trying to press it. I am grateful for all the support that I received from all round the Committee. I shall look again at the wording and perhaps discuss it with my noble friend to see whether we can bring this forward at the next stage of the Bill. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Monson moved Amendment No. 6: Page 2, line 10, at end insert ("Provided that the concentration of fluoride in the water so achieved will at no time exceed one milligram per litre.").

The noble Lord said: This expensively produced folder which will have been distributed to some of your Lordships by the British Fluoridation Society (which, I understand, is subsidised by the Government, or, perhaps more accurately, subsidised by the taxpayer) contains a mass of material, booklets, leaflets and so on, most of which assert time and again that fluorides are safe in concentrations of 1 mg per litre. We believe this assertion to be widely optimistic; indeed, dangerously so. The noble Lord, Lord Sandys, has already told of the committee of five Nobel Prize winners who oppose fluoridation, but I do not think that he went precisely into some of the reasons. Four of these Nobel Prize winners found out independently, not working together, that a number of important enzymes are seriously disturbed by fluoride concentrations of between 0.2 mg per litre and 1 mg per litre. The significance of this range is that it is lower than the concentration proposed in this Bill.

However, even if for the sake of argument one accepts the British Fluoridation Society's contention that fluorides are safe in concentrations of 1 mg per litre, the inference that one must draw is that above that level fluorides are unsafe. Doctor Robert Harris, director of the Nutritional Biochemistry Laboratories at the world famous MIT (the Massachusetts Institute of Technology), said that there is plenty of evidence indicating that fluorine in the amount of one part per million, or slightly more—and we must note those words "slightly more"—interferes with enzyme systems. These enzymes are involved in the growth of bones, the functioning of nerve tissue and so forth. It is clear that fluoridation is a calculated risk.

Even the Knox Report, which generally supports fluoridation—and the report was commissioned by the Government—admits that skeletal fluorosis, a disease of the bone that can be crippling in severe cases, occurs in parts of the world with extremely high natural concentrations of fluoride in water. Of course, we are talking about natural concentrations, but, obviously, if you overdose artificially, you achieve the same unpleasant results. In other words, it concedes that these overdoses are dangerous. This amendment is designed to ensure that statutory water authorities lean over backwards to be safe, as it were. I beg to move.

5.45 p.m.

Lord Campbell of Croy

I wonder whether the noble Lord who had just moved this amendment could give a further explanation. When he speaks of the dangers of one part per million of fluoride in a supply of water, what does he think about those parts of this country which already enjoy that naturally in their water supply? I mentioned three of them earlier on. In some of those areas, the amount of fluoride is above one part per million—in parts of Essex, for example. Is what he has been saying about the dangers of fluoride of that amount in the water applicable to those natural water supplies? Is he, in fact, now warning people living in those areas that they are vulnerable to more dangers than people living on other parts of the country? For that is what he would be doing if he were applying what he has just said to the natural quantities of fluoride in water supplies in areas in this country where a large number of people live. If he is right, there ought to be headlines in the press and the media tomorrow.

Lord Monson

I believe that it may well be the case: I do not know. Not a month goes by without some new scientific discovery being made which reverses all preconceptions. I am told—and I think the noble Lord, Lord Sandys, mentioned this; or it may have been somebody else on the government Benches—that in those areas of the country where fluoride is naturally present in the water supply there are also large concentrations of calcium and magnesium which to some extent counteract the adverse effects of fluorine compounds. I think that my noble friend Lord Energlyn is perhaps in a better position to answer that than I am.

Lord Energlyn


Lord Campbell of Croy

Perhaps I may be allowed to pursue that point, as it is Committee stage. The noble Lord spoke about those areas of the country where there is fluoride in the water. There is no area in the country where there is not fluoride in the water naturally. It is simply the areas where it exists at the recommended amount that I was talking about, and in some of those areas where it exists above. I wanted to ask whether he was intending his remarks about the dangers of that amount of fluoride in the water to apply to the natural supply. If I understand correctly what he has just said, it is that there may be elements such as calcium in the natural water supply which, somehow, counteract the dangerous qualities. That is my understanding of what he has just said. Therefore, what he is saying he is not intending to apply to natural supplies of water. Am I right?

Lord Monson

I never denied that there are traces of fluorides in all water supplies. The question is the concentration. I do not suppose that one-tenth of the amount recommended—unless people such as those suffering from kidney diseases, and others to which I shall come later, consume very large quantities—would do any harm. I, myself, am not competent to know whether or not large concentrations of fluoride in proportions of more than 1 mg per litre are dangerous. But from what I have read I believe that this may perhaps be so. As I have said, I would prefer other Members of the Committee to answer that point.

Lord Energlyn

I think that we are losing sight of the amendment. The amendment is intended to add a safeguard to this whole area of chemotherapy. It is simply an amendment to suggest that under no circumstances should fluorine be added to the water to any concentration beyond one part per million. That was the importance of the amendment. In the world of chemotherapy—which as I have said earlier, is what we are talking about—one uses this yardstick of one part per million quite regularly because there are very few substances that you cannot control inasmuch as their pathogenic effects might be in concentrations less than one part per million. Whether you can exceed that is the point that the noble Lord, Lord Campbell, is bringing out.

The body is a very versatile and robust test tube. It can accommodate a whole lot of facets and chemical and biochemical reactions. What has recently emerged is that if you have fluorine in the water and that fluorine can in any way chelate itself or add itself—I think the noble Earl might just listen carefully to what I am talking about—to an organic molecule like an enzyme, it can alter the whole function of the enzyme. This has been proved now beyond all doubt. Therefore one must look upon the intake of fluorine, whether it is in the form of a fluoride or as elemental fluorine, with considerable scepticism as to its innocuous nature.

The question arises in this way and it has really been brought out very vividly by the noble Lord, Lord Campbell of Croy. There are different forms of fluorine: fluorine from teeth, fluorine from fish and fluorine from the earth. In order to get this fluorine to be of benefit to mankind in the human body, in plants and in animals, it has to pass through the excretory system without any breakdown. That brings me to the point in this clause; namely, that the Government are prescribing—I underline "prescribing"—and therefore indemnifying the harmless character of two compounds: namely, compounds of fluorosalicic acid—two acids joined together.

These have been chosen because it was found from bitter and vivid experience that to use the simpler compound of sodium fluoride created immediate reaction in human beings so violent that they won their case, as in Andover, hand over fist. That is sodium fluoride introduced into the system, in very small quantities, upsets people very badly and creates massive diarrhoea, and so on; so it was abandoned. Therefore these compounds have been invented.

My plea is that we should accept this amendment because when you put these compounds into the water they are serving two functions. First, they will dissipate themselves through the water uniformly, so you can control the concentration of them to very precise limits. Secondly, these two compounds when they are in the water do not dissociate. That is why the fluorine has been added to the silica. Therefore what you now have to judge—and it is a matter of judgment—is what is going to happen to this combination of hydrofluoric acid (which it has now become) and salicic acid (which it has now become). We know that the hydrofluoric acid is going to do babies and children a lot of good so far as their teeth are concerned: but what about the silica? We know, too, that if the silica gets into the bloodstream it can form clotting and so you could very easily alter the fluidity of the bloodstream by very small quantities of silica.

We discovered this in the very early days when we were dealing with silicosis. For example, six of us took a pure crystal of quartz—that is, pure silica—and we ground it into powder and each swallowed a gram. Then we collected the urine and we recovered the whole of the silica that we had consumed in the urine. That was a tremendously important thing to discover. We thought, "That is fine: we now know that silica can move through the body without doing it any harm". But then a surgeon sent me a specimen that he had excavated from a lady's kidney—a Mrs. Newby in Leeds—and when I sectioned it that was the first example of a kidney stone composed of silica. Since then thousands have been discovered. That tells your Lordships the story in essence. This is a very dangerous acid to introduce into the system; and therefore I support this amendment because it gives the Government and the Bill greater protection.

Lord Colwyn

I am horrified to hear what the noble Lord, Lord Energlyn, has been saying. As a very distinguished doctor and man of science, to hear him say such things to this Committee is utterly misleading. There is no question of these substances doing anything that he says. One might as well talk about the hydrogen ion and the chlorine ion in hydrochloric acid being just as harmful. It is just not true. I must stress that the fluoride ion becomes dissociated throughout the water and is harmless. Really, I cannot let the noble Lord go on misleading the Committee in this way.

Lord Houghton of Sowerby

I think there is a simple point that might be put to the noble Lord, Lord Campbell of Croy. That is, that it is one thing to have a water supply which probably from time immemorial, or at any rate for a great length of time, has been of certain composition and in respect of which the residents and different sections of the community have become inured against harm. If you bring other water supplies, suddenly as from midnight from the very next week, up to some very different standard of composition, that may have an effect on the consumer which is quite different from that as concerns people who have been on that kind of composition before merely because of the suddenness of the change. There is surely some layman's point about that. Therefore it may be that just to say that other people are drinking water with this fluoride content and have not come to any harm, so therefore it will not harm you if you bring yours up to the same level, or even let it go a little above, may not really be a tenable argument.

Lord Campbell of Croy

I would agree with the noble Lord that that is possible; but of course the reverse is equally true. People who have been living in an area with the optimum amount of fluoride in their water naturally and who have to move—because of the need to find other employment or for any of the other reasons which have made our population much more mobile now than they used to be—to another area may find an inadequate supply of fluoride so far as concerns their teeth. It works the other way as well, and it would be much fairer to that part of the population if the water in the place they move to was also fluoridated to the one part per million which they had been used to.

Perhaps I might also deal with something which the noble Lord, Lord Energlyn, said, because he referred to me and my reference to tea. That was on Second Reading. I then pointed out that the press in Scotland had drawn attention to the lady who was the principal person in the Strathclyde case which has caused this Bill to be brought forward. She drank a cup of tea after the result had been announced, and the press pointed out that, "she obviously is not worried about fluoride because there is more than one part per million of fluoride in a cup of tea."

The noble Lord, Lord Energlyn, asked me whether I could be more exact, and at the time I told him, "Yes, a weak cup of tea contains just over one part per million, and a strong cup of tea contains two parts per million." Will the noble Lord, Lord Energlyn, please give us some peace of mind straightaway? Are those of us who drink quite a lot of tea going to be subject to all the scientific problems that he has told us about? Does tea contain the kind of fluoride which he talks about as having these dangers?

Lord Energlyn

It does not contain a fluorosalicic acid: it is a sort of tannin. So it has a tannic acid and fluoric acid content; and those two compounds are moved through the urinary system with complete facility. Therefore it does not do any harm, and so you are told quite clearly by your doctor, "Drink some tea and you are a very busy boy".

Lord Campbell of Croy

I am most grateful for that. At least we have some peace of mind. However, what about fish, which contains four to five parts per million of fluoride? Are those of us who eat fish fairly constantly also in danger?

Lord Energlyn

You can make a very good story out of fish; that the more fish you eat the more alert you are and so it is a jolly good thing to have a dose of fluorine. But what I am trying to maintain is this. This amendment is really giving the Bill just an additional area of protection. It cannot be emphasised too often that you should not deliberately put more than one part per million of fluorine into the water, if you can avoid it.

6 p.m.

Lord Sandys

I support this amendment for one very good reason, which is that it is an attempt to prevent a very serious accident taking place, such as did indeed take place in Annapolis in 1979. On that occasion, over 1,000 gallons of fluoride went into the water supply as a result of an accident. The problem of over-fluoridating can occur for reasons quite different from those in that dramatic and terrible accident, which resulted in tragedy.

The whole principle of monitoring assumes that the intake of fluoride is monitored at the point where the water authority adds it to the supply. This is excellent. But from that point onwards we are very dependent upon the main supply system. In some areas, the mains are old and quite antique in their capacity to provide an even source of supply. Were they all of the same size and efficiency, the position would be quite different. I believe that this is an important amendment.

The Earl of Caithness

First, I must apologise to my noble friend Lord Kinnoull. If he thought that I was being discourteous, I did not mean to be. It was merely that as, in my view, a major hole had been drilled in his amendment, it seemed better to ask him to withdraw it and come back. I apologise if I was discourteous.

Fluoridation in this country is carried out according to guidelines laid down by the Standing Technical Advisory Committee on Water Quality. In practice, the concentration varies for most of the time between 0.8 and 1.2 mg per litre. The upper limit imposed by the guidelines is 1.5 mg per litre. This range is entirely acceptable on health grounds, and leaves a wide margin of safety. Dealing with safety, may I suggest to my noble friend Lord Sandys that we come back to monitoring, on which there are specific amendments. I do not want to steal the noble Lord's thunder later on by trying to answer his points now. But these guidelines are consistent with the World Health Organisation's recommendations and also with the EEC directive relating to the quality of water intended for human consumption. Clause 1(5) of the Bill has been drafted to ensure continued compliance with these criteria. It is neither necessary nor practicable for the level of fluoride in water always to be below 1 mg per litre.

Dealing with specific points, the noble Lord, Lord Monson, raised the possibility of skeletal fluorosis. It is true that in India there have been cases of skeletal fluorosis, but this has been only where the person has been subject to prolonged consumption of very highly fluoridated water; that is, somewhere in the region of 10 parts per million or more. We are talking about an average of one with a variance of between 0.8 and 1.2. The noble Lord, Lord Energlyn, was again extremely forthright in his condemnation of fluoride from a scientific point of view, and of course I respect the weight of experience which he brings to bear on these scientific matters. I, for one, should not like to argue with him on a personal basis on these issues.

However, I would say to the noble Lord that the safety of fluoridation has been reviewed many times by groups of scientific experts throughout the world. Indeed, I think it is fair to say that more research has been conducted on this matter than on any other measure of public health. Major reviews have been undertaken by, among others, the World Health Organisation, the Canadian Public Health Association, the US National Academy of Science, the Australian Health and Medical Research Council and, in this country, by the Royal College of Physicians in a report which was published in 1976 entitled Fluoride of Teeth and Health. All these reviews have concluded that there is no evidence to show that fluoride in drinking water at a concentration of one part per million has any adverse effect upon health.

The findings of these surveys were further confirmed by Lord Jauncey in the recent Strathclyde fluoridation case. After a detailed consideration of the evidence, including that of a leading anti-fluoridationist, Lord Jauncey concluded that there is no evidence to suggest that fluoride at the proposed concentration would have any adverse effect at all upon health. As with lawyers, one tends to find that the more eminent scientists are the ones who are more likely to disagree. But overall on this subject they have come down in favour of fluoride being safe.

May I just turn to one point of the noble Lord, Lord Energlyn, relating to enzymes? It is well-known that fluoride in high non-physiological concentrations can inhibit or enhance the actions of many enzymes. For this reason, it is often used as a tool in the investigation of enzyme functions. There is, however, no concrete evidence in humans of enzyme inhibition resulting from the consumption of water fluoridated to one part per million, and still less any suggestion of any specific harmful effect which could be attributed to such enzyme inhibition.

The noble Lord also mentioned the difficulties that might effect one as a result of the silica concentration. The addition of silica fluorides to water, in order to achieve a fluoride concentration of 1 part per million, will produce an increase of up to half a milligram per litre in the concentration of silica. This is small compared to the concentrations already present from natural sources and from water treatment, and trivial compared to the total intake in the diet. In fact, it is believed that silica is an essential ingredient for normal growth and skeletal development. For these reasons, I hope that the Committee will reject this amendment.

Lord Energlyn

Before the noble Earl sits down, may I aks him whether he has ever looked at the statistical picture in the West Midlands, which is the one area in Britain from which one can draw conclusions? It is the one area of Britain which is served by a water supply which comes mainly from Wales and which is of fairly uniform characteristics. Therefore, if you look at the statistics of the West Midlands, which have been operating fluoridation since about 1960, it is fair to draw conclusions. The noble Earl says that I have no evidence to suggest that the introduction of fluorine into the stomach, which is where the enzymes are, has no effect upon the enzymes. Then how does he talk his way out of these two figures, that the average intake of patients into hospitals in this country suffering from endocrine nutritional and metabolic diseases is 300, but for the West Midlands it is 513. How does the noble Earl talk his way out of those statistics, if the enzymes are not affected by the water supply?

Baroness Gardner of Parkes

I hesitate to intervene at this late stage on this amendment, but the noble Lord, Lord Energlyn, and I recently spent a considerable time looking at all these statistics. He said to me that the only common thing with all these people in the West Midlands is the water. I asked: What about the air? Are they not all breathing the same air? This is very true. There is no way of identifying any of those medical conditions, particulary with the water or with the fluoride in it. Indeed, some of the statistics he gave showed a very similar pattern in the North-West. But in the way that clever people do when they want to use statistics, he showed me only the statistics that suited his argument best. You need to have the whole lot in front of you before you can consider this, and I certainly do not think that the statistics prove anything.

