HL Deb 04 June 1985 vol 464 cc691-739

8.30 p.m.

Report received.

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

Lord Monson had given notice of his intention to move Amendment No. 1: Page 2, line 17, 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, this amendment—together with the related although not strictly consequential Amendment No. 2—is, in the literal sense of the word, vitally important in that it concerns the health and safety of the people of this country. Amendment No. 2: Page 2, line 17, 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 health if any suffered by any person as a result of this concentration "). Having said that, the hour, once again, is late. It is much later than forecast. For the third time the hour is late for our deliberations on this Bill. What is more, I sense that the House is anxious above all to come to a decision on the equally important matter of democratic control over the issue of fluoridation. As matters stand, democracy has been relegated to a pretty minor role in this Bill so far. I therefore propose neither to move this amendment nor the accompanying amendment, Amendment No. 2, today—but I intend to move them on Third Reading.

[Amendments Nos. 1 to 3 not moved.]

Lord Charteris of Amisfield moved Amendment No. 4: After Clause 1, insert the following new clause:

("Alternative supplies.

. In any area where a fluoridation order is made the statutory water undertaker shall make available an adequate supply of unfluoridated water to any person resident in that area upon the request of such a person in writing and upon the presentation of a doctor's cetificate certifying that fluoridated water may carry a serious risk of harm to the health of such a person in any of the circumstances set out in Schedule (Health Risks).").

The noble Earl said: My Lords, in rising to move this amendment, I have only one simple point to make. If there is any chance of any person being harmed by drinking artificially-fluoridated water, it is only a matter of common justice that there should be a provision for such a person, on producing an appropriate doctor's certificate, to be provided with unfluoridated water to drink. The point is, to my mind, simply this: is there any possibility of harm? It seems to me that anyone who says there is no possibility of harm is flying in the face of a considerable body of evidence. There is much of this, but for the sake of brevity I shall limit my remarks to one piece of evidence only. If that evidence has any validity, then it should be enough.

I am referring to the research carried out in 1972 in Holland by Dr. H. C. Moolenburg. By the carefully-monitored use of blind and double blind tests, Dr. Moolenburg and his colleagues found a distinct relationship between certain ailments suffered by their patients and the drinking of fluoridated water. Such ailments included—if I may regale your Lordships with them for a moment—stiffness in the joints (from which most of us suffer) and in the bones, muscle weaknesses, nausea, diarrhoea, migraine, mouth ulcers and kidney complains. When fluoridated water was withdrawn from the diet, then these symptoms tended to disappear. And when fluoridated water was returned to the diet, so the symptoms returned. Dr. Moolenburg summarised the study in these words: We, as a group of family physicians, found that between 1% and 5% of our patients reacted adversely on fluoridated water. That these complaints had such a general character that they could be recognised when you looked for them but that these complaints were always overlooked when you did not realise what you saw. That, contrary to what we thought in the beginning, we were not observing rare allergic phenomena but low grade poisoning. And, that all complaints but the joint troubles, cleared up in, at most, five days after stopping the intake of fluoridated water". I understand that the validity of that study was upheld by a court of law in Holland. I do not believe that just because this piece of evidence and many others—including the work of the late Dr. Walbott of Detroit and the work which Dr. Cedric Wilson is now doing at Strathclyde University—are awkward means that they ought to be ignored. On the contrary, I believe that they ought to be taken seriously. I beg to move.

Lord Sandys

My Lords I am very happy to support this amendment which the noble Lord, Lord Charteris of Amisfield, has so eloquently moved on this particular subject. It is very clear that the alternative supply is one which commends itself as the only possibility in the circumstances. It is a particular problem to which we have referred throughout our discussions on this Bill; but in the background there has been the judgment of Lord Jauncey. Perhaps I may draw the attention of my noble friend to page 387 of Lord Jauncey's judgment in the Strathclyde-McColl court action, where Lord Jauncey said this: Section 130 of the Medicines Act 1968 defines 'medicinal product' and I am satisfied that fluoride in whatever form it is ultimately purchased by the respondents falls within the definition". The noble Lord, Lord Charteris, has referred in terms which describe fluoride in very much more colourful language. It is extremely clear that we should address ourselves in the first instance to Lord Jauncey's judgment. If there is an acceptance of his judgment and if there is confirmation by his judgment in the High Court that fluoride is a medicinal product and is being used for a medicinal purpose, then we are on very firm ground. We are on firm ground because we are then able to state in the clearest terms that fluoridation as proposed in this Bill is a form of mass medication. The noble Lord, Lord Charteris, has proposed an alternative water supply. In doing so he is giving the opportunity of choice. For that I think he should be most warmly commended.

I shall not digress further on Section 130 of the Medicines Act 1968, although I could do so at considerable length, and also on the National Health Service Act 1977. Sufficient to say at this stage that alternative water supplies should be considered as a possibility, particularly in the case of those who are affected by particular ailments; and these are set out in the amendment. We considered a number of aspects in Committee relating to the situation as far as sufferers from particular ailments are concerned and this amendment appears to be one solution. I hope the Government will give it very serious thought and will commend it.

The Earl of Kinnoull

My Lords, I, too, support the nobler Lord, Lord Charteris, and congratulate him on the powerful case that he made on this amendment. I am only sorry that he was not available at Committee stage to give us the wisdom of his advice, because if anyone had any doubts about the medical arguments on the efficacy of the fluoridation of water they would have been compelled by his arguments. There are, in fact, arguments on both sides, whatever my noble friend will say later.

I believe that this is a reasonable amendment. It offers the water authorities the choice of providing, obviously, bottled water or they can provide what I learned recently from a small company in Cheshire is new technology called the crystal water column. It is an apparatus which can be fixed to the water tap and will remove fluorides and nitrates at relatively little cost. I hope that such an apparatus can be considered sympathetically by the Government. It would not cost water authorities very much and would meet the arguments of the noble Lord, Lord Charteris.

Baroness Gardner of Parkes

My Lords, I am, of course, opposed to the amendment as it is quite unnecessary. It would make the whole position horribly expensive. Every patient who imagines he has anything wrong will be ready to believe that fluoride in the water is the cause of it. All such people will automatically demand an alternative supply. The noble Earl, Lord Kinnoull, said that one can purchase a small apparatus which can be fitted inexpensively. I think it only right that people who do not want fluoride in the water should buy and fit such equipment for themselves. To make equipment available out of the public purse would be too much.

There is, of course, another easy way of having non-fluoridated water, and that is to move to an area where there is no fluoride. We must not lose sight of the fact that there is no question of this Bill enforcing the fluoridation of water throughout the United Kingdom. It is simply a permissive Bill to legalise fluoride in places where it is already being used. The provisions in the Bill for places where there would be a new supply of fluoridated water are fairly stringent on consultation and people are, therefore, well protected.

I also ask the supporters of this amendment to consider that the report referred to by the noble Lord, Lord Charteris, was produced, he said, in 1972. That is 13 years ago. Is the noble Lord trying to convince me that countries like Australia, where the total water supply is fluoridated, have, in 13 years, not considered very carefully such a report? Surely they must have done so, weighed up the value of it and decided that they were very much in favour of continuing to fluoridate the water. If there is a serious risk I cannot believe that the population of Australia would not have demanded that the matter be seriously reconsidered. I know from personal relations and many friends that nobody thinks twice about the fluoridated water supply. They accept it, take it for granted and are delighted that their children's teeth are so much better for it. Certainly there is no thought whatever of offering an alternative water supply to them.

The noble Earl, Lord Kinnoull, has presented an interesting suggestion that one can buy a small attachment for the tap. There will always be people who have personal preferences. There have been arguments about whether or not we should have softened water to drink. Some people install water softeners and some do not. These are matters of personal choice to which everyone is entitled and I am pleased to hear that an inexpensive appliance is available. However, I certainly hope that no family with children visiting it will ever use it, because that would be losing the great benefit to children's teeth which we all want to see.

8.45 p.m.

Lord Burton

My Lords, in Committee I drew attention to the effect on livestock of the escape of fluoride from the British Aluminium works at Fort William. Has any inquiry been made during the interim by my noble friend on the Front Bench, or by his officials, as to what happened in that area? The teeth of sheep became brown, twisted and fragile. When calves lost their milk teeth a few very weak teeth came through and the animals were of no use because they had no teeth for their adult life.

That happened up to seven miles from the factory. Fluoride escaped from the factory. Five or six years ago a new factory was built and the effluents have been properly treated. Since then the animals' health has not been affected. They can be put back on the land concerned because they now survive. When the fluoride was being discharged it was impossible to keep animals on the land.

If there is any doubt about this and no inquiry has been made I recommend a very good paper which has been produced by Professor Body. Furthermore, the veterinary officer in Fort William—a Mr. Carmichael, who has since retired—was also very well acquainted with what happened and he can give the Ministry full information. If Ministers were to look at what happened to these animals they would very strongly question whether it is a good idea to supply fluoride to human beings.

Lord Beaumont of Whitley

My Lords, I was not intending to speak at this particular stage but I am provoked into doing so by listening to the speech of the noble Baroness, Lady Gardner of Parkes. I cannot go along with the arguments which she put forward. They should not weigh very much with your Lordships. I cannot agree with the idea that all patients are fools who will immediately blame all their ills on fluoride. Of course there are a small number of hypochondriacs who choose any particular excuse. They are small in number. One year it may be fluoride and another year something else but that is not a major reason for not doing something worthwhile.

What I really objected to was the shifting of the burden of what you should do onto the people who wish not to have fluoride added to their water. We start from the right to have water more or less as it comes. I know that in some parts of the world it naturally contains fluoride and I know that in other parts of the world it contains no fluoride or virtually no fluoride. But that is where we start. That is the basic position to which all citizens surely are entitled. To say that if we want to avoid fluoride we must not object to the Government putting in fluoride but must either pay for gadgets ourselves or actually move to different parts of the country to avoid the efforts of the Government is to put the position entirely the wrong way round. It is not at all an acceptable suggestion in relation to what are our basic rights and liberties. I do not think that the noble Baroness has in fact put up a serious argument against this amendment.

Baroness Gardner of Parkes

My Lords, before the noble Lord sits down, may I draw to his attention the fact that I did not say, "You must move"? I said, "Your may move", or "You could move". I was not suggesting any compulsion. I was saying that in this country people still have that free choice.

Lord Beaumont of Whitley

My Lords, since, according to the noble Baroness, I have not sat down, I will go on to say that one should not have to move in order to get a supply of water as it is normally and naturally produced in the area where one was born or in which one had originally settled.

Lord Houghton of Sowerby

My Lords, I think that the whole idea of enforcing a prescriptive medicine on the consumers of water is wrong in principle and I think it is quite monstrous that people should have this imposed upon them for the satisfaction of a minority interest, a minority health interest throughout the community.

But of course this country has gone from shocking neglect of children in the past century to a mollycoddling attitude towards children today. I think grown-up people are now being regarded as second-class citizens, where children are concerned; they must be spared pornography, they must be spared nasty videos; children must be sheltered from all the cold and bitter winds of life. Restrictions must be put upon grown-up people to achieve that purpose.

I think that if this is going to be undertaken, there should be the right of individuals to contract out of it and have a replacement of the water service that they find unacceptable. This, I think, is the right of every citizen. Otherwise he may be left either to buy it in bottles or catch rainwater or something of that kind in order to get away from water medicated in a way that he finds unacceptable.

We shall come a little later to the question of consultation, but it seems to me that the whole trend of propaganda in this matter from Government, from certain scientific and medical quarters, is towards getting this done overall. The Government have shrunk from asking Parliament to enforce this measure nationally by law. They have therefore adopted the device of using the health authorities for the purpose. Previously the local electorate had some say in what should be done. But now that has been taken away and it is to be in the hands of a selected, not directly elected, health authority. They are the people who are given the responsibility of applying to the water authority to implement fluoridation of the water supplies.

I think that with all this influence behind the virtues of fluoridation, brushing aside the rights of individuals is surely against some of our human rights which we were discussing on an earlier Bill a little while ago. I therefore feel that this matter has to be taken more seriously than it has been and that people are entitled to have as much consideration in this direction as in many others under the local health services; for instance, special foods and grants of one sort or another to meet personal requirements as prescribed by doctors and health authorities. But in this instance apparently the citizen will be regarded as having no rights, apart from drinking the water that is laid on for him, with no direct voice himself in whether or not it should be laid on.

In those circumstances I think we must attach a great deal more seriousness to what we are doing in your Lordships' Chamber at the present time. I strongly support this amendment. It may seem a concession to cranks or those with fads who do not want to drink medicated water, but it seems to me that it is a clear right of the citizen to have water as it comes, or as it has come in the past, and not be forced to put up with this new version of water supplies laid on expressly for the purpose of safeguarding the teeth of children who ought really to be consuming a much better diet and so deal with the tendency to caries in a more sensible way.

The Earl of Caithness

My Lords, it might be helpful if in speaking to this amendment I refer also in a little detail to the accompanying schedule to which it closely relates. I have to say that neither this proposed new clause nor the schedule has any scientific or medical basis and they are entirely unjustified. If agreed, they could only serve to raise quite unwarranted alarm among members of the public as to the safety of water fluoridation.

It simply is not the case that any of the conditions listed in the schedule will be aggravated by the supply of fluoridated water. Taking the ailments in the order listed in the schedule, the 1976 Royal College of Physicians' report noted that the evidence did not suggest that fluoride in water at one part per million caused any increase in the incidence of, or mortality from, any renal disorder. Lord Jauncey also concluded that there was no reasonable likelihood of harm to kidney patients resulting from fluoridation.

