§ 7.28 p.m.
§ Lord Lyell rose to move, That the draft order laid before the House on 27th April be approved.
§ The noble Lord said: My Lords, I beg to move.
§ Although there has been a welcome reduction in dental decay over the past 10 years it still remains a significant and costly form of disease. The child dental health survey carried out in 1983 showed, if we take one example, that 64 per cent. of 13 year-old children in Northern Ireland had active decay in permanent teeth, double the number in England. This need not be the case. We owe it to our children, and above all to future generations, to prevent this unnecessary and unsightly handicap. I and my colleagues are convinced that fluoridation of public water supplies at the levels proposed in the order would significantly reduce the very high incidence of tooth decay in the Province.
§ Water fluoridation is not of course the only means of reducing dental decay. Reductions can also be brought about by improvements in diet and oral hygiene but there are limits to what these can achieve. The use of fluoride toothpaste, the provision of fluoride tablets for children and the application of topical fluoride directly onto the teeth are other ways of improving dental health.
§ Much of the recent general reduction in dental decay is thought to be related to the increased use of fluoride toothpaste. However, these methods can be a relatively expensive means of reducing dental decay and require a regular regime. Experience shows that this is not always easy for parents to maintain, particularly in the areas of social deprivation. Water fluoridation has advantages over all of these methods in that it can be highly cost-effective and does not require the use of trained personnel or a conscious effort by the recipient. It also confers a benefit on the whole community using fluoridated water.
§ Successive governments have taken the view that fluoridation is an effective public health measure. 68 Until 1983 it was thought that no specific powers were needed to add fluoride to public water supplies. However, in that year Lord Jauncey ruled that fluoride was ultra vires under Scottish law which at that time was comparable to the present Northern Ireland law. As well as ruling on the legal position Lord Jauncey concluded that the addition of fluoride to the public water supply would be likely to reduce the incidence of dental caries and that there was no evidence that the addition of fluoride at a concentration of one part per million was harmful to health. Although Lord Jauncey's judgment was not binding outside Scotland, the Government decided, purely for the avoidance of any doubt, that legislation should be introduced to clarify the power of water authorities throughout the United Kingdom to add fluoride to the water supply. This was done for Scotland, England and Wales in the Water (Fluoridation) Act 1985, on which several noble Lords spoke.
§ The order which I ask the House to approve today will make broadly comparable provisions for Northern Ireland. Because of the different administrative arrangements which exist there, the order does not exactly mirror the Great Britain legislation. It does, however, in line with the 1985 Act require decisions to be taken locally on whether fluoridation should be introduced in particular areas. Such decisions would be taken by health and social services boards only after they had advertised any proposal for fluoridation and consulted the district councils for the areas affected.
§ The only significant difference between the proposed order and the Water (Fluoridation) Act 1985 is the requirement that boards should seek the approval of the Department of Health and Social Services before asking the Department of the Environment, the sole water authority for Northern Ireland, to fluoridate a particular water supply. The DHSS will fund approved new schemes and this procedure will ensure that the cost effectiveness of schemes will be assessed and the availability of funds confirmed before the water authority starts to take the necessary action.
§ As I have explained to the House, the order would clarify the law in Northern Ireland on fluoridation of public water supplies and bring it into line with what the law is now in Great Britain. I commend it to the House.
§ Moved, That the draft order laid before the House on 27th April be approved.—(Lord Lyell.)
§ Lord Prys-Davies
My Lords, many of the articles of this order have a familiar ring about them. If the terms of the order were amendable I am sure it would attract the volume of criticism which was addressed to the Water Fluoridation Bill in 1985. If that were the position we would have a re-run of the many amendments which were tabled when that Bill was before your Lordships' House.
There is always considerable strength of feeling on the question of fluoridation of the domestic water supply. It is welcomed by many people as being a good example of a preventive health measure, though 69 I believe that the technical evidence is not absolutely conclusive on this issue. For others, of course, there are sound ethical grounds for questioning the decision to fluoridate domestic water.
The opponents of fluoridation may draw a small measure of comfort from the fact that the nominated health board has to consult the elected district council before it formally applies to the Department of the Environment, with the consent of the Department of Health for the supply to be fluoridated. We welcome very much this duty to consult the elected authority which does have some responsibility to the people who live in its district and can therefore be expected to be sensitive to local opinion.
We also note that the health board's application has to be supported by the Department of Health, and that should also be another safeguard. The Minister referred to yet another safeguard. The health board is under a duty to publish in one or more local newspapers its intention to apply for water to be fluoridated and to republish the notice not earlier than seven days after the publication of the first notice.
There is another safeguard which I do not think was mentioned by the Minister. Members of the public are, in general, not to be excluded from the meeting of the health board at which the decision to apply for fluoridation is debated and taken. Therefore, there are three or four safeguards in the order and that may go some way to assure people who are concerned about it.
I should mention that I have not in fact received a single objection to this order from any individual or any organisation in Northern Ireland and the Government may draw some comfort from this silence. With those comments we approve the order.