The Earl of Caithness

My noble friend Lady Gardner of Parkes is absolutely right. On Second Reading, the noble Lord, Lord Energlyn, referred to the West Midlands in connection with heart disease. I did not specifically take him up on that as it was fairly early in the morning, but I would certainly enter into an argument with him about any of the West Midlands statistics, because no one can conclusively prove that fluoride was the cause of those statistics.

Lord Energlyn

I do not think that I have ever said that I have attempted to prove anything. What I am saying is that in all medical statistics you look at the picture. In the field of chemotherapy, which is what I pretend to be working in, you look for a compound which is harmless but will do something useful. The harmless nature of the compound decides on the concentration of the compound. What this amendment is suggesting is that we should be extremely careful not to exceed if we can possibly avoid it one part per million of fluoride. That is all I am saying.

The Earl of Caithness

I do appreciate that. We, too, are concerned that the level of fluoride should not be exceeded. I go back to my original answer. The upper limit is 1.5ppm. Perhaps when we reach later amendments in the Committee stage which deal with the monitoring and how we are going to supervise that, would be the time to deal more fully with the noble Lord's point.

Lord Sandys

Before we leave this point, perhaps I may say this. I do believe that the noble Lord, Lord Energlyn, is on to a matter of real substance which has been discussed in another place. I would draw the attention of my noble friend to what his honourable friend the Parliamentary Under-Secretary of State for Health and Social Security, Mr. John Patten, said at col. 96 of the proceedings of Standing Committee H on 5th February. He said: On the issue of fluoride and enzymes it is absolutely clear that fluoride can certainly both inhibit and activate enzymes in experimental systems". There is his honourable friend agreeing with the noble Lord, Lord Energlyn, on the effect of fluoride on enzymes, which is a very well known fact. He went on to say that he does not deny that, but there is no evidence of the alteration of enzyme activity in human drinking water fluoridated one part per million". This is the very contentious fact. Those of us in the anti-fluoride lobby believe that not to be the case, so the amendment, were it to be acceptable to the Government, would go quite a long way towards resolving this issue.

Lord Monson

The noble Lord, Lord Campbell of Croy, produced a couple of red herrings for us. One, aptly enough, was fish and the other was tea. Surely the noble Lord realises—

Lord Campbell of Croy

I am most grateful to the noble Lord for giving way. It was in fact the noble Lord, Lord Energlyn, who referred to this first in this debate and referred to what I said back at Second Reading. It was not I who raised either of those matters.

Lord Monson

I am taking up the point made by the noble Lord in this debate, not in an earlier one. He does, I am sure, realise that nobody, particularly if he is allergic to fluoride or feels that he may be allergic to fluoride, is obliged either to eat fish or to drink tea, whereas nobody other than a multi-millionaire can possibly avoid consuming fluoride in the water supply.

I am grateful to the noble Lord, Lord Sandys, for mentioning the Annapolis disaster and for pointing out that because of the poor condition of some water mains the concentration of fluoride as it reaches the consumer can vary quite considerably. It was originally claimed that 1 mg per litre was the maximum safe dose. By some strange metamorphosis it has now become the optimum dosage.

The noble Earl, Lord Caithness, says that fluoride in concentrations of one part per million has no adverse effects on health. Be that as it may, he preceded that by pointing out that the concentrations could go up to 1.5ppm. In view of what Doctor Harris of the Massachusetts Institute of Technology says about the dangers of going over the one part per million, I think this is extremely alarming. It is assumed by the Government and the pro-fluoridation lobby that everone drinks the same amount of water. I heard from a notable neurologist a month or so ago that the treatment—it may not be a new treatment; it may be an old one; I do not know—for certain minor strokes is that the patient is required to drink six pints of water a day plus an aspirin. This is much more than the average person drinks. If this treatment is required, and if what the noble Lord, Lord Energlyn, says about the danger to arteries is correct, one can just imagine the dangers which present themselves to people suffering from this sort of condition.

The Deutscher Verein von Gas and Wasserfachmännern, which, I believe, is translated as the German Association of Gas and Water Experts, points out that, because of the presence of fluoride compounds in many foods, particularly foods processed in fluoridated water, the total quantity of fluorides ingested by human beings has become quite uncontrollable and may represent several times the optimum daily dosage. For this reason the fluoridation of water supplies is inadmissible in their view.

I take the point that there has to be some slight margin for error but it seems to me that a 50 per cent. margin of error is grossly excessive. I feel that to specify a maximum of one part per million is perhaps a trifle over-rigid. I think that the best course might be to come back at the next stage and introduce a similar amendment with a little more latitude for error, making the maximum 1.1ppm or 1.2ppm. On that understanding, I beg to leave to withdraw the amendment.

Amendment, by leave, withdrawn.

6.15 p.m.

Baroness Trumpington moved Amendment No. 7: Page 2, line 16, after ("so") insert ("— (a)")

The noble Baroness said: With the Committee's permission, I rise to move Amendments Nos. 7 and 8 together. Amendment No. 8: Page 2, line 17, at end insert ("; or (b) in connection with the carrying out of any works (including cleaning and maintenance) by any of them.")

The effect of these amendments is to extend the circumstances in which fluoridated water can temporarily be supplied to a non-requesting area to include routine works. I commend these small amendments to your Lordships. I beg to move.

On Question, amendments agreed to.

Baroness Trumpington moved Amendment No. 9: Page 2, line 18, leave out from beginning to end of line 39.

The noble Baroness said: With this amendment I should be grateful if your Lordships would allow me to speak to Amendment No. 35. Amendment No. 35: After Clause 2, insert the following new clause:

("Interpretation etc.

.—(1) In this Act— application" means an application under section 1(1); appropriate authority", in relation to a fluoridation scheme which is operated by virtue of section (Continuity of existing fluoridation schemes), means the Regional or District Health Authority to whom the statutory water undertaker concerned are answerable in accordance with the arrangements under which the scheme is operated; emergency" means an existing or threatened serious deficiency in the supply of water (whether in quantity or quality) caused by an exceptional lack of rain or by any accident or unforseen circumstances; health authority" means—

  1. (a) in relation to England and Wales, any District Health Authority (within the meaning of the National Health Service Act 1977); and
  2. (b) in relation to Scotland, any Health Board (within the meaning of the National Health Service (Scotland) Act 1978); and
statutory water undertaker" means—
  1. (a) in relation to England and Wales, any water authority or statutory water company within the meaning of the Water Act 1973; and
  2. (b) in relation to Scotland, any water authority within the meaning of the Water (Scotland) Act 1980.
(2) The provisions of this Act apply to the Isles of Scilly as if the Council of the Isles of Scilly were a water authority and as if the Isles were the area of that water authority.").

These are essentially technical amendments which I hope your Lordships will accept.

On Question, amendment agreed to.

The Earl of Kinnoull moved Amendment No. 10: Page 2, line 28, leave out paragraph (b).

The noble Earl said: I would commend this amendment to the Committee as a refreshing amendment. First of all, it has nothing to do with the health arguments, which is probably rather refreshing after the number of arguments we have had, because no one is going to agree on health arguments. That is quite obvious. Secondly, I think it should appeal to the noble Lord, Lord Campbell of Croy, as a former Secretary of State for Scotland; and thirdly, it is one to which, if my noble friend is to reply, I hope he will be sympathetic.

The purpose of the amendment is very simple—it is to exclude Scotland from the Bill. As we know, Northern Ireland is already excluded. The Committee will recall that in September 1978 Strathclyde regional council, as the statutory water authority, decided to co-operate in a fluoridation of the water supply scheme. It triggered off the longest, most costly legal aid case ever taken at a quarter session in Scottish legal history, and it lasted 201 days. The petitioner was a Mrs. Katherine McColl, who was in her 70s, an inhabitant of a hamlet near Stirling. I suspect that she was drinking whisky out of a teacup, but not drinking tea. Her water came from Loch Katrine, which is one of the finest, purest water supplies in Scotland, with only two chemicals, chlorine and lime, added to make it healthy. Contrast that with the Thames Water Authority, which adds 23 chemicals to London's water. The health need suddenly to mass medicate this beautiful water was never made out to consumers. The health hazard which other countries have perceived was not explained either.

Mrs. McColl had reached an age when she would receive no benefit at all from ingesting chloride into her body. She sought an injunction as her right of choice. She won on a point of law in what I believe was a brilliant and masterly judgment by Lord Jauncey. He stated that under the Water Acts 1946 and 1980 Parliament had never intended that water authorities should be clothed with power to treat the water which they supplied for such general health improvement purposes as they might from time to time think appropriate, using water as a means of passing into consumers' bodies substances which could be obtained aliunde. He went on to conclude that fluoride in no way facilitates the supply of water, and was thus outside the powers of the water authorities. Lord Jauncey added—and I think this is really relevant—that the individual's right to choose how to care for his own body should be encroached upon by statutory provisions only in clear, unambiguous language.

Scotland enjoys one of the finest waters in our islands. There are very few fluoride schemes in Scotland. There is one in Wigtownshire and one in Kilmarnock. Set that against the English and Welsh situations, where there are quite a few schemes.

Scottish law is different from English law; some say superior to it. Scottish water is different. Indeed, anyone who drinks the beautiful Highland spring water knows that it is different. It is beautiful water. I believe that there is an overwhelming case for excluding Scotland from this Bill and for allowing Scotland to decide its own future. I beg to move.

Lord Campbell of Croy

I should like to raise a point or two on the amendment which my noble friend has explained so well and concisely. However, I fear that his expectation that it might appeal to me is not one that I can live up to because I am not in favour of Scotland being taken out of this Bill. After all, it was the case in Scotland that drew attention to the fact that the legislation which has been passed—not only by this House but by the other place—on the understanding that it meant a certain thing, was found not to mean that. The case was in Scotland. What this Bill is trying to do is to clarify beyond any doubt what was intended by Parliament at the time. To exclude Scotland, when the whole of this question has arisen from the Strathclyde case, would not be very sensible.

I have seen my noble friend's Amendment No. 40 which would take Scotland out of the Bill. That must be associated with the amendment that he has just moved.

Fluoride does not occur in Scotland—as it does in other places in the United Kingdom—in the optimum quantity. There are very few places, if any, in Scotland where the one part per million amount occurs in the natural supplies. In Scotland, although the water is very good for making whisky, certainly in the area where my home is, near Inverness, and where, as my noble friend has described, the water is excellent in many ways, although it contains fluoride, as all water supplies do, it is not at the optimum level. Scotland would benefit as much as any other part of the United Kingdom where the natural supplies do not come up to the one part per million.

The amendment which my noble friend has sought to convince your Lordships' Committee about would take the health board out of the Bill. The health board is, of course, the appropriate body in Scotland to be considered in this part of the Bill. My noble friend referred to the fact that I was Secretary of State for Scotland for four years. I was, indeed, the Secretary of State who was responsible for the reorganisation of the National Health Service of Scotland in the 1971 Bill, a year before the reorganisation was carried out in England and Wales. I would point out that we chose a single-tier system for the health boards in Scotland, which subsequent years have proved to have been a correct choice, because criticism was made later of the two-tier boards south of the Border. Therefore, the health boards which my noble friend would seek to take out in this amendment are the ones in Scotland which would be the appropriate bodies to be in that part of the Bill.

I think I am the only Member present in your Lordships' Committee so far today who has been a Minister of Health. I draw attention to that because that is what inspires me to say the things that I have been saying and to be fairly active at this Committee stage. There are in your Lordships' Committee two qualified dentists who have been speaking. I have no medical qualifications, but I am the only person, as far as I know, who has been a Minister of Health during this period in the last 25 years of this controversy. Therefore, I am inspired by that fact to say what I have been saying about the benefits of fluoridation.

The judge in the Strathclyde case, Lord Jauncey, said in his judgment that the legislation was faulty. He was in no doubt about the question of safety. He said that he was absolutely convinced that the safety question does not arise on fluoridation. Let there be no doubt about that.

Lord Somers

May I interrupt to say that I am a little puzzled over this? Are not these two amendments part of the Bill that has already been removed by the noble Baroness's Amendment No. 9?

Baroness Trumpington

No, the noble Lord is not quite correct, because what has replaced it still contains the same measures.

Lord Campbell of Croy

At whatever stage we deal with this matter, the amendment is quite clear and has been moved to the present Bill. It seeks to take out the Scottish authorities, both the health board and the water authority in Scotland, together with Amendment No. 40, which would take Scotland out of the Bill.

If I may just continue—because the noble Lord's intervention was on a procedural point rather than affecting the substance of what I was saying—I have one other matter to add. My noble friend pointed out that the lady who was the main subject of the Strathclyde case was elderly. I do not know her exact age, but she was certainly elderly. He pointed out that people of that age, and, indeed, middle aged people, too, would—not be much affected by fluoridation. Of course, fluoridation is most effective in the early stages of life, from birth. That is the time when people's teeth will benefit mostly, from first childhood and in early years, but they continue to benefit in later life also, as I have heard at least one of my noble friends who are dentists on this side of the Committee tell us before.

My contention is that in this matter, those of us who are no longer very young should be thinking of future generations. We ought to be able to accept something as simple and easy as this in order that unborn generations can benefit when they are born and in their early years—at the ages of one, two and three—from much better teeth which will not be subject to decay. That is the reason why the country as a whole ought to be able to adopt this proposal in order to improve our health.

6.30 p.m.

The Earl of Caithness

I believe that I am correct in thinking that in debating Amendment No. 10 we are speaking also to Amendments Nos. 11 and 40—I am grateful for confirmation from my noble friend. Amendment No. 11: Clause 1, page 2, line 35, leave out paragraph (b). Amendment No. 40: Clause 3, page 3, line 8, at end insert ("or Scotland"). My noble friend said that this Bill did not relate to Northern Ireland. That is a purely technical point. Many Bills do not relate to Northern Ireland and measures such as this are put through by Orders in Council. This provision will apply to Northern Ireland but not under the auspices of this Bill.

My noble friend Lord Kinnoull mentioned also that the Strathclyde authority proposed to add two substances to the local water. There are 18 naturally-occurring chemicals in the water in Strathclyde, including magnesium, aluminium, arsenic, lead, and chloride at five parts per million—including fluoride. Although it is good drinking water, I would agree with my noble friend that whisky tastes a lot better with it. Certainly the water in Strathclyde is not bereft of chemicals.

My noble friend mentioned the possibility of two existing fluoride schemes in Scotland. I can assure him that since the Lord Jauncey judgment there have been no fluoridation schemes in Scotland. There was one at Lerwick and one at Wigtown, and there was one previously at Kilmarnock. But since Lord Jauncey ruled that such schemes were ultra-vires, they were immediately stopped. Also, Lord Jauncey did not in any way say that fluoride would make the water unwholesome or that it was not perfectly safe at the relevant level we are talking about in this Bill.

The great benefit of fluoride, as we all know, is in respect of teeth. In 1983 the Child Dental Health Survey confirmed that levels of dental decay are higher in Scotland than in either England or Wales. For example, among 13-year-olds, there were 51 per cent. of children from Scotland with active decay of the permanent dentition compared with 40 per cent. from Wales and 31 per cent. from England. In these circumstances it would be quite wrong to seek to deny Scottish health boards and water authorities the legal power to undertake water fluoridation if they wish. I can now confirm that the noble Lord, Lord Somers, was right when he said that this amendment is out of order in this part of the Bill. That apart, I hope that my noble friend will seek leave to withdraw his amendment, as I am sure that fluoride can bring great benefits to people in Scotland.

Baroness Trumpington

I believe that I ought to apologise to the noble Lord, Lord Somers. The information that I was given originally was not correct. This amendment seeks to leave out words which are already left out. I fear that my noble friend Lord Kinnoull ought to discuss these matters when we reach Amendment No. 35.

The Earl of Kinnoull

Am I correct in thinking that I ought to discuss this aspect when we come to Amendment No. 35?

Baroness Trumpington

It is when we reach Amendment No. 35 that my noble friend should make his points. I am very sorry.

Lord Somers

I am most grateful to the noble Baroness because it is a great relief to me to know that on some occasions I am right.

Lord Campbell of Croy

Before we conclude this matter, perhaps I may say that the noble Lord, Lord Somers, is very often right. I was aware when he interrupted my remarks that he might well be right.