With regard to allergic reactions, perhaps I may dwell on this point because this was very much stressed by the noble Lord, Lord Charteris of Amisfield. He dealt in some details with this. He mentioned the work of a Dr. Wilson which involved the injection of fluoride into the abdominal cavities of guineapigs. This is obviously very different from the drinking of fluoridated water. I am advised that Dr. Wilson's work does not show that even this unnatural type of exposure causes allergy in guineapigs.

The noble Lord referred then to Dr. Moolenburg's work in Holland and I have to advise him that this work has not been accepted by reputable medical opinion. If it had been, there would have been a much greater reaction to it, as mentioned by my noble friend Lady Gardner of Parkes. The work was not properly scientifically controlled and Dr. Moolenburg's work relates to suggestions that fluoridation causes allergies. Dr. Moolenburg's work was not upheld in the Dutch courts, as the noble Lord implied, where the question of fluoridation was decided purely on a legal issue.

I can tell the noble Lord that the American Association for the Study of Allergies stated in 1971 that, there is no evidence of allergy or intolerance to fluoride as used in the fluoridation of community water supplies". They reaffirmed this statement in 1980, well after Dr. Moolenburg's work. The comments of the American association were also the unanimous view of the British Society for Allergy and Clinical Immunology in 1982.

Before I move on to diabetes, I have one further point on allergies which I should just like to clear up, and that relates to the work of a Dr. Waldbott, also mentioned by the noble Lord. Dr. Waldbott has alleged that various conditions are linked to the drinking of water fluoridated at one part per million. The tests carried out to demonstrate these links have all been inadequate and some merely anecdotal. Dr. Waldbott used concentrations of fluoride in his test well in excess of those to be found in public fluoridated water supplies.

None of the many conditions listed by Dr. Waldbott is more prevalent in areas with a naturally or artificially fluoridated water supply. Investigations of individual cases of supposed intolerance to fluoridated water have failed to confirm fluoride as a cause and there is no evidence therefore to support the noble Lord's contention of problems with allergies.

9 p.m.

Moving to diabetes, the department is aware of suggestions that fluoride might cause diabetes by blocking the action of enzymes in glucose metabolism, but that has simply not been substantiated. As far as thyroid disorders are concerned, fluoride is not concentrated by the thyroid and does not influence the uptake of iodine. After reviewing all the relevant studies, the Royal College of Physicians concluded that: there is no evidence that fluoride is responsible for any disease of the thyroid". Similarly on the subject of arthritis, the Royal college concluded that: there is no evidence that the prevalence of any musculo-skeletal disorder is increased in areas with fluoride at a concentration of one milligram per litre in water". Finally, with regard to heart diseases there is simply no epidemiological evidence to support the suggestion that fluoride increases the prevalence of arteriosclerosis. Indeed, studies in the United States and the United Kingdom have tended to show a lower mortality rate from cardiovascular disease in fluoridated and naturally high fluoride areas. The 1976 report of the Royal College of Physicians noted that: there has been no increase in mortality from coronary disease in Birmingham since it was fluoridated in 1964, relative to low fluoride parts of its region". More generally, I should like to stress that, much as it may disappoint opponents of this Bill, the simple fact is that the medical profession, as instanced, for example, by the support of the British Medical Association, believes fluoridation to be a safe and effective means of reducing dental decay. During the initial 11-year test period following introduction of fluoridation, the research committee set up by the Government of the day specifically approached every general practitioner in the study areas of information about any patient who might be suffering ill-effects from fluoridation. Only two possible cases were reported and neither was shown to have anything to do with fluoridation. It remains the case that general practitioners are not expressing concern to the department about the safety of fluoridation, and this is also the position of our independent expert medical advisers who advise the department.

I turn now to some more detailed points. My noble friend Lord Sandys referred to mass medication which I dealt with at some length at the Committee stage, and so perhaps he will agree that I should not again go into it in depth. He also said that fluoride should be under the Medicines Act. But it is our advice that neither the chemicals we use nor fluoridated water with them are medicinal compounds within the meaning of that Act.

The noble Lord, Lord Burton, asked whether we have been doing any work between the occasion when he last spoke and today. Looking round the Chamber I like to see how healthy the noble Lord, Lord Monson, my noble friend Lord Kinnoull and the noble Lord, Lord Burton, look, compared to my noble friend and I who are looking pale and wan from hours spent in the department trying to make sure that we have our information ready to hand.

The noble Lord, Lord Burton, in particular referred to animals. I have to tell him that fluoridation of water supplies at one part per million does not harm livestock. The problem that he told us about related to animals that were affected as a result of pollution from factories emitting fluoride. As I think I said at an earlier stage in our proceedings, that is now closely controlled. In his argument he admitted that since more safety measures had been introduced, the situation has improved significantly at Fort William.

The noble Lord, Lord Beaumont of Whitley, mentioned "natural water". I do not think that there is such a thing. All water has fluoride in it and it varies from hard to soft. I prefer soft water with my whisky! There is no such thing as pure natural water throughout the country. It varies from place to place as one goes round the country. I do not think that the noble Lord can be that precise.

Lord Beaumont of Whitley

I made that point, my Lords.

The Earl of Caithness

My Lords, I am grateful to the noble Lord. I was only stressing it, which rather proved the flaw in his argument.

I turn now to the noble Lord, Lord Houghton of Sowerby. I should like to deal with some of his points in detail. He mentioned at the Committee stage that he had a case which proved that fluoride in water was detrimental. After that he kindly gave me the file, and we have in the department gone through it in great detail. Perhaps if he agrees, this would be an opportune moment for me to say something on that. Most of the file is concerned with the case of Mrs. Emily Jones. It is alleged that Mrs. Jones suffered from severe skeletal fluorosis and that that resulted from drinking water with a natural fluoride content of 1.5 parts per million.

I am advised that the evidence presented shows that the lady in fact had features of rheumatoid arthritis which has nothing to do at all with fluoride. The X-ray enclosed in the file shows no features of skeletal fluorosis such as bony exostoses or calcified or ossified ligaments. The medical history does not include fluorosis since it appears that the arthritic condition did not improve despite 14 years on a low fluoride mains water supply.

Indeed, it would appear that Miss Keyes, who supplied the file to the noble Lord, is the only person besides him who believes that Mrs. Jones had fluorosis. It is clear from the papers presented that that view was not shared by the coroner and therefore not by the pathologist who carried out the post-mortem. Indeed, Miss Keyes herself says that Mrs. Jones had a fluoride level of 2,000 parts per million in one of her bones. That might sound a lot, but that is a perfectly natural occurrence and is perfectly normal in an 82-year-old woman. It is not an indication of skeletal fluorosis.

I shall not weary your Lordships with all the inaccuracies in the information supplied to us, although I recognise that it was done in wholly good faith by the noble Lord. Suffice it to say that no symptomatic case of skeletal fluorosis attributable to water consumption has ever been recorded in temperate climates where the level of fluoride in the water supply has been less than four parts per million; and we are going nowhere near that figure.

In her file of papers Miss Keyes alleges that symptoms of fluorosis in man go unrecognised and are seldom diagnosed. In fact the only reason why skeletal fluorosis is seldom diagnosed in this country is that it is almost non-existent from any cause. Its radiological features are distinctive and any clinician who found a case would undoubtedly publish details precisely because it is so rare. Against that background one can only conclude, to use a phrase which I recognise will irritate the opponents of the Bill and in particular my noble friend Lord Sandys, that there is still no evidence here of harm from fluoridated water.

The noble Lord, Lord Houghton, said that those of us who favoured the fluoridation of water supplies were in a small minority. I beg to differ with him. I think that we are in the majority, and the opinion polls and the evidence that we have to date suggest that we are. If, however, he is right, why does he worry? This is merely an enabling Bill. It will enable the health authorities, with the water authorities, to fluoridate should they think it right to do so after consultation. We come on to that in due course. As the House will be well aware, my noble friend Lady Trumpington withdrew an amendment to bring back a wider and much more generous amendment, bearing in mind the points made at Committee.

I have dealt with this matter in some detail. I think it has been necessary" to do so. Against the background about which I have spoken, I hope that your Lordships will feel that the suggested amendment is not justified.

Lord Burton

My Lord, before my noble friend sits down, may I ask him this? If it is so beneficial, why are we the only country in Western Europe, except for Southern Ireland, adopting this policy? And why is India trying to remove fluoride if it does not have a deleterious effect on the human body?

The Earl of Caithness

Oh, my Lords, I should love to answer that in great detail. I can tell my noble friend about various countries in Europe. I can tell him about Sweden and the Netherlands, where they still want it. I can tell him about the problems of water supply in France from all the little different sources and how uneconomic it is. If my noble friend would like me to go into a lot of detail on that, perhaps he will please put down an amendment. I should be very happy to deal with it all and so would my noble friend.

Lord Monson

My Lords, I can only express disappointment at the Government's inflexible response to my noble friend's very reasonable amendment. First, may I reply to the noble Baroness, Lady Gardner of Parkes? She spoke of individuals who are suffering, or who believe that they are suffering, from some ailment or other which they ascribe to the presence of fluoride in the water, being able to demand an alternative water supply. However, the amendment says nothing of the kind. It does not provide for that possibility. What the amendment does is stipulate that an alternative water supply would be made available only in the event of a doctor writing out a certificate which certified that fluoridated water may carry a serious risk of harm to the health of the individual concerned. From the noble Earl's reply, it seems to me that the Government are claiming that they are almost infallible in this matter and that any doctor who questions their quasi papal infallibility (and, believe me, there are plenty who do) must be either fools or dishonest members of their profession who would—

The Earl of Caithness

My Lords, perhaps I may just interrupt the noble Lord. I think he is being grossly unfair. The Government base what has been said today on firm and independent evidence. It is not just the Government's view, it is independent and very superior medical advice.

Lord Monson

My Lords, perhaps the noble Earl will agree that not all doctors are agreed on this matter. They really are not. I certainly refute the idea. If the Government are right, then of course they have nothing to worry about in accepting the amendment because there will be no doctors' certificates. If all doctors agree that fluoride cannot cause harm, why should any doctor's certificate be issued in the first place?

The amendment can only be of concern to the Government if the Government turn out to be mistaken and doctors' certificates are issued. I submit that the Government's position might be tenable if at least 99 per cent. or more of doctors, physiologists and others throughout the civilised world agreed that fluoride was harmless and that there was no conceivable possibility of any research in the future proving it to be otherwise. However, that is not the case. I think the Government, if they are honest with themselves, will agree that that is not the case. Therefore, I submit that their position is not tenable.

Lord Winstanley

My Lords, before the noble Lord sits down, may I say this? In relation to the point that he made that not all doctors agree on this matter, I wonder whether he can tell the House any particular matter on which all doctors agree. Doctors, as people, do not all agree. The fact that one or two disagree on this particular matter does not invalidate the firmly-held belief of the overwhelming majority of doctors.

Lord Monson

My Lords, I agree that if it were the case of only one or two doctors disagreeing, there might be something in what the noble Lord has said. However, I submit that there are far more than just one or two.

Viscount Hanworth

My Lords, I think this amendment is very reasonable. However, what worries me about it is how the unfluoridated water could reasonably be made available. Were it not for that fact, I should support the amendment completely.

Lord Charteris of Amisfield

My Lords, as has been already said, doctors never agree. Unfortunately, I do not share with the noble Earl this great learning which he has displayed to us this evening about medicine. I shall study very carefully what he has said. The question now is whether or not we should divide on this issue. Here I am in a slight state of bewilderment since I am not familiar with these affairs. However, I believe that if this amendment was passed, it would lead to financial implications which possibly may be outwith the powers of this House. Thus, if I may, I should like to reserve the right to come back to this question on Third Reading. Otherwise, I beg leave to withdraw the amendment.

Baroness Trumpington

My Lords, I am not absolutely sure of the mechanism for this, but I would prefer the noble Lord not to withdraw his amendment but rather that he should put the matter to the test. It was discussed in Committee.

The Deputy Speaker (Lord Ampthill)

My Lords, the noble Lord has asked leave to withdraw the amendment. Therefore, the Question is: Is it your Lordships' pleasure that this amendment be withdrawn?

Noble Lords


The Deputy Speaker

My Lords, the Question is that this amendment be agreed to. As many as are of that opinion will say, "Content"; to the contrary "Not-content". I think the "Not-Contents" have it. The "Not-contents" have it.

On Question, amendment negatived.

9.15 p.m.

Lord Beaumont of Whitley moved Amendment No. 5: After Clause 2, insert the following new clause:


.A health authority shall be under a duty to review an application or withdrawal of an application made pursuant to section 1(1) of this Act not later than at the expiration of a period of 5 years from the date of such application or withdrawal and at the expiration of every five year period thereafter in the light of all relevant medical and scientific evidence known to it and in the light of any shift in public opinion in the area affected on the question of compulsory fluoridation of the public water supply.").

The noble Lord said: My Lords, this is a very simple amendment. I seek to ensure that this matter is not lost sight of. From the discussions that we have had in your Lordships' House, there can be no doubt that, whatever the majority may be on one side or the other—and I shall not cross swords with the Government spokesman on this—this is a matter which arouses a considerable amount of interest and controversy. Probably it would be true to say that it is not a matter that would be lost sight of. However, I am chronically indisposed to give people powers to do things like adding various chemicals to water without keeping the whole matter under control and review. I do not want to put it any stronger than that.

The amendment suggests that there should be a review every five years and I think that that would be a sufficient safeguard of the interests of the public. I look forward to hearing the Government's response. I beg to move.

