Water (Fluoridation) Bill

HL Deb 25 April 1985 vol 462 cc1257-87

5.41 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)

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

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

Before the Question is put, I should like to draw your Lordships' attention to an error in the Official Report of our proceedings during the first day of Committee last Thursday, 18th April. The reporting error occurs in column 859, eleven lines from the foot of the page. What I actually said was—and this is verified by the tape recording of the proceedings: It [Amendment No. 32] 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 a 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". The effect of the misreporting in Hansard was to reverse the intention of what I actually said. I should just like to add that my admiration for all those who work for Hansard continues unabated.

On Question, Motion agreed to.

House in Committee accordingly.

The LORD NUGENT OF GUILDFORD in the Chair.

The Deputy Chairman of Committees (Lord Nugent of Guildford)

I should point out to the Committee that Amendment No. 28 has been debated:

[Printed 18/4/85; col. 891.]

Unless any noble Lord wishes to continue the debate, I shall proceed to put the amendment.

Lord Houghton of Sowerby

On a point of order, when the Deputy Chairman says that any noble Lord may continue the debate, does he mean that anyone who spoke to this amendment on the last occasion can speak again? Is that "to continue the debate"?

The Deputy Chairman of Committees

Yes, certainly; on Committee stage any noble Lord can speak as many times as he likes.

Lord Houghton of Sowerby

I beg the Deputy Chairman's pardon; I had not realised that one could speak as many times as one liked at the Committee stage. I may have spoken more than once on occasions but I was unaware that one could speak a lot of times.

I have spoken to Amendment No. 28. I made some facetious remarks about it. When I heard them reported on the radio, I recalled that many years ago when I was broadcasting, the BBC advised me how difficult it was to be sarcastic on the radio. They said, "you will be taken seriously". I fear that some listeners probably did take me seriously and really wondered how people could get their money back if they were not satisfied with fluoridation. This shows how unwise one can be to extend one's sense of humour beyond the four walls of your Lordships' Chamber.

The question of compensation was fully dealt with, so far as I was concerned, on the last occasion. I notice that my noble friend Lord Monson has resumed his seat; I believe it was his amendment that was moved in Committee and he may wish to say something about it.

On Question, amendment negatived.

Lord Sandys moved Amendment No. 29: After Clause 1, insert the following new clause:

("Warning on containers.

. The Secretary of State shall by regulation prescribe that all containers of fluoride for use in any application made under section 1(1) shall carry a warning that the contents are poisonous.").

The noble Lord said: This amendment deals almost exclusively with the matter of the labelling of containers. I wish to draw the Committee's attention to the fact that fluorosilicic acid is listed in Schedule 1 to the Petroleum Corrosive Substances Order 1970, SI No. 1945.

I believe it would be beneficial for the Committee to have details of what the manufacturers, Messrs. Fisons, advise in their instructions. If I may be allowed to quote them, they say: Care must be exercised while handling this material. The vapour must not be inhaled. Due to the highly corrosive and toxic nature of the product, particular attention must be paid to ensure that only suitably constructed storage and handling is used and that the vapour is not inhaled". Under the heading Health Hazards, the instructions advise: The vapour irritates all parts of the respiratory system and can cause severe lung damage. The TVL"— that is, the threshold limit value— for fluorides is 2.5 mg/m³ of air". that comes from the Health and Safety Executive Note EH 15/76. We are becoming somewhat technical but a final quotation is necessary, and this comes under the heading of Liquid in the same detail: Fluorosilicic acid burns the eyes severely and also the skin. If swallowed the acid would cause severe internal irritation and damage. Note that symptoms may develop after several hours". I am sure that I have said sufficient to emphasise most particularly how extremely toxic this substance is. With that, I beg to move.

The Earl of Caithness

I am very grateful to my noble friend Lord Sandys for putting down this amendment as it gives me the opportunity to state categorically that the aim of this amendment is already precisely met by existing regulations. The majority of water authorities use hexafluorosilicic acid solutions for fluoridation, and some limited use is made of sodium hexafluorosilicate.

Hexafluorosilicic acid solutions are usually delivered in bulk by road tankers and, as they are corrosive in concentrated form, are subject to the Dangerous Substances (Conveyance by Road Tankers and Tank Containers) Regulations 1981. The tankers need to be placarded to warn of the corrosive properties of the solution unless diluted to a safe level. The placarding includes the hazard warning sign for a corrosive substance together with other information for the emergency services in the event of a fire, spillage or other accident.

Sodium hexafluorosilicate is a powder and is delivered in sacks. These have to be labelled in accordance with the Classification, Packaging and Labelling of Dangerous Substances Regulations 1984 to show the toxic properties of the undiluted substance. The label would carry a danger symbol and the risk phrase "toxic by inhalation, in contact with the skin and if swallowed". It would also include prescribed safety advice. Personnel operating fluoridation plants are required to wear rubber gauntlets, chemical eye protectors, PVC overalls and safety boots.

I would stress that these precautions are aimed at safety and conveyance during use of the two chemicals and have absolutely no bearing on water supplies treated with any small amounts of these substances. The equipment used in fluoridation schemes in this country is specifically designed so that the amount of the chemicals that can enter the supply at any one time is severely limited, and fluoridation schemes in this country have been operated with complete safety to the public.

With that, I hope that my noble friend will find that we have already covered the point he raised and will withdraw his amendment.

Lord Houghton of Sowerby

It is an extraordinary commentary on this Bill that a substance which is to be put into the nation's drinking water should fall within the provisions of the dangerous substances legislation and have to be labelled "Poisonous". Does the noble Earl know of any other substance that has to be labelled "Poisonous" and which is poured into the nation's drinking water, or is this the only one? A gentleman arriving from Mars would wonder what sort of crazy business all this is: that the nation's drinking water has to be doctored with a substance which in more intensive conditions is poison and has to be labelled as poisonous to safeguard the health of those who have to handle it. I find the whole thing so extraordinary that I wonder whether any Government in their senses should be forcing this on the public.

The Earl of Caithness

I am a little surprised that the noble Lord, Lord Houghton, is not slightly better informed. That is unusual for him, because at our previous Committee stage I mentioned some chemicals which are already added to water, and there are over 50 of them. I suggest ammonia, chlorine, hydrochloric acid and sulphuric acid as examples. I promised that a copy of the list would be put in the Library, and that has been done. Therefore, fluoride in itself is not a one-off in this case.

Lord Sandys

I am grateful to the noble Lord, Lord Houghton, for emphasising fluoride's poisonous nature, and the object of this amendment was to do that. I am also grateful to my noble friend Lord Caithness for detailing the manner in which these chemicals should be transported in this country. However, I should like to have one further assurance from him: that under the international carriage of goods the same regulations apply, both within the EC and outside the EC, for carriage by sea. If he can give me that assurance, I shall certainly withdraw the amendment.

Baroness Gardner of Parkes

Before my noble friend the Minister replies I should like to say that there is a certain mischievous element in the wording of this amendment, and particularly in the comments made by the noble Lord, Lord Sandys, who said that he is delighted that the noble Lord, Lord Houghton, has emphasised the poisonous nature of the substance. As was emphasised in a reply already given from the Front Bench, this is not a situation applying to a diluted substance. Most of the substances used in the purification of water are extremely toxic in their undiluted form. I have pointed out previously in this Chamber that every drop of water that we drink in the House has been used seven times before. I can assure noble Lords that they would not drink the water if it had not been treated with these chemicals.

The Earl of Caithness

I am grateful to my noble friend Lady Gardner of Parkes for those helpful words. Referring to my noble friend Lord Sandys, I can assure him that there are appropriate regulations covering the point he raised. They are not the same, but they are appropriate.

Lord Sandys

I am grateful to my noble friend for assuring the Committee on this matter. With that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 2 [Power to vary permitted fluoridation agents]:

The Earl of Kinnoull moved Amendment No. 30: Page 2, line 43, at end insert— ("Save that no reference to another compound of fluorine shall be added except where such compound has been tested to the satisfaction of the Secretary of State as to its having no adverse effects on any person likely to receive it.")

The noble Earl said: This is a small amendment which I regard as important. My noble friend will have realised from the discussions we had on the first day of Committee that a number of us find this Bill very contentious, indigestible and corrosive to our feelings. We do so for two reasons which we went over before and which I shall reiterate because they are part of the amendment.

First, there is no democratic process in the Bill—and I hope that we can persuade my noble friend to put that right—on the decision to introduce fluoride in any area throughout the country. Secondly, it permits for the first time—and whatever anyone says to the contrary it is for the first time, as was explained fully in another place—a deliberate medication to be added to the public water supply.