My Lords, I merely say briefly that I am wholly in support of this order and would not wish to see it amended in any way at all. I should like to feel that, in saying that, I am speaking for every one of my noble friends on these Benches; but, the subject being as it is, I am bound to say that there may be one or two of my noble friends who are still not convinced that this wholly safe and very beneficial public health measure is desirable. There are still some who have to be persuaded.
Having said that I am wholly in support, I express one faint misgiving. In introducing the order, the noble Lord referred to the lengthy debates we had in your Lordships' House on the Water Fluoridation Bill in 1985. As a result of the publicity, a very large number of the people in Britain, having heard that the Bill was passed, automatically assumed that the water they were receiving was fluoridated. Indeed, a poll showed that eight out of 10 people believed that they were having fluoridated water, whereas in reality the number is very much smaller.
My fear is that although we pass an order and an Act, changes do not happen very quickly. In England 70 and Wales this has been partly as a result of the delay in publishing and producing the DHSS and Department of Education joint guidelines. That has delayed matters. However, I hope that this order, once accepted, will entail no great delay in enabling the people of Northern Ireland to benefit from this extremely desirable and, I repeat, wholly safe public health measure.
§ Lord Monson
My Lords, I should also like to thank the noble Lord, Lord Lyell, for explaining this order. Having said that, I must deplore the way in which this extremely contentious issue of fluoridation is being dealt with. When it was to apply to England and Wales it was debated for many hours and for a great many days in both Houses of Parliament. There were many bitterly contested amendments and often close Divisions, especially in your Lordships' House. This order is being rushed through this House in under half an hour with no constitutional possibility of amendment and no realistic possibility of stopping or even delaying it. One cannot help feeling, not for the first time, that Northern Ireland is being treated almost as a colony, and a 19th century colony at that.
Once again I stress that I make no personal criticism whatever of the noble Lord, Lord Lyell. I fully realise that this state of affairs has come about as a result of collective Cabinet decisions which antedate by many years his assumption of office. This is a state of affairs which I must continue nevertheless to deplore.
On the question of fluoridation, it so happens that I have just returned from a transatlantic trip which culminated in five days spent in a territory where the population's drinking water comes entirely from rain-water. That rain-water is filtered but not otherwise treated. Furthermore, it is unpolluted; there are no industries to speak of on or anywhere near the island. There are of course other drinks as well, both hard and soft, but when people want to drink water, as it comes or in the form of tea, coffee, ice for their drinks or added to their whisky, rainwater it has to be. Yet the people of that island have white and healthy teeth. They have notably better teeth than the average Englishman or Englishwoman.
Moreover that state of affairs has nothing to do with a healthy diet: I fear that the people of that island consume large amounts of American-style junk food in the form of hamburgers in sweet white buns, fizzy sweet soft drinks and so on. That makes the state of their dental health all the more impressive. It gives the lie to the assertion that fluoridation is necessary for healthy teeth.
Article 6(6) causes particular worry. It appears to give the Department of Health and Social Security power to suspend the right of a board to take account of public opposition to fluoridation and to act accordingly by withdrawing a fluoridation scheme. The power conferred by that paragraph may not be technically undemocratic but it would nevertheless seem to contravene the spirit of democracy. I hope the noble Lord will explain why that rather alarming paragraph has been included.
Lord Campbell of Croy
My Lords, I also should like to thank my noble friend for the way in which he introduced the order. The noble Lord, Lord Monson, has expressed doubts about fluoridation. I should like briefly to make a few fundamental points about fluoridation. Fluoride exists in all natural sources in the United Kingdom which provide our water supplies. In some areas it exists in the optimum amount for the health of teeth. People who have been fortunate enough to live from birth in those areas have much better teeth than those who live elsewhere in the United Kingdom.
Natural sources contain other substances, dissolved or carried in the water. There is no such thing as pure water in the original sources in the United Kingdom. Therefore, water authorities have for years added other substances for various reasons. In some cases there is a list of those substances. I wonder whether the noble Lord, Lord Monson, has seen the list of some of those other substances to which apparently no objection is made. They are of course added mainly to make water wholesome, palatable and safe.
There is much concern about the burdens placed on the National Health Service and its rising costs. In my view that is justified, although I believe that the Government are doing their best.
The addition of fluoride to water to bring it to the optimum amount in those areas where it does not exist naturally in the optimum amount, if carried out widely, would be of immense benefit. In due course it would save tens of millions of pounds and probably hundreds of millions of pounds in resources. That money could then be used for other purposes for the benefit of the nation's health. It would also relieve the population, and I hope this is something for which all your Lordships will have sympathy, from toothache, especially among young people. To be fully effective fluoride should be ingested in the first few years of life. It is difficult to be thorough when taking tablets or using toothpaste particularly at those early ages. "Save the Children"—that is the cause which I would support. Save the children from pain. It is a worthy cause. I think that it is a campaign which most of us would support.
I hope that these points will be taken fully into account by those people who have doubts about fluoride.