In order to save the time of the Committee, I hope that when we reach the relevant part of the Bill covered by the new amendment, what we have said in respect of this part of the Bill—which presumably will appear on the record as having been said—will not need to be said all over again.

The Earl of Kinnoull

I am a little confused. Is it the wish of my noble friend Lady Trumpington that I should withdraw this amendment?

Baroness Trumpington

Yes, it is.

The Earl of Kinnoull

Then perhaps I may wrap it up by saying how disappointing I found the reply from both my noble friend on the Front Bench and Lord Campbell of Croy. Obviously I did not make my point clearly enough. I am not talking about withdrawing regional health in Scotland; I am simply saying that Scottish law should examine this matter to ensure that there is proper consultation for the Scots, which is not provided for in England. I would hope that Scottish law, which is a proud law, would wish to examine this very important issue by itself. That was my point. Following the very disappointing reply that I have received, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 11 not moved.]

Lord Sandys moved Amendment No. 12: Page 2, line 39, at end insert— ("( ) No statutory water undertaker shall accede to an application by a health authority pursuant to subsection (1) unless the said water undertaker is satisfied that it can continuously and effectively discharge its obligation under subsection (5) as to the concentration of fluoride in the water supplied without employing, directly or indirectly, additional manpower.").

The noble Lord said: In moving this amendment I should like to draw your Lordships' attention to the Explanatory and Financial Memorandum which appears on the face of the Bill. We are only presented with the memorandum at this stage of the Bill, and it gives the Committee an opportunity to examine two very important aspects. As to the financial effects of the Bill, we note that The Bill involves no additional public expenditure"; and in regard to the effects of the Bill on public sector manpower, we are given the same assurance.

It is remarkable that a Bill with very far-reaching consequences should, according to the direction of the memorandum, have no effect on either expenditure or manpower. It is important to examine this question of manpower because we shall shortly lose the Explanatory and Financial Memorandum, which will not be published at the Report stage when the Bill is reprinted.

For a development which will clearly require considerable supervision, considerable monitoring and very substantial considerations as regards its careful promotion within a water supply system, it must be called into question whether manpower should not be increased. We believe that if this direction is given, it should be made mandatory in the course of the Bill and it is with this intention that I beg to move.

Baroness Trumpington

I am grateful to my noble friend Lord Sandys for moving this amendment in as much as it gives me the opportunity to clarify again a misunderstanding which may have arisen as to the manpower implications of the Bill and as to the purpose of Clause 1(5).

To take first the manpower implications, the Bill before us is no more than an enabling Bill designed to clarify the legal powers of statutory water undertakers to fluoridate the water supply at the request of health authorities. The Bill does not oblige any statutory water undertaker to implement any new fluoridation schemes nor to continue existing schemes which are subject to contractual arrangements regarding date of termination or renewal. The Bill is therefore neutral as to the number of fluoridation schemes there should be and consequently as to the manpower required to service them. Hence the Bill is correctly described as having "no public sector manpower implications".

The Committee may, however, be interested to know that the manpower required to supervise the operation of fluoridation schemes is in any case very small. For example, the Newcastle and Gateshead Water Company has an annual labour requirement of four to five man years to provide fluoridated water through nine plants to no fewer than around ¾ million people. Hence, when we talk about the manpower requirement for fluoridation schemes, we are in any case talking in penny numbers. This must be a judgment for the water undertakers.

I hope the Committee will agree with me that my noble friend's amendment should not be pursued further, as at present statutory water undertakers should remain free to take on additional manpower, if required, to safeguard the operation of fluoridation schemes. The numbers involved would be extremely low and the cost would be met by health authorities from their existing cash-limited funds. To accept my noble friend's amendment would impose a wholly unjustified constraint on the freedom of decision of health authorities and statutory water undertakers. Therefore, I urge the Committee to reject it.

Lord Burton

I believe that to fluoridate water will take 11,000 tonnes a year. If that is the case, surely one man would have some difficulty in shifting that quantity of fluoride.

Baroness Trumpington

Is my noble friend suggesting that one man is going to rush round the country with 11,000 tonnes? Perhaps my noble friend will explain what he means.

Lord Burton

If there are 11,000 tonnes to be shifted, surely this is going to involve a considerable manpower requirement.

Baroness Trumpington

No, not with modern machinery, but as I have already said, this must be a judgment for the water undertakers.

The Earl of Kinnoull

Before my noble friend decides what he wishes to do, can my noble friend the Minister give a little more information on the costs of running a new fluoridation scheme with a water authority? I am not asking about the additional manpower costs, but it is the cost of the fluoride that concerns me, most of which I believe comes from Fisons. The cost was not disclosed in another place, although I think a figure of about 200 tonnes a year was mentioned. However, as regards the users, the ratepayers, can my noble friend give an indication of the cost so that we can see the size of the bill that will face those who do not want fluoride in their water?

Baroness Gardner of Parkes

We should also like to know how that is balanced against the savings in health care so that we know the net cost. What are the savings to the taxpayer as opposed to the cost to the ratepayer? My noble friend on the Front Bench will have to be something of a financial genius to come up with an answer.

Baroness Trumpington

My noble friend Lady Gardner of Parkes knows perfectly well that I am not a financial genius but I am grateful for her intervention. Fluoridation schemes currently cost an average of £65,000 to install. Full coverage of the United Kingdom would require an additional 2,000 to 2,500 schemes. Running costs are currently between 15p and 20p per annum per head of population. The costs of individual schemes varies considerably with local circumstances, as I am sure my noble friend would agree. Incidentally, to return to the manpower issue, the manpower used in transporting fluoride is private, not public sector, manpower.

Lord Sandys

I am most grateful to the noble Baroness for giving that information. She will be aware—or possibly she is not aware—that the intention of this amendment is to probe to elicit information. Therefore, it is with pleasure that I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

6.45 p.m.

Lord Monson moved Amendment No. 13: Page 2, line 39, at end insert— ("( ) Before a statutory water undertaker increases the fluoride content of the water supplied by it under subsection (1) it shall consult with the trade unions or other representatives of its employees.").

The noble Lord said: With the leave of the Committee, I shall speak at the same time to Amendments Nos. 14 and 15. Amendment No. 14: Page 2, line 39, at end insert— ("( ) Before making an application under subsection (1) a health authority shall consult with the trades unions representing those persons who will be expected to handle containers of fluoride in the course of their employment."). Amendment No. 15: Page 2, line 39, at end insert— ("( ) Before a statutory water undertaker increases the fluoride content of the water supplied by it under subsection (1) it shall be satisfied that its employees who will be expected to handle containers of fluoride in the course of their employment are provided with protective clothing so as to prevent damage to health.").

All these amendments are concerned with the safety of employees. They are not contradictory or mutually exclusive. They may appear to cover the same ground but that is not so if one examines them carefully. We have already heard how dangerous compounds of fluorine can be, even in diluted form. How much more so are those compounds when found in concentrated form!

Earlier this afternoon I referred to the Knox Report, which was initiated by the Government and which comes out basically in support of fluoridation, but the Knox Report points out that fluoride in large amounts is severely toxic, causing a variety of acute ill effects and, in extreme cases, death. A medically qualified individual, commenting on that paragraph, says: In comparing artificial fluoride with natural fluoride the vital point is not mentioned that natural fluoride is calcium fluoride which is almost insoluble, and therefore can never be present in water in gross excess. In contrast, for artificial fluoridation highly soluble fluoride compounds are used, which through accident, machinery failure, sabotage or just carelessness could be in a dangerous and very harmful excess. The first two amendments are designed to ensure that representatives of employees who may be handling this substance are made fully aware of its toxicity and of the dangers which they may face. This is particularly important in the light of recent press reports of a water board employee—I believe in North Wales—who declined to taste potentially unpalatable water and was, in consequence, suspended from duty.

Noble Lords on the Liberal and SDP Benches—those of them who are present—will be pleased to note that in Amendment No. 13 I have provided for other representatives of employees to be consulted as well as trade unions, because I know the importance that the Alliance attaches to this question. Indeed, I support them on this. I have not done so in Amendment No. 14 because the health authorities would be acting at one remove, as it were, and it is not their employees who will be consulted but someone else's employees. Therefore, it seems more logical to consult only the unions, but if the Committee feels that other representatives of the employees should be included in Amendment No. 14 that can be done at a later stage. The Committee may prefer Amendment No. 13 to Amendment No. 14, or the other way round, but I believe the belt and braces approach is the right one to adopt where the safety of employees is concerned.

Amendment No. 15 is self-explanatory. It provides that employees who are expected to handle fluoride in the course of their employment should be provided with protective clothing to prevent damage to their health. I do not suppose that anyone can disagree with that. I beg to move.

Lord Sandys

I should like to support this amendment because anything which helps towards the prevention of another major accident is a step in the right direction. I have cited the Annapolis disaster in 1979, in the context of a water plant. Recently we have had several disastrous accidents in the United Kingdom, and one thinks of the Flixborough disaster some years ago. In Italy there was the Seveso disaster and in India there was the recent Bhopal disaster. Regrettably that is not the end of the catalogue. All of these came about because of some accident which took place; either a part of the plant or equipment was incorrectly operated or it became defective and was inoperative and the fail-safe procedures failed to come into action at the right time. Attempting to make this procedure mandatory in the Bill is, as I said, a step in the right direction.

Lord Colwyn

I believe we are going wide of the amendment. These amendments are designed to protect the water workers themselves. The water authorities already have considerable experience of dealing with such chemicals. It is advisable to observe a few simple precautions. When fluoride in bulk is handled rubber gloves and simple respirators are worn and staff are instructed in their use and maintenance.

Other chemicals are in common use at waterworks and the handling of such materials is no novel experience for the staff concerned. During the course of the fluoridation studies earlier in this country the urine of waterworks plant operators has been tested for fluorides and the results have not indicated any increased fluoride intake.

Lord Nugent of Guildford

May I add to the point my noble friend is making that operatives are of course accustomed to additions to water, particularly chlorine, which is very similar in its corrosive action in a concentrated state, and would be at least as damaging as fluorine. As this is common practice with all water treatment, to add the fluorine to it would really add no additional danger. It would be asking them to operate with one more tap and one more container, and they are already fully trained in dealing with this. I think I can assure the noble Lord, Lord Monson, that this would not constitute an additional danger. I am sure that my noble friend on the Front Bench will give him that assurance.

Lord Energlyn

I would, as it were, half-heartedly support this amendment, but I think it is a good amendment in the sense that it puts on record the dangers of using liquids of this kind. One must not think in terms of vivid concentrations when you are dealing with salicic and hydrofluoric acids, and so on. We analysts have a vast experience of the use of hydrofluoric acid, and we know it is even more effective dilutions of about 1 per cent. than it is in its highly concentrated conditions. It depends what you are using it for. This amendment draws attention to the invisible and long-continued effects of the fluorosilicates in the water. I think you will find, if you look into the statistics, that the corrosion of water pipes, and so on, in these areas is really quite staggering. I would therefore commend this amendment to your Lordships, if only to draw attention to the fact that we have thought of the dangers of using even these dilute liquids

The Earl of Caithness

I thoroughly appreciate the concern behind the amendments and the concern expressed by the noble Lord, Lord Monson, my noble friend Lord Sandys and the noble Lord, Lord Energlyn, for anybody handling any sort of chemical, from garden sprays right through the whole ambit to the handling of chemicals in major industrial plants. For this reason the Government have taken a variety of actions, and, indeed, the safety of those engaged in fluoridation schemes is already fully taken into account.

A health and safety at work advisory broadsheet on fluoridation has been issued to all water undertakers. It is approved by the National Joint Health and Safety Commission for the Water Services, which consists of employers, trade unions and medical experts. The broadsheet, which was last amended in April 1983, sets out the precautions to be taken in handling the two compounds of fluorine in their concentrated form and the action to be taken in the event of an accident. The recommendations in the broadsheet are followed by all water undertakers. This is essentially no different from the general approach for any other chemical used at waterworks which may be harmful in a concentrated form. I therefore believe that there is no need for these amendments, but I am grateful to the noble Lord, Lord Monson, for raising them.

Lord Monson

I must say that I am astonished by the attitude of the Government here, and I am equally astonished by the deafening silence from the Labour and Liberal Benches on this question of employees' safety. The noble Lord, Lord Sandys, pointed out the magnitude of the disasters which we have seen all over the world in recent months and years, involving chemical works and so on—Bhopal, Annapolis and so forth.

The noble Lord, Lord Colwyn, and the noble Lord, Lord Nugent of Guildford, both claim that employees are already adequately protected. Very well; but what on earth is wrong with dotting the i's and crossing the t's and simply making it a little more positive? It is a little difficult for me to decide which amendment to stick on, because nobody has commented on the separate amendments, Amendments Nos. 13, 14 and 15, but I am bound to say that I am inclined to test the opinion verbally, if in no other way, on Amendment No. 13. Therefore, I do not propose to withdraw it.

On Question, amendment negatived.

[Amendments Nos. 14 and 15 not moved.]

Clause 1, as amended, agreed to.

The Deputy Chairman of Committees (Lord Cullen of Ashbourne)

I have to inform the Committee that the Tellers have agreed that the figures for Division No. 1 should be corrected to: Contents, 64; Not-Contents, 89, instead of 90 Not-Contents, as previously announced.

Lord Prys-Davies moved Amendment No. 16: After Clause 1, insert the following new clause:

("Applications under s. 1(1) to be subject to prior approval of District Councils

.—(1) No application shall be made under section 1(1) of this Act unless the health authority have received prior approval for making such application from the district council in the area to be affected.

(2) The district council may, or shall if requisitioned by not less than five hundred local Government electors for that district, hold a poll on the question whether an application should be made under that section.

(3) If the local government electors for the district determine by a majority on a poll so held that no such application shall be made, the district council shall withhold their approval.").

The noble Lord said: The principle underlying Amendment No. 16 is of even greater importance now that we have lost Amendment No. 4, because this amendment invites the Committee to invest the decision-making power in the people themselves. Initially, it goes to the district authority, but the people of the district are entitled to call for a referendum on the issue.

I appreciate very much that a poll will not produce a consensus, because even with a poll there will be a minority and a majority, and the minority will have to give in to the view of the majority. But the compulsion which has been the source of so much unease in the Committee will have been imposed from within the community by its own members, and not by the edict of a nominated body outside the community.

There is a precedent for such a poll. If the inhabitants of a certain district have to decide through a poll whether or not intoxicants shall be supplied publicly on a Sunday, why should not the same inhabitants decide through a poll whether fluoride should be supplied in their water supply on 365 days a year? Therefore, we invite the Committee to have regard to the underlying principle of Amendment No. 16, and to say that the decision should be left to the people of the district rather than to a prescription issued by a nominated body which may be far away from that district. I beg to move.

7 p.m.

Lord Houghton of Sowerby

I wish to support this amendment. I think that this is quite fundamental. Are the consumers of this fluoridated water to have any say in whether or not they have it imposed upon them? If we regard the citizen as having some right to decide what shall be done for him and to him where he is individually concerned—it is not a social matter, it is an individual matter—then I think we have to review our approach to the democratic process.

One argument was used by the noble Baroness, Lady Trumpington, against the amendment which was earlier put for local authorities to be the determining body. She said, "Look what a tiresome position we shall have if one local authority does it, there is an election, another council of a different complexion gets in which has promised to repeal fluoridation and it stops it". There are precedents even in parliamentary circles for Oppositions saying, "We shall repeal what the Government are doing". See-saw politics, I am afraid, are inevitable, if we are to continue to have regular and statutory occasions when people can decide to change the authority in power. We cannot have that ability to change the people in power without some change when the power changes. That is the long and the short of the matter.

I do not intend to pursue the noble Baroness's argument further, but it certainly does not apply to the poll. If a poll is taken and a majority decides one way or the other, a second poll would not be taken until opinion had formed sufficiently to be noticed as likely to want to reverse a previous decision, whichever way it went. That is the consequence of a poll. We had a poll on the Common Market. Nobody has moved to reverse the decision in that poll through the parliamentary process. I imagine that that will be the case in this regard.

The argument behind the poll is that it is universal, democratic and not likely to be reversed at the whim of party change in a local authority, Parliament or anywhere else. That seems to me the point of decisive consultation with the people in the area concerned. I do not see how Parliament can deny that.

The asembly of consultation referred to in the new clause at the back of the Marshalled List is a miscellany of consultation among authorities, people and organisations, getting the feel of the thing. It is straws in the wind. It is not a satisfactory basis for consultation. It may be some basis for consultation, but unless there is to be authority exercised in connection with it, it seems to me that it is not acceptable. I sincerely hope that the Government will regard this as an important matter.