My noble friend will appreciate that the arguments deployed on the first day of Committee indicated that medical arguments on either side of the fence differ about the correctness of adding fluoride to water. The arguments are split. Those who are concerned about the Bill have given names of scientists and doctors. Indeed, one sees eminent technical papers on the subject. For instance, in May 1983 the New Scientist—and my noble friend has probably read this article—quoted John Emsley of King's College, London, who said in 1981: A warning bell has sounded: through the agency of the strong hydrogen bond fluoride can change the chemistry of many compounds. What it may be capable of doing in the living cell whether for good or ill remains to be discovered". I do not think those words should be lightly tossd aside. I am not qualified to advance those arguments, but it is one's duty in Committee to put them to the Government.

The purpose of this little amendment is what I call a "comfort" amendment. It is simply to place a duty on the Secretary of State—after all, he is the Minister responsible—to see that any additional compound which might subsequently be introduced through this Bill is properly tested. My noble friend may say that that will be done anyway, but there is nothing wrong in writing it into the Bill. In fact, there is a lot right, because it gives comfort to the consumer and lays a duty on the Secretary of State. I think it is time the Secretary of State took a duty in this Bill and not just passed it on to the regional health authorities.

I hope my noble friend will share the purpose and feeling of this amendment, and that the Government understand the legitimate worries of people and will continue to exercise the proper precautions that should exist. I beg to move.

The Earl of Caithness

My noble friend Lord Kinnoull mentioned a number of points before coming to the meat of his amendment, and I shall try to reply to those. We understand the very strong feelings on this matter. They became very apparent in another place and they are very apparent in your Lordships' Committee. We have very carefully considered the arguments both for and against this measure because there are equally strong arguments.

To say that fluoride is safe and has been proved medically safe is a fact that we believe. Although, as I said, the more eminent the scientists the more they tend to disagree—like lawyers—the overwhelming weight of opinion is that there is no harm, at the levels we are talking about, in adding fluoride to water. However, notwithstanding that, if I were a scientist, I would be wanting to drive a hole in that argument. That is what the scientists are trying to do, but so far they have failed.

6 p.m.

My noble friend also said that we were introducing something new; we are not. We are only clarifying the law as we thought it existed for 30 years and as it has been operated by all Governments during that period.

With regard to the measure being undemocratic, I shall leave that to my noble friend to deal with when we get on to deliberate medication, which is another point. That appears in a later amendment. However, I would say that fluoride has been added for 30 years. It also occurs in a natural state and some 500,000 people in this country and 100 million people worldwide have been taking it for generations upon generations.

There are some 50 separate inorganic chemicals and numerous products based on nine groups of organic chemicals (including ammonia, hydrocholoric acid and sulphuric acid) which may be used in the treatment of water for human consumption. These chemicals have all been approved by the DOE Committee on Chemicals and Materials. No chemical or product is approved unless the committee considers it to be unobjectionable on health grounds, and it is used in accordance with the manufacturer's instructions and at acceptable concentrations and points of application. The two chemicals used for fluoridation, hexafluorosilicic acid and sodium hexafluorosilicate have both been approved by the committee.

At the suggestion of the noble Lord, Lord Beaumont of Whitley, during Committee stage on the 18th April, I have placed a list of the 50 chemicals in the Library—the point I mentioned earlier to the noble Lord, Lord Houghton of Sowerby.

The DOE committee when considering a chemical will seek evidence concerning toxicity and possible harm to the environment, to human health and to the materials it comes in contact with. DOE chemists, DHSS and independent medical advisers and water industry experts are members of the committee. Water undertakers recognise the committee's recommendations as authoritative and will use only chemicals approved by it. The legal sanction on a water authority is its statutory duty to provide wholesome water. If the chemical makes the water "unwholesome" as defined by the court, the undertaker would be in breach of this duty. This system has worked entirely satisfactorily and there are no grounds for laying upon the Secretary of State a specific statutory duty in relation to chemicals which may be compounded with fluorine. I must therefore ask the Committee not to accept this amendment, though it is well intentioned, because I believe that the matter is well covered.

The Earl of Kinnoull

My noble friend started off by giving me a crumb of comfort when he said that the Government understands the feelings against the Bill. He went on to say something that we have heard more than a few times since the first days of the Committee—that there were overwhelming medical arguments in favour of this medication. At that point I was depressed by his reply because what I am seeking in this amendment is not a suggestion that the noble Lord the Minister would not act properly or that his advisers or his experts would not be cautious and careful. They have always been cautious and careful. But it is a fact that we are breaking new ground in this Bill, so we want some assurances; we want a duty laid down. We have never had it before in this kind of legislation, so far as I know. When it is a contentious Bill and a lot of people are worried—and there is a lot of worry about it—to see a duty written into the Bill, I think is not asking a great deal of government. It does not harm the Bill in the slightest, damage it, or change it in any way at all, but it gives the assurance to those—not only consumers but also those who have the technical knowledge, as I tried to point out earlier—who feel that there is a doubt about the wisdom of this Bill.

Lord Brougham and Vaux

Perhaps I may interrupt on the point about new ground. The noble Lord the Minister said that these powers have been in existence for 30 years; so it can hardly be breaking new ground.

The Earl of Kinnoull

I did not explain myself correctly. I am talking of breaking new ground with this Bill adding compulsorily, for the first time, with no choice for the consumer, a compound which has never before been put in in this way. This is the first time it has ever been done.

The Earl of Caithness

I really cannot accept that. We are not breaking new ground on this. We are merely putting the law back to the situation that on both sides of the Committee we have believed it to have been for the last 30 years.

The Earl of Kinnoull

I am sorry to disagree with the noble Lord the Minister. I remember the Scottish case very well and the judgment of Lord Jauncey, which came down to the question: what is the test of wholesome water? The test was that wholesome water did not require this Bill and that is why he came down against this legislation, saying that the water authorities did not have the power to add something in addition to wholesome water. That is the argument. I am concerned that the Government are not prepared to make even a minor adjustment or to give an assurance.

I really feel that I should take this away and look carefully at what my noble friend has said. I reserve my position for the next stage of the Bill. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn,

Clause 2 agreed to.

Baroness Trumpington moved Amendment No. 31: After Clause 2, insert the following new clause:

("Continuity of existing fluoridation schemes.

.—(1) Where, in pursuance of arrangements entered into by a statutory water undertaker before 20th December 1984—

1. (a) a scheme for increasing the fluoride content of water supplied by the undertaker in any part of England and Wales was in operation immediately before that date; or
2. (b) work had been begun by the undertaker, before that date, for the purpose of enabling such a scheme to be brought into operation;

the undertaker may, while the conditions mentioned in subsection (2) below are satisfied, operate the scheme.

(2) The conditions are that the arrangements under which the scheme operates require—

1. (a) fluoridation to be effected only by the addition of one or more of the compounds of fluorine mentioned in section 1(4) of this Act; and
2. (b) the concentration of fluoride in the water supplied to consumers to be maintained, so far as is reasonably practicable, at one milligram per litre.

(3) Where a statutory water undertaker is operating a fluoridation scheme by virtue of this section—

1. (a) subsection (6) of section 1 of this Act shall apply in relation to the scheme as it applies in relation to any scheme operated in exercise of the power conferred by that section;
2. (b) the scheme shall cease to have effect upon the appropriate authority giving to the undertaker reasonable notice of the authority's desire to terminate it; and
3. (c) the arrangements under which the scheme is operated may be varied to take account of any amendment of section 1(4) of this Act made under section 2.").

The noble Baroness said: The purpose of this new clause is to meet concerns expressed in another place by the Opposition and my honourable friend Sir John Page, speaking on behalf of the water industry, that the Bill should provide specific legal vires for existing water fluoridation schemes. The amendment before us gives these legal vires, provided the schemes concerned conform, as they all do, with the concentration of fluoride and the compounds of fluorine provided for in the Bill.

Subsections (3)(a) and (c) of the new clause provide for the existing schemes to be subject to the arrangements already embodied in the Bill for emergency supply of fluoridated water to a non-requesting area and for changes in the authorised compounds of fluorine.

Subsection (3)(b) contains a similar provision in relation to Clause 1(2) which enables a health authority to terminate an existing fluoridation scheme provided that reasonable notice is given to the statutory water undertaker. This new clause is entirely in keeping with the philosophy behind the Bill of providing specific legal powers for the existing practice with regard to water fluoridation. I hope that your Lordships will approve the new clause. I beg to move.

The Earl of Kinnoull

Perhaps I may just ask my noble friend about the words "reasonable notice" in subsection 3(b). I wonder whether she can explain a little more clearly why the Government did not choose a specific time period. "Reasonable notice" is very reasonable, but I am not sure who judges what is reasonable notice, or how one judges it. Can the noble Baroness explain?

Baroness Trumpington

The noble Earl, Lord Kinnoull, has answered his own question. "Reasonable notice" is very reasonable.

The Earl of Kinnoull

I think that is a good answer, but it does not actually answer the question. Is one week reasonable, or two weeks, or three weeks? There must be a period of time considered to be a reasonable period.

