Water (Fluoridation) Bill

HL Deb 04 July 1985 vol 465 cc1336-80

5.12 p.m.

Read a third time.

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

Lord Monson moved Amendment No. 1: Page 2, line 15, at end insert: ("(6A) If at any stage it appears to the statutory water undertaker that the concentration of fluoride in the water supplied to consumers in the area in question has risen to 1.5 milligrams per litre or over the statutory water undertaker shall cease further fluoridation and inform the Secretary of State immediately.").

The noble Lord said: My Lords, I do not think there is any need for me to explain this amendment in detail as its purpose is self-evident. The Government say that 1 milligram of fluoride per litre is the maximum normal safe dose. At an earlier stage of the Bill I tried to ensure that the maximum never rose above that. It was subsequently suggested that that was a little too constraining and perhaps 1.2 milligrams per litre was the maximum to write into the Bill.

However, I have been pursuaded by the arguments from the noble Baroness, Lady Trumpington, and her colleagues that perhaps that, too, does not allow for exceptional circumstances and that 1.5 milligrams per litre is the maximum that should be written into the Bill. That is, after all, a 50 per cent. overdose and in the normal way if a hospital or surgery patient were to be given an overdose of 50 per cent. it would be considered a serious matter. I think that the amendment allows for exceptional circumstances and gives a certain flexibility.

It may be of interest for your Lordships to know that recent Swedish research has pointed to the danger to children which can result from overdoses of fluoride. Research was carried out by three Swedish doctors and on 3rd March 1985, in the journal, Pediatrics a paper was published entitled, "Renal Clearance of Fluoride in Children and Adolescents,", which made quite clear that an overdose of 50 per cent. or more was decidedly dangerous and not to be tolerated. The amendment, therefore, has been drafted so that if the concentration of fluoride in the consumers' area has risen to 1.5 milligrams per litre or over the water undertaker shall immediately cease fluoridation and inform the Secretary of State.

It may be for the convenience of the House if I speak at the same time to Amendment, No. 2, which is to all intents and purposes consequential:

Amendment No. 2: Page 2, line 15, at end insert— (" (6B) The Secretary of State on receiving the information set out in subsection (6A) of this section shall order an investigation into the causes of the concentration of fluoride in the water supplied exceeding 1.5 milligrams per litre and into the harm to health if any suffered by any person as a result of this concentration.").

This provides that the Secretary of State, on receiving information that the maximum safe dose has been exceeded, shall order an investigation into the causes of the concentration of fluoride into the water supply and into the harm to health, if any, suffered as a result of this concentration. It is not absolutely necessary that Amendment No. 2 should be accepted although I think it follows logically from Amendment No. 1, and it is for that reason that I am speaking to both. I beg to move.

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

My Lords, I am really at a loss to know what the noble Lord, Lord Monson, means by a 50 per cent. overdose. The short-term consumption of water fluoridated at 1.5 milligrams per litre or even 2 milligrams per litre has absolutely no ill-effects. Indeed, the United States Environmental Protection Agency has recently concluded that a permanent level of 4 milligrams per litre still allows an adequate margin of safety; but that is by the by.

I hope that I can persuade the movers of this amendment that it is unnecessary and should be withdrawn. As noble Lords will be aware, fluoridation is carried out in this country according to guidelines laid down by the Standing Technical Advisory Committee on Water Quality. These guidelines impose an upper limit on the concentration of fluoride in the water supply resulting from a fluoridation scheme of 1.5 milligrams per litre. This upper limit allows a very wide margin of safety and the guidelines are entirely consistent with the World Health Organisation's recommendations and also with the European Community Directive relating to the quality of water intended for human consumption.

The guidelines provide that the schemes should generally run at between 1.1 milligrams per litre and 0.9 milligrams per litre, and daily readings as high as 1.5 milligrams per litre are very unusual. The water undertaker carries out frequent and regular monitoring, and daily monitoring records are sent to health authorities. If one of the daily readings does show a concentration of 1.5 milligrams per litre, the water undertaker will rectify this immediately by temporarily halting the supply of the fluoride compound. In fact, most of the plants operating in this country have systems which do this automatically.

Water undertakers are already obliged to keep within the guidelines, as the guidelines are written into the contracts which govern fluoridation schemes. Similarly, the requirement that the Department of Health has to be informed in certain circumstances already exists. I therefore see absolutely no need for this extra statutory obligation to be placed upon water undertakers operating fluoridation schemes and I would ask that the amendment be withdrawn. If the noble Lord will not withdraw it, I will have to ask noble Lords to reject it.

Lord Monson

My Lords, the noble Baroness gives us a certain minimal reassurance in her description of the procedure which is normally adopted when the concentration exceeds 1.5 milligrams per litre. But she did, if I may say so, despite alleging that much higher concentrations are safe, say that the normal figure was between 0.9 and 1.1 milligrams, which seems to indicate that anything much in excess of that is considered unsafe. It worries me that the Government are not being as careful as they ought to be about the health and safety of the people of this country. Having said that, and in the absence of further support, all I can do is beg leave to withdraw this amendment.

Amendment, by leave, withdrawn.

[Amendment No. 2 not moved.]

Lord Sandys moved Amendment No. 3: After Clause 1, inse0rt the following new clause:

("Suspension of this Act

.—(1) The Secretary of State may by order suspend this Act if at any time he has reasonable cause to believe that evidence of danger to health has become manifest as a result of the addition of fluoride to the water supply.

(2) The Secretary of State may by order suspend this Act if at any time he has reasonable cause to believe that evidence of danger to animals, plants, or aquatic life has become manifest as a result of the addition of fluoride to the public water supply.

(3) The Sectretary of State shall present the evidence for an order of suspension under subsection (1) or (2) in a statement to each House of Parliament.

(4) The power to make orders under this section shall be exercisable by statutory instrument subject to annulment in pursuance of a resolution of either House of Parliament.")

The noble Lord said: My Lords, we return to an amendment in regard to the suspension of the Act and I believe, as do a number of my noble friends, that this is a lacuna within the structure of this Bill at the moment, particularly because the story of research into this vital subject is by no means completed.

Perhaps I may draw your Lordships' attention to two areas where current research may well yield some particularly important information. I refer in particular to the study being carried out by the Japanese into the genetic hazards of fluoride. No final report has yet been published. I understand from the Medical Research Council that work is being done and will perhaps be concluded before long. Nevertheless, should this study yield an adverse report, surely the Secretary of State will be particularly glad to have within the present structure of the Bill the opportunity to suspend the Act without further ado and to report to Parliament, as the amendment indicates, giving the reasons for doing so.

In this country work is being carried out in a number of places. Several times we have referred to the work being done in King's College, London, and also in Strathclyde University; Dr. Cedric Wilson, the consultant physician who was Professor of Pharmacology at Trinity College, Dublin, is doing work at the moment, and once again experiments are being carried out, in this particular case in regard to allergies on guinea pigs produced by fluoride. If we assume that work is being carried out all round the world, surely the need for an amendment of this nature is one of the first things to be considered? My Lords, I beg to move.

Baroness Trumpington

My Lords, I have to tell my noble friend that the Government consider that this amendment really is unnecessary, because, in the wholly hypothetical event that fluoridation were found to be unsafe, the Secretary of State already has the power to direct health authorities to terminate their fluoridation schemes and to withdraw the indemnity to statutory water undertakers. No additional statutory power is required. However, I stress yet again that the Government are convinced that fluoridation is an entirely safe procedure and that the amendment is unjustified to the extent that it seeks to suggest to the contrary. I think it is fair to say that more research has been carried out on fluoridation than on any other public health measure. Most of the evidence on this matter comes from detailed surveys of the health of communities which have been drinking either water with a natural fluoride content of around one part per million, or artificially fluoridated water at this level, for many decades.

Investigations have shown repeatedly that the small increases in the amount of fluoride in the diet that result from these concentrations of fluoride in the water supply have no ill-effects. Laboratory tests have failed to demonstrate mechanisms by which such small increases could have ill-effects. Nevertheless, my department keeps under review all literature published on the subject of fluoridation and we will continue to put any significant new work to our independent expert medical advisers. I would emphasise, however, that we consider it most unlikely that new evidence will come to light showing fluoride at these concentrations in water supplies to be unsafe. This is precisely because of the great weight of detailed evidence that already exists from direct studies of human populations which have been drinking this water for many years without ill-effect.

The department already has an interim report on new mutagenicity studies. There are no grounds at all for believing that once completed the studies will show any adverse results regarding the safety of fluoridation. Dr. Wilson's recent study, to which my noble friend referred, involves the measurement of the electrical potential in the skin of guinea pigs after fluoride has been injected into the abdominal cavity. However, this is not a recognised method for detecting an allergic response, and it is the department's view, as stated at Report stage, that Dr. Wilson has not shown that even this unnatural type of exposure gives rise to allergic reactions.

To be completely certain, we referred Dr. Wilson's study to an independent assessor and the report has just been received. The assessor's conclusion is that the findings of Dr. Wilson and his co-author cannot be sustained and that sensitisation to fluoride, whether in water or when given by injection, has not been demonstrated. It remains the case that, although every human being is exposed every day to fluoride in the diet, no case of allergy to ingested fluoride has ever been demonstrated—and we, as a nation of tea drinkers, should be prime examples. This amendment is both unnecessary and unjustified, and I must urge that it be rejected.

Lord Monson

My Lords, I should like to support this amendment. Unlike with the previous pair of amendments, there are no technical aspects involved here to confuse the issue; it is perfectly straightforward. If there is danger to health, there is danger to health; if there is not, there is not. The noble Baroness repeated the Government's contention that fluoridation is an entirely safe procedure. Not for the first time, I find myself wondering why the Government do not have the courage of their convictions and accept this amendment. It does not cost the taxpayer anything. There is nothing in the amendment which would lead to extra cost or trouble for any of the parties concerned. If they are really convinced that fluoridation is 100 per cent. safe, and that no evidence is likely to come to light in the future to force them to change their mind, what on earth do they have to lose by accepting the amendment?

Lord Ennals

My Lords, may I intervene very briefly, to say that I agree with the conclusions of the noble Baroness. I have no doubt that if it were the case—which I think is unlikely—that evidence emerged to show that fluoride was damaging people's health, it would be made widely known and no water authority or health authority in their right mind would continue with what they were doing.

Lord Sandys

My Lords, if it is the wish of your Lordships' House that this amendment be withdrawn, I shall certainly withdraw it in a moment, but before doing so, I should like to say something on the state of research into the subject. While I entirely agree with the noble Baroness that a very large amount of research has been carried out—I understand that there are over 800 different varieties of researches and reports—nevertheless there is still a divergence of opinion. This divergence is probably best shown in the work that has been done and has been commented on by Sir Richard Doll, and of course Professor Knox of Birmingham University on the one hand and that done by Dr. John Emsley of King's College, London, and many others on the opposite side—and I referred to Dr. Cedric Wilson this afternoon.

I accept entirely that if powers exist within the Bill to empower the Secretary of State to cease the fluoridation, then we need say no more in this matter. I accept the comments made by my noble friend and also by the noble Lord, Lord Ennals, in regard to this. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

5.30 p.m.

Lord Beaumont of Whitley moved Amendment No. 4: After Clause 2, insert the following new clause:

("Review by Secretary of State.

. The Secretary of State shall be under a duty to keep under review all relevant medical and scientific evidence on the effects of fluoridation and to publish a summary of the same at not less than five year intervals after the passing of this Act.").

The noble Lord said: My Lords, this amendment has little or nothing to do with the merits or otherwise of fluoridation, but it emerges as the result of the discussions in your Lordships' House. Those of us who have put our names to this amendment think that it is a necessary and desirable step to take on behalf of open government, on behalf of keeping the electorate informed and on behalf of preserving their liberties. The noble Lord, Lord Winstanley, and I do not see eye to eye on every point to do with fluoridation, but on this point we are in agreement and I think that we shall find widespread agreement within your Lordships' House. Indeed, we have it already. I hope, and would almost go so far as to say expect, that the Government will be able to accept the amendment.

The amendment merely asks the Government to do one thing which the speech of the noble Baroness has already said that they are doing, and that is to keep under review all the relevant medical and scientific evidence on the effects of fluoridation. No doubt they will continue to do that. The amendment goes on to say that that review should be published every five years. It does not say what previous amendments did, that as a result of that the whole question of fluoridation by any given water authority should be brought up again and reopened. It merely says that the state of play and the research at any given time should be made known to the public. That will involve very little public expense, and I think that what public expense there would be would be worth while.

We have discovered in the course of the passage of the Bill that there are real reservations and doubts about the addition of fluoride. It may be, as some of us think, that those doubts are totally unjustified. Nevertheless, they are not completely confined to those whom one would regard as cranks. It is clear that the reservations go much wider than that. It is certainly my attitude in putting the amendment forward that if the Government are to add substances to the ordinary drinking water of the population, without going into the rights and wrongs of that now, it should be known to the public and the effects of it or otherwise should be kept before the public. I beg to move.

Lord Houghton of Sowerby

My Lords, I strongly support the amendment. I think that it is a reasonable request. I think that there is a steady flow of opinion that fluoridation is Government policy and is being foisted on the people by the methods of the Bill. That may be a mistaken view, and it may also be wrong to think that if the health authority decides to make an application, the water authority will necessarily comply with it. The word "may" is to be found in Clause 1(1)—the, undertaker may … increase the fluoride content of the water supplied". Am I right in thinking that there is no statutory obligation upon the water authority to accept the application of the health authority? That is important.