Lord Winstanley

My Lords, I have disagreed with my noble friend on so many matters in relation to this Bill that I thought I might rise very briefly to say that I do not for a moment quarrel with him on this matter. My noble friend has an admirable record in public life in opposing pollutants of one kind or another and of doing what he can to preserve our environment. I hope he will accept that some others of us, who perhaps are on the opposite side in this Bill, have also worked very hard over matters of pollutants and, with regard to this Bill, would not be persuaded had we not looked with extreme care at the possible dangers.

My only question on this amendment is whether or not it is necessary. I anticipate the noble Baroness, Lady Trumpington, saying that she would expect health authorities to keep these matters under continuous review, and not just to hold a review every five years. I believe that this amendment which has been moved and which I support is not really necessary, and I hope that in due course that is what the Minister will tell us.

Lord Houghton of Sowerby

My Lords, I have no confidence in continuous reviews. I know from my own experience how that phrase is misused to hide an intention to do damn all. I believe that some term should be set for the implementation of an application when it is made by a health authority. Only if that is done will they monitor the working of the scheme carefully and get away from the unrecorded propaganda on this process in the way which may be needed to keep a check on its efficacy or its possible harmful effects. What the period should be is, I think, open to dicusssion. It may be that five years is too short and that 10 years might be better. However, I think that the need to review the continuation of fluoridation when applied for by a health authority should exist. Otherwise I do not know how the inertia of a health authority can be overthrown.

There is no method of election which will make known the wishes of the electorate through the process of pressure on health authorities. In those circumstances I think that the Government should be quite reasonable about this and accept the amendment, or indicate that they are willing to accept an amendment with a different time limit. This is the only way in which some of the fears and anxieties can be relieved.

I stress that it is no good using a steamroller on a subject which is so highly emotional, which has been controversial for so long, and upon which there are so many differences of opinion by those who claim knowledge, expertise and experience. I beseech the Government to have some regard for these feelings. We may not be as rational as we ought to be about some things in life. The human being is an emotional animal and is bound to respond to emotional situations and emotional feelings. I had better say "species" in place of "animal", although I do not regard the word "animal" as in any sense a depreciation of the human species. I make that observation in passing only because the noble Baroness was expressing some surprise on the Bench opposite at the use of the word. Anyway, that is how I feel, and I think that the amendment should be accepted at least in principle.

Viscount Hanworth

My Lords, five years ago I would, without any doubt, have supported this Bill. But since then there has been more evidence that just possibly fluoridation might have adverse effects. As we know, it is a form of compulsory medication and it must be justified as such. Therefore, a review in the light of all the facts, and particularly the medical facts, must be made. It is important to place a time limit on doing this, because otherwise it goes by default. I strongly support the amendment.

Lord Prys-Davies

My Lords, I too strongly support this amendment. In Committee we discussed an amendment proposing that the Act itself should be renewed annually, but the Committee could not support that particular amendment and the noble Lord, Lord Monson, did not press it to a Division. But I believe, with the noble Lord, Lord Beaumont, that the health authority itself should be under an express statutory duty periodically to review its decision on fluoridation. It may be that the period of five years is not quite correct, but it should do so periodically.

There are two reasons. First, it is a highly controversial issue. Many consider it to be unethical. All over the country honest and sincere people hold different views about it. There could be a decisive shift in public opinion in the course of time. The second reason has been touched upon by the noble Viscount. The balance of the scientific evidence for and against fluoridation may change, may be changing currently, and certainly may change over the passage of time.

Of course we appreciate that a decision taken by a health authority is not irreversible, but the best way—indeed the only way—of ensuring that the health authority will always be responsive to a shift in public opinion, to a shift in the balance of the medical argument, is by introducing into the Bill a positive duty to review its original decision periodically in the light of the up-to-date evidence. I agree with my noble friend Lord Houghton that if this duty is built into the Bill it is a duty which the health authorities cannot evade. Therefore, I wish to support the amendment.

Lord Monson

My Lords, I too am happy to support this amendment. Surely one can only logically oppose it if one believes that from the middle of 1985 onwards scientific and medical knowledge is going to be frozen at its present level, that it is going to remain static and that there will be no further advance in the relevant scientific and medical evidence. Thank goodness, that is not likely to happen, and for that reason the amendment must be supported.

Baroness Trumpington

My Lords, to borrow from a remark of the noble Lord, Lord Houghton, if ever there was a steamroller to crack a nut, then this is it. This new clause would impose upon health authorities a requirement which is as cumbersome as it is unnecessary. Health authorities, under the Bill as it is currently drafted, will remain free to reconsider their policy on fluoridation at any time. I cannot see what can possibly be gained by obliging a health authority to do this every five years from the time of making or withdrawing an application for fluoridation. Indeed, this could lead to quite ridiculous results. For example, if health authority A requested water fluoridation from water authority B and then withdrew its application (having been told by B that it was technically impracticable in that area) then under the noble Lord's amendment health authority A would nevertheless have to review fluoridation every five years until eternity. This cannot be regarded as sensible.

I appreciate that the intention behind the amendment is to ensure that health authorities take account of any new medical and scientific evidence or evidence on public opinion which comes to light after the initial decision on fluoridation has been taken. This does not require any new statutory obligation to be placed upon health authorities. My department continually monitors the literature on the safety and efficacy of fluoridation and brings significant new material, such as the Knox report published earlier this year, to the attention of health authorities. In the wholly hypothetical case that reasons were ever found for belief that fluoridation was unsafe—for which I must stress that there is no evidence from over 40 years of study of artificial fluoridation schemes—health authorities would be asked to cease fluoridating immediately, and if necessary the Secretary of State's powers of direction could be used. There is no question in such circumstances of leaving health authorities to take their own decisions when, under the noble Lord's amendment, their next five-yearly review became due, possibly in four years and eleven months' time.

I am wondering whether my words are of total lack of interest.

Lord Graham of Edmonton

Not at all, my Lords.

Lord Ponsonby of Shulbrede

No, my Lords.

Baroness Trumpington

My Lords, with regard to shifts in public opinion, evidence on this can be presented at any time to health authorities. In particular, the community health councils—which Parliament has established to represent consumer opinion on the health service—are free to make representations at any time. That said, fluoridation to be fully effective requires that children drink fluoridated water for the whole period of tooth formation from birth to the age of 14 years. It is simply wasting health service money to seek to operate fluoridation on other than a long-term basis. Hence I do not see why minimal and transitory shifts in public opinion, whether for or against fluoridation, should be regarded as justification for operating a stop-go policy every five years. Fluoridation should be regarded as a long-term investment and there should be very strong grounds for any decision to withdraw from fluoridation once it has been initiated. In the Government's view, this amendment is fundamentally misconceived and would serve no useful purpose. I hope that the amendment will be withdrawn, but if not I must ask your Lordships to reject it.

Lord Monson

My Lords, before the noble Baroness sits down, she mentioned the period of a child's tooth formation as being between the ages of nought and 14 years. Is it not the case that there has never been any scientific evidence to show that children's teeth are in any way improved by the ingestion of fluoride once they reach the age of six, by which time the second teeth are fully formed within the gums?

Baroness Trumpington

My Lords, I have sat down, and the noble Lord is not correct.

Lord Beaumont of Whitley

My Lords, I thank my noble friend Lord Winstanley for his remarks. He and I see eye to eye on many subjects, and this amendment is not about medical evidence but purely about watchdogs on public concerns. I tend to agree with the noble Lord, Lord Houghton, when he says that he does not particularly trust ongoing reviews and that he should like periodic checks. I, too, should like periodic checks. I am delighted that there is an ongoing review, as the noble Baroness has said. It seemed to me that she destroyed a lot of her case for saying that this was a cumbersome amendment. If the department is consistently monitoring the whole situation, presumably it would be extremely easy every five years to muster the evidence and consider it; it would not in any way be a cumbersome matter.

I believe that citizens should have their rights. It seemed to me at one moment, when the noble Baroness was talking about not paying attention to minimal shifts in public opinion every five years, that this was something which the Conservative Party might be taking up as a doctrine. Indeed, I rather hope not. I think that in all matters we should have a look every five years at a lot of what is going on. I am afraid I did not quite follow the arguments by the noble Baroness about Health Authority A and Health Authority B, but I have no doubt that if there is a major fallacy in this amendment and if your Lordships decide to put it in the Bill, we can iron out that fallacy or that minor point at Third Reading. As it is, I think that it is a matter of public interest that there should be periodic surveillance and I should like to test the opinion of your Lordships' House.

9.31 p.m.

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

Their Lordships divided: Contents, 38; Not-Contents, 47.

Airedale, L. Hirshfield, L.
Arran, E. Houghton of Sowerby, L.
Barnett, L. Kilbracken, L.
Beaumont of Whitley, L. [Teller.] Killearn, L.
Kinnoull, E.
Boyd-Carpenter, L. Kitchener, E.
Burton, L. Lawrence, L.
Campbell of Eskan, L. McNair, L.
Charteris of Amisfield, L. Mar, C.
Craigmyle, L. Monk Bretton, L.
David, B. Monson, L. [Teller.]
Davidson, V. Moyne, L.
Ennals, L. Parry, L.
Falkender, B. Ponsonby of Shulbrede, L.
Falkland, V. Prys-Davies, L.
Galpern, L. Sandys, L.
Graham of Edmonton, L. Taylor of Blackburn, L.
Gray, L. Wilson of Langside, L.
Grey, E. Yarborough, E.
Hanworth, V.
Allenby of Megiddo, V. Layton, L.
Ampthill, L. Lindsey and Abingdon, E.
Beloff, L. Long, V. [Teller.]
Belstead, L. Lucas of Chilworth, L.
Blake, L. Lyell, L.
Brabazon of Tara, L. McFadzean, L.
Caithness, E. Macleod of Borve, B.
Cameron of Lochbroom, L. Morris, L.
Campbell of Alloway, L. Murton of Lindisfarne, L.
Colville of Culross, V. Redesdale, L.
Colwyn, L. Richardson, L.
Crathorne, L. Rochdale, V.
Darcy (de Knayth), B. St. Aldwyn, E.
Elliott of Morpeth, L. Sandford, L.
Elliot of Harwood, B. Sharples, B.
Elton, L. Skelmersdale, L.
Gardner of Parkes, B. Stodart of Leaston, L.
Glanusk, L. Swinton, E. [Teller.]
Glenarthur, L. Trefgarne, L.
Grimston of Westbury, L. Trumpington, B.
Hailsham of Saint Marylebone, L. Westbury, L.
Wise, L.
Hooson, L. Young, B.
Lauderdale, E. Young of Graffham, L.

Resolved in the negative, and amendment disagreed to accordingly.

[Amendment No. 6 not moved.]

9.39 p.m.

Lord Prys-Davies moved Amendment No. 7: Insert the following new clause:

("Notice of health authority meeting.

. A public notice of the date, time and place of the meeting of the health authority to consider and vote on a motion that the health authority shall make or withdraw an application under section 1(1) of this Act shall be given by publishing it in three consecutive issues of one or more newspapers circulating in the area to be affected by it twenty-one clear days at least before the meeting.").

The noble Lord said: My Lords, looking ahead at Amendment No. 8, we note that the Government acknowledge it is important that the decision whether or not to implement fluoridation should be taken at a meeting which is open to the public. That is common ground. Amendment No. 8: After clause 3, insert the following new clause:

("("Publicity and consultation.

.—(1) This section applies where a health authority propose—

  1. (a) to make or withdraw an application; or
  2. (b) to terminate a scheme which may be operated by virtue of section 3 of this Act (a "preserved scheme").

(2) At least three months before implementing their proposal, the health authority shall—

  1. (a) publish details of the proposal in one or more newspapers circulating within the area affected by the proposal; and
  2. (b) in the case of an authority in England and Wales, give notice of the proposal to every local authority whose area falls wholly or partly within the area affected by the proposal.

(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)(a) above to give notice of the proposal.

(4) The health authority shall, not earlier than seven days after publishing details of the proposal in the manner required by subsection (2)(a) above, republish them in that manner.

(5) Where a health authority have complied with this section in relation to the proposal they shall, in determining whether or not to proceed, have such regard as they consider appropriate—

  1. (a) to any representations which have been made to them with respect to it; and
  2. (b) to any consultations held under subsection (3) above.

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

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

The purpose of giving the press and public the right to attend meetings is for them to inform themselves of what is going on. It is a right given to the citizen to observe and hear for himself what is going on and not merely to have to rely on a report in the press. That being a basic civic right, a member of the public should not be deprived unwittingly of the opportunity to exercise that right, and yet that could easily happen. It is implied in Amendment No. 8, or I believe that it is intended to be implied, that adequate public notice of the time and place of the meeting must be given to the public.

However, we noted in Committee that the statutory provisions in the Public Bodies (Admission to Meetings) Act 1960 merely requires a notice posted at the office of the authority three clear days before the meeting or, if the meeting is convened at shorter notice, at the time it is convened. We would hope that the authority would not be content merely to exhibit this one single notice on a notice board in its head office but would also circulate the notice widely. We would hope also that the authority would not be content to give less then three days' notice but would give as much notice as possible. But on both aspects the Bill is silent, and therefore we have to fall back on the provisions contained in the 1960 Act to which I referred.

It is our submission that the statutory provisions in the 1960 Act for giving notice of the time and place of a meeting are inadequate. A health authority pleading the 1960 Act could rely, as I have said, on a single notice exhibited in its office, giving no more than three days' notice and possibly less than that. In our submission, if it were to proceed on that basis the holding of the meeting would be almost useless and the giving of a right to members of the public to attend would be almost useless, because effectively the public would be excluded from the meeting. It would be the meeting that never was. That should never happen, and that is why we invite the House to give support to Amendment No. 7 and the underlying principles. I beg to move.