§ Lord Hylton
My Lords, I should like to apologise to the noble Lord, Lord Lyell, for not being here soon enough to listen to the opening part of his introductory remarks. I think that there are much better ways of getting fluoride into and onto the teeth than by through the water supply; for instance, it can and is applied by dentists—I believe it is called "topically"—to the teeth of children and young people. It can also be applied through toothpaste and through milk, which is highly effective if done through schools. I hope the people in Northern Ireland who are interested in those matters will take note of those points.
§ 7.45 p.m.
§ Lord Lyell
My Lords, I apologise for the fact that the noble Lord, Lord Hylton, had resumed his seat while I was receiving a note from the winged messenger and my noble friend. I meant no discourtesy to the noble Lord. We shall soon see and discuss who has the most caries. I thank all your Lordships who have spoken with no little passion about this order.
The noble Lord, Lord Prys-Davies, told us that he had received no representations on this order or matter from anyone in Northern Ireland. Your Lordships will not be surprised to know that there have been no major disagreements about water fluoridation in two particular areas. One or two people have made political points about consultation or the lack of it. They made the points made by the noble Lord, Lord Monson.
The noble Lord, Lord Prys-Davies, mentioned the fact that under Article 6(7) the public would have the right to attend meetings. I also noticed that. I am pleased that those members of the public who might express opinions with the passion that some of your Lordships have done will not be excluded from any meetings of the board.
I was not surprised that the noble Lord, Lord Winstanley, agreed with the order. I am pleased that he spoke for all on those Benches. I suspect that he spoke for all his noble colleagues who follow his profession and who are concerned with the health of not just teeth but the whole body. He made a notable contribution in debates on this matter in 1985. We note his strong support for the order once more this evening.
The noble Lord, Lord Monson, once again mentioned the fact that we are dealing with the matter during the dinner break and rushing it through. I hope that that does not stop us having a full discussion on the matter. I think that even he will agree that we do not necessarily want to go over all the ground that was covered in earlier debates relating to England and Wales, and of course Scotland as a result of the Jauncey judgment. I am grateful for his confirmation that his remarks about Northern Ireland legislation were not aimed at me. That is not often said, especially in the Province.
The noble Lord mentioned the rain-water which was consumed, presumably by himself and everyone else, on the island which he visited. I assume this is true of the inhabitants of the island that he visited, but I am advised that island people tend to have a high concentration of fish in their diet. I am further advised that that diet has a high fluoride content. My noble friend Lord Campbell of Croy pointed out that fluoride is present in almost all the water in the United Kingdom. The order gives the Department of the Environment in Northern Ireland, which is the sole water authority, the power to add fluoride to the water. I am given to understand that there is hardly a particle, an atom, of water in Northern Ireland which would not contain a tiny trace of fluoride.
§ Lord Monson
My Lords, may I briefly point out that fish is expensive in the territory in question as it is in most islands nowadays for various reasons. It is therefore not consumed to any degree by the population as a whole but only by the people who can afford it.
§ Lord Lyell
My Lords, I am not able to enter into an interesting debate on where the noble Lord spent his Recess or on the content of fish. My advisers think that most island people have a high content of fish in their diet. But perhaps we had better not discuss the pricing policies of the holiday paradise of the noble Lord with regard to fish. There might be some other element in the population's diet which gives rise to their healthy white teeth.
The noble Lord also asked me about Article 6(6). Article 6 deals with consultation and publicity. Although the boards are required to advertise their proposals for schemes on fluoridation as well as advising and consulting district councils, the article does not place any constraint on the ultimate decision-making power of the board because the statutory duty which is vested by Parliament for preventive health measures lies with the boards and a requirement to seek approval from the department to a scheme does not imply that the department may oppose a board on policy grounds.
The provision in Article 6(6) relating to the Department of Health and Social Services to allow a scheme to be discontinued without consultation preserves an assurance given during the debate on the Water (Fluoridation) Act 1985. This provision would allow fluoridation to be stopped at short notice.
My noble friend Lord Campbell of Croy made an impassioned speech. Indeed, he made my remarks on introducing the order virtually superfluous. I am very grateful for his sound support and for his quotation that water should be wholesome, palatable and safe. It seems that my noble friend's words exactly mirror the words that I remember of Lord Jauncey in making his statement in this famed case in 1983. Certainly, I should not want to enter the lists as to whether fluoride would do my teeth, or anybody else's teeth, any good. I would send for two of my noble friends who deal in this specialised matter. We are not allowed to advertise, least of all from this position, but I think that they, too, would wish to enter the list on the side of your Lordships and possibly on the side of the supporters of the order before us this evening.
Lord Campbell of Croy
My Lords, I can guess from what the noble Lord said that the two noble Lords to whom he refers are practising dentists.
§ Lord Lyell
My Lords, the noble Lord puts it absolutely correctly but while I am in this position I had better say no more: otherwise, noble Lords may make some interesting deductions and know exactly to whom we are referring. However, I do not wish to have treatment now or within the next hour.
I thank all noble Lords who have spoken with no little passion, no little experience and no little insight. I commend the order.
§ On Question, Motion agreed to.74
My Lords, I beg to move that the House do now adjourn during pleasure until eight o'clock.
§ Moved accordingly, and, on Question, Motion agreed to.
§ [The Sitting was suspended from 7.55 until 8 p.m.]