In any case, whether or not my construction of the clause is right, the controversy will leave this House and go into the country. The bodies that will be under the most vociferous public attention will be the health authorities. They will have to face the publicity, consult and do everything else that the Bill provides for their information before they decide to make an application.

But whatever the controversy in localities and whatever the outcome of the Bill, those districts which have fluoridation are entitled to receive some kind of stocktaking of what they are doing at reasonable intervals. I do not think that the scientific and medical controversy will go away, whatever the Government do. I think that feelings will run strongly about this matter for a long time to come. Otherwise it will look as if the Bill will fluoridate the water supply of the country for ever and ever; it will become almost a habit, like taking pills. Nobody will ever know whether it is doing good. Is there to be a check-up? What about all the researches that have been done under controlled conditions and lasting over some years? What surveillance over the effect of fluoridation is to be undertaken by the Government so that the public may be informed? I think that the noble Lord who moved the amendment is absolutely right. There should be a continuing opportunity for public information about the consequences of what is being done as far as they can be discovered and they should be closely attended to. This should all be subject to debate at some future time.

This is not an exercise in the quality of water. We are not deciding whether we like the taste of it or whether it is more palatable. We are looking at it from the point of view of medication. There is no doubt that that word is right. It is medication. It is the importing of chemical substance into water supplies to bring certain ingredients up to a certain standard for health reasons. I do not know what else it is if it is not medication. But we need not quarrel over the term.

The fact of the matter is that a lot of peope do not like it. In those circumstances, I think that we need to have regard to differences in public opinion at the time of the introduction of fluoridation. I think that the review by the Secretary of State should be a statutory obligation. It will assure people that once fluoride goes in the water that is not necessarily the end of the story. They will be able to keep track of the consequences, benefits and possible drawbacks of what has been done, in many cases without their assent.

In order that we may know whether effective steps will be taken in the regions to carry this debate further where it will matter most, we want to know whether water authorities are under a statutory obligation to accept an application by the health authority or whether they have any discretion at all. The noble Earl the Minister is nodding his head, which suggests that I am right in what I have said. If that is so, I need not pursue the matter further.

Lord Winstanley

My Lords, before the noble Baroness comes to reply perhaps I may make my position clear in relation to the amendment to which I have attached my name. Noble Lords are perhaps aware that as president of the British Fluoridation Society my principal purpose in being present for these debates has been to do what I can to see that no unnecessary obstacles are allowed to impede the progress of this Bill on to the statute book. That remains my view.

However, wholly convinced as I am of the desirability of fluoridation, and also of its safety, I become increasingly concerned by the extent to which public anxiety has been aroused by discussion of this matter in your Lordships' House, in another place, and in the press. Anything that can easily be done to reassure the public about their needless anxieties, to set the record straight, and to put the facts clearly and incontrovertibly before the public seems to me to be desirable from the point of view of those of us who are in favour of fluoridation.

This amendment merely asks the Secretary of State, to keep under review all relevant medical and scientific evidence on the effects of fluoridation and to publish a summary of the same at not less than five year intervals after the passing of this Act". It is my understanding that the Secretary of State already has a statutory duty to keep under review all the relevant medical and scientific evidence on the effects of fluoridation. He already has that statutory duty.

It is possible that the scientific evidence that has accumulated is published in the Department of Health and Social Security's scientific reports from time to time, but I should like to be reassured on that point. Therefore, it may be that the noble Baroness will be able to tell the House that the action requested in the amendment will in fact be taken but that it is not necessary to incorporate the amendment in the Bill. If the noble Baroness can say that, then I shall be much relieved. I hope that she can do so.

Lord Sandys

My Lords, I should like to support this amendment because I feel that a review is very necessary. I should particularly like to refer to the question that was raised at Report stage, when I drew the attention of my noble friend Lady Trumpington to Lord Jauncey's judgment in regard to the whole aspect of the Medicines Act and in respect of the supposition which the Government make that fluoridation does not fall within Section 130(3) of that Act.

It is still my submission that further studies should be made of Lord Jauncey's judgment. I drew attention to pages 386 to 392, which detail two matters. The first is, that no product licence is required for fluoridation. That is not disputed, but it was Lord Jauncey's claim that fluoridation does fall within the provisions of the Medicines Act. Therefore, this matter still requires the consideration of the Government in that regard.

If that is so, I agree entirely with what was said earlier by the noble Lord, Lord Houghton, that fluoridation is medication and nothing else. I feel that this amendment in particular deserves our attention. I hope that my noble friend will give serious consideration to the matter with which it deals, which is clearly arousing much interest on all sides of the House.

Lord Charteris

My Lords, this is a very interesting amendment, as it has support from both sides of the argument; by the noble Lord, Lord Winstanley, who is very keen on our water being fluoridated, and by others of us who are very keen on our water not being fluoridated unless we have a chance to talk about it. It therefore seems to me that this amendment should be very seductive to the Government.

The amendment asks the Secretary of State to do something that I am sure he is going to do anyway. It merely asks whether he will, every five years or so, let the rest of us know what the results of the medical and scientific investigations are. The real point of this is—as the noble Lord, Lord Winstanley, said—that it will allay the very natural and real concern that exists among many people about artificial fluoridation of water.

I hope that the Government are right when they say that there is no danger in fluoridating water, but the fear of danger is very real. That has been shown by the almost monotonous regularity with which any democratically-elected body given a chance to consider this question goes against it. That has happened in Anglesey, Staffordshire, Shropshire, Gloucestershire, Herefordshire and Worcestershire. Such is happening not only in this country but all over the world.

5.45 p.m.

I have no doubt that the noble Baroness knows about the report that was published in the Timaru Herald of 24th January. Timaru is in New Zealand, as I am sure your Lordships know. The report stated: As a result of Dr. J. P. van Herel of Timaru writing to the city council on behalf of 2,850 patients listing the risks involved in drinking fluoridated water, the city council voted to cut fluoridation by 50 per cent". I am not sure how strong democratic control is in Timaru and whether what was said should happen did happen, but the fact that it was said shows that there is much concern about this matter, not only in this country but also in New Zealand.

As I said earlier, I hope very much that the Government are right in thinking that no danger can arise from the fluoridation of water. I must say that I find the general attitude towards this matter rather like that which I encountered a week or two ago in Wales, when I met a fundamentalist clergyman. He was able, with a kind of virginal conviction, to cast aside all evidence produced by Darwin and others concerning evolution, and said that everything was exactly as written in the Bible. As I am sure your Lordships know, there are at least two different accounts of the Creation. The clergyman did not say which he was favouring but made it quite clear that the Bible was right and all other evidence was wrong. All I am saying is that it would be sensible to accept this amendment.

Lord Colwyn

My Lords, I hate to go over old ground again and again but the House must remember that in 1976 the Royal College of Physicians undertook a major review of all the available publications on fluoridation. The committee consisted of 14 eminent specialists in the areas of general medicine, paediatrics, community medicine, toxicology, epidemiology and genetics. They met over a period of 18 months and examied all available evidence. They produced a list of all the disorders claimed to be attributable to water fluoridation. These ranged from the trivial, such as flatulence, to the more serious, such as congenital malformations, heart disease and cancer.

Most of the listed disorders were claimed by two persons, Waldbott and Spira, who claimed also that all kinds of allergic reactions could be attributed to fluoride in drinking water. Those who made such claims concerning health hazards often overlooked the difference between inorganic and organic fluorides, or between fluoride in drinking water at one part per million and the concentrations used in certain test tube or animal experiments.

We have heard it said that fluoride added to drinking water differs from that naturally present, but I can assure your Lordships that, due to complete ionisation, that is not the case and the fluoride ion is identical. I reject the criticisms made. The words of the amendment are unnecessary and I feel sure that the aspects mentioned by the noble Lord, Lord Winstanley, when speaking to the amendment are adequately covered in the existing words of the Bill.

Lord Campbell of Croy

My Lords, I do not know what the Government intend to do with this amendment. No doubt they will consider the question of whether a review would be a sensible part of this Bill. I should like to ask those noble Lords who have put their names to this amendment whether the word "fluoridation" embraces also the natural fluoridation that exists in all supplies of water for drinking in this country.

For example, in various parts of Essex and in the Hartlepools and South Shields, the water already contains more fluoride than one part per million and therefore more than the optimum concentration proposed in this Bill. Is it really suggested that there should be a review every five years of areas where fluoride already exists in the water at concentrations even higher than the optimum amount? People in those areas have been lucky enough to enjoy excellent teeth for generations. That is one reason why I am a supporter of the Government's Bill.

My noble friend Lord Colwyn, who is a dentist, has pointed out that there is no difference in effect in the fluoride that already exists in natural supplies of water in every part of this country. I would therefore ask those who are moving the amendment and who have their names to it, whether they consider that a review should take place in those areas where the water already contains the optimum amount or more.

Baroness Trumpington

My Lords, in replying to this amendment, I should like to make it clear at the outset that the Government already accept that they have a duty to keep under review all the relevant medical and scientific evidence on the effects of fluoridation. This has been the position of successive Governments in this country since the 1950s when fluoridation was first considered and then introduced. The noble Lord, Lord Houghton, is quite right. There is no statutory obligation for water authorities to accept applications for fluoridation from a health authority. However, the Secretary of State already has a clear obligation to monitor the safety of any public health measure, in that he is answerable on these matters to Parliament.

With reference to the other point mentioned by the noble Lord, Lord Houghton, fluoridation contractual arrangements are for a fixed term. There are, therefore, periodic opportunities for both health and water authorities to reconsider their position. My noble friend Lord Sandys raised a question in relation to the Medicines Act. My noble friend has argued that hexafluorosilicic acid and disodium hexafluorosilicate should be considered as medicinal products falling within the provisions of the Medicines Act. The Government's legal advice is that neither of these chemicals, nor water fluoridated with them, are medicinal products within the meaning of the Medicines Act.

I can assure the House that the Government will continue to monitor all new published evidence that we are able to identify through regular computer searches. And, of course, health Ministers will continue to be answerable to this House on these important issues. The DHSS will also undertake, in the guidance to be issued to health authorities following enactment of the Bill, to bring to their attention any significant new developments regarding the safety and efficiency of fluoridation. We shall, of course, ensure that Parliament is also made aware of these. Against the background of the assurances that I have given, I hope that noble Lords will agree to withdraw their amendment.

Lord Beaumont of Whitley

My Lords, the House is, I think, united behind the feeling in this amendment. The noble Lord, Lord Colwyn, spoke on the general subject and agreed very strongly with my noble friend Lord Winstanley, whose name appears to this amendment. The noble Lord, Lord Campbell of Croy, raised the point of natural fluoride. All relevant medical and scientific evidence on the effects of fluoridation will, I believe, necessarily include all relevant medical and scientific evidence on the effects of fluoride. In fact, this amendment asks only for a report on fluoridation which, it is clear, is the addition of fluoride to drinking water.

I was extremely encouraged by the reply of the noble Baroness on this point. If I have any doubt, it is that I was not able to take in absolutely what, I believe, was the assurance she gave. The first half of her remarks I understand completely. The department will keep under review all the evidence and will continue to do so. I accept this absolutely. The noble Baroness then went on to talk about—I did not write this down, and I hope therefore that she will repeat it—drawing the attention of water authorities and of the general public, although I am not quite clear about the latter, to additional evidence that may be forthcoming after the Bill is passed.

Is it the case that the medical and scientific evidence that is being kept under review will be available to the public in an easily ascertainable form—I do not mean merely in learned journals—as a result of what the DHSS is undertaking to do? If so, I, for my part—I cannot, of course, answer for my colleagues who have put their names to this amendment—would be happy to withdraw the amendment. It is a question of whether the evidence really will be easily available to those people who have genuine doubts and who are not up to date, and do not keep up to date, with all the scientific evidence or indeed with the more recherchéé documents of the DHSS, particularly ones that would go only to the water authorities as such and would not necessarily go to the general public. In order for me to accept what is, so far as it goes, a good assurance, there must be publication to the general public.

Baroness Trumpington

My Lords, I am absolutely delighted to repeat what I said for the benefit of the noble Lord, Lord Beaumont. I said that the DHSS will also undertake, in the guidance that is to be issued to health authorities following enactment of this Bill, to bring to their attention any significant new developments regarding the safety and efficacy of fluoridation; and we shall, of course, ensure that Parliament is also made aware of these. I would add that studies of fluoridation commissioned by the department are published and will continue to be published. Anything of interest would naturally be taken up by the press. I hope that that answers the noble Lord.

Lord Beaumont of Whitley

My Lords, I think that it does. It is reassuring to have the undertaking that the evidence will not only be kept under review but that it will also be imparted to Parliament. I think that this meets the point. Therefore, unless any of my colleagues differ, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 3 [Continuity of existing fluoridation schemes]:

Lord Burton moved Amendment No. 5: Page 2, line 32, leave out ("subsection (2)") and insert ("subsections (2) and (2A)").

The noble Lord said: My Lords, with the leave of the House, I should like to speak to Amendments Nos. 5 and 6 together.