I have listened to the arguments against the amendment. I say this in conclusion of these remarks. I have an uneasy feeling that behind this Bill is a considerable move to get this fluoridation business imposed on as many people as possible in this country. It is not merely an enabling Bill, because of the propaganda behind it. There are two lots of propaganda—for it and against it. But I think that this is a movement which inspires the Government all the way along the line. After all, both Ministers this evening have been telling us how harmless it is. We have heard what good it can do and that what are regarded in some quarters as excessive dosages would not produce noticeable harmful results. The howl of the propaganda, "Fluoridate, fluoridate" is behind the Bill.

If that is the case—and I am sure that it is—the only check is to consult the people. Although I am not in favour of national referenda on matters other than those of very great importance, the local poll is certainly a method of deciding local issues which has been freely used in the past on one issue or another. I remember years ago in Eastbourne a town poll on the three Bs—bathing, buses and bands on Sundays. Just think of that! It was a poll of the whole of the citizenry on whether there should be Sunday bathing, buses and bands—noisy bands, music on the front on a Sunday morning. That was a very important matter for Eastbourne in those days. That kind of ballot has been used. I sincerely hope that we shall have encouragement from the Government to look at the question of the poll seriously.

The Earl of Kinnoull

I should like to support the noble Lord who moved the amendment and, indeed, the noble Lord, Lord Houghton. Both cases put forward were extremely compelling. The most important matter about the Bill is the lack of consultation, democracy and personal choice. It stands out so strongly that I think that it is offensive not to have this amendment in. I hope that noble Lords will feel strongly on this amendment, even if we have covered similar ground before.

What right of appeal does the individual or the local authority have under the Bill as it is? The answer is, none at all. If my noble friend's amendment goes through, they will have vague consultation rights, but no real rights of appeal. The Secretary of State washes his hands of the situation. He does not want to be responsible at all. How do the health authorities feel? Do they want to be in this embarrassing situation where they have a heavy hand? I do not think so. They are human. Do they not want to test local opinion in the area? They cannot all be interested in fluoridation. Some must have doubts about it, as I do. I find this such an important part of the Bill that I think it is the duty of the Committee to look at it very carefully indeed. I hope that noble Lords will do that.

Lord Monson

I regard this amendment very much as second best to Amendment No. 4, which was not carried, but it is certainly better than nothing and I am very pleased to support it. I hope that a number of noble Lords who could not bring themselves to support Amendment No. 4 because they may have felt that it went a little too far in a certain direction may feel that this represents more of a compromise and feel able to support it.

Lord Nugent of Guildford

This seems to me very much like a re-run of the debate on Amendment No. 4 when it seemed to me that the arguments were well ventilated on both sides. The point is, to what extent should the local health authority take the ultimate decision? My noble friend has put down Amendment No. 32, which requires the local health authority to publish in complete form any proposal either to start or to stop a fluoridation scheme. Having done so, with the appropriate three months' notice, it requires the authority in reaching its decision to take into account the result of the publication that it undertakes in various ways so that the locality and everybody in it is aware of what is proposed. That would be an adequate way of consulting local opinion. It leaves the ultimate decision with the health authority, which is, after all, at the end of the day in the best position to get the right balance on the medical and ethical arguments and in the light of the expression of public opinion which it will have had by then.

These responsible bodies having been set up, I should have thought that it would be right for them to take the ultimate decision rather than to throw it open to a public poll, where the arguments will not, I should have thought, be quite as rationally developed as I would expect them to be in the health authority.

I hope that my noble friend will stand firm in the same position as she took on Amendment No. 4, and that we shall rely on the provision that is to go into the Bill by Amendment No. 32.

Lord Monson

Before the noble Lord sits down, he must surely agree that Amendment No. 32 does not oblige the health authorities to act in conformity with public opinion. That is how it differs from this amendment—which, if I may say so, is a far more democratic one.

Lord Sandys

Before my noble friend replies may I say that I should like to associate myself with this amendment because I think it has very close relations with Amendment No. 4. I am attracted to it for two particular reasons. The district is mentioned in some considerable depth. In the past few years public opinion has been much more easily expressed through a whole variety of different ways, such as by polls, by the existence of local radio stations, by 'phone-ins and by many other means of communicating with the public at large. I believe that the noble Lord who has proposed this amendment may find that there are other matters which we can perhaps refer to on Report. Nevertheless, I should like to be closely associated with it at this stage.

Baroness Trumpington

Once again I recognise that this amendment reflects the views of those who feel strongly that fluoridation should not be introduced unless it has the agreement of locally elected representatives.

I entirely agree with my noble friend Lord Nugent that this is a repeat performance of Amendment No. 4, and I have no wish to make a repeat speech. However, the noble Lord, Lord Houghton, and others have forced me to repeat that I must make the point that, as far as England and Wales are concerned, local authorities no longer have any responsibilities for either the provision of water or the provision of facilities for preventive health measures.

The Government of course attach importance to health authorities informing and consulting local opinion on fluoridation prior to any decision being taken on whether or not to apply for water fluoridation. Health authorities are already legally obliged to consult on this issue with community health councils, which have statutory responsibility for representing the consumer interest in health measures.

I should add that the new Government clause, Clause No. 32, about which I have already spoken—which noble Lords will have read and which I shall be moving later on—is concerned with consultation. It proposes that health authorities should be obliged to give in a local newspaper at least three months' notice of proposals for fluoridation, in order that interested local bodies, which will clearly include local councils and individual citizens, can make their view known to the health authority prior to the decision being made. The Government do not, however, accept that district councils can be given the power of veto over decisions of health authorities, whether on fluoridation or any other matter. It is clearly wrong that any body, whether or not elected, should be able to take the final decision on a matter for which it has no statutory responsibility. This can only amount to power without responsibility.

The simple fact is that responsibility for preventive health measures has been vested in district health authorities, not in local councils. As the noble Baroness, Lady Fisher of Rednal, pointed out at Second Reading, local councils no longer have any professional advice available to them on which they can take an informed decision. Moreover, precisely because this responsibility is lacking, district councils may, as I said before, be tempted to frequent changes of decision, resulting in stop-go policies on fluoridation which would produce highly ineffective and highly expensive results.

I have no wish to repeat all the other arguments I gave. I can only ask the noble Lord to be so good as to take back his amendment.

Lord Cledwyn of Penrhos

As always, the noble Baroness speaks with great sincerity. However, with respect to her, she must realise that she has confused two separate issues. The first issue is whether or not fluoridation is a good thing. There are scientific arguments for and against. I do not propose to go into that this evening. However, in my view, the second issue is the one related to this amendment. I regard it as one of fundamental importance. It is whether a substance should be added to drinking water without the consent of the people who have to consume it. In my view that is the fundamental issue in this amendment and in Amendment No. 4, which was unhappily defeated.

If I may, I should like to inform the House of my experience as a Member of another place representing the Island of Anglesey. Well over 30 years ago, fluoridation was instituted in Anglesey. It was done on the decision of the Anglesey County Council. At that time I had the privilege of being a member of the county council. The medical officer of health, who is a personal friend of mine, was a strong believer that fluoridation was a necessary step in the interests of the dental health of the children concerned. The Anglesey County Council passed, by a majority, a vote in favour of fluoridation. That was a very long time ago.

However, two things happened in the meantime. In 1973 there were two important Acts of Parliament. The first was the local government Act and the second was the Act which reformed the National Health Service. The result of those two Acts was this. The first created a new county council—that is to say, the Gwynedd county council—which included not only the island of Anglesey but the old county councils of Caernarvon and Merioneth. The result subsequently and up to today is that one third of that new county—that is, the Anglesey district—has its water fluoridated whereas Merioneth and Caernarvon have not. In my view, that is an unacceptable anomaly.

Secondly, the power of the county council to decide whether or not fluoride should be added to the water was passed on to a nominated authority, to an appointed authority. That is the area health authority, which, as we know, takes the advice of the water authority. It is a totally different state of affairs. The majority of the people of Anglesey, who are not profoundly concerned or persuaded about the effect of fluoride, now take it amiss that a decision should be taken by an appointed authority rather than by people to whom they can go, such as local authority representatives and councillors, whom they can consult. As noble Lords are aware, the electorate as a whole are not particularly well versed in the membership of appointed authorities. Thus the situation has completely changed.

On that account and that basis, there is a very strong case for returning to the pre-1974 position and giving the people of Anglesey, and other areas who have to drink fluoridated water, the right to decide for themselves whether a substance should be added to their water.

The answer which Ministers have been giving on this matter is that of course chlorine is already in water. I do not regard that as an adequate argument. If one proceeds along that road, at the end of the day we may have tranquillisers added to our water if we have the wrong kind of authority and the wrong kind of Government. That is the danger. This is a matter of profound democratic importance.

It is not that I do not trust the area health authority in North Wales—I do; I have a high regard for them—or, for that matter, the members of the water authority—I know some of them as well and have a profound regard for them. However, I think this matter goes beyond that. It goes right to the very heart of the democratic principle that the people of this country at the end of the day should have the right to decide whether a substance should be added to their drinking water. On that basis, I ask the noble Baroness not to give a final reply tonight but to be good enough to take this back to her right honourable friend and think about it again and let us hear what the Government have to say after due consideration.

Baroness Trumpington

Of course I have listened with enormous care and respect to the noble Lord, Lord Cledwyn. We have already been through this argument this evening. I cannot take the matter back. He has talked about substances added without permission. Over 50 substances are already added without permission. The health authorities are specialised bodies and at least four members of each health authority are appointed by local authorities. The health authorities have to consult community health councils, anyway. Under Amendment No. 32 ample consultation will be possible with the electorate. I do not think that I can say any more, apart from adding that I am sorry that the noble Lord, Lord Cledwyn, spoke as he did.

Lord Cledwyn of Penrhos

Before the noble Baroness, whom I greatly respect, sits down, will she not agree that in the present circumstances the decision to add fluoride to the water will not be taken by any elected authority?

Baroness Trumpington

The local health authority will have full power to consult. In Government Amendment No. 32 we can see the consultation process that will take place, and they will naturally take note of it.

Lord Cledwyn of Penrhos

However, if the elected local authority decides by a majority against adding the substance to the water, will the area health authority take note of that and decide against?

Baroness Trumpington

We shall come to that later.

Lord Beaumont of Whitley

Did I hear the noble Baroness say that 50 different substances are already added to the water?

Baroness Trumpington


Lord Beaumont of Whitley

If that is so, it is a new argument that is being introduced. I have no objection to it, but I was not aware of it and I do not know how many other people are. Perhaps the noble Baroness will write to me and place a copy of the list in the Library?

Baroness Trumpington

I am quite sure that noble Lords would not want me to give a list of 50 items now. I shall certainly place the list in the Library. My noble friend Lord Caithness has already mentioned several of the substances which are in the water that we drink every day.

Lord Campbell of Croy

The noble Lord on the Liberal Benches has had since the Second Reading debate to raise this matter and to look it up in the Library, because it has all been said before.

Baroness Gardner of Parkes

This seems the appropriate moment to mention that every drop of water we drink in this House has been used seven times before.

The Earl of Kinnoull

The noble Lord, Lord Cledwyn, actually asked a very important question. It was whether an elected body would take the decision. I think that my noble friend replied that we shall come to that later. I am not sure why we have to wait. Why cannot she answer that question now? Will an elected body take that decision and, if necessary, have enough influence to say "No"?

Baroness Gardner of Parkes

Perhaps I may also mention that at one time in Scotland, where an elected body turned this into a political issue, they reversed the introduction of fluoride. As a result of a political decision by the local authority, fluoride was already in the water. There was change of political power and immediately that decision was reversed. Then there was a further change of power and the water system was changed yet again. To turn the whole matter of fluoridation into a political football would be of no benefit to anyone because it would mean that the whole issue would be coming and going. People may not realise that it is not a political issue; that is borne out very clearly here tonight. Yet when local authorities have had the power of decision, it has become a political issue.

Lord Cledwyn of Penrhos

With great respect to the noble Baroness, Lady Gardner, the section of the community which has made it a political issue is the profession that she represents, the dental profession. They have made it a political issue and she is speaking here on behalf of that profession and she should make that abundantly clear. The noble Baroness should realise that other people believe equally sincerely that democracy is important, and that people should have the right to decide what is in the water. The noble Baroness, Lady Trumpington, said that there are 50 substances in water. It is not the Government or the area health authority who decide that they are added. We are talking about substances deliberately added to water at the behest of an appointed authority. All the other arguments that are being produced this evening are not only divisive but also divert people's attention from the real issues.

Baroness Gardner of Parkes

I should like to reply to that point, because the noble Lord is quite wrong in saying that I speak for the dental profession. I am a dental surgeon practising in my own profession and in that sense, yes, I am speaking for them. But I must make it clear that I am in no way speaking as a representative of the dental profession. I should also like to make it very clear that, far from having an interest, I have an absolute non-interest. It is very much against my financial interest to add fluoride to the water because that does me out of business.

Baroness Trumpington

Perhaps I may raise two other matters with the noble Lord, Lord Cledwyn. Local councils certainly have a duty to monitor the wholesomeness of the water supply. That is a function which they carry out irrespective of whether or not the water supply is fluoridated. This Bill has come about because of a judgment in Scotland by Lord Jauncey, but in his judgment he did not say that fluoridation of water rendered water unwholesome. That is one point that I wish to make—and I have no intention of getting up again after this, whatever anyone may say.

District health authorities usually comprise 16 to 19 members, of whom about four are nominated by the local authorities concerned, and the remaining members are drawn from the National Health Service and professional and outside interests, such as universities. I think that it would be rather insulting to turn district health authorities into total patsys not representing local interests.

Lord Houghton of Sowerby

I want to make two or three very short points. The simple issue is that if water is to be treated or added to in any way, where is the authority to do so to come from? Under statutory powers, no health authority has the power to do anything about health which is comparable with doctoring the water of the community—nothing. It may be concerned with hospitals, social services and the rest, but this is water. This is forced upon every member of the community. I ask: where is the authority to do that to come from?

The Committee has already decided that, by themselves, district councils are not the proper authorities. Under this amendment the ultimate authority is the poll because whatever district councils do and whatever health authorities want to do, a requisition by at least 500 electors can demand a poll. In those circumstances the local authority would merely be—is the noble Baroness with me?

Baroness Trumpington

Absolutely, all the way, except as regards fluoridation!

Lord Houghton of Sowerby

The only function of the local authority is to act as the electoral body in these circumstances. So the local authority has no power to stop anything or to agree to anything when the poll can test the issue finally on behalf of the people as a whole. Noble Lords opposite are either democrats or they are on the side of the bureaucrats and the indirectly elected authorities. They have certain powers, but some powers they should not have, nor should they be given them. I think that this is quite fundamental and that we should fight it all along the line.

Baroness Trumpington

I wonder whether noble Lords think that we are now going through what I might call Acts 2 and 3, having dealt with Act 1. It may be that your Lordships have made up your minds and that we could do something about this situation. Perhaps the amendment could be taken back, or action could be taken on it, and then we can move on?

Lord Prys-Davies

I shall be brief. Clearly we are not satisfied with the response of the Government. The Government may well be right if they are thinking in terms of management structures in claiming that this decision ought to be taken by the area health authority or the water authority. But the issue with which we are faced is not one of management. Therefore, it can be said that the answer which is formulated in terms of management is the wrong answer.

Secondly, the Minister has referred more than once to the proposed consultative procedure in Amendment No. 32. I do not want to anticipate the debate on Amendment 32, but we shall have to level criticism at the proposed new procedure. The Minister refers to it as a consultative procedure. I have read this amendment a number of times and the word "consult" nowhere appears. We consider that the dilemma which faces us is posed by the ethical problem, and that calls for a solution which involves the public in the community to be affected. I agree that the poll, or the referendum, does not entirely remove one's disquiet, but it goes a long way towards that end because it acknowledges that the voice of the consumer is central to the decision-making process.

I think that I can take a useful analogy to illustrate the point we are making that the decision should not be taken by the health authority. The Bill should follow the good practice of a good doctor. The first thing a good doctor does is listen to his patient. The doctor may not always be right, but he will tender his advice, he will prescribe the treatment, and it is for the patient to decide whether he accepts that advice; it is for the patient to decide how much, if any, of the treatment he will accept. And so on the issue of fluoridation; the health authority are familiar with the medical arguments and they should advise the community. That ought to be their role. It should be no part of their function to compel the citizen, or the consumer, to accept treatment. Therefore, I think it right to put this matter to a vote.