Baroness Trumpington

Ultimately it would be the courts.

Lord Sandys

We are looking at an astonishing situation at present, as I understand it. The position is this. The law as portrayed in the Water Act 1945 was held to contain a provision whereby water hoards and water authorities may fluoridate in their area, subject to the approval of the health authority, and now the district health authority.

This obtained until the Jauncey judgment in 1983. This Bill, which derives directly from the situation as founded, is seeking powers from Parliament to ensure that all those existing schemes may now continue. We are therefore being asked in this Bill to make good what was held to be the state of the law hitherto. I believe that it requires rather greater examination than giving our approval just like that to an amendment which stands in the name of the noble Baroness. Where the law was previously held to be one thing and was found to be another, that is surely a fault much more than a lacuna in existing statute law.

I am no lawyer but I believe that a serious omission must have been made in the intention of the then Government in 1945 if they believed that they had powers and for all those 40 years that has been considered to be the law and has now been disproved.

Baroness Gardner of Parkes

I think that this is typical of many situations and is in fact the way that the law operates in this country. Bills eventually become Acts, people believe that they have certain rights but when it comes to a test case it is found that that is not necessarily so. There is a classic example about which I have just put down a Question. A court has just found that an owner-occupier who lets his home when he goes abroad will not be able to get it hack again. No one would want to leave that situation as it is. I hope that the Government will change it.

In this case the authorities which have been putting fluoride in the water, from which people have been benefiting all these years, have believed—and I think quite rightly—that they were legally entitled to do so. The court case that came about was unbelievably long. In fact those who opposed fluoride were seeking to prove that it was poisonous, but no mention has been made of the fact that the judge specifically ruled that it was not. However, he ruled that there was this grey area and a degree of legal doubt as to whether those people were entitled to put fluoride in the water.

The amendment is clearly to make legal the actions of people who have been doing this over the years to the benefit of their community. I strongly support it. I think that it is wrong that there should have been that degree of doubt in the law, but it is only when test cases are heard that such matters are uncovered.

Baroness Trumpington

I am most grateful to my noble friend Lady Gardner, who has absolutely hit the nail on the head. The amendment applies only to England and Wales, and Lord Jauncey's judgment applied only to Scotland. Fluoridation has never been found illegal by courts in England and Wales, and the purpose of this amendment is, as my noble friend said, to put the law beyond doubt.

Lord Merrivale

May I just ask my noble friend one question? I am no expert on this matter but I am rather concerned about fluoridation and its being extended in England and Wales. In effect, I think the risks will be greater. The clause is headed: Continuity of existing fluoridation schemes", and subsection (2) states: The conditions are that the arrangements under which the scheme operates require … the concentration of fluoride in the water supplied to consumers to be maintained, so far as is reasonably practicable, at one milligram per litre". Will monitoring be extended and this matter very carefully taken into consideration?

Baroness Trumpington

I think that my noble friend was not present when we started the Committee stage of the Bill. This ground has already been covered. Monitoring will most certainly take place. If he cares to look in Hansard he will see that there has been talk of this already. I would just point out to him that fluoridation is not being extended. The position is being put straight after 30 years of its being in use.

On Question, amendment agreed to.

6.15 p.m.

Baroness Trumpington had given notice of her intention to move Amendment No. 32: After Clause 2, insert the following new clause:

("Consultation etc.

.—(1) A health authority shall, at least three months before—

1. (a) making or withdrawing an application; or
2. (b) terminating a scheme which may be operated by virtue of section (Continuity of existing fluoridation schemes) of this Act (a "preserved scheme");

publish details of the proposed application, withdrawal or termination in one or more newspapers circulating in the area affected by it.

(2) Where, in compliance with subsection (1) above, a health authority have published details of a proposal they shall, in determining whether or not to proceed, have such regard as they consider appropriate to any representations which have been made to them with respect to the proposal.

(3) The Secretary of State may direct that subsection (1) above shall not apply in relation to any proposal of a health authority to withdraw an application or to terminate a preserved scheme.

(4) Where, at any meeting of a health authority, consideration is given to the question whether the authority should make or withdraw an application or terminate a preserved scheme, section 1(2) of the Public Bodies (Admission to Meetings) Act 1960 (which would have allowed the authority to exclude the public from the meeting in certain circumstances) shall not apply to any proceedings on that question.").

The noble Baroness said: I am not now proposing to move Amendment No. 32. It may be helpful to your Lordships if I give a very brief explanation.

Since I tabled Amendment No. 32, my noble friend Lord Sandys and other noble Lords have tabled an amendment regarding the procedures for publicising a health authority's intention to consider fluoridation. I have given careful consideration to my noble friend's amendment and I feel that my own may not go far enough. I therefore propose not to move my amendment this evening, and I hope to be able to bring a revised amendment before your Lordships at Report stage.

[Amendments No. 32A and 33 not moved.]

Lord Sandys moved Amendment No. 34: After Clause 2, insert the following new clause:—

("Public consultation.

. Before any health authority makes an application in accordance with section 1(1) it shall consult the public, including elected bodies, in the area the subject of the proposed application.").

The noble Lord said: We return to this all-important matter of public consultation. First of all, I should like to draw your Lordships' attention to the speech of the noble Baroness at the Committee stage a week ago on 18th April. If I may be allowed to quote her, at column 859 of Hansard she said this in regard to the subject: I should add that the new Government clause, Clause No. 32, about which I have already spoken—which noble Lords—

Baroness Trumpington

Will my noble friend forgive me? Noble Lords who were present at the beginning of this evening's debate will have heard me mention that there was an inaccuracy in the reporting of what I said which was fully confirmed by the tape recording. He should not be quoting from that paragraph therefore because it is inaccurate.

Lord Sandys

It is a published record. I apologise to the noble Baroness. Nevertheless, the point that I wish to make is this. If there is to be a corrected version, I hope that she will ensure that it is in the bound copy of the proceedings of Parliament, so we are clear that no inaccuracy will be carried forward.

Baroness Trumpington

Yes.

Lord Sandys

We have that assurance. The same arguments which apply to Amendment No. 4 apply to this amendment. I believe that it would be tedious to rehearse in detail the precise arguments which I related to the Committee at that time. Nevertheless, there are a number of matters which I am sure your Lordships will be somewhat distressed about, particularly the fact that Amendment No. 32 is not to be discussed before the Committee this evening. Of course when we see the amendment at Report stage we shall have only one opportunity to speak individually. That stage does not have the great advantage of the Committee procedure in your Lordships' House when as many speeches may be made as are convenient to your Lordships.

Further, I feel that this incorrect version of what the noble Baroness said which has been published in the Official Report has given cause for concern. I am glad that she has taken the opportunity to correct it this evening. However, it makes one further difficulty for the Committee to manage this amendment satisfactorily.

If I may say so—and I shall draw my remarks somewhat rapidly to a conclusion at this stage—it is apparent that there is a wide gap between the word "consultation" and the expression in the existing amendment before the Committee. I was very interested to read again—and I hope that this is an entirely correct version—the interpretation of the noble Lord, Lord Nugent of Guildford. This is what he said at column 858 of Hansard in regard to the same subject: 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". I had entirely the same view as the noble Lord, Lord Nugent of Guildford, that what is proposed, as we see the Government's intention at the moment, is to make a publication in local newspapers and to leave it at that. We shall be very interested at a later stage to see the noble Baroness's amendment. However, I hope it will be very much broader than what was clearly the intention at an earlier stage. I beg to move.

Lord Prys-Davies

I should very much like to support Amendment No. 34. I, too, wish that we had had a discussion on Amendment No. 32, because it would have given us an opportunity of identifying the weaknesses that we see in Amendment No. 32 as framed. I welcome this clause in particular for two reasons. At least the word "consult" appears for the first time in one of the clauses. "To consult" means that we seek advice from the people with whom we are consulting; whereas the Amendment No. 32 did not impose a duty to consult: all that the health authority would have to do would be to circulate, in one or more papers, particulars of an application without an invitation for the reader to offer advice or to offer counsel. Thus we think that is important. The Minister might say, "Well, that is implied in the amendment" but we would wish this to be expressly spelt out in the amendment when it comes before the Committee. Thus I certainly welcome Amendment No. 34 for that reason.

Secondly, we think there ought to be a specific duty placed on the health authority to consult with the local authority; not merely with the public at large (though that is important) but with the public authority, a democratically-elected authority. Unless there is consultation with the locally elected authority there will be no consultation on this very important and controversial issue with a representative body. After all, the members of the local authority will know their neighbourhood and have some knowledge of the wishes of the majority who live in it.