Amendment No. 6: Page 2, line 41, at end insert— ("(2A) Section 4 of this Act shall apply to a scheme or work under subsection (1) above as if the water undertaker were a Health Authority which proposed to implement the scheme or work four months after the commencement of this Act.").

Both amendments relate to the same subject. This may appear to be a new matter and therefore not suitable for Third Reading. However, your Lordships may remember that my noble friends on the Front Bench introduced a new clause, now Clause 4, on Report. There was an attempt to put the Bill back into Committee to permit this to be discussed. Unfortunately, the Government resisted this, and we had to remain on Report. When I drew attention to the fact that, as at present worded, there would be many supplies already being fluoridated to which the consultation procedures approved by the Government would not apply, my noble friend said that she did not understand my point. Under the rules of the House, I was not in a position to give her further enlightenment.

The only recourse open to me was to seek to move this amendment on Third Reading. It may seem strange that to change the operation of Clause 4 it has been necessary to introduce this amendment to Clause 3. I can, however, assure your Lordships that drafting was not easy, and this seemed the tidiest way in which to operate. Having drawn attention to the matter, and if the Government have faith in their own Clause 4, one might have expected them to introduce their own amendment, if I may I shall now explain in rather greater detail the need for it.

Currently 5 million people in England and Wales receive fluoridated water. If my amendment is not accepted, these people will never be given an opportunity to express their views as to whether or not they wish to have their water supplies fluoridated. The Government have granted some powers of consultation as regards any new schemes, but there are no such powers for existing schemes. If they have granted powers for one, why not for the others? It seems to be totally unfair to leave matters as they are, and therefore I believe that my amendment is fair, equitable and reasonable.

6 p.m.

No doubt my noble friend the Minister will tell us that any schemes prior to 1974 had democratic approval, as in those days the health authorities were the local authorities and had been duly elected. However, that was more than 10 years ago and much has been learned in the interim. Indeed, during that time several countries have given up fluoridating their water supplies. It was 25 years ago that Anglesey started to fluoridate, and if this amendment is not approved Anglesey will be landed with fluoridation for ever and a day, in spite of the fact that most, if not all, of the democratically-elected bodies affecting Anglesey are now against it. It seems most unfair that they should not be given an opportunity to press their view.

Lord Ennals

My Lords, if the next amendment, Amendment No. 7, is agreed to, the noble Lord's worries would be met, would they not? Amendment No. 7: Clause 4, page 3, line 27, at end insert ("and shall only proceed with the proposal if the consultations produce an affirmative response from the local authorities concerned.").

Amendment No. 7 would authorise decisions to be taken by local authorities.

Lord Burton

My Lords, we are not discussing Amendment No. 7; we are discussing Amendments Nos. 5 and 6. I believe that this is the simplest and easiest way of dealing with the matter. Since 1974 there have been several schemes, notably in the areas covered by the West Midlands Regional Health Authority and the Severn-Trent Water Authority. They are areas with large populations, and it seems quite unreasonable that those people should be deprived of any right of consultation.

Prior to the introduction of fluoridation in the areas of those two authorities, a national opinion poll was conducted for the West Midlands Regional Health Authority. The question asked was: "Do you think fluoride should be added to water if it can reduce tooth decay?" What will anyone answer to that but, "Yes, if it has no other effect". It seems a ridiculous question to ask. In 1981 the anti-fluoridation campaign employed a research organisation to conduct a poll and the question then asked was: "Do you think people should be allowed to choose whether or not they and their children will have more fluoride added to their drinking water"? In answer to that, 67 per cent. said yes, they should be allowed to choose; 22 per cent. said no; and 11 per cent. did not know. If that is the case, surely we should give, not a small section of the community a right to have consultation but these 5 million people who will be completely disfranchised if we leave matters as they are. They should be allowed to have their say. I beg to move Amendment No. 5.

Lord Sandys

My Lords, I should like to support most warmly my noble friend's amendment. I do so for a particular reason. In Committee, I drew your Lordships' attention to the situation in the West Midlands, which was referred to by my noble friend, and in particular I mentioned the Severn-Trent Water Authority. I should like to amplify what my noble friend has said in regard to those who will be disfranchised, and that is the important word. Out of a total of 266 elected councils in the Severn-Trent region which had debated, thought about and ultimately voted upon fluoridation, 205 voted against the practice. Yet their democratically-reached decisions were overruled by the powerful non-elected bodies in those areas. Indeed, 205 out of 266 is a very high proportion of those who were disfranchised and who as I understand it, will have no opportunity once again to express their perfectly valid choice and views in this matter.

My noble friend Lord Burton has pursued this matter with great dexterity, because it required considerable skill in drafting to achieve these two interlocking amendments. I realise that at the moment we are speaking to Amendment No. 5, which my noble friend has so lucidly moved, but nevertheless the two interlock. The noble Lord, Lord Ennals, has suggested that Amendment No. 7 would render Amendments Nos. 5 and 6 unnecessary. I do not believe that to be the case. I think that Amendments Nos. 5 and 6 are desirable because they would fulfil another function which concerns those bodies and persons, to whom I have referred, who will be disfranchised if the present Bill before your Lordships becomes an Act.

Therefore, I think that this amendment, is worthy of your Lordships' attention. We have not had the opportunity of having discussions about it at an earlier stage, for the reasons given. However, I think it is most definitely worth further consideration, and I urge my noble friend the Minister to consider the matter.

Lord Campbell of Croy

My Lords, I am glad to be able to speak on an amendment moved by my noble friend Lord Burton, whose home is near mine in northern Scotland and where we enjoy sparkling Highland water which contains a due amount of fluoride. It does not contain quite the one part per million, but it contains enough to be part of the British supply of natural drinking water, which all contains fluoride.

I can appreciate my noble friend's point about consultation. During the various stages of this Bill the Government have done everything possible to ensure consultation at every level and at every stage. I recognise that if Amendment No. 7 is accepted, as the noble Lord, Lord Ennals, said, it would cover the point which my noble friend has raised.

I agree with everything that has been said during the various stages of this Bill about the need for consultation. However, we do not want to have so many stages of consultation that nothing ever happens or that people become frightened about bogies that do not really exist. My noble friend mentioned the 5 million people who he says will be disfranchised. I should mention that nearly 2 million people in this country enjoy the right amount of fluoride in their natural supplies, anyway. Are they to be included in this? I understand that they are not to be included, and in any case it would be rather difficult to remove fluoride which already exists in optimum quantities in the water. Therefore, while we consider the 5 million people, let us remember that nearly 2 million people already enjoy the optimum amount of fluoride in their natural supplies of water in various parts of the country.

I should like to emphasise a point that I made earlier when this Bill was proceeding through this House. For the future health of the population of this country—and I speak as a former Minister of Health—the really effective age is the age 0 to 2. Everything that is said about leaving it to the individual to include fluoride in toothpaste, and so on—and my noble friend repeated it again today—does not apply to a small baby. We must accept that it is at that early age when fluoride is most effective in stopping tooth decay. That is one of the most important provisions in the Bill. Although I recognise the need for full consultation—and no doubt my noble friend the Minister will comment on this when she deals with Amendment No. 7—I must again emphasise that the kind of concern which my noble friend has raised is unnecessary.

Viscount Monckton of Brenchley

My Lords, as an Englishman, I have always assumed that Scottish water was highly dangerous unless mixed with the local whisky. What those of us who feel against this Bill but accept it reluctantly at this stage, and therefore support this amendment, is that it may be good for children from nought to two. What we do not know is the long-term effect of continued use, and how it can be safely done.

Lord Campbell of Croy

No, that has been proved.

Viscount Monckton of Brenchley

My Lords, I do not believe it. Therefore, I support this amendment.

Baroness Trumpington

My Lords, my noble friend Lord Burton has raised with this amendment a point that we have not discussed in detail before, as he said, and I welcome the opportunity to do so now. 1 am equally grateful to my noble friend Lord Campbell of Croy for his helpful remarks. I should also like to congratulate the noble Viscount, Lord Monckton of Brenchley, who looks so incredibly well that I feel that he must live in a fluoridated area.

The purpose of the amendment is to require public consultation to be carried out on the existing fluoridation schemes in much the same way as laid down in Clause 4 of the Bill for the purpose of proposals for new schemes or the termination of existing schemes. I should first of all like to remind your Lordships that it has always been a requirement of the department that fluoridation schemes should be introduced only after full consultation of local opinion. The only difference between the past situation and the provisions in Clause 4 of the Bill is that we are now making specific provisions as to which bodies are to be consulted and how consultation is to take place.

I must also advise your Lordships that the pattern of consultation already undertaken for existing schemes divides into two categories. Most of the smaller schemes in England and Wales were introduced before the 1974 reorganisation of the Health Service and in consequence decisions were taken by elected local authorities after whatever forms of consultation of public opinion they chose to hold such as public meetings, etc. The remaining schemes are almost all included in the West Midlands Regional Health Authority fluoridation plan which followed Health Service reorganisation.

I would remind your Lordships that there was extensive consultation of public opinion by the West Midlands Health Authority before they decided to implement fluoridation. Thus opinion polls, which were independently conducted, found that upwards of 60 per cent., and in some areas 70 per cent. of those polled were in favour of water fluoridation. Equally, the Severn-Trent Water authority has made it a condition of undertaking water fluoridation for the West Midlands Regional Health Authority that a majority of Community Health Councils should be in favour.

In the light of these reassurances as to the extent to which consultation has taken place on existing schemes, I hope that your Lordships will agree that there is no reason why there should be further reconsultation as the amendment would provide. As we have stressed to the House before, fluoridation is a long-term investment for our children and our children's children which must not be subject to stop-go decision-making if the benefits are to be reaped.

The Bill deliberately does not attempt to rewrite history either by requiring further public consultation on existing schemes, as this amendment proposes, or by requiring renewed public consultation in areas where fluoridation has ceased. The Government believe that we should not seek to restart public consultation on either existing schemes or schemes which have already been terminated, and I must therefore ask my noble friend Lord Burton to withdraw his amendment.

Lord Burton

My Lords, I find that response disappointing. Some of those authorities which have been fluoridated go back 25 years, such as the Anglesey one that I quoted. There are others which must have been at least 10 years, because it was 1974. They have had no chance of consultation since then.

May I mention what my noble friend Lord Campbell of Croy said. He said that our Scottish supplies were fluoridated. Lord Jauncey stopped any artificial fluoridation in Scotland. They are not being fluoridated artificially any more.

Lord Campbell of Croy

My Lords, would my noble friend give way? My noble friend has completely misunderstood me. I said nothing about Scottish supplies in what I said. What Lord Jauncey did was to find that the original Act did not carry out what everybody thought it carried out. I said nothing in my intervention about Scottish supplies. I was speaking about the one or two million people in Britain as a whole, who happen to be in England and Wales and not in Scotland, who already enjoy the optimum amount of fluoride in their natural drinking water supplies.

Lord Burton

My Lords, I cannot have been the only one who misheard the noble Lord, because we had a comment about what you add to your water shortly afterwards, and that referred to Scottish water. However, that is by the way. I am pleased to say that so far as I am concerned I am not really affected, because I get it straight off the hill, mainly straight from the heavens, so that it is not likely to have much fluorine in it so far as I am concerned, but I am thinking of other people.

My noble friend, Lord Campbell of Croy also referred to excessive consultation. What I say is that these 5 million people will not be given the chance of consultation, and we are asking that they should be consulted immediately after this Bill comes into operation.

As regards Amendment No. 7, I am sorry but in the middle of talking I could not look at the amendment to pick up what had been said by the noble Lord, Lord Ennals. Amendment No. 7 would apply only to the new schemes. It does not apply to existing schemes. This is quite simple. It is not a question of whether we should, or should not, fluoridate. It is a question of whether new schemes which the Government have agreed, and have put in a new clause to this effect, should be given the right of consultation. If that is the case, why should not existing schemes be given the same right? This seems reasonable. I am sorry that the Minister has not seen fit to accept it. It would not be reasonable to withdraw the amendment.

6.17 p.m.

On Question, Whether the said amendment (No. 5) shall be agreed to?

Their Lordships divided: Contents, 34; Not-Contents, 88.

DIVISION NO. 2
CONTENTS
Bauer, L.	Holderness, L.
Beaumont of Whitley, L.	Houghton of Sowerby, L.
Boyd-Carpenter, L.	Ingleby, V.
Briginshaw, L.	Kilbracken, L.
Bruce of Donington, L.	Kinnoull, E.
Burton, L. [Teller.]	McNair, L.
Charteris of Amisfield, L.	Monckton of Brenchley, V
Craigmyle, L.	Monson, L.
Davies of Leek, L.	Moyne, L.
Dean of Beswick, L.	Mulley, L.
Elystan-Morgan, L.	Nicol, B.
Ennals, L.	Ponsonby of Shulbrede, L.
Ferrier, L.	Ritchie of Dundee, L.
Galpern, L.	Sandys, L. [Teller.]
Grey, E.	Stoddart of Swindon, L.
Hanworth, V.	Strabolgi, L.
Harris of High Cross, L.	Yarborough, E.