7.32 p.m.

On Question, Whether the said Amendment (No. 16) shall be agreed to?

Their Lordships divided: Contents, 26; Not-Contents, 37.

Houghton of Sowerby, L. [Teller.] Monson, L. [Teller.]
Thurlow, L.
Alexander of Tunis, E. Elton, L.
Belstead, L. Enniskillen, E.
Brabazon of Tara, L. Ferrier, L.
Brougham and Vaux, L. Gardner of Parkes, B
Burton, L. Glenarthur, L.
Caithness, E. Hornsby-Smith, B.
Cameron of Lochbroom, L. Mountevans, L.
Campbell of Croy, L. Saltoun, Ly.
Colwyn, L. Skelmersdale, L.
Dean of Beswick, L. Swinton, E. [Teller.]
Denham, L. [Teller.] Trefgarne, L.
Elliot of Harwood, B. Trumpington, B.

Resolved in the negative, and amendment disagreed to accordingly.

[Amendment No. 17 not moved.]

7.40 p.m.

Lord Sandys

Before I move the next amendment, I wonder whether this may be an appropriate stage at which to seek an adjournment of the Committee. At this hour it would appear to me that there is not a surplus of amendments to come afterwards, and perhaps it would be for the convenience of the Committee if we sought an adjournment.

Lord Denham

There was no adjournment organised for tonight, and I do not know quite how long the rest of the business will take. It is a little unsatisfactory to talk about this on the Floor of the Committee. It is generally considered right to discuss this through the usual channels, and not on the Floor. So, perhaps, if the Committee carries on for a moment, we can have a word.

Lord Sandys moved Amendment No. 18: After Clause 1, insert the following new clause:

("Resolution to cease fluoridation.

If at any stage a resolution is passed in the borough or district council in whose area any part of the area the subject of an application made under section 1(1) falls which requires the cessation of any increase in the fluoride content of the water supplied by the statutory water undertaker then the statutory water undertaker shall cease to increase the fluoride content of the water.").

The noble Lord said: This amendment seeks to insert into the Bill a clause which at the moment is absent. There is no machinery whereby the Secretary of State, or indeed the district council, is enabled to annul by resolution the application to fluoridate and to ensure that the statutory water undertaker ceases the supply of the content of fluoride. This is an important amendment because throughout the procedure we have seen up to now we have been aware of machinery to empower the statutory water undertaker to start the fluoridation process, with nothing to stop it. I believe, and I am sure that my noble friends who support me in this believe, that the Bill is defective because no powers are provided. If powers were provided by this clause it would be both helpful and beneficial for the flexibility of the scheme.

One can think of circumstances in which it would be highly desirable to cease the supply, such as in an emergency and in other circumstances, such as the outbreak of disease or an epidemic, when for some reason fluoridation had an influence. We are looking forward in time. Medical research is not always as far advanced as we might wish. There have been changes of opinion, and in legislating we should seek to be flexible when it is practical and sensible to do so. I beg to move.

Lord Campbell of Croy

I should like to raise a drafting point. As worded, there is a reference in the first line to "the borough … council". The clause appears to apply to Scotland and to England and Wales, but there are no borough councils in Scotland. If Amendment No. 40, in the name of my noble friend Lord Kinnoull, is carried at a later stage, it will take Scotland out of the Bill and the drafting could be left as it now is; but as my noble friend Lord Kinnoull withdrew other amendments earlier today which were associated with taking Scotland out, I should point out that the drafting would be defective.

Baroness Trumpington

I urge my noble friends and noble Lords opposite, or wherever they may be, not to allow this clause to be incorporated in the Bill. We have already agreed to place a duty on health authorities to undertake general public consultations prior to taking a decision on fluoridation. However, we see no reason to allow bodies without any direct responsibility for fluoridation to have a veto. The Government do not believe that decisions on fluoridation should rest, in the final analysis, with bodies other than those who have the statutory responsibilities for carrying out the functions inherent in fluoridation.

It is manifestly wrong that a body, whether elected or not, which has no responsibility for and expertise in either preventive health measures or the provision of water supplies should have a right of veto on water fluoridation. It is particularly wrong that they should be able to exercise that right of veto once a fluoridation scheme has begun and expensive machinery has been installed. Fluoridation, as we all know, benefits teeth. The benefits of fluoridation are therefore long-term, and decisions on schemes should be taken in the knowledge of this. A mechanism already exists for terminating particular fluoridation schemes should either the health authority or the water undertaker decide that it wishes to withdraw from the contractual arrangements governing schemes.

With regard to Scotland, as my noble friend Lord Campbell of Croy said, it is equally the case that local district councils have no statutory responsibility for either preventive health measures or water supplies. As in Scotland the water undertakers are the regional and island councils, this new clause would oblige them to be bound by the decisions of a lower tier of Government. Though not wishing to be discourteous to my noble friend, this would clearly be nonsensical as well.

7.45 p.m.

Lord Sandys

I am grateful to my noble friend only in so far as she has given this matter her consideration. The response is another matter.

I believe that there is substance in this. I naturally will reserve my position and will take advice on it for a later stage. With that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Earl of Kinnoull moved Amendment No. 19: After Clause 1, insert the following new clause:

(" Notification to ratepayers.

. It shall be the duty of every statutory water authority to give at least one month's notice in writing to all water ratepayers before the introduction of fluoride to the water supply and to give notice in writing at the termination of supplying fluoridated water.").

The noble Earl said: This I regard as an important, small amendment. I do not think it is contentious. Its purpose is to seek a duty for all water authorities who introduce fluoridation schemes within their area to notify the householders. I have suggested in the amendment that there should be one month's notice so that those who are either concerned about drinking fluoridated water or who for one reason or another want to make their own arrangements are made aware of the position. It would cost very little to implement. It is possible for water authorities to include such a notice with their half-yearly rates. It would cause very little trouble, but it would demonstrate that the Government are sensitive to the argument about communication with the consumers.

I must admit that at the moment there is no duty laid on the water authorities at all to announce such a move, though I assume they would publicise. However, not everyone takes newspapers, and I regard this as an important matter of communication. If one considers water authorities to be the businesses that they are, all businesses constantly communicate with their shareholders and their users. This is regarded not only as good practice but as essential. I hope that my noble friend will look at this favourably and with a smile and will accept this small amendment. I beg to move.

Baroness Trumpington

Always with a smile; but I am sorry to tell my noble friend that I would ask the Committee to reject this new clause. I would say at the outset that this is not because I do not have any sympathy with its basic purpose. Rather, it is because I believe it to be unnecessary in view of the Government's own Amendment No. 32 (when it comes up) which requires health authorities to undertake general public consultation before making any request to the water undertaker to fluoridate the supply. There is no particular reason why water consumers should be concerned as to the exact date of implementation of a fluoridation scheme. Fluoride is completely odourless, tasteless, harmless and essentially undetectable, except by monitoring machinery or, indeed, by the beneficial effects it has on teeth. I would ask my noble friend therefore to withdraw his new clause.

The Earl of Kinnoull

My noble friend is always charming, but she has not convinced me. She says that there is no reason to advise the consumer. There is a reason. The water has been changed, and that is the whole purpose of this notification. If she does not accept that, I cannot accept her advice to withdraw the amendment, because there is a reason. I am disappointed. When she says there will be general public consultation, that is perfectly true if our amendment is accepted; but that is not notification. The ordinary users will not be involved in the general public consultations at all. There will be consultations with the public bodies, with, I hope, the local councils and anyone materially affected, but not the individuals. I feel very strongly that this amendment should be looked at in a more sympathetic way.

I wonder whether my noble friend would be prepared to look at this amendment; in fact, to take it back so that we could discuss it before the next stage. I think that when there are only five of us present it is a little fatuous to think of pressing it. I hope that she might consider taking it back and looking at it sympathetically. I hope that the Front Bench spokesman of the Labour Party would also be sympathetic to this clause. After all, I am sure that he would stand for consumer protection and consumer notification.

Lord Sandys

Before my noble friend replies, I would say that all the same arguments on consultation apply to this amendment as applied to Amendments Nos. 4 and 15. It is an important matter and I hope that the noble Baroness will feel that the sense of the Committee is behind the wish—if not too strongly expressed, the very profound wish—that she should seek the advice of her colleagues and take this back for further consideration and examination.

Baroness Trumpington

I am afraid I cannot oblige my noble friends. The water authorities would certainly be discussing this entire matter with the consumer consultative committees; and the press and the public are allowed to attend these meetings. Therefore, the public would know. I regret that I cannot accept the amendment.

The Earl of Kinnoull

I do not feel that I can withdraw the amendment. I think we have a choice of either testing the Committee or simply negativing it.

On Question, amendment negatived.

Lord Sandys moved Amendment No. 20: After Clause 1, insert the following new clause:


. The Secretary of State shall make provision for constant monitoring of the levels of fluoride within all parts of the United Kingdom.").

The noble Lord said: This amendment is a continuation of the same theme in regard to monitoring which we discussed earlier. I think that it would be highly desirable if the Secretary of State, as a matter of mandatory practice, made provision for constant monitoring of the levels of fluoride. We have already discussed the problems which there are in regard to monitoring. Principally they relate to the question of whether the dosage of one part per million is as near as is reasonably practicable. That famous phrase, which was discussed at considerable length in Standing Committee H, gives rise to concern.

We are dealing, as we constantly remind the Government, with an antique water supply system. It varies in age throughout the country. In parts of the country the water supply has been well established and in others it has more recently been constructed out of the more modern materials. But there are inevitable differences in dimensions, changes in pressure, and alterations in systems for the incorporation of new housing estates in different areas which form a restriction and an alteration. I am not suggesting that necessarily this alone is going to cause difficulty. Water engineers are far better qualified than I upon it, but I would say this. It is desirable that there should be a mandatory instruction within the Bill that monitoring should be carried out at a high level. I beg to move.

The Earl of Caithness

I sympathise with the reasoning of my noble friend Lord Sandys in moving this amendment. I have to tell him that when a water supply if fluoridated the fluoride concentrations are already continuously recorded by an automatic monitor in most cases. In a few schemes there is regular monitoring, but it is carried out manually. The fluoride dosing is stopped automatically if it reaches 1.5 mg per litre and sometimes the cut-off point is set at less than 1.5 mg/litre.

I remember that earlier this afternoon the noble Lord, Lord Monson (who is not in his place, and I hope he reads this) moved an amendment trying to limit the dosage to 1 mg per litre. I think that it is advisable to inform the Committee that even if the dosage moved up to 1.5 mg per litre or a little higher, it has no serious effects on the person who ingests it. The average person will ingest about 3 mg of fluoride per day, and serious, acute fluoride poisoning would require a dose of about 1 gram of fluoride.

I think at this point it is also worth speaking about the point raised by my noble friend Lord Sandys earlier regarding the incident at Annapolis. I promised that I would come back to it when we came to monitoring. He is absolutely right. There was a very serious incident in Annapolis in 1979 which caused the fluoride level to rise to 20 times the optimum level. I can inform the Committee that such an accident could not occur here. The equipment is designed to halt the supply of fluoride if the concentration in the water supply begins to exceed the tolerance level. Even if there were a malfunction in the monitoring equipment, the amount of fluoride compound which could enter the supply at any one time is severely limited.

The Department of the Envioronment monitors new plants to ensure that they are operating satisfactorily for, I believe, a six-month period. Natural fluoride concentrations are periodically monitored by the water undertaker in areas which are not artificially fluoridated. However, natural fluoride concentrations do not vary significantly throughout the year and there is no need for continuous monitoring. I think that my noble friend, if I may say so with respect, needs to look at the drafting of this amendment; because the new clause is not limited to water supplies and would therefore require fluoride levels to be monitored constantly, in rivers, lakes, estuaries, in the earth, in the air and in all parts of the country. Fluoride is a natural element and I have been informed that it is the 17th most common element of all. It has not been shown to have any ill effects at the concentrations normally found in this country. There is therefore no point in instituting such a monitoring regime and I hope that my noble friend will feel able to withdraw his amendment.

Lord Sandys

I am horrified to hear the levels of fluoride which exist in the air and in other parts, which of course are all in addition to the one part per million ingested by the person. My noble friend has suggested—perhaps it is implicit in his argument—that only people are imbibing the water supply; but of course it affects pets, domestic and other animals. It is very widely employed in industry, particularly in the agricultural industry, in cress growing and trout breeding. I would suggest most strongly that there are causes for concern in other industries, particularly in areas of food production, where the level of monitoring is of immense importance. I shall read again what my noble friend has said. It has a familiar ring about it and I think it was similar to what was stated in Standing Committee H. Nevertheless at this stage I will ask the Committee's leave to withdraw the amendment and perhaps return to it on Report.

Amendment, by leave, withdrawn.

8 p.m.

The Earl of Kinnoull moved Amendment No. 21: After Clause 1 insert the following new clause:

("Annual report.

The Secretary of State shall be required to publish an annual report on the constant monitoring of the levels of fluoride for those areas that are supplied with fluoridated water.").

The noble Earl said: This amendment I regard as an important comfort for consumers and it would cost the Government nothing at all to give way on it. It would show consumers, and indeed not only consumers but those who are interested in the scientific study of this subject, that the Secretary of State understands that there should be an annual report published, giving details of the constant monitoring of the levels of fluoride, and showing how they have varied up or down, how accurate they have been and perhaps also giving other useful information.

I am frankly surprised that such a protection has not already been put into the Bill because I should have thought the Government might have taken pride in showing the interest that they have on behalf of consumers. I regard this as being very important and I hope I shall have support for it in the Committee. I beg to move.

The Earl of Caithness

A great deal of what I said in reply to the previous amendment moved by my noble friend Lord Sandys is also applicable to this amendment and therefore I do not think I need go through it again with regard to the monitoring. Apart from the automatic system that I mentioned earlier, there are other safeguards built into the design of a plant to ensure that people do not receive over-fluoridated water. For instance, most plants use hexafluorosilicic acid and have a day-tank which holds about one day's supply of acid and which can be filled only once in any 24-hour period. Also the dosage pump is designed to work close to its maximum output. There are therefore a number of safeguards to prevent over-dosing.

All this amendment would achieve would be the collection by the department at a fairly high cost of a vast number of figures all below 1.5 milligrams per litre, and mostly between 0.8 and 1.2. I do not see, bearing in mind the safeguards that I have already mentioned, that such information is worth collecting. Should any scientist, as my noble friend mentioned, be particularly interested, he can of course write to the water authority and ask for the details. He would then get a sheet of paper with a mass of figures on it, all between 0.8 and 1.2, as I have said. Bearing in mind all these facts, perhaps my noble friend will see fit to withdraw his amendment.

Lord Graham of Edmonton

I wonder whether the Minister will reflect on the purpose, as I see it, of the amendment. Of course it is designed to provide information and of course the Minister is right in saying that the collection of statistics will be costly. But the issue is clearly divisive and there is a great deal of anxiety around. What the amendment would be doing, even though it may be costly and in the aggregate perhaps not be worth very much, is to provide the opportunity for people who may make something out of the fact that they are unable to get information. However, if they are able to get the information they will be satisfied, one hopes, and at least the ministry will feel that although they may not have felt it to be necessary or to serve any great purpose, if those people, for deep reasons, consider that there are things that could happen and that they should be made aware of them, if in fact the information is made available on a regular basis I do not think that the amendment, in those terms, is asking for a great deal.

It is sad, not only in regard to this Bill but in regard to many others, to see the inflexibility of the Government as regards reconsidering arguments that have been put forward. What the noble Earl was saying in moving his amendment was, "I am worried, and the provision of this information (which we understand may be costly) may very well help to assuage anxieties which, if allowed to fester unattended, could very well cause hysteria and wrongly-drawn conclusions."

I am absolutely certain that the Government have no intention of being secretive about the matter. The amendment was moved in a very reasonable way and the Minister is being asked to agree as part of the price of getting the Bill easier rather than harder to have another look at a better way. The noble Earl has yet to respond to what the Minister has said: he may be satisfied. But I do hope that the Minister will reconsider this. We are not here in the business of winning or losing votes or of dividing the Committee, but we are talking about leaving a "better taste in the mouth" on this and other issues. It might be helpful if the Government were prepared to interpret in a more flexible way some of the points that are being made.

