HL Deb 13 November 2003 vol 654 cc1690-5

50A Clause 61, Line 2, at end insert "providing that the opinion referred to in section 89(1)(a) has been gained by the principal local authorities in the area in question"

Lord Livsey of Talgarth

My Lords, I beg to move, as an amendment to Commons Amendment No. 50, Amendment No. 50A. Amendment No. 50A states: Line 2, at end insert 'providing that the opinion referred to in section 89(1)(a) has been gained by the principal local authorities in the area in question'"; in other words, the local community must be questioned to establish its views on the fluoridation issue. The noble Baroness, Lady Miller of Chilthorne Domer, intended to move this amendment but she is unable to do so. I have done a fair amount of homework on the matter and I shall do my best in presenting it to the House.

I refer to the whole question of indemnity. Indemnity should be provided only when fluoridation is the clear wish of a community to be affected. Local authorities are clearly best placed to test that opinion. They have no axe to grind, unlike strategic health authorities which are promoters and judges of opinion.

I would not have returned to this subject except that the Commons had a big vote on this point. The result, 200 to 243, constituted possibly the smallest majority that the Government have had on anything since 1997. Honourable Members in another place clearly hoped that we would tackle this matter.

As my honourable friend the Member for Lewes, Norman Baker, said, local authorities might not be perfect but they are local, democratically elected and accountable, which is more than can be said of strategic health authorities. Indeed, Mr Wiggin MP stated that strategic health authorities are neither democratically elected nor accountable. Their accountability comes only through the Secretary of State, which is not a direct local mechanism. They do not match up with the Government's insistence on local consultation.

The situation that I am discussing allows for local referendums in the areas of local authorities. The indemnity will kick in only if local authorities have tested public opinion. It is extraordinary that the Government in the House of Commons would not accept the principle that local authorities could decide whether or not to add fluoride to a public water supply in their locality without first testing local opinion.

There is no doubt that fluoride has a beneficial effect on teeth, but no one truly knows what side-effects the addition of fluoride may have on a wide spectrum of aspects of human health. Indeed, this is a matter on which science is inconclusive. As we know, there are supporters of both sides of the argument.

The important point about the amendment is that it gives the residents of an area a vital element of choice on whether or not to have fluoride added to the local water supply. The Government ignore that principle at their peril.

Moved, That Amendment No. 50A, as an amendment to Commons Amendment No. 50, be agreed to.—(Lord Livsey of Talgarth.)

9 p.m.

Baroness Byford

My Lords, I support the noble Lord, Lord Livsey, on Amendment No. 50A. The noble Lord said that he considered that the responsibility for deciding whether fluoride should be added to a local water supply should lie with local authorities.

We debated this matter at length during the Bill's passage through this House. As it was suggested that the responsibility in this regard should lie with the strategic health authorities, I decided to table an amendment to the relevant health Bill to try to obtain greater clarification on that responsibility. In the end, we still do not know how they will achieve getting a public view. What came out of that is that there will not be a local referendum, as the noble Lord, Lord Livsey, may not be surprised to know. That is the one fact that has clearly come out of discussions both at earlier stages of this Bill and when I spoke on the health Bill.

Again, we were told that the decision would be made by regulation. I do not know how many times when we debate matters in this House, particularly when we have the opportunity to put something in a Bill, we are told that they will come through by regulation. To have to accept that again is yet another time that it is unacceptable, certainly to us on these Benches and I suspect to colleagues on the Liberal Benches as well.

Voting in the House of Commons was really quite close, and many questions are still unanswered. I hope that noble Lords will not mind if I take a minute or two to raise some of them again. Only recently it was claimed by Dr Dean Burk, who has worked with the National Cancer Institute in America for the past 35 years, that it is possible that fluoride is killing up to 2,000 people per year. He gave the All-Party Fluoridation Group a hearing in a House of Commons meeting, and said that the American evidence showed a significantly higher cancer death rate in fluoridated areas.