NOT-CONTENTS
Abinger, L.	Lucas of Chilworth, L.
Annan, L.	Mclntosh of Haringey, L.
Arran, E.	Mancroft, L.
Attlee, E.	Massereene and Ferrard, V.
Avebury, L.	Mayhew, L.
Aylestone, L.	Merrivale, L.
Belhaven and Stenton, L.	Mishcon, L.
Beloff, L.	Molson, L.
Belstead, L.	Montgomery of Alamein, V.
Bessborough, E.	Morris, L.
Blease, L.	Mottistone, L.
Bottomley, L.	Mountevans, L.
Brabazon of Tara, L.	Munster, E.
Brougham and Vaux, L.	Murton of Lindisfarne, L.
Caithness, E.	Orkney, E.
Campbell of Alloway, L.	Peyton of Yeovil, L.
Campbell of Croy, L.	Rankeillour, L.
Colwyn, L.	Reay, L.
Constantine of Stanmore, L.	Renton, L.
Cork and Orrery, E.	Ridley, V.
Craigavon, V.	St. Aldwyn, E.
Denham, L. [Teller.]	Shannon, E.
Denning, L.	Shepherd, L.
Diamond, L.	Silkin of Dulwich, L.
Dilhorne, V.	Skelmersdale, L.
Drumalbyn, L.	Smith, L.
Eccles, V.	Somers, L.
Elliott of Morpeth, L.	Stedman, B.
Elton, L.	Sudeley, L.
Faithfull, B.	Swansea, L.
Gardner of Parkes, B.	Swinfen, L.
Glanusk, L.	Swinton, E. [Teller.]
Gridley, L.	Taylor of Mansfield, L.
Hailsham of Saint Marylebone, L.	Terrington, L.
	Teynham, L.
Hardinge of Penshurst, L.	Trefgarne, L.
Harris of Greenwich, L.	Trumpington, B.
Hooper, B.	Vaux of Harrowden, L.
Hylton-Foster, B.	Vickers, B.
Kilmarnock, L.	Vivian, L.
Kinnaird, L.	White, B.
Kirkhill, L.	Whitelaw, V.
Lane-Fox, B.	Winstanley, L.
Lindsey and Abingdon, E.	Wise, L.
Long, V.

Resolved in the negative, and amendment disagreed to accordingly.

[Amendment No. 6 not moved.]

6.26 p.m.

Clause 4 [Publicity and consultation]:

Lord Ennals moved Amendment No. 7:

[Printed earlier.]

The noble Lord said: My Lords, it has been interesting throughout all the stages of this Bill that all political parties have been divided on the advisability of fluoridation. The Liberal Party has been divided. My own party does not have a party line. The Conservative Party and the Cross-Benches are divided. However, I have sensed increasingly from the debates that there are certain matters on which there is agreement. This concerns consultation and is the purpose of my amendment.

I must put my own position. I believe that on all the evidence available to me the ingestion of an appropriate amount of fluoride is important for the dental health of the public and especially of our children. The questions to which this amendment addresses itself are: how should this be done, how should the consultation be conducted and how should the decisions be taken?

I pay my tribute to the noble Baroness, who at the Report stage introduced an amendment about consultation. It will be recalled that at the Report stage I moved an amendment, as I am now moving Amendment No. 7, which is slightly different from the one moved on Report. I did not press this to a Division at Report stage, because at that time it was half-past eleven and it seemed to me that issues affecting the whole of the nation should not lightly be taken in your Lordships' House at that time of night. I therefore gave notice that I would move a similar amendment again during this stage.

The noble Baroness has taken us some distance. She has inserted in Clause 4(3): Before implementing the proposal the health authority shall consult each of the local authorities (if any) to whom they are required by subsection (2)(b) above to give notice of the proposal". The real problem is that the decision-making as left in the Bill is done entirely by non-elected bodies. The health authority quite clearly is a non-elected body. We know that the majority of health authorities are likely to recommend that there should be fluoridation. They will make that recommendation directly to the water authorities. The water authorities have clearly said that they do not want to have this decision forced upon them. They, like health authorities, are not elected but are appointed bodies.

I am speaking as a result of representations made to me by the Water Authorities Association. They said what I repeated on Second Reading, that they did not wish to be put into a situation where they had to take a decision on something relating to the health of the nation, which was, quite frankly, not an area in which they believed they had competence".—[Official Report, 4/6/85; col. 722].

I find it difficult to believe that that is not absolutely fair and reasonable. Why should we put upon a body who are responsible for providing water to the country the requirement to change the way in which they have done it for what can only be sound or unsound reasons (according to the views of your Lordships) and that they should have to decide whether or not they should put fluoride in the water? It seems to me that the water authority is not the body that should decide this, because it is not in any way an elected authority. Frankly, I wish that I had so worded my amendment that I had taken in the points made by the noble Lord, Lord Burton. I congratulate him on the way in which he introduced his amendment. Perhaps if we had had it before us during the Committee and Report stages, I might have been wiser than I was and put in an amendment which would have dealt with his considerations as well.

The noble Baroness has said that local authorities must be consulted. What does that mean? The health authority goes to a local authority and says, for example, "We are about to propose to the water authority that the water should be fluoridated". I believe that 95 per cent. of the health authorities will so decide. What do the local authority do? They have been consulted; they have been informed. Is it expected of them that they should have some consideration on this? And, if they do have some consideration, is it expected that the health authority would be bound by it? There is nothing to suggest this.

I say with respect to the noble Baroness that consultation can be made a nonsense if no one is bound to take any notice of the outcome of consultation. It can be made absolute nonsense. You can see it in all sorts of fields in which organisations are told about something; they may react or they may not react. The Government say, "We have had wide consultation"—as no doubt they would say that they had with local authorities, that they had to tell them about it. But a local authority which is not required to take a decision is not going to take a decision. Why should local councillors stick their necks out and start taking decisions, as they should properly take decisions, unless they are required to do so?

So the argument that I put forward—and I shall try to put it as briefly as I can because I argued it at much greater length at a much later hour of the night—is that the decision itself should be taken by the local authority; that the health authority should consider and make their recommendations and that as part of the consultation with local authorities the health authority must be bound by the elected local authority.

Reference was made by the noble Baroness to public meetings. I am all for public meetings. Why should not the issue be debated? I think that there is a strong case for having local referenda, as they have done in Wales in relation to rules on drink on Sundays. I think that this is the sort of issue on which there ought to be general interest. Simply to fool people about consultation cannot be right. I have given my views about fluoridation. We have different methods of doing it and we have further amendments down. But I believe that the general public should not simply be taken by the nose by bodies that are not elected.

I believe, therefore, that if the health authority so decide, they could go to the local authority and the local authority should be asked to take decisions. When the local authority take a decision, one way or another, the matter is not then sent to the water authority. Many people, we know, may greatly object to it. I may disagree with them; but they greatly object to it. It is an extremely controversial question.

If you have a controversial question, the best way to decide it is by election. What have we got local government for? I believe that local councillors who have to be voted in or voted out at the next election should have to stand up and be counted in the council chamber. I believe that every individual, whether he is in favour (as many are) or against (as some are) should be able to make their respresentations to their local councillors, to go to talk to them at their surgeries and make their representations.

I simply argue that for the Government to say, as they do too often, "We know best. Of course we shall consult; but we do not have to take any notice of it, or rather the health authorities do not have to take any notice of it", makes a nonsense of the word "consultation". I hope that the noble Baroness will accept this but I fear that she will not, because I heard her reply in the previous debate. But I believe and hope that your Lordships will feel that there should be proper consultation and that that must mean decision-making by elected bodies. Too many decisions are now taken in this country by appointed bodies and not enough decisions are taken by elected bodies.

Lord Campbell of Croy

My Lords, before the noble Lord moves his amendment, perhaps I may ask him one question. During the course of his remarks—and I think he made a cogent case for the local authorities' decision—he said that he expected, if I heard him aright, that about 95 per cent. of the health authorities in the country would recommend fluoridation. Can he tell us the reasons he thinks such a high percentage would do so?

Lord Ennals

My Lords, the reason is quite clear. I may slightly have exaggerated the percentage. It might be 92 per cent. or something like that. I have been in correspondence on the initiative of the National Association of Health Authorities who have consulted with their health authorities; and the vast majority of them—I do not know whether the percentage is 94, 92 or 95; I cannot be precise and perhaps it was silly to say 95—are likely to make that recommendation. Similarly, I had discussions with the Association of Water Authorities. They said, "We don't want to have to take these decisions. Surely they ought to be taken by people who are actually elected to take decisions".

Lord Maude of Stratford-upon-Avon

My Lords, I rise to support very strongly the important amendment moved by the noble Lord, Lord Ennals. I cannot really believe that the Government can conscientiously reject it—because what is the meaning of consultation if nobody takes any notice of the consultation and of the views that are expressed by the people consulted? Secondly, since we are talking about consulting elected authorities where all the other people involved are unelected, it makes an absolute nonsense of the democratic principle that you bow to those who are unelected but ignore those who have been elected.

This is quite obviously a democratic safeguard which ought to be introduced into this Bill. Frankly, the whole business of consultation is so much eyewash unless this provision is inserted. I hope very much that the noble Lord will press this amendment and I hope very much that the Government will be sensible enough to accept it.

Lord Houghton of Sowerby

My Lords, what this Bill does is to say to the people, "We think that fluoridation of your water is so good for you that we dare not entrust the final decision whether or not to have it to you. We must listen to what you say but we need only have such regard as we consider appropriate to what you say before reaching a decision; but we are not bound to take any notice of what you say". It seems to me that this amendment is the final test of the democratic principle in this Bill, and indeed in what we are doing not only in this Bill but probably in other directions as well.

What the Government have not the courage to do is to say to people, "Smoking is so bad for you that whether you like it or not—but we will listen to what you have to say—eventually we shall reserve the right to take statutory steps to see that tobacco is placed outside your reach". That is what they have done with drugs. The Government say, "Drugs are so dreadful, because they are eating into the fabric of the nation and young people are falling for them, that we cannot allow them to get into the hands of the people except on medical prescription. We shall use the strongest measures to suppress any illicit traffic". This is really the Government's position.

The truth is that no matter how democratic we are in principle, all governments lack confidence in democracy. They do not like it; they do not want too much of it; it gets in the way; they have to listen to people too much. It is only when we get near to an election that they will listen enough and say, "We will put your noises in our noises, which is called a manifesto, but we do not guarantee to fulfil it: we hope you will forget it and by the time we come to you again, we shall have a new lot for you to think about". This is democracy in practice and one is bound to be cynical about it. Any noble Lord who has been in politics for 35 years and still has all his ideals intact has not been listening. A healthy degree of cynicism is essential to maintain one in political life, with a sense of humour added to it.

I find it very difficult to have patience with a discussion of this kind because I know what is at the root of this matter. This Bill represents a sleight of hand against the public; there is no doubt about it. If the Government are so convinced that fluoridation is good for us and is essential in the interests of the dental health of children, they should introduce a Bill so that Parliament can decide whether or not it shall be imposed upon the public. Then we would see what would happen; because I think that people do have a very understandable fear of pollution, of having things which are essential to their standard of living being tampered with. They are probably deceived in the matter of food content, additives and so on, and what they do not see they probably do not realise may be harmful to them.

However, there is an uneasiness that somehow or other we are being doped, medicated and misled and that we are in the hands of the hidden persuaders, so that we can hardly call our living our own. This is all part of it, and I think there is only one way, which is the one mentioned just now by the noble Lord who has just spoken. We have to put it to the test of democratic assent. There is no other way, if one is dealing with something which comes close to strong feelings and emotions. Fear may be unjustified but it is there, and the only way to deal with it is to submit the matter to a referendum of the people, one way or another, according to our democratic system.

There is one water authority, which I regret I cannot mention by name because the information was on a sheet of paper which came to me and which I left behind in the Library and have not been able to recover. The paper said that one water authority had already made it known—and this is why I asked a question of the noble Baroness earlier—that they will not put the fluoride in the water without a referendum to consumers. They believe that they are responsible to their consumers and they are not going to be a party to this unless they have consent. Therefore, I wondered whether the word "may" was an important word in Clause 1; and indeed it appears to be.

The Government should not be afraid of democracy. They should put it to the test, and if people do not like it they should not have it. There are alternatives to this. No one need go without the benefits of fluoridation if they want them. I shall be referring in a later amendment to one alternative so far as children are concerned. But as regards the present Bill, with all the elaborate publicity and consultation which the noble Baroness was so proud of when she spoke at Report stage, one reads Clause 4 of the Bill and sees what has to be done and how much "blah" has to be spread around, and then comes to the words: in determining whether or not to proceed, [they] shall have such regard as they consider appropriate— (a) to any representations which have been made to them with respect to it; and (b) to any consultations held under subsection (3) above. Really, my Lords, what is in the tail of the publicity story is contempt for those whom you have consulted—not even the words "have due regard" appear. Of course there is a later amendment on this but we do not see even such words as, "having due weight to" or "having full weight to". It is amazing what discoveries one can make in a Bill, going through it for a second or third time. We see these words in this clause: have such regard as they consider appropriate". Can anything be more patronising than those words, the terms of reference of the health authority?

Therefore, I think this is the test of the Bill. Are the Government going to concede something to the democratic principle, or are they going to have it in the hands of combined nominees on authorities, responsible to nobody but themselves, with an addition of nominated elected representatives from local authorities, with no direct accountability to the people in any democratic form? That is really what we are considering now, and I sincerely hope the Government will understand that here we are in the final stages of the Bill, and we want more democracy in the process of decision taking.