Baroness Trumpington

My Lords, I must ask my noble friends and noble Lords opposite to reject this new clause. I have to say that I think it is completely unnecessary to place this statutory obligation upon health authorities. Under the Government's own new clause on consultation, the health authority's plans for fluoridation will be fully publicised in newspapers, and indeed many health authorities may choose to take that opportunity to inform the general public when and where their decision is finally to be taken. Moreover, I understand that it is a common practice for health authorities to make their meeting agendas and venues available to the local press, as well as to interested bodies such as community health councils, health service trade unions and local councils. Local interest in fluoridation will certainly be reflected in the press, which may be relied upon to publicise the matter widely and to report the outcome of health authority discussions on the issue.

9.45 p.m.

There are two main reasons why we are unwilling to make this a statutory obligation. First, I think that it is very important to put the matter in perspective. Fluoridation is only one among very many important decisions taken by health authorities. The Government do not consider it appropriate to make this extra provision just for this one particular category of decision. Secondly, it is not entirely clear what purpose this provision would actually achieve. The public can of course attend health authority meetings, and indeed many choose to do so. However, as at local authority meetings, they cannot speak or take any part in debate. Indeed it would be most improper for them to seek to influence the actual course of a health authority meeting.

What is far more important than the actual presence of the general public at the meeting is that the public should have ample opportunity to make their views known to the authority prior to the meeting, so that the health authority can take them sensibly into account. Noble Lords will be aware that we have specifically provided for this already and I therefore ask that this amendment be withdrawn. If it cannot be withdrawn, I would urge noble Lords to reject it as constituting a wholly unjustified imposition upon health authorities.

The Earl of Kinnoull

My Lords, if the noble Baroness says that the health authorities "may" take the opportunity to include in their published notice their intention to introduce fluoridation, I am not quite sure why she is not prepared to say "must" take the opportunity, because really that is the whole issue. There is this doubt that a district health authority could consider this very short notice, even having published a notice saying that they were going to take this decision. It is the fact that they are denying the possibility of the public being present that I think moves the noble Lord's amendment. I must say that I would support the amendment, because I think there is nothing between the Government and the amendment, if I were certain that the district health authority would publish the date of the meeting at the time they published the notice of their intention. There is nothing really at fault there.

Lord Ennals

My Lords, I must say that I found the noble Baroness's reply very unconvincing indeed and I entirely agree with every word that was said by the noble Earl, Lord Kinnoull. The noble Baroness is not saying that what is contained in Amendment No. 7 is not an extremely good idea. She just says that she knows it is going to happen anyhow. Just how can she be sure it will happen anyhow? She cannot speak on behalf of health authorities. They act for themselves.

Here is a decision which is, after all, a fairly unique one. It is not like the closure of a hospital. Yes, my Lords, that is very important and people will want to be involved in that; but this is a very fundamental decision and it may be right. I am not arguing that it is not a right decision. That is not the question at all. The question is whether they should be given plenty of notice on an issue that is extremely controversial, so that people may know by advertisements in the press of the conditions set out here. If, as the noble Earl, Lord Kinnoull, says, and the noble Baroness is saying, the health authorities would do this, in Heaven's name why not put it in the Bill?

Baroness Trumpington

I am allowed to speak again, I think—and if I am wrong I apologise—but I believe that the noble Lord has not understood what I said. May I just say again that under the Government's own new clause on consultation the health authorities' plans for fluoridation will be fully publicised in the newspapers, and I went on—

Lord Ennals

My Lords, I absolutely accept that, and I was just going on to give the noble Baroness some congratulations. As she will realise, the reason I did not move Amendment No. 6 was that she was wise enough to write virtually the identical words of Amendment No. 6 in the names of myself and my noble friend Lord Prys-Davies into her new clause. What I do not understand is why she was not prepared to follow our wording with a little more accuracy and precision in what she had to say at this point in the new clause.

I do not intend to press this amendment to a Division, because I think that the case is overwhelming and, if the Government are prepared to say that they will at least look at this again, we shall be able to deal with it on Third Reading. So I ask the noble Baroness to say that she is prepared to look seriously at the arguments put forward in what has admittedly been a very brief debate. There is nothing between us, except that one says, "We hope it will happen" and the other says, "It must happen."

The Deputy Speaker

The Question is that this amendment be agreed to?

Lord Ennals

My Lords, I beg leave to withdraw the amendment.

The Deputy Speaker

Is it your Lordships' pleasure that this amendment be withdrawn?

Baroness Gardner of Parkes


The Deputy Speaker

The Question is that this amendment be agreed to?

On Question, amendment negatived.

Lord Houghton of Sowerby rose to move, pursuant to Standing Order No. 60, That the House do now resolve itself into a Committee to debate Amendments Nos. 8 to 12.

The noble Lord said: My Lords, there is nothing in this Motion of a dilatory or obstructive nature—

Noble Lords

Hear, hear!

Lord Houghton of Sowerby

There is nothing in this Motion of a dilatory or obstructive nature—

Noble Lords


Lord Houghton of Sowerby

Do I have to say it again? I am relying on Standing Order No. 60, which was made on 27th March, 1621—an event which not even the noble Lord, Lord Shinwell, can remember. It begins: To have more freedom of debate, and that arguments may be used (pro and contra) Committees of the whole House are appointed, sometimes for Bills, sometimes to discuss matters of great moment". This is a recommittal Motion—that is all—and there is no mischief in it. I remind the noble Baroness very briefly of the course of events. She will recall that at the Committee stage on 25th April, at col. 1266 of the Official Report, she came to her Amendment No. 32, which is set out there. But she went on to say: I am not now proposing to move Amendment No. 32. It may be helpful to your Lordships if I give a very brief explanation". What she explained was that after she had put down her amendment she took account of other amendments that were down dealing with the same subject. Indeed, we have just been debating one of them which is on the Marshalled List, dealing with the Public Bodies (Admission to Meetings) Act.

But in not moving her amendment she said that on reconsideration it probably did not go far enough and she wanted to take it back to give further consideration to the matter and bring forward a revised version. That is what she did, and Amendment No. 8 on our Marshalled List is the revised and improved version of Amendment No. 32, which she did not move after it had been tabled in Committee stage earlier on.

I think the noble Baroness will agree that she tabled her amendment in Committee stage late and did not bring it forward for debate at Committee stage, so that the customary opportunity of dealing with it in full in Committee did not arise. Naturally, when a Minister indicates a willingness to take something back, or not even to bring it forward without further consideration in the hope of improving it, we take her at her word and do not harass her too much in Committee. That is what happened.

I hope that my motive in this matter will be accepted as absolutely pure. It is merely to get greater freedom on these amendments, particularly on the noble Baroness's amendment, than we would usually get on Report stage. The proceedings do not constitute a Committee stage requiring another sitting of the House to complete the Report stage. As soon as these amendments are disposed of the Report stage will be resumed straight away. It is merely an interlude during which we are given that greater freedom of debate on these amendments, including her own, without having to come to the House each time and say "By leave" in order to speak again.

I hope that the noble Baroness will not be difficult about this. I do not want to disturb her state of happiness at the moment but I should regard it as an act of serious discourtesy, quite honestly, if in rejecting this Motion she implied that there was more to this than I had stated. It is literally what I have said that I intend and no more will happen than that we can go into Amendments Nos. 8 to 12 a little more freely than under the procedural condition of the Report stage. I do not think that that is unreasonable, bearing in mind that we are dealing with an amendment that appears for the first time in its present form on Report, after not having had adequate opportunity for debate on that amendment in Committee.

That is all I need say. I am sure that my noble friends, and I hope noble Lords everywhere, will take it amiss if the noble Baroness brushes aside this very reasonable request, which is a procedural matter and which has no ulterior motive whatsoever except to deal, as I shall indicate in due course, with the fact that what we are about to discuss here is the last bastion of freedom remaining in this Bill, because it is on consultation between the health authority and the public that the matter will ultimately rest.

That is why the provisions for that consultation are vitally important. They must be seen to be complete and fully observed. That is what makes this particular phase on this Bill of such great importance. Everything else has gone. The noble Baroness has rejected everything and has even described some amendments as ridiculous. We have been very patient, if I may say so, in listening to the forthright condemnation from the Front Bench opposite of amendments and arguments put forward by my noble friends and myself. Here is an opportunity for a little sweet reasonableness at this hour of night in order that we can get on to the Committee phase of these amendments, get on with the Bill and resume the Report stage as soon as we have disposed of the amendments in Committee. I beg to move.

Moved, pursuant to Standing Order No. 60, That the House do now resolve itself into a Committee to debate Amendments Nos. 8 to 12.—(Lord Houghton of Sowerby.)

10 p.m.


My Lords, of course I would never ever dream of thinking that any of the motives of the noble Lord, Lord Houghton, were anything but crystal pure, clear water with a dash of fluoridation. I have to say that I can see no justification for the Motion of the noble Lord, Lord Houghton, that the House should resolve itself back into a Committee to consider the new clauses and consequential amendments on consultation. It is simply not the case that consultation was not extensively debated at the Committee stage or that any new facts have emerged subsequently.

Indeed, no fewer than five amendments were discussed on this issue—moved by my noble friends Lord Sandys and Lord Kinnoull, and by the noble Lord, Lord Prys-Davies. In fact, of the eight-and-a-quarter hours which the Bill's Committee stage lasted, approximately two-and-a-half hours were spent discussing consultation. In other words, consultation was one of the subjects which received the most attention at Committee stage.

On this basis alone it seems rather unreasonable to suggest that consultation should again be discussed in Committee. It is of course true that the Government amendment on consultation was not discussed directly in Committee. This was for the very simple reason—as the noble Lord, Lord Houghton, explained—that I withdrew it. But I did so in order that it could be amended to take account of the views expressed by noble Lords at Committee stage.

Indeed, I am particularly surprised that the noble Lord, Lord Houghton, should feel it necessary that the new clauses in his name and mine on the subject should be referred back to Committee since, in their essentials, they are very similar. Equally, it will be seen that provisions which appear in my clause but not in that of the noble Lord, Lord Houghton, have been added either for technical reasons or to meet points raised by other noble Lords.

Thus, subsection (4) is designed to meet the essentials of an amendment tabled at Committee stage by my noble friend Lord Sandys. Similarly, subsection (7) meets specifically an amendment tabled by the noble Lords, Lord Ennals and Lord Prys-Davies. Subsection (5) reflects the wish of your Lordships that there should be a specific obligation upon health authorities to consult local authorities on their proposals for fluoridation. Subsection (6) preserves the principle about which several of your Lordships have expressed concern: that there should be adequate powers to terminate fluoridation schemes in the wholly hypothetical eventuality that there were doubts as to their safety.

This is not an appropriate time for me to make a detailed presentation of the Government's amendment on consultation. I hope, however, that what I have said will be sufficient to convince your Lordships that consultation was fully discussed at the Committee stage and that the Government amendment—which closely resembles that of the noble Lord, Lord Houghton—is in fact a synthesis of the views expressed there. This illustrates how carefully the Government have listened to the views of your Lordships.

If we are to agree with the Motion of the noble Lord, Lord Houghton, to return to Committee stage, then we may have this kind of procedure applied to every Government amendment put down at Report stage in every Bill from now on. I have to say that I would regard it as a sign of ingratitude, to say the least, if after the Government have bent over backwards to meet the wishes of my noble friends and noble Lords opposite our reward were to be that the amendments in question were sent back to Committee for what could only be time-wasting purposes. This Bill is not party political. My amendment has not been bounced at your Lordships out of the clear blue sky. There is no case for this Motion and I urge your Lordships to reject it.

Lord Moyne

My Lords, much as I admire so much of what the noble Lord, Lord Houghton, has said on this Bill, I cannot support him on this Motion. The reason is the hour on the clock. So many arguments have been advanced so succinctly and so well that it seems to me unnecessary at this time of night that we should all speak several times. If it had been three o'clock in the afternoon I would have supported this Motion wholeheartedly. I am simply speaking from a commonsense point of view.

Lord Monson

My Lords, the argument of the noble Lord, Lord Moyne, proves—if proof were needed—the Government's skill in arranging for these debates to be held so late in the evening. This is not a party political Motion, as must be obvious. Nor is it an underhand, tactical delaying Motion, as the noble Lord, Lord Houghton, has explained—despite the slightly cynical laughter emanating from the proponents of fluoridation when he said so.

We have, after all, a recent precedent in the Insolvency Bill where a large number of clauses were re-committed. I believe a whole day was lost. By way of contrast, agreement to this Motion would not materially hold up proceedings and would allow proper discussion of the Government's new clause which, on their own admission, they had not got right in Committee. As a matter of interest to your Lordships, the Government had not even got it right as recently as last Thursday. Since last Thursday the Government's consultation amendment has been revised yet again, albeit in a relatively minor way; one particular subsection was revised. If the Government, with all the back-up at their disposal, cannot get an amendment on this undoubtedly complex question right until only one working day before the Report stage, then surely this proves the necessity for recommitment.

Lord Sandys

My Lords, while listening to my noble friend Lord Moyne, and agreeing with him that the hour is late, I feel that there is one matter of substance which all your Lordships should recollect; that is, we are a deliberative Chamber. This Motion will permit your Lordships' House to deliberate on an issue which, while fully recognising every word that the noble Baroness has said in regard to the concessions which she has made and consideration given, will permit that degree of flexibility.

If the Government deny us that flexibility it will, of course, be necessary to apply the usual procedures for a Report stage. Due to the skills of your Lordships it may be possible to achieve perhaps half or three-quarters of the intention of the noble Lord, Lord Houghton. Nevertheless, I do not agree on the substance that it would be necessary, in the words of the noble Baroness, to re-commit clauses on every Bill. The noble Lord, Lord Houghton, quoted standing orders in detail and has taken legal advice on this matter. He referred to a standing order which dates back, I think he said, to 1621. It is a standing order which has been used, and used with care and value, on particular Bills. The noble Lord, Lord Monson, mentioned the most recent use of it on the Insolvency Bill. However, I believe that it would be for the benefit of consideration if we adopted the suggestion of the noble Lord, Lord Houghton.