The Earl of Caithness

The Government will reflect on all the arguments that have been put forward tonight and I know indeed that tomorrow morning my noble friend and I will be perusing Hansard and going back over everything. Of course we will look at it. I do not say that I will look at it and come back with an amendment; but I will look at it and reflect. However, I am still of the very firm opinion that my original answer was correct, because this information can be obtained by writing by anybody who is interested direct to the water authority. I feel, at the moment anyway, that that is the right way to do it.

I think the noble Lord was a little bit ungenerous to us when he said that we were inflexible. I think we have been very flexible on this Bill. Its purpose is to put us back into the position that we always thought we were in, until the Jauncey judgment. But, having taken into account many of the points that were raised in another place and without altering the position, we have introduced five amendments into the Bill here: I think that shows that we do listen.

The Earl of Kinnoull

I am most grateful for the intervention of the noble Lord, who obviously speaks with great knowledge of the way things work. However, I must admit that I am not convinced about the cost of collecting the information. Quite frankly, everything is on computers nowadays and it can be swept into the central computer and spun out at the touch of one button. Therefore the cost argument is not really a convincing one. What I am worried about is that there might be thought to be a "cover-up" situation, because a situation could arise in which there was a blow-out of the pipes or a blow-through of the fluoride, so that the level gets up to 4 or 5 mg when it should be only 2 mg. No one might ask about it on that day so it would be hidden and it could be a great temptation for any water authority, which is not obliged to publish, not to make it known because it might cause a lot of criticism and indeed hysteria among users.

We are at a sensitive stage and the Government must realise that a high percentage of people distrust fluoridation, whatever the medical people say, so the Government should be prepared to do everything possible to make information available. It must be remembered that the scientists' work is still continuing. I have an article from the New Scientist which is dated May 1985, and which records further work into fluoridation and the worries that might come out of it. So it is not at all a dead duck as an issue and the acceptance this afternoon that it is absolutely safe is not totally convincing to me. There is a seed of anxiety in people's minds and the thought that there could be a cover-up, which could be avoided by providing this information at very little cost.

All people will look for is to see how the level varies, so this suggestion should not be written off because it is too expensive. Why should the information not be published? Why should it not be the duty of the water authority to make available this interesting and vital information? I hope that my noble friend will look again at this amendment. I do not want to press the amendment, but—

Lord Graham of Edmonton

Will the noble Earl give way? I am grateful for the remarks of the noble Earl, picking up the fair comment of the Minister. What we want is for the Minister to look again more carefully. Knowing this Minister, I am satisfied that he will do that. But will the noble Earl agree that we are also concerned about the Government doing more than being willing to respond to anxious consumers? What the Government ought to be prepared to do is to take the initiative in making the information available. Such information will not be harmful to the Government's case, and may go a long way to assuage the anxiety of other people, and it is all part of the cost of democracy. Does the noble Earl agree that, in many instances, the absence of candour feeds the people who, for malicious or malevolent reasons, want to make something out of nothing? I hope that the noble Earl will watch the issue very closely, as I intend to do.

The Earl of Kinnoull

I am grateful for the noble Lord's support and for the understanding which my noble friend has shown. With the assurance that the matter will be looked at again—and perhaps we can discuss it before the next stage—I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

8.15 p.m.

The Earl of Kinnoull moved Amendment No. 22: After Clause 1, insert the following new clause:

("Notice of concentration.

. Each statutory water undertaker that supplies fluoridated water shall make available to any consumer on request a copy of daily recordings of the concentration of fluoride of the previous month and shall give notice of any excessive recordings, above one milligram per litre, quarterly to each householder.").

The noble Earl said: This is another amendment calling for consultation. All these amendments are designed to try to encourage the Government to put into this very important Bill better procedures for consultation. Under this amendment, any water authority which supplies fluoridated water shall make available to any consumer on request a copy of daily recordings. It may be that this requirement is already there automatically, but water authorities are not always quite so co-operative as they should be—and understandably so. They must get a lot of "nut" cases writing to them for information. So I should like to see this amendment accepted, unless there is a duty laid down elsewhere for water authorities to provide this information. Perhaps my noble friend will elucidate. I beg to move.

Lord Rugby

I should like to add a certain amount of weight to what the noble Earl has said because as a consumer of water I have bought that water from the authority. Consequently, I am perhaps also entitled under the Trade Descriptions Act to know whether there are any added constituents to that water, other than the normal constituents which one gets in fresh water, whether under that Act the water authority is responsible in any way to the private consumer in regard to those constituents and whether, if the authority has it wrong, it is then answerable in law.

The Earl of Caithness

In moving the amendment, my noble friend Lord Kinnoull related it to fluoride again, but I wonder what the effect would he if consumers were entitled to demand, and water undertakers were required to supply, information of this nature for the other 50 or so chemicals which water authorities can add to their water supplies. Even if only fluoride were singled out for this treatment and not hydrochloric acid, sulphuric acid, aluminium sulphate or chlorine, I can envisage the offices of water authorities expanding to contain the staff who would be needed to provide the information.

And for what purpose? The guidelines for fluoride levels laid down by the Standing Technical Advisory Committee on Water Quality, which I have already mentioned, allow for concentrations to vary between 0.8 mg per litre and 1.2 mg per litre, with a maximum of 1.5 mg per litre. These guidelines—and it is wise to repeat them—are consistent with the World Health Organisation's recommendations, and also with the EC Directive relating to the quality of water intended for human consumption. I do not see any need at all for consumers to be notified when levels exceed precisely 1 mg per litre, as there is no health risk involved. And the safeguards are such that no occasion would ever arise where the maximum allowable concentration of 1.5 mg per litre is exceeded.

I said that I would have a very close look at the previous amendment referring to the annual report. A lot of what my noble friend wants under this amendment could also, possibly, be included in the annual report and the two could be lumped together. As I said, I will look very carefully again at the previous amendment, with no commitment to bring it back, but on this one I am much firmer.

Lord Energlyn

Before the noble Earl sits down, is he aware that bottled water has to carry with it a complete analysis? This is what my noble friend Lord Rugby means. Is not the consumer in this country entitled to an analysis of the water? This is not a simple matter because when you look at the analysis that has to be provided by the bottled water people, you find that it contains a full scale account of the major and trace elements of the water, including the fluorine.

The Earl of Caithness

I understand that bottled water does not contain a fully detailed breakdown of its constituents and you can buy it in a supermarket with nothing at all on it. Indeed the noble Viscount, Lord Monckton of Brenchley—who alas! is not here—said on Second Reading that he preferred bottled water. In many cases, such as in Vichy water, the fluoride level is considerably higher than any artificially fluoridated water supply in this country.

Lord Energlyn

This will drive us to bottled water. But sticking to my point, if the noble Earl buys a bottle of Perrier or Vichy water he will find a complete analysis on each bottle.

Lord Campbell of Croy

I use such bottles and I have not seen an analysis on the ones that I have bought.

Lord Energlyn

I think that this may be straying a little from my amendment, but my noble friend likened fluoridation to the natural presence of all the other elements that are already in water. It really is crucially important to understand that what we are talking about is mass medication or the addition of something which has nothing to do with making the water pure but has to do with health. I hope that when my noble friend considers this later on he will take on board the point that it is not good enough to say in a reply that if the water authority has a duty to give information on this, it will have a duty to give information on the 50 other different substances that are in the water. That is not really a very sound answer.

Lord Graham of Edmonton

Would the noble Lord also think it disingenuous of the Minister to throw aside the possible requests for information about any one of the 50 elements simply because one is given a response about this one? After all, the Minister must know of the enormous interest in and suspicion about this one element. If I accept the situation as it is, which I certainly do, because the Minister has said so and I believe every word that he says—sometimes—I would simply, as a layman, assume that the inclusion of those elements has caused no suspicion, no annoyance, no anger and no fear. However, we know that, no matter how the Government proceed, there will always be a very large section of the population who will be suspicious. Just as the Minister said on the earlier amendment that there is nothing to stop anyone who asks for the information getting it but that they would not provide the information themselves, this amendment says, "All right, if individuals ask for this one, can they get it?"

As I understand it, the Minister is saying that he will look very closely at these two amendments but will give no commitments, just as the noble Earl, Lord Kinnoull, has given no commitment that if the amendments are withdrawn, he will not come back at a later stage with these amendments or something in their place. I think the Minister underestimates the anxiety that will continue to be felt by a very large section of the public about this subject.

Lord Energlyn

Earlier on the noble Earl asked for a monitoring instrument or a method of extracting fluorine. One of the simplest elements in water to determine in terms of concentration is fluorine. One has only to put it in a fluorimeter and in one second one knows exactly how much fluorine there is in the water.

The Earl of Kinnoull

I am very grateful for the support I have received and for the undertaking of my noble friend to have a look at these two amendments. I think that what has been expressed to the Committee shows the amount of concern. I hope that my noble friend will take that on board. Has my noble friend given an undertaking to look at this amendment?

The Earl of Caithness

Not the same undertaking that I gave about the earlier one.

The Earl of Kinnoull

I am not sure what degree of undertaking that is.

Lord Graham of Edmonton

It is a little watery.

The Earl of Kinnoull

A little watery, I rather agree. I am happy to withdraw the amendment, but on the understanding that I shall wish to look at this again.

Amendment, by leave, withdrawn.

Lord Sandys moved Amendment No. 23: After Clause 1, insert the following new clause:

("Monitoring: specific effects.

The Secretary of State shall establish machinery for monitoring the effects of the operation of this Act with particular reference to—

  1. (a) benefit for teeth;
  2. (b) harm to health;
  3. (c) harm to plant and aquatic life,
and report the result of such monitoring to each House of Parliament every 12 months.").

The noble Lord said: This amendment is also linked in a backwards direction with Amendment No. 21.

Amendment No. 21: [Printed earlier.]

It is related to a monitoring system which should be reported to each House of Parliament. In this amendment the Secretary of State is asked to establish, machinery for monitoring the effects of the operation of this Act". Once again, it is a question of identifying the benefits. Are there benefits to teeth? Are there benefits, for instance, which will clearly establish that the unfluoridated areas such as Bristol and the Isle of Wight are any worse or better off than fluoridated areas where so frequently dental health is no better?

It is a matter of interest and significance what my noble friend said earlier this evening in regard to the amount of fluoride present in the air and in the environment generally. This is the whole question of the intake of fluoride to the human, animal, plant and aquatic life, wherever it may be. With regard to harmed health, I think it should be stated that a recent article in the New Scientist published on 28th February said: Fluoride switches off the enzymes by attacking the weakest links, the delicately balanced network of hydrogen bonds surrounding the enzyme's active site". I shall not go into hydrogen bonding, but it is very clear indeed from the article and from similar articles in other publications that damage to health can be established by modern methods of approach to this subject. Therefore, in this amendment harm to health is a matter of real importance and not one that can be set aside to be brushed under the carpet.

The third matter of concern is, hard to plant and aquatic life". I earlier mentioned the question of water supply to cress growers and to other institutions where the production of water is important for the benefit of shellfish or other plant or marine life. It may well be that the effect of fluoride on a cross-growing establishment or a trout egg hatchery will be extremely severe. My information is that it is, and I hope that the Government and perhaps one of my noble friends will be in touch with the Ministry of Agriculture after this debate to discover whether either the Marine Research Establishment or the freshwater biological establish- ments of this country are aware of the possibility of damage to plant and aquatic life because of the outfall of fluoride in greater quantity.

With regard to the reporting of it to each House of Parliament, while one is very well aware of the cost of so doing, this is a matter of considerable public concern. The way in which it is reported may be made very much more beneficial in that it gives the opportunity for public debate. I beg to move.

8.30 p.m.

Lord Campbell of Croy

I should like to comment briefly on the amendment which has just been moved. I realise that important discussions are taking place with the authorities of the House and I shall therefore spend a little time to enable my noble friend to be able to hear what I am going to say. I hope that my noble friend has now finished his conversation about an adjournment and can now listen to what I am saying.

It is the form in which this new clause has been tabled and now moved with which I would find fault. I believe it is quite unbalanced. I recognise that it is a starred amendment and therefore appeared only today and was no doubt drafted in a hurry. It refers to:

  1. "(a) benefit for teeth;
  2. (b) harm to health;
  3. (c) harm to plant and aquatic life".
To be properly balanced it should be "benefit and harm" in each case.

The Government, for the reasons they have given on earlier similar amendments, are unlikely to regard this amendment, this new clause, as necessary, anyway. But I think that if it is to be considered for the Bill, it ought to be re-drafted. For example, point (b) should refer to, benefit and harm in relation to health", and not just "harm". As we know—doctors have told us many times—if you have good teeth, on the whole your body benefits from that. If, on the other hand, you have bad teeth, that can cause a run-down or a debilitated state of health. That is one example of how there could be a beneficial effect for health. There is always the possibility of harm, however.

Then I come to (c), harm to plants and aquatic life. Those of us who have taken part in previous debates on this subject know by now that some forms of aquatic life—namely, fish—contain about four to five parts in a million of fluoride as part of their make-up. It could well be that they need more fluoride than they have already. These are things we cannot go into now, but no doubt my noble friend will agree with me that besides harm to aquatic life—which seems to eliminate any possibility of benefit in that area—it could well be that some fish could benefit from getting more fluoride because they are not getting enough.

All these cases should be like this: where it says, "benefit for teeth", it ought to be balanced by saying, "benefit and harm relating to teeth". After all, we know that in some cases fluoride can cause some minor mottling of the teeth. There is a remedy for that, but that is the kind of thing that ought to be there. It should say "benefit and harm" in each of those three cases in order to be balanced.

My noble friend knows that I do not agree with one statement he made, but that this is not the time to go into it. He said there was very little difference between areas where there was water which had less than the optimum amount of fluoridation and areas where there was natural fluoridation at the optimum rate or the water had been fluoridated up to that amount. I disagree with that. This is not the moment for it, but in my experience of looking into these things as a Minister, and then in other capacities, I have come to the other conclusion. In fact, the results show benefits. I will not go into that now because I know that we disagree on that. I felt I could not allow that statement to go past without some dissent. My main point is that this new clause, as it is now drafted, is completely unbalanced. It ought to say "benefit and harm" in each case.

Lord Energlyn

If I may follow the noble Lord, as Members may recall, I said earlier that in the field of chemical treatment of disease—chemotherapy—one looks for a harmless compound and finds out its effect. I would suggest that perhaps a better way of phrasing this would be to refer to the effect on teeth, the effect on health and the effect on plant and aquatic life. That would really meet the noble Lord's point. I quite agree with him that we ought not to concentrate on the pathogenic or disease aspects of this element, fluorine.

This clause is a very sensible addendum to the Bill because it will provide the information that we scientists lack. We lack precise information about the effect of the existing practices of adding fluorides to water on teeth, on general health and on plant and aquatic life. We are very thin indeed on plant and aquatic life but a little thicker on the ground as far as human health is concerned.

If one is constructive about this—and I should like to support this amendment in this constructive way—the Government would be well advised to spend a good deal of money on investigating the progress of the addition of fluorides to water, which, as the judge in Scotland pointed out, means you are converting water into a medicine. It is very important to find out how much of this medicine you wish to take and what its long-term effect will be. If I were an advocate against the Bill, with great ardour I could bring out all kinds of statistics from the West Midlands. That is the best type of area to look at because of the uniformity of the water and the 20 years of treating the water and converting it into a fluoride medicine. One could draw some significance from the incidence of diseases of the skin in the West Midlands as distinct from the rest of the country. It is much higher in the West Midlands. Why we do not know. If we had this investigation into the water we might get an answer.

Then we find that in the West Midlands there is a dramatic increase in muscular skeletal diseases. They really are quite vividly higher than the national average, but we do not know why. Fractures fall into the same category; indeed, even infant mortality. After all, the fluoride medicine is intended for infants. If we investigated the water supplies more critically and more definitively we might come up with a better answer than simply putting fluorosilicates into the water. We might come up with the answer of putting a fluoroprotein into the water. It would make a far better medicine than fluorosilicates.

All these constructive things would come out of such an addendum as is suggested by this amendment. I appeal to the Committee to support this because it would be money well spent and it would remove most of the arguments which are bandied about by our scientists and doctors, and would bring some constructive elements into this picture.

Lord Monson

The noble Lord, Lord Sandys, has made out an excellent case for this amendment. That is reinforced by what the noble Lord, Lord Energlyn, has just said. Despite a great deal of evidence to the contrary, the Government claim that the benefit to teeth is wholly undisputed, that the harm to health is nil and that the harm to plant and aquatic life is also nil. The Government should have the courage of their collective convictions and put their money where their mouth is. If they decline to do so, it seems to me that there is something a little fishy.