There is another reason why the local authority should be involved in the consultative procedure. The representation will have to be made vigorously to the management of the health authority. The locally elected authority is accustomed to participating in consultative procedures. I should have thought that the local elected authority is therefore in the best position of all to ensure that the representation is made vigorously. Thus, for those two reasons in particular, I should wish to support Amendment No. 34.

The Earl of Kinnoull

Before my noble friend replies, I wonder whether I may just say this. I find it most important to get right the clause on consultation in this Bill. I support everything that the noble Lord has just said. I think he spoke very clearly. I was encouraged by my noble friend that, in withdrawing her amendment, she used the words, "it may not go far enough". That is most encouraging. It certainly does not go far enough.

If I may analyse three things in the amendment, they are these. First of all, there is the duty to publish in one or more papers. I think under planning legislation there is always a duty to publish in at least two papers, certainly not just one because it is quite possible that people will not see that. Thus I hope that that will be firmed up in any amendment that passes through the Committee.

Secondly, I think the noble Lord is absolutely right, that there should be a duty on the health authority to consult the local council. That really is an absolute must: "a duty to consult". To say, in the words of the amendment, "have … regard … to representations" is to use the vaguest words one can possibly devise. I hope that my noble friend would import the words "a duty to consult local councils", and indeed to firm up what rights other representations have.

One is bound to enter a situation where the health authority has a duty to consult and takes account of representations, and finds that all the body of opinion is against bringing in the scheme. The question then is: what do they do? Do they accept that criticism, or do they just go blindly ahead? I hope my noble friend can cover that point because it is very important.

The third matter concerns not excluding the public. I think this was an amendment that the noble Lord moved on the first day, as far as I remember, as an amendment to that Act. I cannot remember the name of the Act. However, it was basically to allow the public the right of access to a hearing discussing this point, whereas they do not necessarily have the right at the moment, for instance, to attend a health authority's meeting. I think that is correct.

I hope that will be coming. I am not sure what effect it has because I assume the public are not able to speak; they simply have the right to attend. I do not know whether my noble friend can answer me this question, which is whether the press would have the right to be in attendance on any discussion that the health authority has. I hope that they do. It is very important that they should do. There should never be any secrecy in that light at all. I hope that my noble friend can reply to those points.

Baroness Gardner of Parkes

I should like to support the point that it would be good to have consultations with the elected local authority. I am very much for elected authorities, particularly at local level. However, there seems to be a misunderstanding about the actual wording of this amendment. I hope that when the Minister brings back an amendment it will be a better one.

First of all, I should say this about consulting the public. Surely the way in which all health authorities consult the public is through the community health councils. That is the existing machinery for public consultation. Most community health councils are extremely active and spend a great length of time in discussing the matters within their own community health council. They represent the local people. Also at most district health authorities they are allowed to speak. Usually the representative of the community health council is allowed to speak and is often invited to do so. Thus I think there are certainly adequate ways in which public consultation is already in action within the health service. Indeed, these meetings are certainly open to the public, as the noble Lord has questioned. I have been to many which are open to the public.

I hope that when the Minister brings back an amendment she retains some power within the amendment that if the meeting gets totally out of hand, the health authority could take such action as to continue the meeting correctly. On quite a different issue from this, my husband attended a district health authority meeting which they had moved from the normal room to a much larger roon in order to enable some hundreds of members of the public to attend. Members of the authority felt totally intimidated throughout by the vast proportion of the public there interfering with the proper conduct of the meeting.

Therefore I think this is very important. Although I am all for public consultation and I support the general principle of this, I do not think the wording in this amendment is correct and I hope that the Minister will see that powers are retained to conduct the meeting in good order.

Lord Somers

I support entirely what the noble Baroness had just said. Elected bodies are no doubt elected and I should not wish them to be anything else. However, if there is anything wrong with one's health, one goes not to an elected body but to a doctor. Dentists are not elected, but if there is anything wrong with our teeth we go to a dentist—I can say that from experience because I went to one this morning! Therefore, election surely does not make you an expert on any subject; and this is a particularly scientific subject.

6.30 p.m.

Lord Houghton of Sowerby

I think the noble Baroness may find she can deal with this matter more satisfactorily if we all have our say on it. It seems to me that it will form part of the more comprehensive consideration of consultation when we come to this later stage. We cannot very well discuss Amendment No. 32 because it has not been moved. We cannot very well discuss the revised version, the correct version, of the noble Baroness's speech earlier on because we do not have it before us; so we really have to take this amendment as a basis for a fairly wide consideration of the subject of consultation.

I would put this point to the Committee. This subject is different from any other subject that can be considered by the health authority; it is quite separate and distinct. It is different in kind from anything else with which they have to deal. Therefore, the consultation that they should have is likely to be much more controversial than that on any other subject. The noble Baroness, Lady Gardner of Parkes, who has just spoken, has given us a glimpse of what may happen when consultation takes place with local authorities or with community health councils to which the public are admitted. Yet the public have a right to be admitted, and I stress the point that we must regard consultation as meaning taking into account the volume of protest, because that is what it will be. It will not be to consider representation in any sort of gentle and rational kind of way: it will be to consider the emotional reaction of a lot of people towards something against which they are profoundly opposed; so I do warn the noble Baroness.

May I refer to the state of mind of the Government by quoting from Amendment No. 32? That says that a health authority shall, in determining whether or not to proceed, have such regard as they consider appropriate to any representations which have been made to them with respect to the proposal". So the health authority is put in the lofty position of being able to consider the representations they regard as appropriate.

I think that some health authorities will have something more to think about than the rather placid consideration of representations. This is a very important aspect of the whole question of consultation. When elected representative bodies of the public are deprived of a statutory voice in reaching a decision on a matter of this kind, naturally there is going to be a volume of frustration on this matter that does not occur on other questions.

What does a health authority generally do? It takes care of the health of the community. But this is not a Bill to take care of the health of the community. This is not a Bill to ensure that the general health of the community is cared for. This is a proposal to do something to the water, with the specific purpose of having an effect upon a section of the community. Nobody pretends that this Bill is to make the water better for grown-up people. This is not to improve the health of those who may have all sorts of conditions which may respond unfavourably to what they are asked to drink. No; if they are in difficulties they must seek a remedy elsewhere or not drink the water that is offered them. They can drink anything they like, but they will have no option regarding the content of the water which is laid on through the statutory authority.

I should be glad if the noble Baroness could tell me of anything that the health authorities do which is in the same class as this health measure. It is not a health measure in terms of the health of the community. It is an alternative to parents' care of their children's teeth; it is an alternative to parents' care of their children's diet; it is an alternative to parental responsibility. That is really what it is. This Bill is intended to cure by this means something which parents themselves do not look after sufficiently. That is the answer.

This is not a matter of the health of the community. It really should not be in the hands of the health authority at all. This is a matter for democratic decision, because the niceties of the conflict of opinion between scientists and experts on one side or the other will scarcely occur to many people. They will object to this in principle. If they object to it in principle, their representations will not be of a calm or rational variety. They will be representations of protest, of demo, of making life difficult. You might say it is almost equivalent to protests against motorways going through certain parts of the country: they will react to what is being done in a very unpleasant way.

I conclude by suggesting to the noble Baroness that she has an awful lot to think about in bringing forward the more comprehensive measure here. My noble friend who spoke from the Front Bench a moment ago made a very good point when he referred to the fact that the word "consultation" now appears in this Bill for the first time. The original Bill did not appear to care tuppence about representations; there was no mention of them. This does show that the Government are at least realising now that, with the deprivation of any effective voice of the local authorities, they have to take a great deal more care of consultation. That is my humble advice to the noble Baroness. I am sure she does not want a rocket at the Report stage on the subject, so there is a little thinking to be done between now and then.

Lord Prys-Davies

May I impose two further burdens on the noble Baroness? When the amendment sees the light of day, I should be grateful if the stage at which consultation is to take place could be clarified. In the Second Reading debate the Minister said that the Government would bring forward an amendment to ensure that there was consultation in advance of a decision being taken by the health authority."—[Official Report, 26/3/85; col 967.] It seems to me that the health authority will take two key decisions. There will be a decision that it ought to put fluoride in water. That is the first decision. Then there will be a second decision: that it will apply to the water authorities for fluoridation. I would hope that the amendment will make it clear that there will be consultation before the authority decides that it ought to fluoridate the water. The views of the public, the views of the local authority, ought to be one factor in front of the health authority before it decides on balance that it will fluoridate the water supply. That is important. We fear that if there is no consultation at that stage, and if consultation is only introduced after the authority has decided to apply to the water authority, it will be found that the health authority has taken a view and that it will stick to that view irrespective of the representations received by the authority.