The Earl of Kinnoull

My Lords, I support the noble Lord, Lord Houghton. I believe there is a weakness in the Government's case in advising the House not to accept the procedural point he is making. First, the kernel of this Bill is consultation. Secondly, in another place the Government promised as far back as February that they would produce an amendment. We have not yet had the chance to speak to the Government's amendment. We have been denied that.

When one looks at the words of the Companion to Standing Orders one sees that recommitment is leaving the Report stage to its proper function as an opportunity to review and perfect the Bill as amended in Committee.

Whatever the hour of night—perhaps some of us speak better after dinner than before it and we have been going for 14 minutes on this procedure Motion—I think we owe a duty to the Bill to consider it properly. Therefore, I support the noble Lord, Lord Houghton.

Lord Ennals

My Lords, I too want to support the noble Lord, Lord Houghton. As he pointed out, and as has been said by noble Lords on all sides of the House, we are, after all, concerned with the central crucial issue of this debate—that of consultation. I do not believe that this House, this reforming chamber, has had adequate time to discuss this most important part of the Bill.

We have been discussing a number of other issues, and as the noble Baroness said, and as she knows, I welcome the fact that she has tabled a new clause which eventually will be discussed. But I have to say that that new clause, unless I am corrected, was only tabled on the day before the House rose for the recess. If it was two days then no doubt I shall be corrected.

I must say that on a number of occasions—and this will be recalled by those on the Front Bench—I asked when the new clause would be tabled. Day after day, the new clause was not tabled. As I said, to the best of my knowledge it was tabled the day before the House rose. We are now getting to the stage where we may be discussing the new clause proposed by the noble Baroness together with amendments that have been proposed to it. It is a very difficult and short time to get amendments down to it.

I believe therefore that the noble Lord, Lord Houghton of Sowerby, was absolutely right to make the proposal that he did. I know the noble Baroness said right at the very beginning that he was crystal clear, as pure as unfluorided water, or whatever the effect was; and whatever term the noble Baroness used in praising my noble friend, at the end she referred to time-wasting purposes. I have to say to her that if she had just readily agreed to the proposal put forward by my noble friend, we would now be discussing the issue instead of discussing procedural questions. I think she ought to realise that to start now, in the Report stage, at ten minutes past ten—or it may well be later than that before this debate ends—on the most crucial part of this Bill is simply not good enough.

It is for that reason that I support the proposal made by my noble friend.

The Earl of Caithness

My Lords, as my noble friend has already spoken, I feel that it is only right to speak once more from these Benches, in this sense on her behalf. I would just remind—

Lord Houghton of Sowerby

Would the noble Earl allow me to rise on a point of order?

The Earl of Caithness

There is no point of order.

Lord Houghton of Sowerby

My Lords, this is a procedural matter. Where is the authority on the Front Bench opposite to deal with the proceedings of the House at this moment? That is what I want to know. This is not a departmental matter, it is not a matter relating to a particular department. It is a matter relating to the procedures of the House and we ought to have on the Front Bench opposite either the Chief Whip or his deputy so that we know who we are dealing with.

The Earl of Caithness

My Lords, it is quite clear that the procedure of this House is that it is the Whip on duty, and I am the Whip on duty in lieu of the Chief Whip. We are discussing the procedure of the House; but I should like to remind the noble Lord we are still in the Report stage.

I should like to remind the House that the Government amendment was discussed inter alia, but not specifically, at the Committee stage. The noble Lord, Lord Sandys, said that we were a deliberative chamber. We spent one hour and 50 minutes on his amendments alone, which refer to consultation. There was considerably more time spent on consultation, and let us bear in mind when we look at the passage on recommitment what the Companion says: Bills have been re-committed where important amendments were tabled in Committee of the Whole House too late for them to be properly considered at that stage". That does not apply here. These are not the circumstances here. I quote again: or where amendments, on a subject which had not been considered in Committee, were tabled at a later stage and required detailed examination. Decision on such amendments may then be reached on Re-commitment". My Lords, considering that we spent at least 2½ hours discussing consultation in Committee, I think there is no case to take the House back into Committee at this point.

10.15 p.m.

Lord Ponsonby of Shulbrede

My Lords, we have spent some 19 minutes on this procedural matter. If we proceed to a Division, I hazard that it will be another 10 or 15 minutes before we get back to continuing our proceedings on the Water (Fluoridation) Bill. I wonder whether the noble Baroness would consider the fact that we might make much quicker progress if the Government accepted the Motion moved by my noble friend Lord Houghton. All we are actually talking about is whether people can speak once or twice on particular amendments which are tabled. We are not talking about lengthening the proceedings to another day.

As I said, we have already spent 20 minutes on this procedural point. We shall spend another 10 minutes if the Government do not agree to this point. It is not a question of re-commitment. These clauses and amendments have not been committed so far. We are talking about the commitment of these clauses and the amendments to them. As has been said by the noble Lord, Lord Monson, it is considered by those closely concerned with the Bill that this is a crucial issue within it. I should have thought that the House would make the speediest progress if the noble Baroness could accept the Motion of the noble Lord, Lord Houghton, and we could then proceed post-haste with the next amendment in her name.

Baroness Trumpington

My Lords, with the leave of the House, I think that the most speed could be gained if the matter were put to the test.

Lord Houghton of Sowerby

My Lords, it will not be put to the vote for a moment or two. I am sorry, but if noble Lords on the Front Bench opposite are so unskilled in the art of parliamentary activity and understanding, it is their fault and not mine. There is less understanding of the Opposition's position being shown in this matter than I was accustomed to over many years in another place. After all, Oppositions are regarded as having some claim upon the consideration of the Government of the day and upon the time of the House—more particularly on the time of the House. A certain amount of time is customarily allotted to Opposition Members or parties.

Had I wished to deal with this matter in what I would call a confrontational way, I should have put down the Motion on the Order Paper for debate and if necessary for Division of the whole House. That was open to me. Had I adopted that method and had the Motion been carried, we should have gone into Committee on the amendments and it would have required another day to deal with the Report stage. I said at once that I did not wish to follow that course because it would appear to be a form of obstruction. The alternative method was the present one. The matter could be taken in the course of the Report stage on the Bill and would constitute only a brief intervention in the proceedings on Report solely to allow a little greater freedom in debate. That is not to say that all of us wanted to speak several times. But it would spare those of us who wished to speak more than once, or to examine—

Lord Beloff

My Lords, will noble Lord give way?

Lord Houghton of Sowerby

My Lords, is the noble Lord trying to assist me or is he not? I am sorry, then, I cannot give way.

Lord Beloff

My Lords, will the noble Lord give way?

Lord Houghton of Sowerby

My Lords, I am sorry, I cannot give way.

Lord Beloff

My Lords, will the noble Lord give way?

Lord Houghton of Sowerby

I am sorry, I cannot give way, my Lords.

Noble Lords


Lord Beloff

My Lords, I beg to move, That the Question be now put.

Lord Houghton of Sowerby

No, no, no, no, my Lords. I resume what I was saying. This would have given only a little more licence in the course of debate to deal with these amendments.

I am very sorry indeed that the Government have not been forthcoming. I know that one can speak at length on a matter of this kind. I have no desire to do that. But if it is time that we are trying to save, surely people with experience of the House will realise that it is not being saved by being obstructive.

The Earl of Swinton

My Lords, I understand that it has been moved, That the Question be now put. That is not debatable and should be put to the House straight away.

Lord Houghton of Sowerby

My Lords, it is a matter for the noble Lord on the Woolsack to decide whether the Question shall be put. If I may say so, it is not a matter for the noble Earl. I shall continue speaking unless the noble Lord on the Woolsack intervenes to say that I must resume my seat because he proposes to put a Motion to the House. If he does that, obviously I shall obey his ruling, but in the meantime I ask the Front Bench opposite to think again for the final moment on this matter. Whatever happens to this Motion, the debate on the amendments must go on.

Baroness Trumpington

My Lords, I should be grateful, and I think the House would be grateful, if the noble Lord could get to the end of his remarkable speech.

Lord Houghton of Sowerby

My Lords, I am sorry, but I cannot help what the House may want. The House is doing nothing to help me and I do not propose to do anything to help the House. I am advised that the thing to do in order to quieten the restiveness of the noble Lords opposite is to get on with the Motion and let us proceed from there. However, I was about to say that we have still to get through the amendments, whether in Committee or on Report. The House can have it whichever way it likes. However, noble Lords opposite must not expect any accommodation from this side of the House on getting things through more quickly their way than they would have done our way. They certainly would have gone through them quickly enough our way. The noble Baroness would have been on her feet long ago, moving her Amendment No. 8 and we should now have been well into the debate on that amendment. But they are so stubborn about this. They do not understand the workings of Parliament and the feelings of opposition, especially on an issue of this kind. Thus, all I can say is that I move my Motion.

10.21 p.m.

On Question, Whether the House do now resolve itself into a Committee on the Bill to debate Amendments Nos. 8 to 12?

Their Lordships divided: Contents, 23; Not-Contents, 49.

Arran, E. Kilbracken, L.
Beaumont of Whitley, L. Kinnoull, E.
Burton, L. McNair, L.
Charteris of Amisfield, L. [Teller.] Monson, L.
Napier and Ettrick, L.
Craigmyle, L. Parry, L.
David, B. Phillips, B.
Ennals, L. Ponsonby of Shulbrede, L.
Falkland, V. Prys-Davies, L.
Graham of Edmonton, L. Sandys, L.
Gray, L. Wilson of Langside, L.
Houghton of Sowerby, L. [Teller.] Yarborough, E.
Allenby of Megiddo, V. Crathorne, L.
Ampthill, L. Darcy (de Knayth), B.
Beloff, L. Davidson, V.
Belstead, L. Elliot of Harwood, B.
Blake, L. Elton, L.
Brabazon of Tara, L. Gardner of Parkes, B.
Caithness, E. Glanusk, L.
Cameron of Lochbroom, L. Glenarthur, L.
Campbell of Alloway, L. Gray of Contin, L.
Colville of Culross, V. Grimston of Westbury, L.
Colwyn, L. Hailsham of Saint Marylebone, L.
Cork and Orrery, E.
Lawrence, L. Redesdale, L.
Layton, L. Rochdale, V.
Lindsey and Abingdon, E. St. Aldwyn, E.
Long, V. [Teller.] Sandford, L.
Lothian, M. Shannon, E.
Lucas of Chilworth, L. Sharples, B.
Lyell, L. Skelmersdale, L.
Macleod of Borve, B. Swinton, E. [Teller.]
Mar, C. Trefgarne, L.
Masham of Ilton, B. Trumpington, B.
Monk Bretton, L. Winstanley, L.
Morris, L. Wise, L.
Murton of Lindisfarne, L. Young of Graffham, L.

Resolved in the negative, and Motion disagreed to accordingly.

10.30 p.m.

Baroness Trumpington moved Amendment No. 8:

[Printed earlier; col. 708.]

The noble Baroness said: My Lords, there has been wide concern in this House and in another place that there should be public consultation before a decision is taken on whether or not to initiate a fluoridation scheme. This clause provides that local authorities should specifically be consulted on proposals for fluoridation schemes and that three months' notice should be given in the local press in order to allow interested local bodies and individuals also to make representations. Before explaining the detail of this clause, I should like to stress that these provisions are additional to the statutory requirement which already obliged health authorities to consult community health councils.

Subsection (1) of the new clause defines the scope of the clause as applying to proposals by health authorities to apply or withdraw an application for fluoridation or to terminate an existing fluoridation scheme covered by Clause 3 of the Bill. Subsection (2) requires a health authority to give advance notice of at least three months of a proposal under subsection (1) above. Notice is to be given directly to the relevant local authorities in England and Wales and in addition health authorities (including the Scottish health boards) are to advertise their intentions in at least one newspaper circulating in the locality.

Subsection (3) specifically requires health authorities in England and Wales to consult local authorities upon their proposals. Subsection (4) obliges a health authority to republish its proposals at least seven days after their publication under subsection (2) above. Subsection (5) obliges the health authority to have such regard "as they consider appropriate" to the representations they receive and the outcome of consultation with local authorities when the time comes to decide whether or not to initiate or continue with fluoridation. I make no apology for the inclusion of the words, "as they consider appropriate". It is intended to ensure that health authorities can consider representations on their merits and not simply by volume or by strength of emotion generated.

This must be right when serious decisions on public health are to be taken. To illustrate this, I might ask your Lordships to imagine that a health authority received 5,000 letters suggesting that fluoridation should be rejected on the grounds that it caused AIDS.

Since my department is aware that this proposition rests solely on the observation that San Francisco is fluoridated, I am sure your Lordships would agree that a health authority would be quite entitled to disregard such correspondence in its deliberations!

Subsection (6) allows the Secretary of State to direct that a health authority wishing to withdraw an application for fluoridation or terminate a preserved fluoridation scheme under Clause 3 may do so without engaging in public consultation. The sole purpose of this subsection is to preserve the assurance given by the Government in another place that it would be possible to stop all water fluoridation immediately if this were ever to be found necessary on safety grounds. Needless to say, we see no reason why this should ever be the case and this provision is provided purely on a contingency basis. I would also stress that this subsection does not provide any power for the Secretary of State to dispense with the requirement for public consultation prior to consideration of new fluoridation schemes.