There was also evidence of higher incidence of breast, colon, rectum, kidney and thyroid cancers in Britain's fluoridated areas. Mr Lawrence said that many MPs were appalled at the complete refusal of Britain's medical hierarchy to recognise the evidence when challenged on fluoride's absolute safety. He went on to say: The arrogance of those who blundered in giving their endorsement to the safety of thalidomide, asbestos and other disasters"—

to which I might add BSE—"seems to be boundless". This is really our last chance to try to persuade the Minister that the matter should not be left to strategic health authorities that are not elected. Instead, the role should be transferred to local government. People in local government are obviously elected in a proper manner. They are not there because they are asked to serve on the health authority. We feel very strongly that the Minister might consider that in the light of the evidence.

When we debated the issue earlier in this House, reference was made to the research undertaken at York. In fact, many have questioned that research as being inadequate. I press the Minister again tonight to tell us what research has been undertaken since the York experience. Is the matter something that the Government think of concern, or do they say that the claim made by that American is completely unfounded? We really do not know, and have no evidence at all in support of the Government's persistence that fluoride is the best way.

I accept and have accepted all along that fluoride can make a difference to people, and to children's teeth particularly. However, fluoride toothpaste makes a difference, too. Why have the Government not come forward with any facts to support their view that fluoride addition to the water has no side effects that support our concerns?

Tonight I am grateful to the noble Lord, Lord Livsey—the noble Baroness, Lady Miller, is quite right to be silent at the moment. I question the grounds on which the Government base their assumptions. I support the amendment.

Lord Whitty

My Lords, when the House debated the issue at earlier stages, there was acceptance that public health was a matter for the health authorities— that the strategic health authority would be the body that made the proposition, and that fluoride should be added to the water in those parts of the country where that was not already the case. That was to be subject to major consultation within each health authority's area, but of course that area will not be the same as a local authority area. Indeed, most strategic health authority areas will include several local authorities.

The reference in the amendment to putting the local authority in pole position, effectively, is not appropriate. It is important that local authorities play a major part in reaching the decisions on the proposition from the strategic health authority on whether an area should or should not fluoridate. I understand some of the anxieties about decisions that are taken solely by the strategic health authority. While the burden of science seems to be in favour of fluoridation, there are alternative arguments. In answer to the noble Baroness's specific question, the Government have commissioned two research studies by the MRC and the University of York and neither found any association with cancer. However, we are not complacent about that. Strategic health authorities must make a judgment on the latest science and on how it affects their particular areas, types of water and populations, but it is a public health decision and the strategic health authorities must make it.

However, because it is an issue about which there is uncertainty and some doubt, it is important that strategic health authorities engage in public consultation and that public opinion is assessed objectively. Local authorities must play a full part in the opinion-sounding process, be it by open debate or other forms of participation, but a single local authority within a strategic health area could not make or block the final decision. The decision must be taken across the strategic health area as a whole following area-wide public consultation.

On a technical point, the amendment is in the wrong place. It conflicts with Section 89(1) of the Bill, which would require the relevant strategic health authority to ascertain public opinion. That relates to indemnity issues. Even if the amendment were carried, it would not achieve what the noble Baroness apparently seeks, which would be to involve local authorities in the public opinion-gauging exercise, because strategic health authorities would be given that authority by Section 89 of the Bill.

Nevertheless, while the strategic health authority is responsible for assessing public opinion, it is right that local authorities should play a major role in that exercise and ascertain opinion within their own areas to feed into it. Ultimately, however, it is a public health issue and the strategic health authority is the body that should make the proposal and test opinion on it.

Baroness Byford

My Lords, before the noble Lord, Lord Livsey, responds, I must say that I am intrigued. The noble Lord said that several local authorities should be involved. It is true that there will be several different strategic health authorities in exactly the same place, so I do not accept the distinction between local authorities and strategic health authorities. The borders of strategic health authorities do not match those of water companies and different points of view will be expressed for one place.

The amendment is not my own, so I shall weigh in heavily. I am extremely disappointed that the Minister should leave it until the ninth minute of the ninth hour of the ninth day to tell us that the amendment is in the wrong place. That is amazing and very unlike the Minister, who is normally most helpful. His argument is not very good at all.

In response to my question, the Minister said that the research had been continued. He did not reveal what has happened since the research in York and how long it is since it was completed; in other words, has research been going on in the past six months while we have been debating the Water Bill? My understanding is that there has been no more up-to-date research. He certainly did not answer my question on what possible dangers there are. We would like to hear a little more from the Minister before the noble Lord, Lord Livsey, decides whether to proceed with the amendment.