6.45 p.m.

Lord Campbell of Croy

My Lords, I certainly agree with the noble Lord, Lord Houghton, that the decisions in connection with this Bill should be taken democratically. I shall listen with interest to my noble friend the Minister when she replies to this debate as to whether she thinks the necessary degree of consultation is already in the Bill or whether this addition is necessary.

I should like to draw attention to what I thought was the most significant part of the speech made by the noble Lord, Lord Ennals, when he said he thought that about 95 per cent. of the health authorities would be recommending fluoridation. He was good enough to give way to me when I questioned him, and he said he thought that it might be 92 per cent. Of course, it does not make any difference to me whether the figure is 92 or 95 per cent. What he is saying is that all over the country, excluding Northern Ireland—England, Wales and Scotland—he expects the authorities who are basically responsible in the areas for the health of this country will be recommending fluoridation to the extent of over 90 per cent.

Some people here might well think this is a conspiracy of some kind; but can it really be suggested that those people who are there because they are experts in health matters or in the administration of health and who are there because their only concern is to promote the health of the country have anything to gain by causing difficulties or bad health? They are making a recommendation on that scale, and that is really very significant. The noble Lord, Lord Ennals, was a very distinguished Secretary of State for Health and Social Security—that was his title in those days—and he is really speaking with some authority and knowledge in these matters. I would draw your Lordships' attention to that fact.

The final decision in these matters will be taken no doubt after consultation, which is in the Bill already, and the degree of it will be decided no doubt by amendments which are made to this Bill. I am certainly in favour of elected representatives being fully consulted, but those elected representatives should bear in mind that the people who have only one interest in the matter—that is, the health of the country—appear to be going to recommend the fluoridation of water to this degree: over 90 per cent. of them, according to a former Secretary of State for Health for England and Wales. I would, as I say, draw attention to that, and I hope that those local authorities in due course will pay attention to the advice they are given. After all, they have no axes to grind; they do not have to look over their shoulders at constituents who have been unduly frightened by some alarmist proaganda, and so on. They are concerned only with the health of the country and therefore I would draw that to the attention of your Lordships' House.

Lord Sandys

My Lords, I should like to support this amendment as indeed I believe that the whole substance of it is extraordinarily similar to an amendment which I moved at Committee stage on 18th April. But this is a better, more succinctly worded amendment, and presented to a different clause. The original one was addressed to Clause 1 of the Bill. When your Lordships considered the amendment on 18th April, the Committee divided; those Content numbered 64 those not Not-Content 90, at that time. But that gives way to the opportunity on Third Reading to reconsider this matter. I warmly welcome the fact that the noble Lord, Lord Ennals, has, with great ingenuity, found a means of doing so.

I address myself to the similar problem under Amendments Nos. 5 and 6, which were proposed by my noble friend Lord Burton. I had cause there to remind your Lordships what 205 out of 266 local authorities in the Severn Trent area did in voting against fluoridation which was radically different from what has been suggested by the noble Lord, Lord Ennals, and my noble friend Lord Campbell of Croy. There is a difference of opinion. Surely it is to the great health and benefit of this country in the much wider aspect of democracy that this amendment is aimed. It is to promote the possibility of a further discussion and a decision being reached which aligns itself with the wishes and views of the people concerned. I therefore wholeheartedly support this amendment.

Baroness Trumpington

My Lords, the amendment moved by the noble Lord, Lord Ennals, is precisely the same as was moved and discussed quite extensively at Report stage. It is also very similar, as my noble friend Lord Sandys said, to the amendment moved by him at Committee stage, which was decisively rejected by your Lordships. I appreciate the kind words of the noble Lord, Lord Ennals, but I must again repeat that the Government have bent over backwards, as I undertook at Committee stage, to accommodate the views of those who feel that elected local authorities should be consulted by health authorities before any decision is taken to implement water fluoridation. Indeed, subsection (3) of Clause 4—which we introduced at Report stage—as your Lordships know contains precisely such a legal obligation. Clause 4 in fact makes comprehensive arrangements for ensuring that health authorities are fully aware of local opinion on fluoridation before any final decision is taken to approach a water authority or company.

The amendment before us is, however, much more far reaching and, in our view, constitutionally improper. I must again point out that under the amendment a health authority would be allowed to exercise its statutory responsibility for the introduction of preventive health measures only with the agreement of local councils. This is clearly wholly wrong given that local authorities no longer have any statutory responsibility in this area; and indeed—as the noble Baroness, Lady Fisher of Rednal, pointed out in an earlier debate—no longer have access to the appropriate medical and dental expertise. Moreover, as again I pointed out in our last debate on this matter, it should be remembered that the cost of fluoridation is borne by the health authority and not by the local authority. Under the amendment of the noble Lord, a local authority can prevent a health authority from spending health authority money on fluoridation and indeed prevent a health authority—

Lord Ennals

My Lords, I am most grateful to the noble Baroness. In what part of the Bill does it say that the financial responsibility falls on the health authority?

Baroness Trumpington

My Lords, the responsibility has existed before the Bill. The responsibility is there.

Lord Ennals

My Lords, no. On the water authority, not the health authority.

Baroness Trumpington

My Lords, on the water authority, not the local authority. I will repeat what I have just said. Moreover, as I pointed out in our last debate, it should be pointed out that the cost of fluoridation is borne by the water authority—I am sorry. I am grateful to the noble Lord.

Lord Burton

My Lords, may I interrupt—

Baroness Trumpington

My Lords, I think I want to get on.

Lord Burton

My Lords, the noble Baroness is referring only to England and Wales, I am afraid.

Baroness Trumpington

My Lords, yes, I am. As the noble Lord will know, in Scotland the local authority is the water authority. I must repeat this once again, after two interruptions. Under the amendment of the noble Lord a local authority can prevent a water authority from spending health authority money on fluoridation and indeed prevent—I hope I have this right (it says in my brief)—a health authority from ceasing to continue to fund a fluoridation scheme. I do not know how this can be right.

The Government's position is quite simply that the final decision on whether or not to fluoridate must be taken by the relevant bodies which have the statutory responsibility for the functions inherent in fluoridation—that is to say, the health authorities and water authorities which have responsibility respectively for preventive health measures and the provision of the water supply. The Government cannot accept the principle inherent in this amendment that local authorities, simply because they are elected, can be given the right of veto over the expenditure of funds by non-elected bodies for purposes for which the local authorities have no statutory responsibility or expertise. This principle is of cardinal importance.

If the noble Lord, Lord Ennals, will not withdraw his amendment I must again ask your Lordships to reject it, recognising the substantial amendments that the Government have made to the Bill to ensure that local opinion is fully consulted. I would just remind you that the Health Service Act 1977 provides that health authorities have responsibility for procedure under health measures. This Act authorises their authority.

Lord Ennals

My Lords, I am most grateful to the noble Baroness. I shall press this to a Division because I have to say, frankly, I found the reply not very satisfactory and not meeting the points which I had sought to make when moving the amendment.

Perhaps it is best that we deal with the very last point which the noble Baroness made. The financial responsibility undoubtedly lies with the water authority because they have to do the work that actually involves the addition of fluoride to the water. The water authorities have made it quite clear that none of them wants to have this decision foisted upon them because they say they are not experts in whether fluoride should be added or should not. All right, if they are of the two bodies at present involved—

Baroness Trumpington

My Lords, I wonder whether the noble Lord would allow me to say this. He was kind enough to give way. All the financial expenses come under the health authority.

Lord Ennals

My Lords, is that in the Bill?

Baroness Trumpington

My Lords, no, it comes under the Health Service Act.

Lord Ennals

My Lords, I am most grateful to the noble Baroness for seeing that. I went through the Bill to look at this question for myself and I found no place where that was said. But, quite frankly, it strengthens my argument. We know that it is a very expensive operation, I have quoted figures to your Lordships' House about how much it would cost. This is money that will come out of patient care, so let that be remembered, my Lords. The health authority would therefore be taking a decision to expend money which the water authority would carry out, and the water authorities have made it clear that they do not want that responsibility placed upon them.

I therefore come back to what I believe is the main point. The noble Lord, Lord Campbell of Croy, drew attention to the views of the health authorities. No doubt if they feel very strongly about this they will argue their case in public meetings, or they will go to see councillors. They will lobby councillors in just the same way as those who may take a different view have the right to lobby councillors. This is what councillors are about; to take decisions affecting their voters.

7 p.m.

I agree absolutely with my noble friend Lord Houghton of Sowerby, that if the Government were determined that it should be done everywhere, then they would pass a Bill which said, "Water authorities are obliged to do it." What they have done is to put the responsibility upon two non-elected bodies, and I do not believe that that is right. Decisions like this affect the whole of our population on issues which are very controversial and on which, rightly or wrongly, very strong views are held on both sides. I am not taking any further part in that discussion—my views are known—on whether fluoride is good or bad to be ingested into the human body. I therefore feel very strongly and I hope I can persuade your Lordships on both sides of the House that this is a matter of deep principle; that we should not take a major decision like this and put this responsibility upon appointed nonelected bodies. It is a decision for elected bodies and they should decide what is happening—

Baroness Trumpington

My Lords, by leave of the House and before the noble Lord sits down, may I just say that the Government's concern is that final decisions on fluoridation should be taken by those bodies which are qualified to do so and which will have responsibility for implementing the decisions. The question of whether or not these bodies are elected is immaterial. Indeed, in Scotland the final decision on fluoridation will be taken by elected bodies as the water authorities there are the regional islands councils.

Lord Ennals

My Lords, since the noble Baroness intervened, I shall reply to that. I cannot think how she can stand at the Dispatch Box and say that the views of elected authorities do not matter. After this Bill has passed—I hope with this amendment in it—it will go to another House where they have been duly elected. They will take a decision as to whether or not what I hope we shall have done is right. Is the noble Baroness saying that democracy is not the best way; that the choice of the people is not the best way of deciding vital issues like this? I do not understand how she can stand up and make a point like that.

Baroness Trumpington

My Lords, I am saying that I do not go to an undertaker if I want a loaf of bread.

7.2 p.m.

On Question, Whether the said amendment (No. 7) shall be agreed to?

Their Lordships divided: Contents, 50; Not-Contents, 53.

DIVISION NO. 3
CONTENTS
Aylestone, L.	Houghton of Sowerby, L.
Bauer, L.	Hylton-Foster, B.
Beaumont of Whitley, L.	Jeger, B.
Blease, L.	Kilbracken, L.
Boston of Faversham, L.	Kilmarnock, L.
Bottomley, L.	Kinnoull, E.
Boyd-Carpenter, L.	McNair, L.
Broadbridge, L.	Maude of Stratford-upon-Avon, L.
Brockway, L.
Burton, L.	Mayhew, L.
Carmichael of Kelvingrove, L.	Monckton of Brenchley, V.
Charteris of Amisfield, L.	Monson, L.
Coleraine, L.	Morton of Shuna, L.
Collison, L.	Moyne, L.
Craigmyle, L.	Munster, E.
David, B.	Napier and Ettrick, L.
Davies of Leek, L.	Nicol, B.
Dean of Beswick, L.	Ponsonby of Shulbrede, L. [Teller.]
Elystan-Morgan, L.
Ennals, L.	Ritchie of Dundee, L.
Galpern, L.	Sandys, L.
Graham of Edmonton, L.	Seebohm, L.
Greenway, L.	Stedman, B.
Hanworth, V.	Stoddart of Swindon, L. [Teller.]
Harris of Greenwich, L.
Harris of High Cross, L.	Yarborough, E.
Hatch of Lusby, L.

NOT-CONTENTS
Airey of Abingdon, B.	Long, V.
Attlee, E.	Lucas of Chilworth, L.
Belhaven and Stenton, L.	Mancroft, L.
Beloff, L.	Massereene and Ferrard, V.
Belstead, L.	Morris, L.
Bessborough, E.	Mottistone, L.
Brabazon of Tara, L.	Mountevans, L.
Brougham and Vaux, L.	Murton of Lindisfarne, L.
Caithness, E.	Orkney, E.
Campbell of Alloway, L.	Peyton of Yeovil, L.
Campbell of Croy, L.	Rankeillour, L.
Colwyn, L.	Reay, L.
Cork and Orrery, E.	Renton, L.
Craigavon, V.	St. Aldwyn, E.
Crathorne, L.	Shannon, E.
Denham, L. [Teller.]	Skelmersdale, L.
Denning, L.	Sudeley, L.
Dilhorne, V.	Swinfen, L.
Elton, L.	Swinton, E. [Teller.]
Faithfull, B.	Trefgarne, L.
Ferrier, L.	Trumpington, B.
Gardner of Parkes, B.	Vaux of Harrowden, L.
Hailsham of Saint Marylebone, L.	Vickers, B.
	Vivian, L.
Hooper, B.	Whitelaw, V.
Lane-Fox, B.	Winstanley, L.
Lindsey and Abingdon, E.	Wise, L.

Resolved in the negative, and amendment disagreed to accordingly.

Lord Monson moved Amendment No. 8: Page 3, line 33, leave out ("such regard as they consider appropriate") and insert ("regard').

The noble Lord said: My Lords, this amendment, too, is designed to enhance democratic control over the issue of fluoridation. It is less ambitious than the excellent amendment recently moved by the noble Lord, Lord Ennals: I hope therefore that the Government will feel able to accept it. However, if they do not, I certainly hope that the noble Lord, Lord Ennals, and his colleagues, noble Lords on the Alliance Benches and those Members in other quarters of the House who had slight reservations about the previous amendment, will be able to support this one.