The second point arises from Amendment No. 32, in its last paragraph, and Amendment No. 33, which have not been moved. It is important that there should be sufficient public notice of the time and the place of the meeting at which the health authority decides to put fluoride into the water. I understand that the Bill incorporates the Public Bodies (Admission to Meetings) Act 1960. The requirements of the 1960 Act will be fully met if notice of the meeting is posted at the offices of the health authority three clear days before the meeting or, if the meeting is convened at shorter notice, then at the time it is convened. There is no obligation to include in the notice the agenda of the business. There is no obligation in the Act to ensure that the notice is exhibited in a conspicuous part of the offices and is readily available to the public. I would therefore be grateful if the Government would consider whether they are satisfied with the provisions in the 1960 Act for giving notice of the public meeting.

The object of a public meeting is that members of the public can attend. They can see what arguments are being advanced; they can see how a decision is arrived at. According to my understanding, there need not be even three days' notice of the meeting. There need not be notice of the agenda. I would have thought that Members of the Committee would say that the provisions of the 1960 Act are not good enough and that they should be strengthened and improved.

The Earl of Kinnoull

Is the noble Lord saying that procedures that have been so well used under planning legislation should be adopted where this is sensible? The procedures in planning provide for statutory duties of notice and all the matters that the noble Lord has mentioned. Is that what he is suggesting?

Lord Prys-Davies

There are the two issues of the timing of consultations with the local authorities and the public. We suggest that there should be thorough consultation before the authority decides, on balance, that it should apply for fluoridation. Secondly, we are saying that the public should have ample notice of the date and the place of the meeting where the decision is to be taken and of the agenda that will be placed before the members of the authority.

Baroness Trumpington

To start with, I should like to congratulate the noble Lord, Lord Houghton, on the eloquence of his Second Reading speech. The noble Lord talked about protest. Your Lordships may care to know about a peculiar case in New Zealand which seems to me to demonstrate both the effectiveness of anti-fluoridation propaganda and its lack of respectability. In Hastings, New Zealand, in 1953, the authorities announced the final date of the implementation of a fluoridation scheme. Publicity was distributed by a number of anti-fluoridation groups telling the townspeople that they would be poisoned by the scheme. A number of citizens duly recorded the symptoms listed in the literature and complained about them to the council. The fact that the claims were essentially psychological is best demonstrated by the fact that the scheme was delayed by a technical hitch and had not even started. The New Zealand Commission on Fluoridation discussed the case at some length. Its conclusion was: We have no doubt that the propaganda material which has been distributed in Hastings and elsewhere or acquired by citizens for their own information has done much to arouse fear of fluoridation in the minds of receptive persons and to create an emotional stress in which people become unduly responsive to the suggestion that they were suffering due to fluoridation". I understand that there was a similar occurrence in this country when parts of Leeds were fluoridated.

6.45 p.m.

The Earl of Kinnoull

Will my noble friend say from what article or report she was quoting?

Baroness Trumpington

It was, I believe, the New Zealand Commission on Fluoridation. Yes, that is right. I am assured of it from on high.

I turn to another point raised by my noble friend Lord Kinnoull with regard to the right of the public to attend meetings. The public already have the right to attend health authority meetings on fluoridation subject to certain possible restrictions in the Public Bodies (Admission to Meetings) Act 1960. The Government propose to clarify the legal position on this but, in practice, public admission already takes place as a matter of course.

In answer to the noble Lord, Lord Prys-Davies, it is the Government's intention that consultation should take place before any application is made under the Bill for fluoridation. The local press will ensure that there is much publicity. The Government are in broad agreement with the thrust of the amendment that health authorities should be obliged to consult local opinion before reaching a decision on whether or not to seek water fluoridation. The present position is that health authorities are advised to do this in departmental guidance, and in particular they have a statutory duty, as my noble friend Lady Gardner of Parkes has said, to consult community health councils, which are set up to reflect consumer interest, over fluoridation.

However, we shall be moving our amendment on Report on this issue. In revising Amendment No. 32 for your Lordships' consideration we shall also be taking into account the views expressed regarding the position of local councils on fluoridation policy. The noble Lord, Lord Prys-Davies—I hope that he is also my noble friend—will understand that I would not wish to elaborate further at this stage as we are still considering the terms of the future amendment. I hope that my noble friend will in due course agree that my amendment will meet the spirit of his amendment and that he will therefore withdraw his amendment.

Lord Sandys

I had not anticipated that my noble friend Lady Trumpington woud say more this evening on the subject of Amendment No. 34. I am most grateful to all noble Lords who have spoken at length and very much in support of the general thrust of the amendment. I was naturally glad to hear from my noble friend that the Government accept that general thrust. I was also glad that my noble friend Lady Gardner supported the amendment and that she did not describe it as a mischievous amendment. That was her description of my earlier amendment.

I believe that it would be for the benefit of your Lordships' Committee if my noble friend Lady Trumpington could bring forward her amendment sufficiently in advance of Report stage to enable noble Lords to study it. It would be greatly to the benefit of noble Lords who have spoken to the amendment now under discussion if they could see that amendment of my noble friend in advance, bearing in mind that all of us have been suffering from the after-effects of the postal strike and that no less than 20 million letters are now rapidly, we hope, being dispatched on their way. Nevertheless, there are problems of communication between Committee and Report stages. I hope that if I withdraw my amendment I shall have the assurance of my noble friend that she will do her utmost to see that the Committee is informed sufficiently in advance of Report stage to enable us to have time to examine the amendment, to which we all greatly look forward. With that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Trumpington moved Amendment No. 35:

[Printed 18/4/85; col. 846.]

The noble Baroness said: I have already spoken to this amendment with Amendment No. 9. This is purely a technical amendment, which I hope your Lordships will accept. I beg to move.

On Question, amendment agreed to.

Clause 3 [Short title, commencement and extent]:

Lord Monson moved Amendment No. 36: Page 3, line 4, leave out ("Water fluoridation Act 1985") and insert ("Compulsory Mass Medication (Fluoridation) Act 1985").

The noble Lord said: The purpose of this amendment is to alter the Short Title of the Bill, so that its effects may be described more accurately. It cannot be denied that for all practical purposes the ingestion of fluoride will be compulsory once a particular health authority has decided that fluoride is to be added to the public water supply. This is all the more so now that the Government have, alas, resisted all our very reasonable amendments designed to ensure an alternative water supply for those who are at risk or who feel themselves to be at risk from fluoridation.

I pointed out last Thursday that only millionaires or possibly even multi-millionaires could in practice exempt themselves from the practical effects of this legislation. The proponents of fluoridation point to legislation requiring certain additives to be made to common foods. However, nobody, in the last resort, is obliged to buy a Mother's Pride sliced loaf to which sundry vitamins and minerals have been added—they can make their own wholemeal bread. Nobody is obliged to buy margarine to which vitamins A and D have been added, when for a few pence more they can buy butter. Nobody is obliged to buy salt to which iodine has been added—they can instead opt for sea-salt.

However, water is a very different matter. Whereas quite a few people can afford bottled spring water to drink on its own or to mix with spirits or fruit concentrates, how many people could afford to boil their potatoes or their cabbage in bottled water? How many people could afford to stew their rhubarb in it? How many people could afford to check through every item of frozen, tinned or bottled food and every bottle of beer or soft drink, to ascertain whether fluoridated water has been used in its preparation? We all know full well what the answer is, and for that reason the word "mass" is as appropriate as the word "compulsory", which leaves us only with the word "medication".

Last week the noble Lord, Lord Winstanley, denied that fluoride was a medicine. Yet the Collins English Dictionary in our Library defines "medication" as, "Treatment with drugs"; and it defines the word "drug"as: any synthetic or natural chemical substance used in the treatment or prevention of disease". The noble Lord, Lord Winstanley, and those who think like him, believe that fluorides prevent or ameliorate the disease—if disease it can really be called—of caries. Therefore, logically they should endorse the inclusion of the word "medication". I am sorry that the noble Lord, Lord Winstanley, is not in his place to express an opinion on what I have just said. Perhaps the noble Lord would prefer the word "prophylaxis". If so, no doubt he will suggest the substitution of that word at the next stage of the Bill.

However, as one eminent West End dentist has pointed out, fluorides in water can only be prophylactic for those aged six or below in the case of ordinary teeth, or those aged 11 or 12 or below in the case of wisdom teeth. Above those ages there is some speculation, but no positive proof, that the ingestion of fluoride does any good. It is noteworthy that the noble Lord, Lord Jauncey, conceded that fluoride was a medicine in his judgment, albeit not one covered by the Medicines Act. I beg to move.