Having said that, I take the point made by the noble Lord, Lord Campbell of Croy. I do see that there is merit in assessing the benefit and harm to each of these three areas—teeth, human and animal health, plant and aquatic life. I wonder whether the Government can indicate whether they may introduce an amendment of their own at the next stage, or alternatively allow us to move a suitably altered amendment, to change the amendment so that it will allow for the monitoring of the benefit or harm to teeth, health, and plant and aquatic life. If they do so, I dare say the noble Lord, Lord Sandys, would be prepared to withdraw his amendment. If the Government refuse altogether to consider doing anything of the sort, it is really rather alarming.

Lord Moyne

I should like very briefly to support this amendment. The point has been made that it is unsatisfactory. Councils change their mind, moving this way and moving that way. This is because the data are not there. If over a few years the data could be got, all the argumentation that we have had to go through this evening would be unnecessary. The facts could be put before councils. Democratically they could make up their minds. At the moment there are prejudices. There have been a lot of allegations made against fluoride. We know that there is a case in favour for children's teeth, but I think we need scientific data. Looking to the future, that really is the answer. I strongly support this amendment.

Lord Prys-Davies

I too strongly support this amendment. The Government will be aware of the unease felt throughout the country about this Bill. I hope that they can see their way clear to accepting the principle of this amendment. That would be some evidence that the Government are prepared to act in full understanding of the unease which has been expressed. The wording of this amendment may not be correct but unless the Government can assure the Committee that there is already in the DHSS effective monitoring machinery, then they ought to act in full understanding of the public's unease and go along with the principle behind this amendment.

The Earl of Caithness

Perhaps I may say how grateful I am to my noble friend Lord Campbell of Croy, who put his finger on a very important point concerning the defect of this amendment. The noble Lord, Lord Energlyn, stated that fluoride is a medicine. If it was a medicine, Lord Jauncey would have said that it should have been covered under the Medicines Act. He did not say this. He did not consider fluoride to be a medicine, which is contrary to what was said by the noble Lord, Lord Energlyn.

Lord Energlyn

I gathered that Lord Jauncey's judgment was that it was illegal to convert water into a medicine.

The Earl of Caithness

No, his judgment was that it was ultra-vires to add fluoride to the water supplies in Scotland as the law then stood. That was his judgment. That was the only point on which Mrs. McColl gained any credence for her argument. The rest of her arguments were dismissed.

Lord Energlyn

I apologise if I misinterpreted the story.

The Earl of Caithness

I am grateful to the noble Lord. I accept the thought behind this amendment, which is that no new public health measure should be introduced without adequate monitoring for the initial period. There seems to be a total misunderstanding of the present situation, and this was revealed by the comments of my noble friend Lord Moyne and of the noble Lords, Lord Energlyn, Lord Monson and Lord Prys-Davies. I would remind the Committee that fluoridation has been carried out in this country for nearly 30 years and that precisely the kind of monitoring suggested in the amendment (other than with regard to plants and aquatic life—a subject to which I shall return) has already been carried out and the results published. I can refer very briefly to the Knox Report, which I can recommend to my noble friend Lord Moyne for being very good heavy reading, full of scientific information, and having an extremely knowledgeable list of contributors.

8.45 p.m.

Fluoridation was introduced in this country only after an expert team had visited the United States to assess the fluoridation schemes which were already in progress there. Their report was published in 1953. They concluded: We have found no scientific evidence that there is any danger to health from the continued consumption of water containing fluoride in low concentration". The authors recommended that fluoridation should first be introduced to specially selected communities in this country and that there should be both medical and dental examinations.

The Government accepted those recommendations and established a research committee to keep the evidence on safety under review. They did this by contact with general practitioners practising in the test areas, and by analysis of the relevant statistical data by means of investigations carried out on sample sections of the public. Their methods and the results were set out in two reports published by HMSO, The Conduct of Fluoridation Studies in the United Kingdom and The Results Achieved after Five/Eleven Years. The conclusion of the second report issued in 1969 stated that: Apart from demonstrating the beneficial effects of fluoridation the report has confirmed its complete safety. During the 11 years under review, medical practitioners reported only two patients with symptons which they felt might have been associated with fluoridation. Careful investigation in both cases failed to attribute the symptons to the drinking of fluoridated water". In conclusion on this part of the amendment the groundwork for monitoring the safety of fluoridation has already been carried out. I am, however, happy to state that my department will continue to keep under review all evidence relevant to the safety of fluoridation. The passage of the Bill will not lessen our commitment to that task.

With regard to the effect of fluoride on plants and the aquatic environment, I can assure the Committee that the fluoride intake of plants is not significantly increased and that their growth patterns are not affected by fluoridation. My noble friend Lord Sandys mentioned that we should consult the Ministry of Agriculture. This has been done already. Indeed, the ministry has never expressed any concern about the effect of fluoridated water on plants, animals or aquatic life. There have been no substantiated complaints to that effect. The fact that the aquatic environment is not affected is unsurprising when one considers that fluoride is naturally present in the sea at a concentration of around 1 mg per litre.

In respect of aquatic life, tests have been carried out both on brown trout and, in another instance, on redeye roe and red-eye fry, which are the type of fish likely to suffer if the water were fluoridated. It was found that they suffered no effect when the fluoride was at a concentration of 25 ppm and not the level that we are debating now.

The department operates a regular computer search of all literature published on the subject of fluoridation and of the studies with the advice of outside experts. When needed, all new relevant information is considered in detail. Indeed, I confirm that I have read a number of reports published by the department which have examined this point. Bearing in mind the comments that I have made, I hope that my noble friend will see fit to withdraw his amendment.

Lord Sandys

I must thank my noble friends who have supported me, and I should also like to thank the noble Lord, Lord Campbell of Croy, for mentioning ways in which my amendment could be made more effective. I warmly acknowledge what he has said. So far as concerns the effect of fluoridation on marine and aquatic life, I have no doubt that fish are affected—possibly in a different way. I am advised that the trout egg situation is in question. I should like to have further thought and consultation before either pursuing this amendment or setting it aside at Report stage. I am grateful to my noble friend the Minister for giving me the information he has. The fact that we are to have constant monitoring supervision is satisfactory, but only to a limited extent. There is a possibility that we may return to this amendment on Report, but meanwhile I beg leave to withdraw it.

Amendment, by leave, withdrawn.

Lord Sandys moved Amendment No. 24: After Clause 1, insert the following new clause:

("Indemnity: local authorities

Any local authority obliged to replace water pipes and fittings ahead of their reasonably anticipated life as a result of the corrosive effect of fluoride upon the pipes and fittings shall be indemnified by the Secretary of State.").

The noble Lord said: This amendment deals with the question of indemnity in regard to the replacement of water pipes and fittings. This is an interesting subject because there is a fairly established and well-documented set of cases reported from Melbourne in Australia, where fluoride has severely damaged a public water supply. I have very little doubt that other water supplies have been affected. If one reflects upon the fact that fluoride is used in the etching of glass, then one may concede that fluoride must have a powerful effect on water pipes which are made of mild steel or a similar substance.

The question of the life of a water pipe is one that will give cause for concern. There are water pipes still in use which are of considerable antiquity. Nevertheless, it is a matter of concern. I was examining a water pipe recently which had severely deteriorated in a matter of 20 years. It is a matter of conjecture whether fluoride was the whole cause or part of the cause. Nevertheless, there is a well documented case in Melbourne, and I have little doubt that there are in other places. I should like the problem of the replacement of water pipes to receive the attention of the Government; hence, I beg to move.

The Earl of Kinnoull

As I have a similar amendment which follows perhaps I may speak on this amendment and not move my own. My noble friend will have seen that in another place there was a most illuminating discussion where the honourable Member for Burton put forward a sheaf of actual evidence from America and Australia of the effects of corrosion by fluoridated water on water pipes. He produced a report from Seattle, where experience confirmed that fluorosilicic acid was not only highly corrosive but increased the plumbing corrosion costs to £7 million a year for the city; an equivalent of 30 dollars for each dwelling. The report stated: Especially important for domestic plumbing are the total immersion or standing water tests, which indicate that fluoridation increased the rate of corrosion for copper and galvanised steel pipe by a greater margin than the addition of an equivalent concentration of chlorine", from the Tolt river. I think it is worth putting these quotes on record. He also quoted a report by the Kennedy engineers which states: Obviously, if a substantial portion of this scale (inside a pipe) breaks loose and is accidentally ingested, it could be quite toxic. Moreover, such build-up levels indicate that fluoride distribution in the water is far from uniform and even. In fact, the Kennedy Report shows water fluoride concentrations ranging from 0.62 to 1.55 ppm for the Cedar River distribution system. That indicated that there is not this natural flow that has been projected, certainly with older pipes. In 1974 the Seattle water department proposed to add 400 tonnes of lime to the supply to counter the rising tide of corrosion. It was not carried out because they had insufficient knowledge of the consequences.

I am sure that my noble friend has studied this subject because it is important to the Bill. He will have seen a report from the Journal of the American Water Works Association which stated: Sodium silicofluoride solutions have been found to destroy steel pipes very rapidly.". A later paper by the Institute of Plumbers of Australia, headed, Fluorides in Industry: Effects on Water Pipes", said: Fluorides are doing a real cleaning job on the inside of the underground water mains of the town of North Andover's public water supply! Their corrosive action will soon require their replacement. Fluoridation is softening the heavy rust formation that has collected on the inside of the town water mains over the years, to a semi-soft consistency. As it frees itself, it carries along with the water. The water brings this semi-soft sludge to our filters. Finally, in Melbourne there was a recent report on this similar problem of softness. All these are actual experiences. They are facts recorded round the world. I should like to have an answer tonight from the Government. I am sure they have looked into this very carefully because they have had notice of it from the proceedings in another place, where the case was not answered, as the Government did not have any information. We should have this information. It is important to the water authorities, to the Government and to the users. We must know what the Government's considerations are. Perhaps we can have the answer now from my noble friend and then carry on the discussion. I beg to move.

Lord Energlyn

I do not want to be tiresome but I am grateful to the noble Earl for bringing to our attention the various examples of the corrosive effects of fluorine in water. The really important aspect, I humbly suggest, is that the Bill prescribes the use of fluorosilicates. I keep repeating this. You are putting two corrosive acids into water. We chemists know that we cannot use any metal other than platinum when we are dealing with silicic acid and hydrofluoric acid. It is the only metal that will resist corrosion. When we come to steel, as this enzymatic experiment has proved, the fluorosilicates will add to the iron and form an iron fluorosilicate. This is an extremely brittle substance and it will readily form scale.

What must be done, and this is what was embodied in the previous amendment, is to look into the various properties of water which contains fluorosilicates. We are using enormous quantities of fluorosilicated water in boilers in power stations. We know from experience that these boilers have their lives drastically shortened by the fact that the water contains fluorosilicates. This has nothing to do with the medical aspects of the water but it is an example of why we should know more about fluorosilicates in water than we know at the present time. I strongly support the amendment.

Lord Colwyn

I wonder whether my noble friend Lord Sandys or the noble Lord, Lord Energlyn, can help me because I do not understand this. I am aware that hydrofluoric acid is probably the strongest acid that we know of at the moment. It will dissolve anything, including glass and gold. I am also aware that hydrochloric acid is very strong. Hydrofluoric acid consists of a hydrogen ion and a fluoride ion. Hydrochloric acid consists of a hydrogen ion and a chloride ion. We have chlorine in our water which, according to the argument of the noble Lord, Lord Energlyn, and my noble friend Lord Sandys, must form hydrochloric acid in our pipes. Can he tell me whether this is going to do similar damage and perhaps explain why pipes fur up with calcium carbonate, which is the classic form of furring, and why hydrochloric acid is not working on them? I am sure that cannot be right.

Lord Energlyn

With the greatest respect, the noble Lord has got it backwards. We are talking about a halogen when talking about fluorine and about chlorine. Equally, you can talk about bromine as another halogen. You can talk about iodine as another halogen. What is a halogen? As the name tells you, it is a salt-forming substance. The difference between the behaviour of hydrochloric acid in relation to biological material is this. The chlorine goes into the biological material—that is, tissue—and readily joins up with the sodium, the potassium and the phosphorous. But the fluorine will not do that. So, if you want to extract fossils from a rock, you dissolve the rock in hydrofluoric acid and because the fossils are composed of organic matter they are untouched by the fluoric acid. Therefore, you are dealing with a different halogen from chlorine. That is the answer.

Lord Colwyn

I am pleased to hear that hydrofluoric acid does not touch organic matter.

9 p.m.

The Earl of Caithness

We believe that there is no firm evidence that fluoride corrodes water pipes and fittings at a concentration of one part per million. In hard alkaline waters the addition of fluorosilicic acid to give 1 mg per litre of fluoride will have no effect on either the pH or the alkalinity. Even in very soft, low alkaline waters, with low pH, the effects of the acid, if any, on the pH will be only marginal. Very soft waters are more corrosive than hard waters, and it is common practice in this country to correct the pH in such waters to reduce their corrosive effects. The largest and longest-lasting fluoridation scheme in the country is in Birmingham, which receives very soft water from the Elan Valley. There is no evidence of any greater corrosion in Birmingham since the introduction of fluoridation some 20 years ago.

My noble friend Lord Kinnoull mentioned the case of Seattle, and the theory that fluoride attacked the pipes there. There was a very detailed report after that matter was looked into. The United States Environmental Protection Agency produced that report, and I shall quote from it if I may. It says, dealing with corrosion: One of the first objections to the feeding of fluorides was that the chemicals were thought to be extremely corrosive and would cause disintegration of the pipelines. Part of this erroneous conception can be traced to the confusion over fluoride versus fluorine, and the association of fluoride with hydrofluoric acid". It goes on to say: the amount being put in the water is usually around one part per million as the fluoride ion, and one part per million of the most corrosive substance would have little or no effect at this dilution. Flurosilicic acid and its salts exhibit a low pH in solution, the depression of pH being most apparent in poorly buffered waters, but there is no indication that such waters have their corrosivity increased by the addition of fluoride. There has been no reported instance of pipeline corrrosion traceable to the fluoride content of the water". There are a number of reasons why pipes corrode, but I hope I have explained satisfactorily to the Commitee that it is not fluoride; and I think that if my noble friend Lord Kinnoull looks into it he will find that the 400 tonnes of lime were not put in in 1984 probably because they realised it was not fluoride that was causing the damage.

Lord Sandys

I am grateful to my noble friend for giving us this information. I am still not convinced so far as the situation in Melbourne is concerned, where the effects were traced to an enamelled tank. I think that is one other matter at which perhaps we should look.

I am aware that the hour is late. I am also aware that we still have more amendments. At this stage I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 25 not moved.]

Lord Sandys moved Amendment No. 26: After Clause 1, insert the following new clause:

("Notification of evidence of risk.

The Secretary of State shall bring to the attention of all health authorities and statutory water undertakers all studies of which he is aware on the effect of fluoride on—

  1. (a) fluorosis and dental mottling;
  2. (b) genetic damage;
  3. (c) toxicity;
  4. (d) carcinogenicity; and
  5. (e) animal and plant life.").

The noble Lord said: This amendment deals with the notification of evidence of risk, and we are here concerned that the Secretary of State shall bring to the attention of health authorities all the studies which concern the effect of fluoride on five different categories. This is a different amendment from Amendment No. 23. Nevertheless, it is cognate and it deals particularly with fluorosis and dental mottling. This subject was considered in some depth by Standing Committee H. It was further considered on Report in another place. I think what is very necessary to consider here is the generality of how fluoridated water affects the teeth—it makes them mottled—of about 10 per cent. of children.

At one stage in the discussions and in the report of the Royal College of Physicians mention was made of noticeable mottling. Young people, and particularly girls, Ware very much aware of their appearance, and especially their teeth, and noticeable mottling is a very considerable cause of anxiety for young people generally. I also feel that it is a matter which is lasting, and in this respect no amount of tooth brushing can remove dental mottling.

So far as the other categories are concerned—genetic damage, toxicity, carcinogenicity—we have already heard referred to the Knox Report, and I think at this hour it may not be well received if I go into the Knox Report in greater detail; but it would seem that the Government are convinced that the Knox Report is the last word. There are other matters concerned. So far as the carcinogenicity aspect of it is concerned, it may well be that research at the moment is on the wrong track. It is very difficult to trace it and very difficult to prove it.