We discussed this matter briefly at Report stage but did not proceed at that point. Our contention, which has now become a conviction, is that the phrase, such regard as they consider appropriate", is so permissive and wishy-washy as to be almost useless in protecting democratic rights. There are certain water authorities and health authorities which place a high value on democratic consultation. There is, for example, a report in the Lincoln, Rutland and Stamford Mercury of Friday, 17th May—this is the point to which the noble Lord, Lord Houghton, was referring. It says: A massive opinion poll has been launched in a bid to discover the true feelings of Rutland people"— I do like the word "Rutland"— on the question of fluoridation of water supplies. The opinion poll has been organised by the Leicestershire Community Health Council in response to a pledge from the Severn Trent water authority not to accede to requests to add fluoride unless it is satisfied that a majority of its customers are in favour". This is a most heartening piece of news. But there may well be other authorities which are contemptuous of the opinions and fears of the man in the street. The phrase, such regard as they consider appropriate", gives them a complete let-out should they decide to accord ordinary public opinion an extremely low priority in arriving at their final decision on whether or not to fluoridate.

This amendment, let me stress, imposes no straitjacket on health authorities. There would be no absolute obligation whatsoever to act in conformity with the representations they had received or in consequence of the consultations which they had held. They would be required to have regard to the consensus of opinions expressed but would not be required to act in accordance with them. In other words, the subsection would remain as it is now permissive and not mandatory. The only difference is that the health authorities would have to pay just a little more attention to public opinion than they would under the Bill as it stands. I beg to move.

Lord Ennals

My Lords, obviously I would wish to support the amendment proposed by the noble Lord, Lord Monson. It does not, as he said, go as far as the previous amendment which was very nearly carried. But it certainly does indicate to the health authorities that they have to do rather more than simply have, such regard as they consider appropriate", which is, as he said, a sloppy form of wording. They have to take "regard". If we are unable to achieve the proper democratic process, at least we can ensure that the health authorities must properly take into consideration views once they are expressed by the local authorities. I warmly support the amendment.

7.15 p.m.

Lord Houghton of Sowerby

My Lords, I hope that the noble Baroness will accept this amendment. She really cannot be so impudent, if I may put it like that—

Baroness Trumpington

Impudent?

Lord Houghton of Sowerby

—as to reject a simple plea like this. As I said earlier, the words used in the Bill are contemptuous; they are worse than wishy-washy; they are really insulting. I think they should be replaced. I would have been willing to concede the phrase "due regard", but "regard" is not very much more than "due regard". We have been playing with words on a number of Bills in recent days. We have had the word "persistently" and now we have "regard". I hope quite seriously that the noble Baroness will do what we ask. Then she will go out in a blaze of glory, with the milk of human kindness to follow in Amendment No. 9, and we shall finish the Bill in a good mood. I sincerely hope that the noble Baroness does not have in her hand a brief which says that this amendment will presumably be rejected. That is usually what is in the brief of Ministers when they come to the Committee and Report stages of Bills.

Let us have this "regard" put into the Bill so that, as my noble friend Lord Monson said, some "regard" shall be given to the representations received. Otherwise it will be spitting in the face of those with whom consultations are being sought.

Lord Sandys

My Lords, I should like to support the amendment. I feel that our discussions would indeed yield some small fruit if the noble Baroness would concede that this is an absolute necessity. I would hold it to be self-evident in the discussions we have had, and also in the result of the Division which took place on the previous amendment.

Lord Burton

My Lords, I too should like to support the amendment. On the previous amendment I think the argument was put forward that local authorities were not qualified, whereas health authorities were qualified. In Scotland, it goes to the local authority. The Highland Region does it. If they are not qualified in England, I cannot see why they are qualified in Scotland. If that is the argument, it means that Scotland is getting its water treated by a body which is not qualified. Here we must have due regard to what the local authorities say.

Baroness Trumpington

My Lords, we have debated this amendment before at Report stage, and nothing that has been said by any noble Lord has changed the view of the Government. I would reiterate that the words in subsection (5) of the clause on consultation have been inserted for a particular purpose. That purpose is the very important one of ensuring that health authorities remain free to judge on their merits all the representations made to them and can exercise a proper discretion in weighing up the various arguments that will be put to them. We particularly seek to avoid that health authorities should have to judge the issue purely on the volume of voices in favour of a particular standpoint, whether for or against fluoridation. We believe that this would be a very serious limitation on the exercise of their statutory responsibilities.

It may be helpful if I give an example of the kind of difficulty which in our view would arise under the amendment of the noble Lord, Lord Monson. It may be that, in response to newspaper publicity, a health authority receives 100 letters on fluoridation from members of the public. Of these letters, let us assume that some 70 are against fluoridation. Equally, let us assume that the health authority has before it the results of opinion polls conducted locally from a much larger random sample of the population which show that the same 70 per cent. of the local people are in favour of fluoridation. In these circumstances, is it really thought desirable that local opinion should be thought to be represented by the 70 letters rather than the results of the opinion polls? It is clear that in these circumstances no right-minded health authority could pay any attention to such anti-fluoridation correspondence.

The same considerations must apply to the views of local authorities. I stress again that the Government will certainly expect health authorities to take seriously the views of local authorities in England and Wales, but at the end of the day they cannot be decisive. This is simply because, as we have said on more than one occasion—and, my goodness, this Bill has been repetitive—these local authorities possess neither responsibility nor expertise in the field of preventive health measures, or the provision of the public water supply.

Lord Stoddart of Swindon

My Lords, what do the Scots have that the English do not?

Baroness Trumpington

My Lords, I have already stated what the Scots have. The local councillors there are particularly appointed. My noble friend will correct me if I am wrong because he is a Scotsman and a former Minister and knows better than I, but my understanding is that the local councils who make up the water authorities are therefore experts at the job. I shall give way.

Lord Campbell of Croy

My Lords, perhaps I can assist my noble friend, because I happened to be Secretary of State for Scotland at the time. I had the unenviable task of dealing with the Wheatley Royal Commission on the reorganisation of local government. As a result of decisions I had to take on that there are two tiers of authority. There are no county councils in Scotland and it is the regional authorities, of which there are few, and the three islands authorities, which are multi-purpose authorities, which are also water authorities.

A noble Lord

My Lords—

Baroness Trumpington

No, my Lords, I am continuing. The views of local authorities will represent an important test of public opinion but they will not be the only such test as health authorities will also have to consider the views of community health councils which have been appointed by Parliament to represent consumer opinion in Health Service matters as well as the results of local representations by other local bodies and individuals.

I hope that what I have said will be sufficient to persuade the noble Lord, Lord Monson, to withdraw his amendment again. If not, I regret that I will have to ask your Lordships to reject it as it remains our view that acceptance would be contrary to rational and responsible decision-taking by health authorities on fluoridation.

Lord Monson

My Lords, I am disappointed at the reply given by the noble Baroness. Her replies are quite often disconcertingly effective but this is not one of those occasions. The examples she gave imply that my amendment would give the health authorities absolutely no discretion. She implied, in effect, that my amendment is tantamount to saying that they must act in accordance with representations, and so on. That is not the case. The trouble for the Government is that they are hoist with their own petard because they have effectively conceded no less than three times within the past two months that the phrase "have regard to", which I suggest, is as different as it can be from the phrase "act in accordance with".

On two separate occasions—one being 12th June last—the noble Lord, Lord Skelmersdale, resisted amendments to the Wildlife and Countryside (Amendment) Act moved by the noble Earl, Lord Onslow, and the noble Lord, Lord Airedale, respectively, which would have substituted the phrase "have regard to" for the phrase "act in accordance with". He resisted them on the ground that they would weaken the Bill, that they were too permissive.

Furthermore, on 24th June the noble Baroness, Lady Birk, moved an identical amendment—that is, to substitute the phrase "have regard to" for the phrase "act in accordance with"—on the Local Government Bill. Her amendment was resisted by the noble Lord, Lord Elton, on the ground that this too would weaken the clause in question because it was too permissive and not mandatory.

Therefore it simply cannot be claimed that this amendment goes too far. All it does, and all it is designed to do, is give the ordinary citizen a little more democratic say in this vital matter affecting his health and that of his family. I believe that democracy is important, and therefore we must press this amendment.

7.24 p.m.

On Question, Whether the said amendment (No. 8) shall be agreed to?

Their Lordships divided: Contents, 40; Not-Contents, 44.

DIVISION NO. 4
CONTENTS
Alyestone, L.	Ennals, L.
Bauer, L.	Galpern, L.
Beaumont of Whitley, L.	Greenway, L.
Bottomley, L.	Harris of Greenwich, L.
Boyd-Carpenter, L.	Harris of High Cross, L.
Brockway, L.	Houghton of Sowerby, L.
Burton, L.	Jeger, B.
Charteris of Amisfield, L.	Kilbracken, L.
Coleraine, L.	Kilmarnock, L.
Craigavon, V.	Kinnoull, E.
Craigmyle, L.	McNair, L.
David, B.	Monckton of Brenchley, V.
Davies of Leek, L.	Monson, L. [Teller.]
Dean of Beswick, L.	Morton of Shuna, L.
Elystan-Morgan, L.	Moyne, L.

Munster, E.	Stedman, B.
Napier and Ettrick, L.	Stoddart of Swindon, L.
Nicol, B.	Taylor of Mansfield, L.
Ponsonby of Shulbrede, L.	Tweeddale, M.
Sandys, L. [Teller.]	Yarborough, E.

NOT-CONTENTS
Attlee, E.	Long, V.
Belstead, L.	Lucas of Chilworth, L.
Brabazon of Tara, L.	Massereene and Ferrard, V.
Brougham and Vaux, L.	Morris, L.
Caithness, E.	Mountevans, L.
Campbell of Alloway, L.	Murton of Lindisfarne, L.
Campbell of Croy, L.	Orkney, E.
Colwyn, L.	Peyton of Yeovil, L.
Crathorne, L.	Rankeillour, L.
Crawshaw of Aintree, L.	St. Aldwyn, E.
Denham, L. [Teller.]	Shannon, E.
Denning, L.	Skelmersdale, L.
Elliott of Morpeth, L.	Sudeley, L.
Elton, L.	Swinton, E. [Teller.]
Faithfull, B.	Trefgarne, L.
Ferrier, L.	Trumpington, B.
Gardner of Parkes, B.	Vaux of Harrowden, L.
Hailsham of Saint Marylebone, L.	Vickers, B.
	White, B.
Hooper, B.	Whitelaw, V.
Killearn, L.	Winstanley, L.
Lane-Fox, B.	Wise, L.
Lindsey and Abingdon, E.

Resolved in the negative, and amendment disagreed to accordingly.

7.32 p.m.

Lord Houghton of Sowerby moved Amendment No. 9: Page 3, line 36, at end insert— ("(c) to Regulation (EEC) No. 2167/83 (which lays down rules for the supply of milk and milk products to school children) as amended by Regulation (EEC) No. 237/85 of 30th January 1985 (which permits the addition of stipulated maximum additions of fluoride in whole or semi-skimmed flavoured milk and yoghurts intended for school children.").

The noble Lord said: My Lords, this amendment is an addition to the factors to which the health authorities must have regard when deciding whether to make an application. Surprisingly enough, it has to do with the fluoridation of milk for school children under the auspices of the EEC. I must confess that I was unaware of this service, which is available under the EEC, until my attention was drawn to it by the Borrow Dental Milk Foundation. There is a regulation of 30th January 1985—the number is in the amendment—under which the EEC is prepared to subsidise the supply of milk into which a measure of fluoride is to be put for young children. It is fluoridated milk of particular types intended for children; namely, whole or semi-skimmed flavoured milk and yoghurts.

The regulation appears to be little known and certainly little used. Nevertheless it is an alternative method of reaching children with fluoridated liquid, which by general consent seems to be good for them. Grants from the EEC may be applied for. We are all anxious to get some of our money back from the EEC and we can get it in the form of grants to subsidise this milk which is available to school children.

I read in the bulletin of the Borrow Dental Milk Foundation that the present level of subsidy is guaranteed for five years and that the amount paid will rise in line with Community farm prices. It is also said that the amount of milk allowed for each child is surprisingly generous. It also provides for the actual technical details of the fluoridation addition which is to be made. This seems to be good for children at school. It is to apply to children in nursery schools and up to sixth form colleges, and special arrangements can also be made for independent schools to receive the subsidised milk. I do not know to what extent fluoridation is being used in the supply of milk to school children. However, it is an alternative which might be in operation in some places or which might be adopted in place of the fluoridation of water. After all, it goes direct to the children, which is the main object of the Bill. I know that fluoridated water can reach children of earlier than school age. Nevertheless this is a scheme blessed by the EEC and it must presumably have some merit.

The amendment does not ask local authorities to do anything about it; it says that regard should be had to the existence of the regulations providing this service, if it is relevant to what the local health authority wishes to do. The local health authority may decide that they prefer a scheme of this kind to making an application to the water authority. It is left to their discretion. It might be cheaper to do it in this way rather than by themselves paying for the fluoridation of water, as the noble Baroness says that they would have to do. It is one of the options and no more than one of the options.

