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Mr. Denham: The examples that I gave earlier in the debate show that fluoridation leads to significant improvement in the amount of tooth decay suffered by children. The Sandwell study suggests that, in the 10-year period after fluoridation began, the level of tooth decay in children more than halved. That is a significant change.
The final decision on implementing fluoridation schemes rests with the water undertaker. The Water (Fluoridation) Act 1985 was consolidated in the Water Industry Act 1991. Section 87(1) of the 1991 Act states:
We have been encouraged by the readiness with which water companies have said that they are prepared to look again at the legal and practical problems of fluoridation. What they most want is clarity over the distribution of responsibilities. They have emphasised that their primary duty is to provide a sufficient and wholesome supply of water. They consider that the question whether a water supply should also contribute to wider public health objectives should be for the health service to decide. Should a fluoridation scheme be approved, the health service should meet the operational costs and indemnify the water operator against any unforeseen cost consequences. There is little in those arguments with which we disagree. We shall seek the views of the water industry on any proposals for legislative change.
Mr. Duncan:
How does the Minister define an unforeseen cost consequence? Will he undertake that "may" will not become "shall" during this Parliament, given that the proposal was not in his party's manifesto?
Mr. Denham:
I was about to explain how we intend to proceed. The Green Paper "Our Healthier Nation", which we published last year, initiated a consultation onoral health and fluoridation. The responses were overwhelmingly positive. The great majority took the view that no other oral health promotion measure would be as effective in reducing inequalities in dental health as the fluoridation of water in areas with high levels of tooth decay.
However, there were also comments from people opposed to fluoridation, mirroring some of the concerns expressed by the hon. Member for New Forest, West. Some commentators questioned the effectiveness of
fluoridation and, together with a larger group, argued--[Interruption.] The hon. Member for Rutland and Melton persists in interrupting. I was merely pointing out that the water companies have said that the health service should meet the operational costs and indemnify the water operator against any unforeseen cost consequences.
Mr. Swayne:
Will the Minister give way?
Mr. Denham:
No. I have given way many times and I have only a short time to go.
Mr. Duncan:
It is my hon. Friend's debate.
Mr. Denham:
The hon. Gentleman has interrupted consistently. I must press on towards the end of my remarks.
Some commentators questioned the effectiveness of fluoridation. They joined a larger group of those who suggested that its safety was in doubt. A few were also opposed on the grounds that mass medication was unethical. I have acknowledged the breadth of views and representations from the water industry and others. We are considering all those views carefully in drawing up a policy statement to be included in the forthcoming public health White Paper planned for the spring.
I am not able to answer all the points that have been raised this evening, many of which will need to be addressed in response to that consultation process. The White Paper will take full account of the sensitivity of this issue, the potential benefits to dental health and the importance of building a consensus on clearly established evidence for the safety and effectiveness of fluoride.
Question put and agreed to.
"Where a District Health Authority have applied in writing to a water undertaker for the water supplied within an area specified in the application to be fluoridated, that undertaker may, while the application remains in force, increase the fluoride content of the water supplied by the undertaker within that area."
December's judgment in the judicial review, in which the Tyneside health authorities sought unsuccessfully to challenge Northumbrian Water's refusal to accede to their request to fluoridate their water, confirms that the Act has not worked. Since 1985, 55 health authorities in England--nearly half, taking into account the mergers that have taken place in the past 12 years--have requested water companies to introduce water fluoridation, but none of those requests has been accepted. There have been no new fluoridation agreements since 1985, because none of the water companies has exercised their discretion to agree to a health authority's request. We said in the Green
Paper "Our Healthier Nation" that the legislation needed to be reviewed. The key issue is whether "may" should become "shall".
Adjourned accordingly at twenty-nine minutes past Ten o'clock.
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