Lord Sandys

I am very glad to support this amendment and I should like to quote from an interesting document which will be available to your Lordships. I am referring to the Expenditure Committee, Social Services and Employment Sub-Committee Minutes of Evidence for Wednesday 10th March 1976, before which the late Lord Douglas of Barloch, who was such an eminent authority in this field, appeared. He was asked the following question which appears at column 218 and which is numbered Question 1027. He was asked: Can you tell us what is the difference between adding fluoride to water and, as you heard the previous witness say, adding calcium to bread"— a point mentioned by the noble Lord, Lord Monson— or vitamins to margarine, which we do for health reasons? You heard the previous witness reject the idea that it is mass medication. He said that it was adding a nutrient to water that the human body needs". Lord Douglas replied: Let me take the last point first: it has never been demonstrated that fluorides are essential nutrients for human beings. Nobody has ever demonstrated that. The Central Health Services Council some years ago, when it was considering this matter, admitted that it had never been proved that they were essential nutrients". I think that an essential fact to bring forward before your Lordships' Committee is that the process is mass medication. I was very glad to read over the minutes of evidence and I am particularly glad that the noble Lord, Lord Monson, put down this amendment. It would be tedious to enlarge upon it, but having drawn the Committee's attention to this particular matter, I feel that it deserves your Lordships' consideration.

The Earl of Caithness

The Government do not believe that fluoridation represents mass medication in the sense in which that term would normally be used. The benefit of fluoridation was first discovered by observing the dental health of people living in areas where the water supply contains natural fluoride at the required concentration. It is arguable that these people are not subject to mass medication and that there is no significant difference between people living in areas where fluoride is naturally present at the optimum level—and that is about half a million in this country and 100 million worldwide—and those people living in areas where the fluoride content has been increased in order to replicate this naturally occurring level of benefit.

The noble Lord, Lord Monson, raised a number of points. He said that fluoride was a medicine and went on at the end of his remarks to admit that, it was not within the Medicines Act and he, therefore, answered his own point. The noble Lord mentioned bottled spring water. It was only a week ago that I was saying to noble Lords that if they drink Vichy water, they are probably getting a higher concentration of fluoride than they would if they drank tap water. We must also bear in mind that fluoride occurs naturally in all water supplies throughout the world at different levels and, therefore, to rectify the situation to bring it up to the optimum level does not seem to me in any way to be mass medication.

The point which the noble Lord, Lord Monson, tends to forget when he puts forward an argument such as the one he tried to put forward just now is that this is an enabling Bill to put the situation back to what we always believed the law to be. It enables the water authorities, on advice from the health authorities after due consultation to rectify the level of fluoridation, should they so wish. If, after consultation, the health authority says that it does not recommend it, the water authority does not need to do it. That is the difference.

7 p.m.

Lord Houghton of Sowerby

I apologise for being absent from the Chamber for a little while, but I was called out by the daughter of the late Admiral Lord Keyes who has handed to me a file of her experiences of arthritic fluorosis. I am bound to say, from a preliminary glance at what can happen to people who have an unfavourable reaction to fluoridated water, that I shall have to refer to this at a later stage in the proceedings.

This is medication. There is no doubt at all about it. It has to be distinguished from either obscure description or a complete disregard of what it is really going to do. It is extraordinary when we hear, and have been hearing throughout the discussions on the Bill, that no harm can come to people and yet here I have evidence of a person who had to be put, by the National Health Service doctors, on what was called a fluoride exclusion diet, and had to go on to non-fluoridated water as the only hope of arresting the deterioration of an arthritic condition.

That suggests that we might have to have an amendment at a later stage of the Bill which will protect people who, for good reasons and on medical advice, require an exclusion diet, and make provision for it. This lady told me that she was unable to afford what she would otherwise have had, and that was bottled water free of fluoridation. While this is before us I thought I might take the opportunity of another intervention on Committee stage to give some hint of things to come.

The Earl of Kinnoull

The noble Lord has raised a serious issue. What he had done, for me anyway, is confirmed something which is always at the back of one's mind, but when one listens to my noble friend Lady Trumpington quoting from this New Zealand report one almost thinks that we are all crackpots and unbalanced. But when one hears evidence like that—

Baroness Trumpington

If I may just intervene, my noble friend has not heard any evidence.

The Earl of Kinnoull

Perhaps evidence is too strong. The noble Lord has been given something—and it is obviously at too short notice for him to verify everything—which is deeply disturbing. I think we had an amendment on the first day which said that for those who medically should not receive fluoridated water there should be an alternative supply, or some compensation so that they could purchase water which did not have the content of fluoride in it.

My noble friend Lady Trumpington is putting up a pretty tough defence for her Bill, for which we of course admire her, but I hope that she will take this serious point which the noble Lord has just made into consideration when we all I hope meet again at Report stage.

Lord Colwyn

May I briefly say that there has been expensive research on this subject that we are discussing of the possible connection between fluoridation and arthritis. Some years ago Ansell and Lawrence took a comparative study of the incidence of rheumatism in Leigh and Watford—which are among the United Kingdom fluoride study areas—and they found no difference in the amount of rheumatoid athritis, osteo-arthritis, spondylitis, gout or disc degeneration between the two towns. In fact, there were significantly fewer complaints of rheumatism and less incapacity due to rheumatism in Watford, which is fluoridated, than Leigh. But the authors were cautious in attributing this to fluoride. There is no evidence.

Lord Swinfen

So far as I understand it, we are discussing the Short Title of the Bill. I have always understood that it was customary for the Short Title to be as short as is convenient, and to the point. The title in the Bill before us has only two words, one is "Water" and the other "Fluoridation". That is precisely what the Bill deals with. The proposed title in this amendment is far too long and quite unnecessary.

The Earl of Caithness

I was interested in the remarks of the noble Lord, Lord Houghton. Doubtless he will let my noble friend have a copy of that report this evening so that we can take a look at it too. I was grateful for the comments of my noble friend Lord Colwyn. I can tell him and the rest of the Committee that besides the evidence that he stated there was a report of the Royal College of Physicians which reviewed the studies relevant to claims that fluoridation caused harm through osteo-arthritis and other musculoskeletal disorders. They concluded: There is no evidence that the prevalence of any musculoskeletal disorder is increased in areas with fluoride at a concentration of 1 milligram per litre in water. Certain evidence suggests that osteoporosis and its complications are less prevalent in high-fluoride areas but it may be noted that some of this evidence refers to levels in excess of 1 milligram per litre". Therefore there are certain benefits to be derived from fluoride according to the Royal College of Physicians' report. However I shall certainly read Lord Houghton's papers with interest, and look forward to debating them with him at a later stage. Going back to the precise amendment of the noble Lord, Lord Monson, there is nothing that I have heard from the rest of noble Lords in Committee which makes me change my mind that we are right to resist this amendment. I hope that the Committee will do so.

Lord Sandys

Before the noble Lord makes a final decision on his amendment, I should like to express my pleasure at hearing Lord Houghton's speech because he brought forward the fact that he was going to give evidence. We have almost repeatedly throughout the Committee stage heard from my noble friend Lord Caithness about the absence of evidence. I have been through the record and I discover that he said on 18th April that there was "no evidence" at column 842, and that there was "no concrete evidence" at column 843, and at column 880: "We have found no scientific evidence".

When we come to Report stage we shall no doubt have considerable evidence from the noble Lord, Lord Houghton, and indeed others. What it brings out is that the principal document on which the Government base their entire case is the 1976 report by the Royal College of Physicians entitled Fluoride of Teeth and Health. No report by 18 eminent physicians can be more greatly disputed because of course they have closed their eyes to so many of their colleagues. I could say much more about that, but I shall refrain from doing so.

The Earl of Caithness

I am sorry that I have to repeat so often that there is no evidence, but it really is restating the case as a result of matters put to me by noble Lords. With regard to my noble friend's last point that that report was the sole basis of this Bill, I can assure him that it was not. There is a mass of evidence, including the recent Knox report and many other studies, which has convinced us that, I say it again, there is no evidence.

Lord Monson

I am most grateful to the noble Earl, Lord Kinnoull, the noble Lord, Lord Sandys, and the noble Lord, Lord Houghton of Sowerby, for their support on this amendment. The noble Earl, Lord Caithness, told us that artificial fluoridation came about because it had been observed that children's teeth were better in areas with above average concentrations of fluoride naturally present in the water supply. He omitted to mention that concentrations of magnesium and calcium are also very much above average in those same areas.

Who can be sure whether the relative state of the children's teeth can be attributed to any one of those three elements on their own, or possibly in combination? He also talked about an optimum level of fluoride, and not for the first time. This is surely begging the question. Is he really suggesting that people above the age of 13 would come to any harm whatsoever if there were no fluoride in the water supply? Surely not. He spoke of Vichy water containing fluoride. Vichy water is not one of the bottled waters that I personally like, not because fluoride is present, but simply because I do not like the taste. There are many other bottled waters which contain very small proportions of fluoride indeed.

The dictionary definition of "medication" is as I stated. It is a perfectly correct word to use in the title of this Bill, if the Committee were so to decide, but I do not think this is perhaps one of the most important amendments that we want to stick on. There are more important things to concentrate upon and therefore for the time being I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Deputy Chairman of Committees (Lord Ampthill)

Before calling Amendment No. 37 I should point out to the Committee that if it is agreed to, I cannot call Amendment No. 38.