I think it will test the sincerity of the Government in the provisions of this Bill to obtain their reactions to an alternative way of achieving substantially the same purpose. The noble Baroness can probably tell us a little more about the use that is being made of this new opportunity, although of course the regulation only dates from 30th January of this year and probably has not had time to become generally known or adopted. All the procedures for the making of grants and so forth are laid down in the Commission regulation.

This method appeals to me as offering a more sensible and direct procedure than the fluoridation of water, especially when I see pictures in the bulletin of the Borrow Dental Milk Foundation of happy children drinking flavoured milk and eating yoghurts, which are all duly fluoridated for the benefit of their health. Apparently it is called "Dentamilk". I have no interest in this, and this is not a commercial. In fact I have little or no interest in the Bill as a whole, because I do not have a water supply that can be fluoridated. I have been asking the local authority to tell me the amount of fluoridation in my domestic water and they say that owing to the cuts in local government expenditure they will not be able to decide whether to test it until the next financial year. Your Lordships see what horrible things can happen when these indiscriminate cuts are made in local authority expenditure. I do not even know whether I am being poisoned, although the authority says from time to time whether the water is satisfactory or unsatisfactory. I shall not continue. I am just saying that I personally am not interested at the moment in the fluoridation of water. I find London water too unpalatable to drink anyway.

I hope that the noble Baroness will be able to look at the amendment with some favour. It is the penultimate one. The next one is a difficult one for her, but this one is easier. I hope to get a favourable response. She has only to say that among the other things to which the health authority has to have regard is this. I beg to move.

Lord Campbell of Croy

My Lords, the noble Lord has introduced the amendment as an interesting option, as he said. But significantly, in the course of his remarks he said that by general consent fluoride in milk was good for children. In moving this amendment he has dismissed the apprehensions which appeared to motivate the amendments put down by a number of other noble Lords, some of whom are not with us at the moment—apprehensions about dangers to health—

Lord Houghton of Sowerby

My Lords, at this stage in the Bill I have just come to terms with reality. That is all.

Lord Campbell of Croy

My Lords, the noble Lord and I were in another place for many years and, I think I may say, had the best of relations during that time although we were on opposite sides of the House. I am so glad to think that he has reached that happy state at this point in the Bill.

The amendments which we have been discussing at earlier stages of the Bill conjured up all kinds of dangers to health, the possibility of cancer and things like that. I am just pointing out that this amendment in any case has dismissed them and accepts that fluoride is good for children. It is just a question of what is the best way for them to ingest it. I did at earlier stages, and even earlier today, point out that the most effective time for people to receive fluoride is from the age of nought to about two or three. There are two dentists in the House who will know more about this than I, but they have told me in the past that that is so. I shall not go into the question of mother's milk being best and all that, but it is quite clear that from the age of nought to six months anyway the children may not be taking the kind of milk that the noble Lord is putting forward.

There is another point, which is that people continue to benefit from fluoride for the rest of their lives, although it is most effective during early youth. Although it is important for children to receive it, it is not just a question of receiving it in milk during the period of childhood. I think that this option does not cover the whole field which of course fluoridation of water supplies does.

I shall be interested to hear the Government's comments. I agree that it is an option which is open and it accepts that fluoride is good for children. I should have thought that it was a more complicated option. Anyone who is involved with the National Farmers' Union, milk and its distribution, which I inevitably have been over periods of years, will know that it is a pretty complicated operation in any case. To add this to it I should have thought would have been far more trouble than the question simply of making up to one part per million the fluoride which already exists everywhere in all supplies of drinking water. If that is accepted, I still do not think that it is a replacement for the proposition of bringing up to the optimum water supplies where they do not already have the optimum amount of fluoride, which they do in some parts of the country. I agree that it is an interesting option, but I do not think that it is a replacement for what is in the Bill.

7.45 p.m.

Lord Moyne

My Lords, before saying even a very few words, I should perhaps declare an interest as a dairy farmer. I want to point out only that children up to the age of two or three drink milk much more than water. On the other hand, when they are breast fed the fluoride may go through the mother. My noble friend Lady Gardner has just told me that it does. This seems to me to be rather a matter for research—watching and keeping statistics. As my noble friend Lady Trumpington explained, the health authorities are the people who understand. We have been arguing about the county councils and so on, but in the Government's view the people who fundamentally ought to give the advice and take the decisions are the health authorities. I suggest that it should be open to the health authorities to take into account this alternative or ancillary method.

Lord Campbell of Croy

My Lords, I am most grateful to my noble friend for commenting on what I said. I have been involved in this question for 20 years, and I can tell him that the research has already been done on the way that fluoride can come to very small babies.

Lord Ennals

My Lords, I warmly support the amendment proposed by my noble friend. I have here some of the research findings on the benefit of milk. There was a five-year study of schoolchildren in Scotland and another study was done in Hungary. They produced similar results. Roughly, after three years the caries reduction was 70 per cent. for the children monitored who were taking milk between the ages of five and six.

Of course it is in option. My noble friend is not saying that it should be an obligation, but that the health authorities should draw attention to the fact that it is an option. Let me say why I think that it should be done. First, the EC has taken the decision and has been convinced that fluoride in milk is a real option. Otherwise it would not have produced the new regulation referred to by my noble friend and which I read out on 4th June (at column 724 of Hansard). It is a new development and one of which health authorities should be made aware, but there is no attempt in this amendment to make it compulsory.

For what it is worth, my view is that most water authorities will not act on the advice of the health authorities. I do not believe that most water authorities will take the decision. Some have already decided not to, even before they have been asked. They do not want controversy. Had the Government really wanted to ensure that fluoride was put into water across the country, that is the measure that would have been before us now. They would not have placed the decision on health authorities and water authorities; they would have taken it themselves. They are an elected Government. I should then not have had to move my amendment. I think that this is especially important if most water authorities decide not to do it. Some will and some will not, and we shall have whole areas of the country where they will decide not to. There is toothpaste and all sorts of other things, but milk is much better.

On 4th June (at column 732 of Hansard) in replying to an amendment the noble Baroness made a significant statement. I should like to spend a minute or two in analysing it. She said: There would be significant difficulties of distribution during the school holidays and the fluoride would not begin to be received early enough by the children". Let me make this clear. The Borrow Foundation is a charity with which I have been involved for some time, and I negotiated with the EC for it to do what it finally decided to do. It is not the intention of the Borrow Dental Milk Foundation to flog dental milk up and down the country. It will be the milk producers who would do so. It would come on the market. It is a simple procedure with which Dr. Borrow and his staff have experimented. It is much less costly than putting fluoride in water.

If a local authority decides to take up that option if a water authority has not fluoridated water and parents are keen on their kids having fluoride, they can order milk from the ordinary milk distributor for kids of six months, during the school holidays for older children, or what have you. There will be no difficulty whatsoever in it being available for all children.

I was interested when the noble Lord, Lord Campbell of Croy, said that this was of great advantage also for adults. I had not quite realised that. I do not know what the evidence is. My impression is that it is meant for children up to the age of 15. Of course the method remains for adults, too, but I was not aware that it has much great initial value for those over that age.

I return to the interesting speech of the noble Baroness. She said also that there would be likely to be consumer resistance to the product on the part of older children, who may grow less fond of milk in general, and from parents, who are likely to prefer their children to drink fresh milk rather than UHT fluoridated milk, flavoured and marketed by the Borrow Foundation. There is no proposal that the milk should be marketed by the Borrow Foundation. The noble Baroness has not got hold of the right end of the stick in this case, although I was most grateful for the help that she did give in her reply.

Why should the noble Baroness think that children would be less likely to drink milk that has fluoride in it? The fluoride does not affect the flavour of the milk at all, as we know is the case with water. The fluoride has no effect on the flavour of the milk and there is no reason, therefore, why children will be less likely to drink it. In fact, the opposite is likely to be the case. I would say to the noble Lord, Lord Moyne, with all his experience in the farming industry, that I believe this is one way—and this has nothing to do with the Bill—in which more and more people will naturally see to it that their children drink milk. That could help to use up some of the milk lakes which exist at the present time.

The noble Baroness went on to say, in her reply on 4th June, that: Local authorities in areas without water fluoridation may however, wish to supply fluoridated milk to their schoolchildren".—[Official Report, 4/6/85; col. 732.] If the noble Baroness said that, why does she not agree to putting fluoride in the milk? The noble Baroness went on to say that: The supply of school milk in general is entirely a matter for them and the Government would not wish to intervene. The EC has agreed that dental milk"— and I would not use that term myself but rather, milk with fluoride— should qualify for the same subsidy as non-fluoridated milk". If the noble Baroness feels that, then surely this option should be written into the Bill. It will not require the health authority or the local authority to take a decision, because they can decide the matter for themselves. But, as the noble Baroness rightly said in her own speech, this new factor should be recorded in the Bill.

Lord Colwyn

My Lords, despite the possibility of a grant from the EEC, I cannot accept fluoridated milk as a reasonable alternative to fluoridation of the water supply, for three main reasons. The first is the logistics of the matter. Secondly, this alternative has been inadequately researched. Thirdly, it is still far more expensive.

The provision of free or near-free fluoride tablets to mothers for their children has never been successful in Great Britain. I feel it is highly improbable that the similar provision of fluoridated milk would be any more successful. If fluoridated milk were made available to mothers in shops, then only the most enthusiastic and those capable of paying would consider buying the product.

Fluoridation of drinking water adjusts the level of fluoride to the optimum concentration of one part per million. Most drinking water contains fluoride below that level, and hence adjustment via milk would depend on a large variety of local conditions. To comply with those conditions there would need to be cartons of milk containing varying doses of fluoride, and mothers would need to make continual adjustments as their children moved from one age to another—and possibly as the family moved from one district to another. The complexity of the many variables would mean that most mothers would either not consider this method of supplementation or would abandon it as impracticable after a very short period of time.

Lord Ennals

Why, my Lords?

Lord Colwyn

My Lords, if provided in schools, where children start their education at about four or five years of age, the benefit would not be available for the formation of the deciduous dentition and most of the important and crucial period of permanent tooth development. It is known that permanent teeth develop some six years before they appear in the mouth.

If it is expected that fluoridated milk is consumed every day throughout school life, it would miss out the children who do not like milk or who tend to consume less as age advances. I mentioned inadequate research. There have been very few studies in which fluoridated milk has been tested, and most of them are not acceptable as providing adequate evidence of efficacy. The trials carried out have been short-term clinical trials which have never progressed to medium-term or long-term trials.

Lord Ennals

My Lords, if the noble Lord will allow me to intervene, the research that has been carried out certainly has been accepted by the European Commission. It must stand up. The negotiations with the European Commission took nearly 18 months, during which time the evidence was studied very carefully by the Commission's scientists. I cannot see on what basis the noble Lord argues that this method has not been adequately researched. It has been extensively researched.

Lord Colwyn

My Lords, so far, the research has embraced only short-term trials and it has never progressed to medium-term or long-term trials. Trials have not therefore been able to indicate whether the method or agent gives true primary prevention, or merely delays the onset of the disease by a few years.

Because of the natural occurrence of fluoridated drinking water at the optimum level of one part per million, it has been possible to ascertain lifelong benefits under field conditions. Much work has been done on the relative cost-effectiveness. I will not go into that in detail except to say that an approximate estimation is that the provision of fluoridated milk is about 120 times more expensive than the cost of adjusting the fluoridation level in water.

Lord Ennals

No, my Lords.

Lord Colwyn

It is, my Lords. For the cost-effectiveness of school milk to break even with water fluoridation, the former method would need to be five times more effective—but that is impossible. A method only twice as effective as water fluoridation would eliminate all caries throughout life—an impossible task for fluoridated school milk.

Viscount Massereene and Ferrard

My Lords, as my noble friend Lord Campbell of Croy has said, it is a far more complicated matter to fluoridate milk. Many breeds of cattle give a different type of milk. Some cattle graze on lime land and some on acid land, and they may have a different diet. How can one be sure of the level of fluoride in the milk given by each of them? One cannot go around testing the milk from every herd. How can one be sure that some milk does not have a high enough level of fluoride in it already? It will depend entirely on what the cow has been eating and on what land she is grazing.

Suppose one has a rural farming family. If the children drink fluoridated milk at school and then return home to drink the milk from the house cow, the levels could be completely different. The method suggested is far too complicated, and I agree with everything that my noble friend has said.

Baroness Trumpington

My Lords, we have already debated during earlier stages of the Bill the relative efficacy of fluoridated milk as opposed to fluoridated water. As my noble friend Lord Campbell of Croy has already pointed out, fluoridated milk has the great disadvantage that it does not reach the recipients at an early enough age to be fully effective. Fluoridated water, on the other hand, has a beneficial effect on the developing teeth of children from birth until the teeth are fully formed.

The noble Lord, Lord Ennals, will correct me if I am wrong, but I believe he is actually a consultant of the Borrow Dental Milk Foundation and lobbied the European Commission extensively in 1983–84—

Lord Ennals

Extensively, my Lords.

Baroness Trumpington

—to allow fluoridated milk to qualify for subsidy. I hope I am correct on that point. The noble Lord will know already that all the European Community has done is to allow fluoridated, flavoured UHT milk to qualify for the same subsidy as similar, non-fluoridated milk. This hardly constitutes positive promotion of fluoridated milk. The Government's position is simply that, while fluoridated milk can certainly be of value in reducing tooth decay, it does not have the same demonstrated potential for improving the health of local communities as fluoridation of the water supply has.