Lord Whitty

My Lords, the most up-to-date research does not show any link with cancer. The noble Baroness referred to the American experience and that is the latest information that we have.

Lord Livsey of Talgarth

My Lords, the Minister has made a number of statements about local authorities and strategic health authorities, as though they did not talk to each other. Often, local authorities consult the strategic health authorities and I believe that the local authority is the right body to conduct a referendum on this issue. The noble Baroness, Lady Byford, is right in saying that there is no coterminousity between water companies, local authorities and strategic health authorities. None the less, it is possible to co-operate and for the local authority to be the vehicle through which a referendum is held. I see no problem with that.

In these circumstances, it must be right that the addition or not of fluoride must be tested by public opinion in the district and the amendment is the correct way of achieving that. It may not be in the right place, which I concede, but we saw this as a way of including the provision in the Bill in relation to indemnity. As the Minister has a little more legal fire power than we do, he may well be correct in saying that it ought to be in another place.

Reference has been made to research and America has been mentioned. Noble Lords have also said how good are the teeth of people in Birmingham because fluoride has been added to the water for the past 40 years. As far as I know, no tests have been undertaken in Birmingham as to the possible impact of that on other aspects of human health, nor has Birmingham been compared with somewhere else of similar population which does not add fluoride to its water. As the noble Baroness, Lady Byford, correctly said, scientists are not agreed on the situation in York, and I quoted that in detail in Committee.

In my opinion, it is important to test the opinion of the House because it is one of the most important amendments we are discussing today.

9.17 p.m.

On Question, Whether the said amendment (No. 50A as an amendment to Amendment No. 50) shall be agreed to?

Their Lordships divided: Contents, 26; Not-Contents, 57.

Division No.7
CONTENTS
Attlee, E. Miller of Chilthorne Domer, B.
Barker, B. [Teller]
Bridgeman.V. Montrose, D. [Teller]
Brooke of Sutton Mandeville L. O'Cathain, B.
Brougham and Vaux, L. Palmer, L.
Byford B Pearson of Rannoch, L.
Carlisle of Bucklow, L. Phillips of Sudbury, L.
Rennard, L.
Cope of Berkeley, L. Roper, L.
Craigavon,V. Selborne, E.
Dixon-Smith, L. Thomas of Walliswood, B.
Geddes, L. Wallace of Saltaire, L.
Howell of Guildford, L. Watson of Richmond, L.
Livsey of Talgarth, L. Williams of Crosby, B.
NOT-CONTENTS
Acton, L. Borrie,L.
Amos, B. (Lord President)] Bragg, L.
Andrews, B. Brett, L.
Archer of Sandwell, L. Brooke of Alverthorpe, L.
Ashton of Upholland, B. Brookman, L.
Bach, L. Burlison, L.
Bassam of Brighton, L. Carter, L.
Bernstein of Craigweil, L. Chandos, V.
Crawley. B. Hunt of Chesterton, L.
Davies of Coity, L. Lea of Crondall, L.
Davies of Oldham, L. [Teller] Macdonald of Tradeston, L.
Donoughue, L. McIntosh of Haringey, L.
Dubs, L. McIntosh of Hudnall, B.
Evans of Parkside, L. Mackenzie of Framwellgate, L.
Evans of Temple Guiting,L. Massey of Darwen, B.
Farrington of Ribbleton, B. Morgan, L.
Faulkner of Worcester, L. Pitkeathley, B.
Gale, B. Ramsay of Cartvale, B.
Gilbert, L. Rendell of Babergh, B.
Golding, B. Rogers of Riverside, L.
Goldsmith, L. Scotland of Asthal, B.
Sewel, B.
Graham of Edmonton, L. Simon V
Grocott, L. [Teller] Stone of Blackheath, L.
Hannay of Chiswick, L. Turnberg, L.
Hayman,B. Warwick of Undercliffe, B.
Howells of St. Davids, B. Whitaker, B.
Hoyle, L. Whitty, L.
Hughes of Woodside, L. Wilkins, B.

Resolved in the negative, and amendment disagreed to accordingly.

On Question, Motion agreed to.

9.27 p.m.