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Mr. Butterfill: All sorts of substances occur naturally in water--some beneficial, some harmful. In some areas, there is a natural occurrence of lead, and there are radioactive substances in the water in Cornwall. Does the hon. Gentleman suggest that those should be added to the water as well?

Mr. Lock: The hon. Gentleman makes my point precisely. Where there are substances in the water, we should analysis them carefully to see whether they are for the public good or the public harm. If they are for the good, they should be retained. If harmful, they should be removed.

Tangible benefits flow from fluoridation to the socially deprived, and where health authorities have consulted, upwards of four out of five people actively supported fluoridation. In those circumstances, I find it difficult to justify the right of a small number of determined, but perhaps narrow-minded, individuals who wish to oppose the benefits that the general public want.

The third problem--the one on which I seek to press my hon. Friend the Minister--is the issue of indemnities for the water companies. The existing system, under the Water (Fluoridation) Act 1985, provides for health authorities to request water companies to provide fluoridation in water where, after public consultation, the health authority decides that it is appropriate for its area. The Green Paper raised the issue of the level and the process of consultation. I can only say that the consultations in which I have been involved have been models of consultation and public debate, and have provided a real opportunity for the public to discuss both sides of the argument. These are the processes which have, after public education, produced a 79 per cent. approval rating for fluoridation.

Certain indemnities against criminal or civil liabilities can be given by the Secretary of State to the water companies to protect them against claims, good or bad,

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arising as a result of fluoridation of the water supply. The water companies have, in effect, a discretion under existing law whether to comply with a request from the health authorities. Some companies--including Severn Trent, which serves my constituency--are seeking much wider indemnities than those provided by the current scheme.

The problem of the extent of indemnities is complex. I accept that, as indemnities can lead to exposing the public purse to the risk of extensive liabilities, the Minister must consult the Treasury before any extended liabilities can be given. Although I have some sympathy for the position of the water companies--which do not wish to expose themselves or their shareholders to unquantifiable liabilities--it must be recognised that they are monopoly suppliers which make substantial profits out of exploiting their monopoly position. In those circumstances, they are entitled to reasonable indemnities, but it cannot be right for companies to seek an indemnity from all criminal acts--even if there is fault on the part of a company or its employees.

Today, I am seeking assurances from the Minister on three grounds: first, that she will, at an early date, conduct discussions with the water companies and her Treasury colleagues to seek to agree a standard set of indemnities that can be given by public authorities where a request to fluoridate is made; secondly, that when the Green Paper is followed by a White Paper and legislation, the standard indemnities will be set out in a schedule or in secondary legislation so that everyone knows where they stand on indemnities and so that these issues are not open to further negotiation; thirdly, that when she comes to consider new legislation on fluoridation, my hon. Friend will look carefully at the discretion given to water companies by section 1(1) of the 1985 Act to comply with a request from a health authority.

If a public body such as a health authority conducts a public consultation exercise and reaches a view, in public, that fluoridation of the water supply is right as a public health measure, it should not be open to a private water company to have the discretion to block that measure. There have been no new fluoridation schemes since the discretion was given in the 1985 Act. That has resulted in the blocking of health benefits for a large number of our citizens. I ask the Minister to carefully consider whether the time has come to remove the discretion.

I close by commending the Government on raising the issue in the Green Paper. I hope that the excellent start which has been made will, in the near future, be turned into an effective scheme to give local health authorities an enforceable power to require water to be fluoridated where they consider that appropriate to local circumstances. With this power, I look forward to seeing tangible benefits for my constituents so that the rate of children's tooth decay in Kidderminster falls by two thirds, as demonstrated in neighbouring towns.

Mr. Butterfill rose--

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. If the hon. Gentleman wishes to speak in an Adjournment debate--which is essentially for the hon. Member who raises the matter--he must have the permission of the hon. Member and the Minister. Without that, I am afraid that I cannot call him.

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1.45 pm

The Minister for Public Health (Ms Tessa Jowell): I commend my hon. Friend the Member for Wyre Forest (Mr. Lock) on securing this important debate at a time when the public consultation on the Green Paper on public health is drawing to a close. We have received more than 5,000 responses, and there has been overwhelming support for the Government's approach to improving health and tackling health inequality.

As my hon. Friend has described, tackling inequalities in oral health is an important part of the overall programme. There is very good evidence that significant inequalities remain in the oral health of the population. Even at a regional level, there are factor differences in the levels of tooth decay in children. For example, in 1995-96, five-year-olds in the west midlands had, on average, less than half the numbers of decayed, missing or filled primary teeth than those in the north-west.

As my hon. Friend mentioned, some 5 million people receive water where the fluoride content has been artificially increased to a level of one part per million. Major schemes are in operation in Birmingham and throughout the west midlands, and also in Tyneside. About 500,000 people in this country receive water which is naturally fluoridated at or about the optimum level of one part per million. A further one million people receive water which is naturally fluoridated at a lower level, but which still confers some dental benefit.

Well-documented studies have shown that fluoridation of the water supply can produce a reduction in dental decay in children of about one third or one half. Sandwell was fluoridated in 1986. Over the following 10 years, the amount of tooth decay in children had more than halved. During the same period, an area with a comparable population mix--Blackburn, in the north-west--saw little change in its children's oral health. That example has been replicated in many other places over the past 50 years.

Mr. Butterfill: Very few people in the House would deny that there are health benefits from fluoridation. All my children have received fluoride treatment, and it is difficult to buy toothpaste without fluoride. However, does the Minister agree that there is a significant civil liberties argument, which is that people should be able to choose the medicines they receive? Once the state starts saying that it will enforce the addition of medicine to the water supply, we will be in a dangerous area. We may be open to challenge from the European Court of Human Rights.

Ms Jowell: I thank the hon. Gentleman for that intervention. We recognise that strongly held views exist on both sides of the argument. Undoubtedly, important civil liberties matters need to be considered and I hope that as I continue with my remarks he will understand that the Government's approach is intended to take proper account of those concerns.

My hon. Friend referred to the important deterioration in dental health that occurred when fluoridation was withdrawn in Anglesey. Obviously, in considering a public health measure such as fluoridation, we are concerned above all else with safety. Nothing can ever be pronounced safe in absolute terms, but no ill effects have ever been found to exist as a result of drinking fluoridated water. The view that water fluoridation is safe is that of

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the majority of medical and scientific opinion throughout the world, based on practical experience and research over 50 years. In that time, many health problems have been alleged to be linked to fluoridation. They have been investigated and no link was found. I must make it clear to the House that the Government will proceed with an open mind, always willing to consider evidence on either side of the argument. That is a policy pursued in the interests of tackling inequality and applying what works, not in the pursuit of dogma.

Dr. Peter Brand (Isle of Wight): Does the Minister agree that a precedent to counter the civil liberties argument is the addition of vitamins to white flour, bread and margarine, which has been going on for many years in this country, about which no one has complained and which has certainly prevented much disease?

Ms Jowell: Undoubtedly, there are analogies, but rather than drawing on a point of principle, our concern is to examine fluoridation as a potential area of public policy that would effectively tackle inequality in the enjoyment of oral health. To do so, it is extremely important to enable proper opportunities for local representation.

To underline the safety issues, the most recent research of which we are aware in this country concerned a potential link with hip fracture, which has also proved to be unfounded. Any convincing evidence of harm to general health as a result of drinking artificially fluoridated water at one part per million has yet to emerge. Indeed, it is estimated that throughout the world 210 million people drink artificially fluoridated water.


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