Finally, subsection (7) of this new clause fully meets the purpose of the amendment which stands in the names of the noble Lords, Lord Ennals and Lord Prys-Davies, by obliging health authorities to meet in public to consider fluoridation when public disorder prevents this.

The Government believe this amendment fully and fairly meets the concern that local authorities and local people and organisations generally should be able to make their views known before a health authority takes the final decision on whether or not to apply for fluoridation. I commend the new clause to your Lordships. I beg to move.

Lord Ennals had given notice of his intention to move, as amendment to Amendment No. 8, Amendment No. 9: Subsection (3), at end insert— ("and shall only proceed with the proposal if the consultations produce in each case an affirmative response from the local authorities concerned.").

The noble Lord said: My Lords, I want to speak to the Government's amendment which has been proposed by the noble Baroness and to refer to the principles contained in Amendment No. 9, but I do not intend to move it this evening. I wish to give notice that I will move an amendment either in these terms or in similar terms when we reach Third Reading. It would be unfair to your Lordships, at this hour of night, not that we should debate it, but that we should seek to have a Division on this when clearly so many noble Lords who are deeply concerned about consultation one way or the other cannot be here.

I want first to thank the noble Baroness and to say how much I appreciate the advances that have been made in the new clause that she has produced. I hope that she will laugh as long as she can because the opportunity will not last long. I very much appreciate subsection (7), which relates to health authorities and the importance of public meetings. I welcome subsection (3), which concerns consultation with local authorities. It is about consultation with local authorities that I wish to raise an issue.

I recognise that what the noble Baroness has done is a considerable advance on the situation as it was at the Committee stage. I give her credit for that, but I hope to persuade her and the Government to move further forward than they have so far. Clearly the Government are open to persuasion because in Committee stage they were persuaded, and I wish to persuade them to go a stage further.

The whole question is: how does the consultation take place? I am advised that since I am not moving the amendment I should not proceed, but I should have thought that it would have been helpful for the House that I should comment on the new clause, which is what I propose to do unless I am advised otherwise.

We have to ask what consultation really means. A health authority wants to reach a decision and wishes to consult, as it is now obliged to do. It goes to the local authority, says what it has in mind and asks for views. The local authority has no instructions about how it should act when consulted by the health authority. Does the local authority have to take a decision? Is it simply necessary that the local authority is informed of what has been done? Should the local authority take a decision and convey it to the health authority? If it were to take a decision which was contrary to that of the health authority (whether it was against or whether it was for) surely it would be unsatisfactory that the health authority should proceed after it knows the views of the local elected authority and knows that that body takes a different view from the health authority.

We are in a difficult situation. The only two bodies referred to, except in terms of consultation—the only two bodies that have to take decisions—are two bodies that are not elected. The health authority is a nominated body. We know from the National Association of Health Authorities that the vast majority of health authorities are in favour of fluoridation. They may be right, they may be wrong: but that is their view.

The other body which has to take a decision is of course the water authority. It is not obliged to do what it is asked to do by the health authority. It can decide for itself. Yet the water authorities and the water authorities' association have made it absolutely clear—and I quoted their letters to your Lordships' House—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. I referred to this at Second Reading and I certainly will not read it again now. Their competence was a technical competence as to whether they could effectively fluoridate the water: they did not wish to be put into a position where they had to take a decision. That is the dilemma that has been created and I know that it was considered by your Lordships at the Committee stage.

There is only one body which has now been brought into the act which can, in a sense, take a decision on behalf of the people. I think that there is something which unites so many Members in this House, including those who have put their names to the amendment that I am not formally moving tonight. Those who have put their names to that amendment take different views about the value or otherwise to the health of the nation of fluoride. But what we are concerned about is the right of the public to be consulted and to decide.

When this amendment was tabled, it was with the view that consultation by the local authority should be binding, that they should take a decision that the health authority would not be able to proceed until there was agreement among the members to give to ordinary people the opportunity of lobbying their local councils. Local councillors have to stand for election: members of the water authority do not and members of the health authority do not. Therefore, if there is strong feeling one way or the other, then that view will be reflected in the decision that will eventually be taken by the elected local authority.

My contention therefore is that, if there is to be consultation, then consultation, to be meaningful, must lead to a decision; and if that decision is taken by the local authority then that decision is one that should be carried out. Otherwise, it seems to be almost a meaningless process in relation to a properly elected authority. I put forward the arguments. Firstly, freedom of choice by the public would be denied if a decision taken by the local authority were not to be carried out. The public would have no way of expressing their view in a way that would lead to a decision. They could express their view to the health authority, to the local authority, to the water authority, yet, whatever they did, there would be no one who was bound to come before them again and have to stand at the next election.

I believe that this question of accountability does really lie at the heart of the matter. If I had my own way, I should prefer a local referendum in order that everyone could say whether their water should be fluoridated or not. We have to recognise that there are arguments on both sides. I recognise the arguments that have been put forward by the Fluoridation Society, by the dental profession, by the British Medical Association, and there is much evidence to show the tremendous advantage to the dental health of our people, of people getting the right amount of fluoride. But if we look at the other side we know that it is very expensive. The figures that have been brought to my attention suggest that the capital cost, if it were to be carried out throughout the country, would be about £150 million and that the operational costs to ensure that the fluoridation was effectively carried out throughout the country, if that were to be the decision of the water authorities, would be of the order of £20,500 million. Secondly, there is no way—

The Earl of Swinton

My Lords, if the noble Lord will give way, I think he is taxing the patience of the House a bit by speaking to an amendment that he says he is not going to move. I think that his own Chief Whip has advised him that this is perhaps not a very desirable procedure. Perhaps he will take a message from this side of the House that he is straying a bit.

Lord Ennals

I am sorry; I needed advice.

Lord Ponsonby of Shulbrede

I think the position is clear: if my noble friend Lord Ennals was not moving his amendment he should have spoken very briefly, but if he had moved his amendment it would have been quite in order for him to speak for as long as he did or for even longer. No doubt the noble Earl wishes to determine whether he is moving the amendment or not.

10.45 p.m.

Lord Ennals

I am advised that in order to proceed with my speech, which I wish to do, I must move my amendment. But I indicate that I shall not put it to the vote this evening. I shall put this or a similar amendment to the vote when we reach Third Reading.

I was arguing that there are cases to be considered against fluoridation. The expense is one that I am not going to be taking into consideration for the moment, but, on the question of the effect upon health, I have to say that there is no way of ensuring that the public, who use 340 litres of water per head per day, will ingest the appropriate amount of fluoride in water. After all, it is perfectly clear that very heavy drinkers, particularly of beer, who consume a very large amount of water, or for that matter those who drink a very large amount of tea, will ingest far more fluoride than those who are abstemious both in relation to beer and in relation to tea, so the public will get different amounts of fluoride ingested according to their own personal habits.

There is another factor. On Second Reading I argued the case for fluoride in milk and have had many letters from those who agree that this is an ideal way out. The alternative is a powerful argument in favour of leaving it to local authorities. Those local authorities who have responsibility for education could decide as between fluoride in water and fluoride in milk for children by free choice of their parents.

This is one of the results of the important decision that was taken by the EC. I quote from the Commission Regulation (EEC) No. 237/85 of 30th January 1985: Whereas Commission Regulation (EEC) No. 2167/83 established the list of products qualifying for Community aid; whereas experience has shown that it is appropriate, within the context of measures to protect the health of young children that, subject to certain conditions, the Member States should be able to permit the addition of fluoride to whole or semi-skimmed flavoured milk and yoghurts intended for schoolchildren". That was a decision recently taken, and the same local authority could decide whether it was going to take advantage of the milk subsidy, which would enable children to have fluoride in milk at the choice of their parents, or whether the water should be fluoridated in the same area. It would not do both, because otherwise an excess of fluoride would be ingested by the public.

It has already been recognised in debates on earlier amendments that it would be unwise for too much fluoride to be taken. I have to admit that I sought to table an amendment on fluoride in milk for consideration at Report stage and that it was ruled as being outside the range of the Bill. But certainly it is very relevant, as I think all Members of the House would agree, to the amendment which I have moved.

I have already quoted the regulation concerned. I said that several letters had been received. Perhaps I may read a couple of paragraphs from one of them. This is from Sir William Richardson writing from Hastings. He said: If the Government has any sense they would concentrate on children by restoring the former school milk scheme rather than forcing water fluoridation on a hostile public. Fluoridised milk would be included, but parents could decide whether their children took the fluoridised or plain milk, a right that is impossible with water fluoridation. The cost would be less than that of water fluoridation, and would be helped by sharing in the £50 million subsidy that the EEC are offering to member countries that will give a daily milk drink to children in schools. Fluoridised milk is included in the EEC subsidy. Thus, an elected local authority could have an alternative. In addition to saying yes or no to fluoridated water, it could take the milk option, as giving freedom of choice. That surely is a principle which would be supported by this Government.

To conclude, your Lordships need not support my views on fluoride in milk. Those are views that I hold, but they are not necessary for this amendment to be a convincing one. The real issue is: should people be given a choice and should those who are responsible to the public be the people who are required to make the choice? They may then resist or support the pressure that is brought upon them by their constituents. In conclusion, my Lords, I wish to move my amendment and to hear the views that are expressed by your Lordships.

Lord Charteris of Amisfield

My Lords, I am not absolutely clear whether this amendment is being moved or not, but I should nonetheless like to express myself in complete agreement with what the noble Lord, Lord Ennals, has said about it. I start by congratulating the noble Baroness and thanking her for having, as one might say, come up with her amendment. I do not think it is good enough, though. A point that has not really been mentioned in the debate this evening is that putting fluoride in the water supply is a very serious matter, quite apart from the medical side, because it is being put in not to make the water wholesome and drinkable, but to medicate us. That is a matter which I think has been described, not without justice, as an infringement of the liberty of the individual.

Your Lordships may agree or disagree with this, but I think it is a real point and, because it is so important, surely there ought to be a bit of genuine, democratic consideration in it. Therefore I think that the noble Baroness's amendment is in its own way a bit of medication. But I am afraid it is really eyewash and I think we should put some bite and teeth into it so that the people who are to be forced—against their will perhaps—to drink fluoridated water will have a real opportunity to say whether or not they want to and, if they say they do not want to, they should be listened to.

Lord Moyne

I should like to express appreciation of the noble Baroness's amendment and to offer her thanks, since I was one who made written representations. It is a splendid amendment so far as it goes, but it does not define what is consultation, and uncertain law is the worst kind of law. If the following amendment, No. 9, is passed, that will make the position abundantly clear. Everybody will be satisfied and we need debate the matter no longer. I understand that the noble Lord, Lord Ennals, is not going to move his amendment now, but if—

Baroness Trumpington

My Lords, he has moved it.

Lord Moyne

Yes, my Lords, but regardless of that, I wonder whether between now and Third Reading the noble Baroness will adopt the principle of defining "consultation" by means of the affirmative resolution procedure. I hope she will accept the amendment; that is what I am asking. I can say no more than that.

Lord Sandys

My Lords, I should like to associate myself, as I have on the amendment, with the noble Lord, Lord Ennals, and I should like to start my remarks by thanking the noble Baroness. Lady Trumpington, for giving so much time to the redraft of Amendment No. 32 on Committee and now producing it in the form of Amendment No. 8 on Report.

One recognises, having been associated with some of these operations, the difficulty involved in drafting and the accommodations to be reached. But it is clear from the remarks made earlier by all my noble friends that there is one further pace to be taken—I think the noble Lord, Lord Ennals, has put his finger on it, as indeed my noble friend Lord Moyne has done—to enlarge the spirit of consultation into the fact of consultation in this Bill. No amount of assurances which the noble Baroness has given to us will be written into the Bill. The Act, on publication, will be bereft of these valuable assurances. It is only the words which your Lordships and another place actually write into this Bill that will be seen and used before the courts. So I feel that Amendment No. 9 will be a very valuable addition to Amendment No. 8. I do so for one particular reason. Perhaps my noble friend Lord Kinnoull will permit me to quote him on Committee, because this stood out to me in rereading through the proceedings on Committee, when he said, at col. 872, of Hansard on Thursday, 18th April: We are at a sensitive stage and the Government must realise that a high percentage of people distrust fluoridation, whatever the medical people say …", and so on. It is a fact that there is a sense of uncertainty, distrust and outright opposition, and I think, in order to achieve all that the noble Baroness undoubtedly wishes—and I thank her for promoting all subsections of that clause including subsection (4), which she attributed to some of the pressures brought by myself and others—that it is very desirable to enlarge her amendment by the amendment of the noble Lord, Lord Ennals, if possible.

The Earl of Kinnoull

My Lords, before my noble friend replies to the noble Lord, Lord Ennals, I should first like to congratulate Lord Ennals on his amendment and also of course my noble friend on her amendment. I hope that the fact that the noble Lord, Lord Ennals, has moved his amendment, means there will not be some plot to try to annul the amendment and therefore frustrate it coming up to Third Reading, because I think it is very important that it should come up as it is such an important subject of this Bill. I know my noble friend would not advise any Members to do so.

I should like to congratulate my noble friend because she has gone some distance in arranging to publish, then to republish, then to serve a notice on each district local authority, and then to have a duty to consult each district local authority. Then, of course, as the noble Lord, Lord Ennals, said, we do not have the problem because all this appointed body has to do is to "have regard to" whatever representation has been made. I must admit I find that wholly unacceptable, and I therefore feel it really has to be improved upon, in a way that the amendment of the noble Lord, Lord Ennals, will do.