Baroness Trumpington moved Amendment No. 37: Page 3, line 6, leave out subsection (2).

The noble Baroness said: The effect of this amendment is to bring the Bill into immediate effect upon Royal Assent. The justification for this is to be found in the new clause which provides for continuity of existing fluoridation schemes. The Government have considered representations made in another place and have concluded that it is, indeed, right that the legality of existing schemes should be put beyond doubt as soon as possible without there being an intervening period of two months after Royal Assent. I understand that we have the support of the water industry in this and I commend the amendment to your Lordships. I beg to move.

The Earl of Kinnoull

We shall not have a chance to speak on the next amendment, proposed by the noble Lord, Lord Monson, if we agree to this one. Amendment No. 38: Page 3, line 6, leave out from ("force") to end of line 7 and insert ("one month from the date on which the Council of Ministers of the European Economic Community agree that fluoridation of all public water supplies shall be the policy of the Community.") I should like to support his amendment on the grounds that having flown back from Strasbourg this morning at dawn from the Council of Europe, I am getting a taste of becoming European. What the noble Lord's amendment does is to provide that a decision of this nature should be considered by the Council of Ministers. I think that is its purpose.

I inquired at Strasbourg as to how many other Western European countries have fluoridation. I think I am correct in saying, though if I am wrong, my noble friend Lady Trumpington will correct me, that no other Western European country has fluoridation. We are now into Europe. We are dealing with a very important subject. With electricity supply crossing the Channel from France it is quite possible that we shall have a supply of British water going to France. At this stage we would be negated if we tried to do that.

I have always been a tremendous admirer of Welsh water. They charge far too little for what they supply to Birmingham. It is a wonderful, clear, beautiful water. If they were trying to export water and the area water authority had fluoridated it, there would be no question of their being able to export to Europe. The noble Lord, Lord Monson, has a strong point in his amendment, which I hope he will discuss as well, because as we move closer to Europe it seems crazy to be out on a limb on a serious and important subject such as water.

7.15 p.m.

Lord Houghton of Sowerby

May I ask the noble Baroness a question? The noble Baroness explained that the purpose of this amendment was to cover the health authorities where fluoridation is already in operation. I can well understand that they want to be legitimised at the earliest possible moment, and this amendment would do that. I do not think we want health authorities to be in serious jeopardy for any length of time. They may have been acting illegally up to now. They are probably lucky to be at large. But we will forgive them because they did not know what they were doing when they did it and the law does not really legitimise what they have done, now that they have done it. But is it necesary to cover future schemes in this way?

Is it not possible to give full effect to what the noble Baroness moved earlier in Amendment No. 31? Amendment No. 31 deals with continuity of existing schemes. Could not the Bill provide that the continuation of existing schemes is covered with immediate effect after the passing of the Act? Is there any reason why new schemes should not wait while local health authorities get into position? I am not sure what is the purpose of the amendment if it is only to cover the continuation problem, when previously it had apparently been understood that there would be a lapse of time between the Bill becoming law and its being given effect. Am I wrong about this? We do not want to give health authorities the starting pistol for new schemes. We do not mind covering them for old schemes. Am I not talking a little sense? The noble Baroness is looking at me and I am not sure whether she is wondering what I am saying or whether she is taking it all in? Is the noble Baroness with me?

Baroness Trumpington

On this occasion I am not with the noble Lord. He knows how fond I am of him and what immense repect I have for him. He said he was talking a little sense. I fear he was taking a little nonsense. When the Bill is enacted it will have no effect on new schemes because they will take the course that they have to take to come into effect. The places which already have fluoridation obviously will want to get going. The effect of the amendment is to bring the Bill into immediate effect so that they can all start again as soon as possible. But new schemes where there has been no fluoridation could not possibly start immediately.

Lord Houghton of Sowerby

But, with great respect and affection, the noble Baroness is in error, surely. The Bill as printed states in Clause 3: This Act comes into force at the end of the period of two months beginning with the day on which it is passed.". Why was that put in the Bill? The noble Baroness is seeking to delete this provision from the Bill because she says that it would leave the health authorities with existing schemes without statutory authority for what they are doing. For that reason she wishes to remove it from the Bill altogether. But the existing schemes appeared not to be covered adequately in the Bill as printed, and that is the reason for the amendment moved by the noble Baroness, as Amendment No. 31 has been put into the Bill, to clear up that doubt about where existing schemes come under the Bill.

The noble Baroness says that this does not really matter for future schemes because the coming into force of the Act does not do anything. What it does is to enable health authorities to set in motion their process—

Baroness Trumpington

That is right.

Lord Houghton of Sowerby

—to make applications and to advertise and all the rest. But why was this delay of two months put in the Bill? Why did she want to delay the starting pistol for two months for new schemes in the Bill as it stands, whereas now she tells me when I want to keep it in for future schemes that it is all nonsense? There is either a misunderstanding or there is some lack of appreciation of what the point is. Probably the noble Earl might have a go.

The Earl of Kinnoull

Before my noble friend considers her reply, she did explain, in fairness to her, when she moved this amendment that it was specifically to assist those health authorities which had existing schemes to legitimise; but of course it does not cover Scotland. Scotland has no schemes at all; they will be all new schemes in Scotland. I would support the noble Lord and I should like to ask my noble friend: why are they plucking this out of the Bill now in Scotland, when they are all new schemes?

The Earl of Kintore

The question of European water has been raised and I should like just to mention that from Aberdeen we supply many thousand tonnes of water to Russian trawlers and also to all kinds of shipping. At the moment it is not fluoridated. There is another point that I should like the noble Baroness to take note of, and that is that, for instance, in the Grampian region there are something like 80 different sources of water. There is the question of the practicality of fluoridating a small water supply if you are told by a health authority that you have got to do it. I hope this is only a local argument which will be decided by the regional council and the regional health board. I hope it is not an overall direction which can just be walloped on to us, because in some cases it is not impossible but it would be totally uneconomic to fluoridate a supply for, say, three crofts or something of that sort.

Lord Swinfen

Perhaps when my noble friend considers her reply to those questions she will confirm that the Council of Ministers in Europe have already in fact agreed to the fluoridation of water.

Baroness Trumpington

I should like to say to the noble Lord, Lord Houghton, that the amendment allows existing schemes to continue in England and Wales: they have not stopped. No new schemes will come into immediate effect anyway. Time is required for planning, consultation and so on. There is no reason why the provisions of the Bill relating to the new schemes should not come into immediate effect. With regard to the remarks of my noble friend Lord Kintore, may I say that the answer to his question is that it will be up to the local water authorities.

I do not think it would be strictly correct for me to answer questions on Amendment No. 38; but, as we have talked about it intermittently and if the object of Amendment No. 38 is to suggest that the EEC do not consider the concentration of fluoride used in our fluoridation schemes and provided for in Clause 1(5) of the Bill is safe, I can assure the Committee that that is not the case. Indeed, the Council of Ministers has approved the EEC directive relating to the quality of water intended for human consumption, which covers this point among others.

The directive, which comes into effect this year, provides for a maximum admissible level of 1.5 mg per litre of fluoride in the water supply. That is precisely the maximum level that we already observe in water fluoridation schemes. It is really quite wrongheaded to suggest, as the amendment does, that this country should not adopt preventive health measures by its own choice but should do so only if they are implemented by the European Community as a whole. There is no basis at all for such a suggestion.

Lord Monson

I had originally intended to rise on this amendment only to—

Lord Houghton of Sowerby

On a point of order, which amendment are we talking about? I addressed myself to Amendment No. 37, and that is the one which I thought was before the Committee at this stage. We drifted on to Europe in anticipation of the next amendment, which has not yet been moved.

The Earl of Caithness

May I say that the point is that the next amendment cannot be moved if this one is accepted, and therefore my noble friend was merely trying to help the Committee in her normal generous way?

Lord Houghton of Sowerby

I apologise if I misunderstood the mission that she was on at that particular moment, but it is a second or two since she said that there was no reason at all why there should be any delay in the effective date of this Bill when it became an Act of Parliament. All I can say on that is that it was in the Bill, it is in the Bill and it is now proposed to take it out. Very well then: the noble Baroness ought to get up and say, "It was in the Bill; we have changed our minds; we have made a mistake and we propose to take it out."

Lord Monson

I had originally intended to rise to speak on this amendment only to make the point which has just been made by the noble Lord, Lord Houghton: that is, why the alleged necessity for this Amendment No. 37 and why had it not been introduced earlier while the Bill was going through another place? Subsequently of course I realised that once this amendment goes through, as it almost certainly will, there will be no opportunity to speak to the principle of my amendment, Amendment No. 38, which I think does deserve an airing—and at this stage, what is more, since we are going to be very busy at the next stage.