The noble Lord, Lord Ennals, will probably already know that a health authority can already, if it wishes, fund fluoridated milk schemes as a preventive health measure, as part of its responsibilities for preventive health measures under the Health Service Act 1977. No health authority is known to do so—perhaps because of doubts among the dental profession as to its comparative effectiveness, as mentioned by my noble friend Lord Colwyn. No amendment to the Bill is needed to permit a health authority to fund a milk fluoridation scheme if it wishes. It already has the legal power to do so. I hope that your Lordships will not accept this amendment.

Lord Houghton of Sowerby

My Lords, it is the same old sorry story to the end, is it not? It is very disappointing. It is almost disheartening. I do not think that I should like to be a minister again if this is how they have to go through life. What satisfaction do they get out of it? They do not please anyone. The public do not think any better of them. One wonders why they are there. I am sure that before very long we shall have some technology that can give us all these ministerial replies in rooms upstairs and we can choose which one we go into. There will be no need to sit here to hear the same old reply given to all suggestions for improvement. I have not suggested for a single moment that this scheme for milk is a complete alternative to the fluoridation of water. I am advised from what I have read that it is not desirable to have both. If children are having fluoridated water, there is no need for them to have fluoridated milk. In fact, it might be harmful if they were taking above the approved dose.

It seems to me to be one of the things that health authorities should have regard to. There is no more in it than that. If some health authorities choose not to make an application, it may be that they have something of this kind in mind as an alternative. It is up to them. As it came fresh to my mind, I thought it was worth mentioning in the Bill, alongside the fluoridation of water, something that the EC is doing so far as the fluoridation of milk is concerned. That is all there is to it.

As regards my own position, one is considering options at this stage. The period of fundamentalist belief or disbelief has passed. We are near the end of the Bill, and we are trying to make it a little better if we can. That is all that there is to this. If I feel about this at all, it is because the Government are so stubborn. There is no harm done at all in drawing the attention of health authorities to this scheme. We are supposed to be in the EC approving of what it does and drawing the directives of the EC to the attention of the authorities concerned. Here is an opportunity of a reference to a scheme which the EC has agreed and which might be of some value in considering all the matters that have to be kept in mind and all the representations that have to be received—the whole lot of it—in Clause 4 of the Bill.

I really do not feel that one should just submit to this unhelpful attitude on the part of the Government Front Bench. So far as I am concerned, I would urge the House to include this in the list of things that the health authorities must have as much regard to as they think appropriate. That is little enough in all conscience. I therefore ask the House to approve this amendment.

8.3 p.m.

On Question, Whether the said amendment (No. 9) shall be agreed to?

Their Lordships divided: Contents, 29; Not-Contents, 40.

DIVISION NO. 5
CONTENTS
Ailesbury, M.	Houghton of Sowerby, L. [Teller.]
Aylestone, L.
Bauer, L.	McNair, L.
Beaumont of Whitley, L.	Monckton of Brenchley, V.
Blease, L.	Monson, L.
Brockway, L.	Moyne, L.
Burton, L.	Napier and Ettrick, L.
Charteris of Amisfield, L.	Nicol, B.
Craigmyle, L.	Ponsonby of Shulbrede, L.
David, B.	Sandys, L.
Davies of Leek, L.	Stedman, B.
Dean of Beswick, L.	Stoddart of Swindon, L. [Teller.]
Elystan-Morgan, L.
Ennals, L.	Taylor of Mansfield, L.
Harris of Greenwich, L.	Yarborough, E.
Harris of High Cross, L.

NOT-CONTENTS
Abinger, L.	Gardner of Parkes, B.
Airey of Abingdon, B.	Hailsham of Saint Marylebone, L.
Brabazon of Tara, L.
Brougham and Vaux, L.	Hooper, B.
Caithness, E.	Lane-Fox, B.
Campbell of Croy, L.	Lindsey and Abingdon, E.
Colwyn, L.	Long, V.
Craigavon, V.	Lucas of Chilworth, L.
Crathorne, L.	Masham of Ilton, B.
Crawshaw of Aintree, L.	Massereene and Ferrard, V.
Denham, L. [Teller.]	Morris, L.
Denning, L.	Mountevans, L.
Elliott of Morpeth, L.	Orkney, E.
Elton, L.	Rankeillour, L.
Faithfull, B.	Renton, L.
Ferrier, L.	Rootes, L.

St. Aldwyn, E.	Vickers, B.
Skelmersdale, L.	Whitelaw, V.
Swinton, E. [Teller.]	Winstanley, L.
Trefgarne, L.	Wise, L.
Trumpington, B.

Resolved in the negative, and amendment disagreed to accordingly.

8.11 p.m.

Lord Monson moved Amendment No. 10: After Clause 4, insert the following new clause:

("Duration.

.—At the end of the period of two years beginning with the day on which this Act comes into force all regulations, resolutions and instructions issued pursuant to this Act shall expire unless they are continued in force by a resolution of each House of Parliament.").

The noble Lord said: My Lords, the purpose of this amendment is self-evident. It provides that the Act shall effectively lapse after two years unless each House of Parliament decides otherwise by resolution. This Bill did not feature in the Conservative Party manifesto at the last general election. As far as I know, support for the principle of fluoridation was not in any Conservative candidate's election address, and I doubt whether it was in any other candidate's election address. The whole matter was sprung on the public.

I should like to raise another point. Within the next two years it is quite possible that more evidence may come to light showing the harmful effects of fluoridation upon certain adults, mainly elderly people, but also including some younger people. Indeed, if the health of people in newly fluoridated areas starts to suffer in consequence of fluoridation, it is probable that the symptoms will start to become apparent within the next two years. Therefore, in advance of the next general election, I think that Members of Parliament should have a chance to show their constituents where they stand on this issue and that political parties have a chance to make their position clear to the country at large. I beg to move.

Lord Campbell of Croy

My Lords, I feel that I must comment on what the noble Lord, Lord Monson, has said. In the past I have been involved in the drafting of party manifestos, and a subject such as this—which quite clearly is not a party political issue, as has been shown in this House as well as in another place; it is a matter on which members of all parties have different views—certainly would not normally find a place in a manifesto. Indeed, many people complain that manifestos, which nowadays are very long anyway on main political issues, should not include a subject such as this, which is not a party political issue. Therefore, I take issue on that point.

On the question of the Bill arising in Parliament, it was because comparatively recently Lord Jauncey in Scotland in the Strathclyde case found, after a very long hearing, that the Act which everybody had thought meant one thing did not in fact carry out that purpose and so it became necessary for a Bill of this kind to be brought forward. I am perfectly certain that any party which was in office in this country at this time would bring forward such a Bill, because the law had to be examined and clarified for that purpose. However, I return to the point that this is not a party political issue, which I believe has been quite clearly demonstrated. Therefore, I take issue with the noble Lord on that.

Baroness Gardner of Parkes

My Lords, I strongly oppose this amendment because, although it looks so harmless, it is an incredibly vicious little amendment. It would mean that in two years' time all those authorities which presently have fluoridated water would find themselves in that same illegal position as they are in today. We are passing this Bill simply to legalise fluoridation of the water where it already exists.

It also means that, if any authority is considering a new fluoridation scheme, it might be deterred by the thought that the expense could be only for two years and that at the end of two years the scheme would be thrown out. Tonight we have had very adequate assurances from the Minister that, if there is any evidence whatever that there is doubt about the effect on people's health, appropriate action would be taken. I rely upon our health department to do that. I believe that this amendment would be very unsatisfactory, and I oppose it.

Baroness Trumpington

My Lords, I regret that the Government are unable to discern any merits in this amendment, and I would suggest that the movers withdraw it.

Lord Houghton of Sowerby

My Lords, the noble Baroness is becoming more terse every time. I can understand how weary she must be. So are we. At least she has what little satisfaction there is in being a kind of inverted Micawber, waiting for something to turn down; but she cannot treat my noble friend Lord Monson as brusquely as that.

I believe that two years is too short, but apart from that, I believe there is some merit in the amendment. I am prompted to comment on what the noble Lord, Lord Campbell of Croy, has just said. I am sure it is true that this issue was not in the manifesto. I believe that a number of Ministers in the Government are being asked to account for their votes in another place, having regard to the pledge that they gave earlier that they would not vote in favour of a Bill that would enforce fluoridation upon the people.

Lord Campbell of Croy

My Lords, I am most grateful to the noble Lord for giving way. That is a rather different point. The anti-fluoridation campaign queries every Member of Parliament on his or her views on this matter and then takes that Member to account for what he or she does later. Does the noble Lord think that a matter like this should appear in a political manifesto?—because I would never imagine that such a subject would appear in an election manifesto.

Lord Houghton of Sowerby

My Lords, having regard to the boldness of the Prime Minister and the sense of purpose and determination of Her Majesty's Government, and having listened to all the arguments right from the beginning of this Bill, I should not have been a bit surprised if the Government had said, "Fluoridation is good for you, and you are jolly well going to have it".

Lord Campbell of Croy

My Lords, they did not.

Lord Houghton of Sowerby

My Lords, they could then have said, "We shall pass a Bill which, if necessary, will go through all its stages in one day in both Houses in order to make sure that your health is safe with us".

Lord Campbell of Croy

But they did not, my Lords.

Lord Houghton of Sowerby

My Lords, they did not; they just played about with it all the time, without tackling the fundamental issue. With regard to those Ministers who gave pledges and who voted with the Government, apparently there was a free vote for everyone in another place, but the payroll vote was conscripted. It is the conscripted payroll voters who are now being called to account by constituents who say, "You promised us otherwise. How do you account for what you have done?" In the replies that I have seen, and I have seen one or two, they say that it is Government policy and that as a member of the Government they have to follow it.

I believe that political parties put far too much in manifestos. I wonder that the public do not rumble these manifestos. They have had so many of them and the manifestos have produced so few results in many directions that there should be a provision about manifestos in the Representation of the People Acts.

I am in a playful mood now because we have gone from the sublime to the ridiculous. The noble Baroness is treating this all very lightheartedly at this moment. I think that the suspended sentence of two years is too short, but it is too late to increase it. So far as I am concerned, I am disposed to call it a day.

Lord Campbell of Croy

My Lords, may I comment briefly?

The Earl of Caithness

My Lords, I am afraid I would say to my noble friend that he cannot speak for a second or even third time at this stage of the proceedings.

Lord Campbell of Croy

My Lords, I thought that the noble Lord had given way to me. I do not think I have otherwise spoken on this amendment.

Lord Denham

My Lords, if my noble friend wishes to interrupt the noble Lord with a short intervention, the formula is, "Before the noble Lord sits down", otherwise on Third Reading he would be out of order.

Lord Campbell of Croy

My Lords, I have not yet spoken on this amendment, Amendment No. 10. The noble Lord, Lord Houghton, gave way. Well, I shall sit down.

Lord Monson

My Lords, I am bound to say that I thought that the noble Lord, Lord Campbell, had spoken because I jotted down what he said and I should like to reply to it. He was talking about party manifestos. Many of his honourable friends in another place are extremely embarrassed and upset that this fluoridation has been sprung upon them and their constituents without warning.

We should remember that there is a precedent for the amendment we propose, in the compulsory seat belt legislation, which provides for a review after three years. My noble friend Lord Houghton, who added his name to this amendment, has had partial second thoughts in that he now thinks that two years is too short. I put down two years because that would bring us to the middle of 1987 and shortly before the next general election, and it would enable everybody to put their cards on the table in advance of the election.

However, if we pass this amendment tonight it would go to another place, and if it was thought in another place that two years were too short a period they would disagree with our amendment and suggest that three years, or five years, should be substituted instead, and naturally we should accept the decision of the other place on that matter.

The Government have been extraordinarily inflexible over this Bill. They have not given way at all. The concession made in Clause 4 is so minor as to be virtually inconsequential. I know that the noble Baroness has done her best, but I realise that she is not a free agent in this matter. However, this is the way it is, and I feel we should test the opinion of the House on this matter.

On Question, amendment negatived.

Lord Denham

My Lords, it has been agreed through the usual channels, and after consultation with as many as possible of the noble Lords involved in both Bills tonight, that further proceedings on the Water (Fluoridation) Bill should be adjourned for a short period in order that further proceedings after Third Reading on the Sexual Offences Bill can be taken. Further proceedings on the Water (Fluoridation) Bill will follow immediately thereafter. I beg to move, therefore, that further proceedings after Third Reading on the Water (Fluoridation) Bill be adjoured.

Moved, That further proceedings after Third Reading on the Water (Fluoridation) Bill be adjourned.—(Lord Denham.)

Lord Ponsonby of Shulbrede

My Lords, before the Question is put, could the noble Lord the Chief Whip say whether there is any time limit on the proceedings on the Sexual Offences Bill?

Lord Denham

My Lords, it has been agreed after consultation with all noble Lords who are interested that the proceedings should be formal on this matter. I think an agreed solution has been arrived at. I have assured noble Lords on the Water (Fluoridation) Bill that if there should be any wish to extend proceedings I would ask the House to adjourn the proceedings on the Sexual Offences Bill in order that they should not take too much time.

On Question, Motion agreed to.