There is another factor which really came up in a previous amendment, when we were talking about reviewing every five years. There is no provision in my noble friend's amendment—the Government's amendment—to consider how local authorities are consulted over a review period. It is terribly indefinite and I hope that on Third Reading we can perhaps improve that as well. Finally, I support very deeply the efforts that my noble friend has made and the amendment of the noble Lord, Lord Ennals.

11 p.m.

Lord Houghton of Sowerby

My Lords, I agree with noble Lords who have already spoken that we must get a little more democracy into this Bill. I join other noble Lords in congratulating the noble Baroness on having succeeded in getting rather more than there was. I must say, however, that it is an indication of the state of the Government if the noble Baroness had to fight with them to get more democracy into this Bill, which the Opposition in another place failed to get. It shows that at times your Lordships perhaps carry rather more weight with the Government than the Opposition in another place, because we are the only Chamber in which the Government can be defeated.

However, I embarrass the noble Baroness—cross as I have been with her—by saying that I am glad she made this attempt with this measure of success, and I hope that nothing that we say now will diminish her own self-esteem, if I may say so, in this matter, and ours too. There must be some long-stop somewhere in the field, where bureaucracy and authority can hold sway under this Bill. I deplore the fact that gradually the electors in the various local authorities and communities have had taken away their democratic right to decide on this matter. They have now been regarded as incompetent to decide for themselves. It must be left to health authorities, with emphasis on the authority, and we know how health authorities are composed. They are largely selected by the Government of the day for a term of office but with some measure of representation from elected bodies.

I had it in mind at one stage, and I have not entirely given up the idea to move an amendment to double the representation of local authorities on the health authorities when they are taking a decision on this matter, in order to reinforce the democratic element in this question. I did not understand why my noble friend Lord Ennals had not moved his amendment, or why he should not. We are not in Committee. We are on Report and the amendments, as I understand it, are being taken in the order in which they are on the Marshalled List. If the House decides to adopt one of these amendments, that will amend Amendment No. 8 and Amendment No. 8, as amended, will then be put to the House. That is how I understand the procedure. So I do not think we need to get into a procedural muddle now as to whether or not we are moving things. I think that we are.

Although I am not making any threats on the matter, it is open to the House to decide on any of these amendments, because the noble Baroness's Amendment No. 8 is virtually the substantive Motion before the House at the moment. I would link the proposal in Amendment No. 9 with subsection (2) in my Amendment No. 11, which is another reinforcement that consultations under Amendment No. 9 should produce in each case an affirmative response from the local authorities concerned. I take it in my amendment just that little bit further and say that the response must be that of a decision of the whole council. That reinforces the democratic principle just that little more and I hope that the two things may be related in deciding what we are going to do. I feel that the Government should go the whole hog in meeting reasonable claims to influence public opinion on what the relative authorities are going to do. They have no power of veto any more and no power to displace the health authority if they do not agree with what it does.

It is very important to avoid any suggestion that this consultation is a sham. We know how much consultation is regarded as a sham in public life today. Few people attach importance to consultation because they feel that you are consulted but that the decision has already been taken before they ask you. In many instances it is probably literally true that consultation is a motion to be gone through. Here we want to give it reality. If the Government want the goodwill of all those who have been opposing this Bill—and there are many outside the House who oppose it—if they want to restore some confidence in what they are doing, they should have regard to the desire of those who oppose fluoridation to have the opportunity to make their views known to the health authority in a manner which they will understand and take notice of. That is implicit in my noble friend's amendment. I hope that we can get some favourable response on this from the Front Bench opposite.

In conclusion, one of the features about work in your Lordships' House is the inflexibility of the Government Front Bench. Whether those noble Lords and noble Baronesses who hold office lack the authority to come to terms with the House I do not know, but I get the impression, having spent 25 years in another place, that you can get sense out of the Front Bench of the Government when you are in Opposition. We did it for 13 years in Opposition. If we had not been able to do that in 13 years in Opposition, there would have been a revolution. Here in this House we have the briefs read out to us. The inflexibility of the Government's stance is made clear because it is all written down; the formula is the same every time. One wonders whether one is speaking to disembodied ministerial voices or to real people.

I feel very strongly that something has to be done to liven up the proceedings in your Lordships' House on matters of this kind. We must be more alert to the importance of the business we are doing and not put up with the complacency and the false courtesies of the last generation. Let us get to grips with some of these things and deal with them in a franker way. Let us have some overtures from the Government side to get the co-operation of the Opposition by meeting their wishes and not by exchanges of courtesies.

Lord Burton

My Lords, so far as it goes, I, too, should like to welcome the amendment of my noble friend Lady Trumpington, if I may call her "my noble friend" this evening, having consistently voted against her. However, the noble Baroness rejected a short time ago the proposal that health boards should reconsider the matter every five years. As I read it—I hope I am wrong—if an authority is fluoridating at the moment, it looks as though there will be no opportunity for the public to be consulted. This amendment instructs the authority to consult. But if they are already fluoridating, I cannot see that the public in that area will be consulted at all. Perhaps I am wrong; I hope so. If not, perhaps my noble friend will manage to put it right on Third Reading. However, bearing in mind that the Government are trying to save public expenditure, I really find the proceedings in regard to this Bill amazing. As the noble Lord, Lord Ennals, said in comparing fluoridating water and fluoridating milk, this will cause very considerable additional expenditure. It seems to be largely wasted expenditure, as far as I can see. It might just as well go into milk and save a great deal of money.

Baroness Gardner of Parkes

My Lords, although the debate seems to have ranged over Amendment No. 8, which I welcome, we are actually debating Amendment No. 9 moved by the noble Lord, Lord Ennals, as an amendment to Amendment No. 8. His speech was very lengthy and ranged over all sorts of arguments about beer and tea, without going on to make the point that however much beer or tea one drinks, the concentration of one part per million means that one would need to have an almost inhuman, impossible capacity for drinks to be able to reach a danger level. That point was not mentioned.

The noble Lord's amendment as set out on the Marshalled List would produce a situation where local authorities could dictate to the health authorities and those authorities would have the right to a decision taken away from them. The amendment states that the health authority, in consultation with the water authority, shall only proceed with the proposal if the consultations produce in each case an affirmative response". That is surely giving the veto which the noble Lord, Lord Houghton, said did not exist. He said that the local authorities had no right of veto. But surely the amendment to the amendment would give them exactly that—a right to veto.

That would be very wrong. I believe that health decisions should be made by health authorities and not by local authorities. The noble Lord, Lord Houghton, spoke about health decisions made by local authorities in the past; indeed they were. I was chairman of a local authority health committee, but that was prior to the formation of area health authorities and now district health authorities. Under the restructuring of the Health Service what was formally the local authority element of health has been transferred to those other bodies.

There is really quite good representation of local authority interests on district health authorities. I did not speak earlier because I know we are all rather tired and do not want to continue for too long, but on many of these points this evening I could have risen to my feet to say that the community health councils receive every paper from every district health authority meeting long before the health authority meetings. I am sure that the noble Lord, Lord Ennals, knows this very well. There is no reason whatsoever for the public not being informed through the community health authority, because every community health authority includes someone who is anti-fluoride. I cannot accept the points which have been made.

The noble Lord, Lord Charteris, commented that fluoridation was meant to medicate us. I do not accept that view. He cannot claim one moment that fluoridation is medication and then claim the next moment that it is not right that health authorities should deal with it. If his argument is that fluoridation is medication, surely health authorities above all are the people to deal with it.

To introduce in this amendment a veto on the part of local authorities would be very wrong. That would be to underestimate the intelligence and integrity of district health authorities and of health authorities in general. I myself have experience of health authorities. I clearly remember a paper coming to one area health authority that is now a district authority, concerning the closure of a particular obstetrics department. That paper went out for consultation and as a result the unit was not closed; an entirely different unit was closed. Great attention was paid to public consultation in that case.

I believe that people are becoming a little jaded in their ideas when they say that there is no real interest and that no one listens to public consultation. If people really believe that, why are they pressing for these amendments to the Bill? It is because we believe in public consultation and believe that it is effective that it is being included in the Bill's provisions.

The noble Lord, Lord Houghton, says that we should be more alert, but we are all pretty alert for 11.15 at night. Personally I am strongly opposed to this amendment. My final comment concerns the words, "in each case". This means that if a health authority comes under two or possibly even three different district councils, each one of those district councils would have to give an affirmative reponse. So any one of those three councils could thwart the wishes of the other two. Amendment No. 9 is at fault technically, as well as in its general principles. I certainly oppose it.

11.15 p.m.

Baroness Trumpington

My Lords, I hope your Lordships still have a sense of humour at this time of night because I am afraid that I have to start with an apology. It is most extraordinary that when I was going through all my notes and words of so-called wisdom I noticed a mistake in the typing. It was, I thought, taken out; but in the stress of combat this evening it went in. It is ridiculous and I not only have to put Hansard right but tell your Lordships that when I was discussing subsection (7) of the new clause, which fully met the purpose of the amendment in the name of the noble Lord, Lord Ennals, and the noble Lord, Lord Prys-Davies, by obliging health authorities to meet in public to consider fluoridation, I said "when" public disorder prevents this and it should have been "unless". I apologise, but I must get the record right and it is quite a "funny".

In reply to one of the questions put by the noble Lord, Lord Ennals, the local authority has the opportunity under the new clause to take a decision on fluoridation and to communicate it to the health authority. The health authority is not obliged to follow the decision of the local authority. How the local authority reaches its decision is a matter for the local authority to decide.

I shall now refer to Amendment No. 9, moved by the noble Lord, Lord Ennals. The effect of the amendment is very similar to the amendment moved by my noble friend Lord Sandys in Committee. The amendment seeks to allow fluoridation to proceed only with the agreement of local authorities in the areas concerned. As I trust will be evident from the Government's new clause on consultation, the Government have bent over backwards, as I promised in Committee, 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, in subsection (3) of the new clause we have introduced just such a statutory obligation.

The amendment before us is, however, a different proposition. For the first time 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 constitutionally wholly improper given that local authorities no longer have any statutory responsibility in this area. Indeed, as the noble Baroness, Lady Fisher of Rednal, pointed out in an earlier debate, they no longer have any access to the appropriate medical and dental expertise. In addition, it should be remembered that the cost of fluoridation is borne by the health authority and not by the local authority. Under the noble Lord's amendment the local authority would be able to prevent a health authority from spending its own money on fluoridation and would also, in fact, be albe to prevent a health authority ending funding for an existing fluoridation scheme.

I know of the keen interest of the noble Lord, Lord Ennals, in the Borrow dental milk foundation, which is a charity that does very good work. The Government's view on fluoridated milk is that water fluoridation has significant advantages over all other methods of fluoride supplementation, including fluoridated milk. It reaches everyone in a given community and is not dependent on a high level of parental or personal motivation. Moreover, water fluoridation confers a benefit on the developing teeth of children, as we all know, all the time they are being formed, from the ages that I have mentioned previously.

Our view is that the supply of fluoridated milk to children in schools would be a less effective and therefore less desirable measure than either water fluoridation or, where this is either not feasible or not acceptable to local opinion, the use of other methods of fluoride supplementation such as fluoride tablets. This is because of a number of drawbacks particularly associated with fluoridated milk; namely, there is no certainty that the milk would be drunk by the intended recipient or in the desired quantity.

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. Also, 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 of parents who are likely to prefer their children to drink fresh milk rather than UHT fluoridated, flavoured and marketed by the Borrow foundation. Local authorities in areas without water fluoridation may, however, wish to supply fluoridated milk to their schoolchildren. 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 should qualify for the same subsidy as non-fluoridated milk. It is not giving preference to fluoridated milk over non-fluoridated water.

I am grateful for the bitter-sweet remarks of the noble Lord, Lord Charteris. I am afraid that we must agree to disagree. In reply to the noble Lord, Lord Moyne, there is no requirement to define consultation in the Bill. The term appears frequently in the statute without any such definition. In layman's terms, the expression means simply to take the views of a person or body. I was grateful to the noble Lord, Lord Houghton, for his kind remarks, as far as they went.

In conclusion, I must repeat what I said on the earlier parallel amendment by the noble Lord, Lord Sandys, at the Committee stage. It is clearly wrong that the final decision on fluoridation should rest other than with those bodies which have the statutory responsibility for carrying out the functions inherent in fluoridation. Bodies, whether elected or not, which have no responsibility for either preventive health measures or the provision of the water supply should not have the right of veto over water fluoridation. This principle was clearly accepted by your Lordships at Committee stage. The new clause does not provide for consultation on continuance of existing schemes. This is because consultation took place on such schemes when they were initiated and often decisions were taken by elected local authorities. With those words, I would urge your Lordships to reject this amendment, if it is not withdrawn.

Lord Ennals

My Lords, I have listened with great care to the noble Baroness. I trust that she will not only listen, as she has, but that she will read in Hansard tomorrow the words of wisdom not only of the mover of the amendment but of those who supported the amendment. She has already proved, by the new clause that she has tabled, her willingness to be converted by great wisdom. In this hopeful and charitable mood, and in the hope that the noble Baroness will not only read and listen but learn from what has been said in this exchange, I shall now withdraw this amendment. However, unless the Government are able to make some change I shall return to the issue on Third Reading.

Amendment, by leave, withdrawn.

Lord Monson moved, as an amendment to Amendment No. 8, Amendment No. 10: Subsection (5), line 3, leave out ("such regard as they consider appropriate") and insert ("regard").

The noble Lord said: My Lords, this amendment is not as ambitious or far-reaching as the amendment which has just been withdrawn, but I should like to think it is important and potentially useful nevertheless.