I have myself never pretended to be an enthusiast for Britain's membership of the EEC, but in this I realise that I differ from most of the Members of this Committee. I know that if there is one ambition that fires "Euro-enthusiasts", if I may use that term, it is the desire to harmonise British laws, British customs and British practices as closely as possible with those of the other member states of the Community. Indeed, one of the arguments deployed for making the wearing of seat belts compulsory was that this move would harmonise our laws with those of the other EEC countries, excepting only Greece and Italy. The legislation was duly passed—the only difference being that, for some reason, the maximum penalty for non-compliance here was fixed at a draconian level about 15 times the EEC average.

Logically, then, noble Lords who favoured adhering to the EEC norm in the matter of seat belt compulsion should also be in favour of following the EEC in the matter of fluoridation: in other words, they should oppose this Bill. Instead, somewhat illogically I cannot help thinking, a number of noble Lords have done the precise opposite. It cannot be emphasised too strongly that virtually every EEC country, with the exception of the United Kingdom and the Republic of Ireland, opposes compulsory fluoridation at a national level no matter what EEC directives there may have been. They include not least those countries which have experimented with fluoridation on a trial basis.

Fluoridation is either not employed or positively banned in all the continental EEC countries: that is to say, France, Belgium, the Netherlands, Luxembourg, Denmark, West Germany, Italy and Greece, as well, incidentally, as Norway and Sweden, which are of course outside the EEC. I mention these two countries as the Scandinavian countries are not only what one might call medically and scientifically scrupulous countries: they are also countries which are never traditionally averse—

The Earl of Caithness

May I interrupt the noble Lord? We are strictly out of order in debating Amendment No. 38. My noble friend raised the point that she did on Amendment No. 38 for the benefit of the Committee. I hope that the noble Lord will be brief in concluding his remarks.

7.30 p.m.

Lord Monson

I can certainly give the noble Earl that assurance. The Scandinavian countries are countries which are not averse to producing dirigiste or maternalist (one might say) legislation when they consider it essential. In other words, if those Scandinavian countries thought that fluoridation was safe, they would have had no hesitation whatever in introducing it. Instead, of the EEC countries, we see that Belgium discontinued one small experiment in fluoridation; in Denmark, fluoridation is forbidden by law not only in water but also in food; in France, the government does not allow fluoridation as its safety has not been sufficiently proved; in West Germany, fluoridation was discontinued in 1971 because of health and legal considerations. There is no fluoridation in Greece, there is no fluoridation in Italy or in Luxembourg, where the official view is that the method is naive and utopian without practical effect. In the Netherlands, after an exhaustive—

The Earl of Caithness

The noble Lord did say he would be brief. I think he is now abusing the privileges of the Committee.

Lord Monson

I will not go any further except to point out that a committee set up by medical people with considerable qualifications, including biologists, pharmacologists, dermatologists and so on, has come out against fluoridation. In consequence, permission to fluoridate was revoked by Royal decree on 31st August 1976. The point is this. Can we really claim that we and the Republic of Ireland are right and all the other EEC countries wrong? Surely not!

The Earl of Kinnoull

The noble Lord, Lord Houghton, made a good point, as always. The reason, as I understand it, why Acts always are given a time lapse before they come into operation is to ensure that people have time to digest the provisions; that their advisers have time to digest the Act. It is very unusual, unless there is an emergency reason, to bring in an Act straight away.

My noble friend has explained her reasons for withdrawing subsection (2) as being really to legitimise the existing schemes. I do not quarrel with that. I quarrel when it comes to Scotland; because we know that there are no existing schemes in Scotland and I know that people do not always read Hansard and do not always follow what is happening in the Houses of Parliament. I think that there is a case for making a special exception for Scotland, because it is an exceptional position, to allow the two-month period which was the original purpose and which, rightly, was written into the Bill. Scotland should be the exception. I hope that my noble friend will consider this favourably with a view perhaps to putting down an amendment at the next stage.

Baroness Gardner of Parkes

I certainly support this amendment and I think that all this talk about needing two months' thinking time is quite unnecessary. This is simply an amendment to ensure that those authorities presently fluoridating their water will be acting legally that much more quickly. We have had considerable debate in the Committee and the Minister has told us that she will be bringing back an amendment to allow adequate public consultation. My experience of public consultation is that anything under two months would be totally impossible and that two years are more likely to be needed for public consultation. So that all this alarm at the thought that every authority is going to go rushing through a fluoridation of water scheme within two months is quite unnecessary. I support the amendment as it stands.

Lord Houghton of Sowerby

If I may say so, with great respect to the noble Baroness, Lady Gardner of Parkes, she is sometimes more ministerial than the Minister. She rises effectively to put a kind of three-line whip under the observations of the Minister to emphasise their importance and their conclusiveness. I think that the noble Baroness still has to justify wanting to take out of the Bill something that was put in in relation to new schemes. The point about continuation would be met if her amendment were to exclude from Clause 3(2) those schemes that are dealt with under the amendment that she moved, Amendment No. 31, which refers specifically to continuation schemes.

I would say this. To give the starting pistol at the moment when this Bill is passed into law would enable a health authority to get going very quickly; and the passion behind pushing fluoride into the water is so strong in some areas that they want to get on with it quickly. There must have been some reason for the two-months delay. Right from the beginning in the Bill, with two months' delay and three months' notice there is at least roughly six months before matters come to the crunch. If your take those two months away, schemes can begin two months earlier. I warn the noble Baroness that this will appear to be a manoeuvre to curtail the period of consultation and discussion locally and to give the health authorities the green light to get on with the job. I think that would be a great mistake. As far as I am concerned, I would divide the Committee on this amendment rather than let it go through.

Baroness Gardner of Parkes

I should like to say that my comments come purely from the fact that I have served on health authorities for a good many years and I know just how long and slow are all sorts of consultations. That was the basis of my comment.

Baroness Trumpington

This amendment is consequential on Amendment No. 31, which the Committee has already passed. If noble Lords will read Hansard, they will see that I have answered their various questions in my original speech. I see nothing that I can usefully add. We are going round and round the mulberry bush at the moment.

7.36 p.m.

On Question, Whether the said amendment (No. 37) shall be agreed to?

Their Lordships divided; Contents, 44; Not-Contents, 6.

DIVISION NO. 1
CONTENTS
Auckland, L.	Inglewood, L.
Belhaven and Stenton, L.	Kintore, E.
Bethell, L.	Lawrence, L.
Birk, B.	Long, V.
Brabazon of Tara, L.	Lucas of Chilworth, L.
Broadbridge, L.	McIntosh of Haringey, L.
Brougham and Vaux, L.	Molson, L.
Caithness, E.	Mountevans, L.
Carnegy of Lour, B.	Moyne, L.
Colwyn, L.	Ponsonby of Shulbrede, L.
Craigavon, V.	Prys-Davies, L.
Crathorne, L.	St. Aldwyn, E.
Dean of Beswick, L.	Simon, V.
Denham, L. [Teller.]	Skelmersdale, L.
Diamond, L.	Stewart of Fulham, L.
Elton, L.	Strathcona and Mount Royal, L.
Faithfull, B.
Gardner of Parkes, B.	Swinfen, L.
Glenarthur, L.	Swinton, E. [Teller.]
Graham of Edmonton, L.	Trumpington, B.
Henderson of Brompton, L.	Westbury, L.
Hornsby-Smith, B.	White, B.
Hylton-Foster, B.

NOT-CONTENTS
Houghton of Sowerby, L.	Sandys, L.
Kinnoull, E. [Teller.]	Stoddart of Swindon, L.
Monson, L. [Teller.]	Yarborough, E.

Resolved in the affirmative, and amendment agreed to accordingly.

The Deputy Chairman of Committees (Lord Aylestone)

I cannot call Amendment No. 38.

Lord Monson had given notice of his intention to move Amendment No. 39:

Page 3, line 7, at end insert— ("( ) This Act shall lapse twelve months after coming into force unless before that date its continuance is approved by a resolution of each House of Parliament.")

The noble Lord said: This amendment is self-explanatory. However, partly because it has occurred to me since tabling the amendment that 12 months is perhaps rather too short a time to evaluate the practical effects of the Act or to evaluate the most recent scientific studies drawing attention to the possible dangers of fluoridation, and partly because of the heavy workload that faces us in Committee next week on the Local Government Bill and because of the lateness of the hour (I am sure that, like me, the noble Baroness is looking forward to a stiff whisky to which a dash of unfluoridated water has been added) I do not propose to speak to this amendment tonight, but will come back with a revised amendment at a later stage. Therefore the amendment is not moved.

[Amendment No. 39 not moved.]

[Amendment No. 40 not moved.]

Clause 3, as amended, agreed to.

House resumed: Bill reported with amendments.