My noble friend referred to the question of the monitoring which is going on at the moment, and I would draw his attention to the monitoring which took place in Holland, when that country decided after 23 years of fluoridation to abandon their national fluoridation campaign in view of the weight of evidence that there was and the multiplicity of disbenefits which flowed from fluoridation. In particular, the works and reports of Dr. Mulenberg are important in this connection.

The final category of animal and plant life is somewhat similar to the category in Amendment No. 23. I have referred to the Ministry of Agriculture, and I impress on my noble friend the Minister that there is evidence that fluorosis can affect cattle. It can affect the whole question of their imbibing an over-surplus of fluoride with a variety of different effects upon their bone structures. I suggest to my noble friend that this subject requires very much greater consideration than perhaps has been given to date, in particular because there is a direct ban on the inclusion of fluoridated water in foodstuffs. I beg to move.

Lord Monson

I should like to support this amendment. The noble Lord, Lord Sandys, explained it so well that I think there is no need for me to enlarge upon his explanation of why these various categories have been included, but I should like to make one point to the noble Earl, Lord Caithness. When replying to Amendment No. 23 he made the point that the Government monitor the effects of fluoride from time to time. The trouble is that the pace of medical advance is so rapid nowadays that what was thought to be valid two of three years ago may be totally invalid today. What is heresy in medical circles one year is accepted practice in those very same circles the next.

One remembers a few years ago that anyone who had an operation was kept in bed for a fortnight afterwards. Nowadays people are hauled to their feet within 24 hours. In the dietetic field it used to be thought that the more protein people ate, the better. We could eat as much meat, eggs, milk, cheese and so on as we liked and it could only do us good. Now, with the exception of those who are about to participate in the Boat Race or some similar feat of athletic endeavour, that is no longer thought to be so.

There are constant arguments over the danger from fat. I remember well my father giving me a rocket for not eating up the fat on my plate. Nowadays I dare say that most fathers would rush to prevent their sons eating any fat that may be left on the side of their plates. The butter versus margarine controversy goes on and on, both sides claiming the other product is almost deadly.

A few years ago potatoes were thought to be something that we should eat sparingly. Now they are thought to be an excellent source of Vitamin C. Again, I remember reading in one book written by a dietitian that one, or possibly two, slices of wholemeal bread a day was the most that any person should eat. Now I read that the Swedes say that if we do not eat at least five or six slices of bread a day, we are positively endangering ourselves.

The point is that it is not good enough simply to say that every few years we shall have an investigation into the effects of fluoride or anything else that may be introduced. I think that there must be constant monitoring. If anything untoward is found, it must be brought by the Secretary of State to the attention of the health authorities, because the health of the people must not be endangered.

Lord Energlyn

I should like to add my support to this amendment. If only it improves the communication of new and constructive knowledge to water undertakers and the national health authorities, it will be a good thing. Perhaps I may give an example. It is only we academics really who have the time and the patience to follow some of the more erudite pieces of work on what is, after all, the most important substance on earth—water.

There is this on-going, highly charged controversy as to the nature of water when it is in the capillary spaces of cellular tissue. It is claimed, and there is strong evidence to show that it is possible, that the water changes from being a straight chain compound of two hydrogens linked to oxygen, and it becomes a polymer, like an organic compound. In that condition it behaves differently from water which is simply HOH. One has a ringed structure of oxygens linked to hydrogens.

That is an erudite adacemic area, but it is the kind of knowledge which may never get to the water authorities unless we have a clause of this kind. We need a clearing house for such knowledge. I support the amendment.

Lord Prys-Davies

I, too, should like very much to support the amendment. It is a simple improvement and I hope that it will be acceptable to the Government.

The Minister earlier referred to the studies which are received at the DHSS. I accept what he said. Indeed, when I was associated with a regional health authority I was always impressed with the library at the DHSS. But it is surprising that it takes time for the reports from the DHSS to reach the areas. The heart of the amendment is that, The Secretary shall bring to the attention of all health authorities and statutory water undertakers all studies which are available. I think that we are right to ask the Government seriously to consider the amendment. If informed decisions are to be taken by the health authorities and water undertakers, they should be aware of the results of the continuing research and studies as they are reported. Thus I should very much like to welcome this amendment and support it in the light of the little experience I had of working with a regional health authority.

The Earl of Caithness

I went into the health aspects of fluoride when discussing Amendment No. 23. I think it would be wrong to go through them all again. However, with due respect to my noble friend Lord Sandys I think to repeat the same argument now would not be in accordance with the tradition of this Chamber. I must make it clear that we are certainly prepared to inform health authorities of major studies on the safety of fluoridation. Hence my department recently issued to all health authorities a copy of the report of the Knox working party on the alleged link between fluoridation and cancer. Thus all our health authorities were able to read the conclusions of that report: We have found nothing in any of the major classes of epidemiological evidence which could lead us to conclude that either fluoride occurring naturally in water, or fluoride added to water supplies, is capable of inducing cancer, or of increasing the mortality from cancer. This statement applies both to cancer as a whole, and to cancer at a large number of specific sites. In this we concur with the great majority of scientific investigators and commentators in this field. The only contrary conclusions are in our view attributable to errors in data, errors in analytical technique and errors in scientific logic". 9.15 p.m.

Besides this, we look very rapidly into any reports that come up. In fact there was the recent report and recent evidence produced in Japanese studies by Tsutsui. We looked into that very quickly and came to the conclusion that: there is no evidence leading to an expectation of hazard through the induction of heritable abnormalities". We have not been able to circularise to the health authorities details of cases involving toxicity resulting from water fluoridation and this is because none has been reported in the United Kingdom. The same applies to animal and plant life where no damage has been reported from fluoridation. My noble friend Lord Sandys mentioned fluoridation in Holland. I can just tell him that fluoridation was discontinued in the Netherlands but not as a result of any evidence of harm to health. In fact, the Dutch ministry of health re-affirmed its support for fluoridation and the government in that country still support it.

My noble friend Lord Sandys also raised the question of cattle. I dealt with this at Second Reading. There is no evidence at all that from the fluoridation of water supplies at the level that we propose or recommend, that there is any effect on cattle. With regard to mottling—and contrary to what my noble friend has said—the 1976 Royal College of Physicians report concluded that it has been shown in both in the United States of America and the United Kingdom, that at a level of one milligram per litre, there is no noticeable mottling. Indeed, at least two studies found fewer cases of even mild mottling at this level than in low-fluoridated areas. I could go on. There is the work we did into the paper prepared by Edwards, Poulos and Krant as well as a number of other reports. However, the weight of the evidence to date has shown that there is not a serious health risk at the optimum level.

I should conclude by saying a point that I mentioned at Second Reading. If there is any evidence that says that fluoride is unsafe, any Health Minister worth his salt (he or she) must take action immediately. The powers are already there in the 1977 Act and I do not doubt that any Health Minister from any party would take the necessary action.

Lady Saltoun

In view of what the noble Earl has just said, can he tell us why fluoridation was discontinued in Holland?

The Earl of Caithness

I am grateful to go a little further into that. The noble Lady, Lady Saltoun, is extremely well liked in this House and highly thought of. I believe there is even a fluoridation society. I hoped to goodness that she would have been a little more fluoridation minded.

In the Netherlands, fluoridation ceased in 1973 as a result of the ruling of the supreme court that those who objected to it should be provided with a separate unfluoridated supply. This was technically impractical and fluoridation therefore ceased for the approximately 4 million people who had then been served by it. A Government measure to allow fluoridation was defeated in parliament. As we understand it, there are no present plans to reintroduce it, but, as I said before, the Government remain in favour of it.

Lord Monson

I put it to the noble Earl that if there is no link between cancer and fluoridation, as he alleges, and if there is no harm to animal or plant life, then he has absolutely nothing to lose by accepting this amendment. It would simply mean that the Secretary of State would have that much less to bring to the attention of health authorities.

The Earl of Caithness

I do not allege that there is no risk, as the noble Lord said. It is independent and Government scientists who have proved that there is no link.

Lord Houghton of Sowerby

The noble Earl is very well-equipped with information and he is making very skilful use of it. Does he have any evidence at all of experiments using fluoride on animals? Under the LD.50 test, have animals been pumped full of fluoride in order to see how much they can take before they die? Any information on that subject would be very welcome.

The Earl of Caithness

There have been tests on animals. Nature has assisted because there is fluoride in everything that they eat and in the water that they drink.

Lord Sandys

I am grateful to all my noble friends in all parts of the Committee who have participated in this discussion. It is very clear from the Minister's reply that, once again, to use the phrase he has used, he thinks there is "no evidence". At this stage I think we should be well advised to pass on to the next amendment, and, while reserving my right to return to this amendment in a modified form on Report, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Sandys moved Amendment No. 27: After Clause 1, insert the following new clause:

(" Secretary of State's power to terminate application.

. If at any time it appears to the Secretary of State that the addition of fluoride to the water supply is harmful to health he shall terminate any application made under section 1(1).")

The noble Lord said: Once again, we return to the question of stopping the situation. Here we recommend that: If at any time it appears to the Secretary of State that the addition of fluoride to the water supply is harmful to health he shall terminate any application made under section 1(1)". This is a somewhat similar amendment to an earlier one which I tabled in which a parallel situation occurred between the borough and the statutory water undertaker. I believe there is a self-evident need that the Bill requires a clause of this sort. I beg to move.

Baroness Gardner of Parkes

I wish to oppose this amendment because the very statement made by my noble friend a few minutes ago was that these powers already exist under the 1977 Act. If that is so, there is no reason in the world to repeat them here.

Lord Campbell of Croy

Dealing with questions of possible harm to health, this might be an appropriate moment to verify a matter which was raised on an earlier amendment by the noble Lord, Lord Rugby, and which was taken up by the noble Lord, Lord Energlyn, who suggested that in this country bottled water must have an analysis on the label. At the end of that debate I said that I sometimes bought Perrier and similar bottled water and, as far as I knew, it did not have an analysis on the label. Since then, I remembered that I had such a bottle in my car and I fetched it at an appropriate moment and have shown it to the noble Lord, Lord Energlyn. I am afraid that the noble Lord, Lord Rugby, was not present.

I think that the noble Lord, Lord Energlyn, must now be satisfied that there is nothing by way of an analysis on the bottle label. The bottle is not far away from your Lordships' Committee so I can show it to other noble Lords if they wish. I bought it at a supermarket not very far from here as part of my normal London shopping, which I have to do when I am here. The only point of any relevance on the label is the description "naturally sparkling". It is a bottle of Perrier water but it says a great deal about where it was produced, which of course was in France. Therefore, I think that this verifies the point that some bottles containing water of this kind may have an analysis on the label, but certainly not all of them are required to have one.

Lord Energlyn

In France it is a statutory requirement to have the analysis on the bottle label. If the noble Lord would kindly look at his bottle, he will find that it is sparkling water. Does it tell him where the water was bottled?

Lord Campbell of Croy

It says that it was bottled in France, but it does not say when.

Lord Energlyn

That is right. This raises a rather interesting question but it is not the time and place to discuss it now. This will raise an interesting question in this House which we might be talking about on Monday.

The Earl of Caithness

Returning to the amendment, I think that the best thing I can do is to confirm what my noble friend Lady Gardner of Parkes said. I can assure the Committee that adequate powers are already available to halt fluoridation should it ever be considered harmful. I think that that answers the point of my noble friend.

Lord Sandys

I accept entirely my noble friend's statement. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Monson moved Amendment No. 28: After Clause 1, insert the following new clause:

("Compensation for ill-health.

. Any person who suffers ill-health as a consequence of drinking water fluoridated in accordance with the provisions of this Act may claim compensation from the health authority.").

The noble Lord said: This amendment is self-explanatory. It provides; Any person who suffers ill-health as a consequence of drinking water fluoridated in accordance with the provisions of this Act may claim compensation from the health authority". The Government are being extraordinarily inflexible over this Committee stage. They have not accepted any of our reasonable amendments. Once again the Government should logically have no difficulty whatsoever in supporting this amendment, in so far as they claim that nobody can suffer ill health as a result of drinking fluoridated water. Again I ask the Government, if nobody can suffer from drinking this water, what have the Government to lose by accepting this amendment? I beg to move.

The Earl of Caithness

We support this amendment, but the power already exists in common law for a person to sue for damages against either a statutory water undertaker or a health authority. Therefore, this amendment is redundant and it is not necessary to put it in the Bill.

Lord Energlyn

I am rather pleased about that, but I should point out the elemental danger in this clause. I refer your Lordships back to the two compounds which this Bill prescribes as being safe. If it is proved that neither of these compounds is safe, the Government are caught over a barrel.

The Earl of Kinnoull

I think that the noble Lord, Lord Energlyn, has made a good point. Surely there is nothing wrong in putting into a Bill what would be statute law. You do not just have to rely on common law. The Government know the emotions and the emotive feelings arising from this Bill, and they should write in this amendment.

They have accepted it under common law; why not accept it under statute law? Then it would be much clearer and people would know their rights. It is sometimes expensive to go to law, particularly under common law where there may be lots of doubts. If it is written into this Bill, every consumer will know that he has this right, and that is important. I hope that my noble friend will seriously bear that in mind when he considers what to do about this amendment.

Lord Prys-Davies

Is the Minister saying that if a person establishes as a fact that he has suffered ill health as a consequence of drinking fluoridated water, he will automatically be paid damages, or will he have to go to the court and establish that the health authority was negligent? The force of this amendment is that he ought to receive compensation automatically. Is the Minister saying, "Yes, that is my understanding of the position. He will be paid damages automatically"?

Baroness Gardner of Parkes

This amendment is simply in order to try to worry people. The noble Earl, Lord Kinnoull, said that this is an emotive issue, and that is exactly what he has been stirring up here. I thought that his comments were almost unbelievable, and I believe that this amendment is unnecessary.

Lord Houghton of Sowerby

The Minister should use this amendment as a basis for sales promotion. The Government do not for a moment want to admit that anybody can suffer any harm from the fluoridation of water. They have resisted many amendments on the basis that there is no such evidence. They say that there is no evidence of anything harmful in this. All right, why not use it in a boastful spirit and say, "Not only will it do no harm, but if it does you can have your money back"? It is a conventional sales promotion. The boastful firm always offers to return the money without question if you are dissatisfied. Here is an opportunity for the Government to challenge the dissatisfied customer to say that he has pimples on his stomach as a result of fluoridation and to claim compensation.

I think that the Government are being most unimaginative. There is no need to go on defending fluoridation and resisting criticism when they have the best selling talk in the land if they were to advertise and publicise. What will the health authorities do but publicise it? We shall want to know before we finish with this Bill what health authorities will do to make an application. How will they begin? What will spur them on? What kind of stimulus will they have? What will arouse them on this subject? It will not be the elected authority because they have no voice. It will not be the people because they will not know what is going on and whether they will be able to collect their voices anyway. What will be the inspiration behind this? It can only be publicity and telling the people that "We can improve your children's teeth with fluoride" and give them all the information about it. "You can have shining kids' teeth" and show "before" and "after". There is no end to the ways in which this could be promoted if the Government will put their minds to it, and the health authorities get into the spirit of the thing.

In those circumstances, I suggest there is a wonderful oportunity for the Government to say that the one amendment in the whole book that will enable them to publicise this favourably they will accept with both hands and underline it in red ink in all the publicity on this subject to the people.

The Earl of Caithness

The Government do promote this, as did the noble Lord's Government when they were in office. They promote it by indemnifying water authorities against actions over alleged damage to health. Neither in the clause nor in common law is there an automatic right to compensation. The claimant will have to prove the damage. That is standard practice. I remind the Committee that no one has ever sued a health authority or water undertaker for damages arising from water fluoridation. It is there in common law if needed. The amendment is unnecessary.

Lord Monson

What the noble Earl, Lord Caithness, has just said proves my point. What have the Government to lose by accepting the amendment? The noble Earl, Lord Kinnoull, made an excellent point. Of course it is better to incorporate it in the statute rather than to leave it to common law. This is in a sense the nub of our feelings about the Bill. The Government continue to claim that no one can ever suffer harm, but they resist any amendments designed to put that to the test. I think therefore that we must press this amendment.

9.34 p.m.

On Question, Whether the said amendment (No. 28) shall be agreed to?

Their Lordships divided:

The Deputy Chairman of Committees (Lord Hayter)

I have to inform your Lordships that as it appears that fewer than 30 Lords have voted, in accordance with Standing Order No. 55 I declare the Question not decided, and, pursuant to the same Standing Order, the House will now resume.

House resumed.

House adjourned at eighteen minutes before ten o'clock.