The noble Baroness has told us on two or three occasions this evening that she has leant over backwards in the new clause contained in her Amendment No. 8 to accommodate the views of those of us who want greater democratic control over the issue of fluoridation. I entirely accept that she has done her best, and we are very grateful to her for doing so. But unfortunately it is evident that she has been working under very tight constraints and has been given relatively little latitude. The concessions made since the abortive Government amendment, Amendment No. 32, tabled at the Committee stage are, I am afraid, all too few, and I am afraid also that I cannot join in the general words of welcome given by other noble Lords to the new clause.

We have been granted two minor concessions, so far as I can see. The first is the suggestion that publication of the relative proposals be made on two separate occasions rather than on only one. That is a welcome but fairly trivial concession. I suspect also that it is a somewhat inadequate one. Many of us feel that publication on at least three separate and well spaced occasions is the minimum acceptable. Then we come to the other concession, if such it be—namely, that health authorities are obliged to notify local authorities as well as the public at large of their proposals. Surely any local authority whose members were neither senile nor illiterate would have got to hear about the proposals in any case.

I am sorry to be so disparaging about the concessions, but so far as I can interpret them they are not concessions of any real substance. Almost the chief defect of the new clause is that it only obliges health authorities to: have such regard as they consider appropriate … to … representations … made", to them. That means in effect that they need have no regard to representations if they feel that they are, for example, intellectually ill-founded.

My amendment, Amendment No. 9, to the Government amendment, would simply oblige health authorities to have regard to the overall tenor of all representations received. It would not, I need hardly say, oblige them to act in total conformity with those representations. They could still decide to override them in the last resort; but it would oblige them to take the representations a little more seriously than would be the case if the new clause were left unaltered. I beg to move.

Lord Sandys

My Lords, I should like to support the noble Lord, Lord Monson, in this amendment. At the Committee stage I cited a particular case at col. 819 of Hansard, where the Severn-Trent Water Authority rejected entirely the views of parish councils, district councils and county councils. I think that a particular instance like that shows the need for strengthening this part of the clause. It would seem to me desirable to move the words as set out in the amendment and retain those parts which give a very clear instruction to have regard.

There must be a very large number of instances in which health authorities have set aside public opinion. There may equally be occasions when health authorities have taken it into consideration. But to strengthen the clause in the Bill to ensure in the clearest terms that the health authority must have regard is a way to make the law clearer and to establish a principle which is quite unequivocal.

Baroness Trumpington

My Lords, I must stress that the words in subsection (5) of our new clause on consultation, which this amendment seeks to delete, have been inserted for a specific purpose. That purpose is to ensure that health authorities are free to judge the representations made to them on their merits and not simply according to the volume of voices in favour of a particular standpoint, whether for or against fluoridation.

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 repeatedly explained, these local authorities possess neither responsibility not expertise in the field of preventive health measures or the provision of the public water supply. 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 have also 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. If not, I regret that I shall have to ask your Lordships to reject it as, in our view, its acceptance would be contrary to rational and responsible decision-taking by health authorities on fluoridation.

11.30 p.m.

Lord Monson

My Lords, the noble Baroness has put me in something of a dilemma. It seems that we are getting further and further away from democratic control over the whole issue. To say that local authorities have no expertise in medical matters may well be true; but we are talking about issues other than purely medical ones, are we not? It is a difficult point. It seems to me that my amendment, if accepted would not oblige health authorities to act against their better judgment. They would have merely to pay rather more attention to representations made, from whatever quarter, than would otherwise be the case. Perhaps it is a matter of fine legal definition and a matter of drafting. My original impulse was to put this matter to the test. However, in the absence of support from any other quarter of the House than from the noble Lord, Lord Sandys, for whose support I am very grateful, I beg leave to withdraw this amendment for the time being.

Amendment, by leave, withdrawn.

On Question, Amendment No. 8 agreed to.

Lord Houghton of Sowerby moved Amendment No. 11: After Clause 3, insert the following new clause:


.—(1) A Health authority shall be under a duty to consult the appropriate District Council or Councils in relation to the making or withdrawing of any applications under section 1(1) of this Act.

(2) The advice to be given by the local authorities so consulted shall be decided by resolution of the whole Council.").

The noble Lord said: I need not keep the House more than a minute or two on this. Subsection (2) of Amendment No. 11 is the material proposal. If your Lordships look at subsection (3) of Amendment No. 8, you will see that it says: Before implementing the proposal the health authority shall consult each of the local authorities … to whom they are required by subsection (2)(b) above", etc. It says, shall consult each of the local authorities". I want this to be something quite specific, a kind of statutory resolution by the councils concerned. This is a formal consultation under Act of Parliament to take a step which they are authorised to take by Act of Parliament. We want to ensure that it is not just a letter from one official to another official, or a decision of a general purposes committee, or whatever. We should require the councils to take a decision to the full council. I do not think that is unreasonable.

If I may anticipate something the noble Baroness may say, it is not sufficient to leave it to the councils. Anybody with experience of councils knows how sloppy some of them are. Perhaps I may say that some are rather more than sloppy. Anybody who happened to be on a Royal Commission for as long as I was, to go into standards of public life, would know what some authorities were like. Therefore, I think there should be no hesitation in laying down the law about a resolution of the whole council.

My Lords, I beg to move Amendment No. 11.

Baroness Trumpington

My Lords, at the outset I should like to say that I welcome in principle the amendment of the noble Lord, Lord Houghton, in relation to the proposals on consultation and publicity, which are very similar to my own proposals, although I hope to persuade the noble Lord to withdraw his new clause in favour of mine. I should like to put on record my personal satisfaction that it has been possible to achieve so much common ground, be it never so late.

In the Government's view, there are some minor sins of commission, together with some sins of omission, in the amendment of the noble Lord, Lord Houghton of Sowerby, which lead me to recommend to the House to prefer the new clause which stands in my name. The first sin of commission, if I may so call it, lies in subsection (2) of the new clause on consultation which is in our view unnecessary. The Government see no reason to lay down in statute how local authorities should arrive at their advice to health authorities; this is a matter which should be left to them to decide. Secondly, we see no reason to stipulate, as in subsection (2) of the new clause on publicity, that health authorities should publish details of the proposal: in such form and manner as may attain the highest degree of comprehension by consumers", simply because in our view such a phrase could not constitute a satisfactory legal test. I may say that the noble Lord may be less keen on pressing this point when I tell him that experience suggests that for health authorities successfully to campaign for fluoridation in any case requires them to adopt a high publicity profile.

Turning to sins of omission, I hope the noble Lord, Lord Houghton, will accept that our clause has certain useful additional provisions not contained in his clauses. First, we provide in subsection (2)(b) for both district and county councils to be consulted on fluoridation. Secondly, we provide in subsection (4) for health authorities to republish their newspaper notification of their plans for fluoridation. Thirdly, in subsection (6) we provide for the wholly hypothetical situation where fluoridation has to be immediately withdrawn. Finally, in subsection (7) we cover the point raised earlier.

I am sure that the noble Lord, Lord Houghton, and your Lordships generally will agree that these are worthwhile provisions, and I hope that the noble Lord, Lord Houghton, will feel able to withdraw his alternative clauses, recognising the extent to which his views have been taken into account.

The Earl of Kinnoull

My Lords, before the noble Lord, Lord Houghton, replies, may I point out that I believe he was speaking only to Amendment No. 11 and not to Amendment No. 12, which deals with publicity, but I may be incorrect in saying that.

Lord Houghton of Sowerby

My Lords, I did not hear that.

The Earl of Kinnoull

My Lords, I think that the noble Lord is moving only Amendment No. 11 and not speaking to Amendment No. 12 about publicity, but I may be wrong. My noble friend replied to Amendment No. 12 as though the noble Lord had moved it.

Before the noble Lord replies, perhaps I may ask my noble friend the Minister a question which I should have asked her earlier, to which I am sure she will give a very quick reply. In her new clause on consultation she talks about the health authority notifying local councils in England and Wales and I am not at all sure—and I do not think this has been raised this evening—why that does not also cover Scotland. In Scotland we have district councils as well. Can my noble friend reply to that question?

Lord Houghton of Sowerby

My Lords, I shall beg leave to withdraw my amendment and I shall consider what has been said. However, if I may say so with great respect, I wish the Government would introduce a different form of words into their technique of rejection. Why is it that the Government always see "no reason"? Where do they get that from? They may not see sufficient reason, but I cannot understand why, when we make a proposal which has some merit, the Government see "no reason". However, I shall let that pass for the sake of goodwill at this time of night, and beg leave to withdraw the amendment. I shall consider what else to do at a later stage. I should like to get on to Amendment No. 12, which is perhaps a rather more important amendment.

Amendment, by leave, withdrawn.

Lord Houghton of Sowerby moved Amendment No. 12: After Clause 3, insert the following new clause:


.—(1) This section applies where a health authority propose—

  1. (a) to make or withdraw an application; or
  2. (b) to terminate a scheme which may be operated by virtue of section 3 of this Act (a "preserved scheme").

(2) At least three months before implementing their proposal the health authority shall publish details of the proposal in such form and manner as may attain the highest degree of comprehension by consumers in one or more newspapers circulating within the area affected by the proposal.").

The noble Lord said: My Lords, the material point lies in the second subsection, which is the only change from the formula in Amendment No. 8. This is prompted by very hitter experience of statutory notices by local authorities which have been just about as uninformative and as stupid as anyone could imagine.

I shall never forget the enormous local controversy and the terrific expense involving a Select Committee of your Lordship's House in connection with the notorious case of the Burnley dogs. What happened was that the local authority passed a motion at a council meeting to make application to the Home Secretary for power to exercise certain rights under a provision in the Burnley Corporation Act 1876. The local authority published a statutory notice. They said that any representations that the public wished to make should be sent in by a certain date. They got three letters. The proposition was to ban dogs from all public parks in Burnley.

The Home Office queried this. But no, they went on. When they posted the statutory notices on the park gates, in no time they had a "demo" of 3,000 people with dogs. From then on there was a long-drawn-out battle between the dogs and the people and the parks. It lead to High Court proceedings, dog protection societies sprang up, and there were unlawful acts of breaching the prohibition which lead to prosecutions. It was an awful mess. Indeed, it was the Select Committee of your Lordships' House that got Burnley out of that mess by a compromise solution which was proposed by the Select Committee. It was something awful, and merely because the local authority had no more nous than to put up a statutory notice which merely referred to a section of an Act of Parliament passed in 1876.

I do not say that that sort of nonsense would ever be repeated elsewhere. It took place a number of years ago and I think all authorities have been improving their public relations since then. I hope so. But what I want is that what they put out shall convey to the reader exactly what it is about. I propose that the details shall be published in such form and manner as may attain the highest degree of comprehension by consumers in one or more newspapers circulating", and that is already in the formula in Amendment No. 8. The effective provision is: in such form and manner as may attain the highest degree of comprehension by consumers".

I hope to God that the Government are not going to say that they see no reason why consumers should have it put to them in a comprehensible way; that they will get it anyhow; and that anyway there will be enough rumpus locally to give them all a clue that there is something doing that they ought to object to. No; let us have a little imagination for once.

The public do not pick up these things from the casual announcements in newspapers, unless newspapers wish to make an issue of it themselves. The curious thing was that in Burnley the newspapers did not make an issue of it until there was a protest, and until the dogs and the people were on the streets. Although this is not a typical case it is one that sticks in my mind so much that we must ensure that local authorities put it across—that is what we want—so that people know what is in the offing. They can then stimulate whatever activities they want to get their point of view put to the local authorities and to the health authority. May we at this hour just have a gesture of understanding from the Front Bench opposite to say that this is a good idea, and at least good enough to be accepted?

Baroness Trumpington

My Lords, I must apologise that I took the clause on publicity with the clause on consultation, so I have already spoken to that. This gives me the opportunity to answer my noble friend who asked me why the Scottish health boards are not required to consult their local councils. The purpose of subsection (2)(b) is to allow elected local authorities to be consulted before the final decision is taken by health authorities and statutory water undertakers in England and Wales. No such provision is needed for Scotland as the final decision there will rest with water authorities, which are the elected regional and island councils.

Lord Houghton of Sowerby

My Lords, did I get a reply, or just a comment?

Baroness Trumpington

My Lords, I think the noble Lord has had his chips.

Lord Houghton of Sowerby

My Lords, I may not have heard perfectly all that the noble Baroness said, but in the circumstances I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 4 [Interpretation, etc.]:

Baroness Trumpington moved Amendment No. 13: page 3, line 31, after ("1978)") insert— (" "local authority" means the council of a county or district, the council of a London borough or the Common Council of the City of London;")

The noble Baroness said: My Lords, this is a technical amendment to add "local authority" to the list of definitions which is required by the Government's new clause on consultation. I beg to move.

On Question, amendment agreed to.

Lord Monson had given notice of his intention to move Amendment No. 14: After Clause 4, insert the following new clause:


.—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, in view of the lateness of the hour I do not propose to move this amendment tonight, but I reserve the right to do so at the next stage.

[Amendment No. 14 not moved.]

Lord Sandys had given notice of his intention to move Amendment No. 15: After Clause 5, insert the following schedule:

("Health Risks.

Any person with the following medical condition may suffer additional harm to their health if they consume water to which fluoride has been added in a concentration of one milligram per litre:—

  1. (a) Diseases of the kidneys;
  2. (b) Allergic reactions;
  3. (c) Diabetes;
  4. (d) Diseases of the thyroid gland;
  5. (e) Arthritis;
  6. (f) Heart diseases,
and any other condition which the Secretary of State may by order authorise to be added to the above list.")

The noble Lord said: My Lords, this schedule was spoken to with Amendment No. 4. In view of the fact that Amendment No. 4 was negatived, this schedule therefore is left in a very unfortunate condition and I do not propose to move the amendment.

[Amendment No. 15 not moved.]