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'shall indemnify every water undertaker which enters into arrangements under section 87(1) above against all liabilities that any such undertaker may incur in complying with such arrangements, other than liabilities arising from the undertaker's own fault or negligence.
(1A) Subject to subsection (1) above, each indemnity shall be on such terms as (with the consent of the Treasury) may be agreed between the Secretary of State and the undertaker.'.
Amendment No. 49, in page 81, line 13, after 'authority', insert 'or the water undertaker'.
Amendment No. 50, in page 81, line 23, leave out from first 'the' to 'to' in line 24 and insert—
'person who has made the determination shall give notice of his determination to the relevant authority and'.
Government amendments Nos. 92 and 93.
Amendment No. 2, in schedule 9, page 227, line 10, at end insert—
'Sections 88 and 89.Section 91.'.
Mr. Thomas: To date, the Bill has been disagreed with in detail, but not in principle. Now, we come to the part of the Bill with which there is disagreement in principle—a disagreement that crosses the House and runs throughout the parties. The amendments deal directly with whether we should fluoridate our water supplies, whether we should continue the fluoridation of water supplies that are already fluoridated and, if we are to fluoridate further water supplies, how we should consult local populations. New clause 1 and amendment No. 1, which stand in my name, and amendment No. 8, which stands in the name of the hon. Member for Llanllienni—or Leominster (Mr. Wiggin), although in view of his appointment, we should refer to his constituency by its Welsh name—go to the heart of the debate on fluoridation.
In the next hour and a half or so, I hope to hear the views of hon. Members on both sides of the House on how the House wants to come to a view—whether it wants to make a firm ruling on the principle of fluoridation, or whether it wants to make a more practical ruling on whether to extend fluoridation by means of the Bill. Given that this is, for the most part, a free vote—hon. Members on both sides have already expressed different ideas on how we should proceed—I hope that the House will be able, by means of the necessary votes, to make a firm declaration on fluoridation, and I hope that that declaration will be no: we do not have the evidence, the public support or the confidence at this stage, in this Bill, to pass such an important public health measure.
Stephen Hesford (Wirral, West): The hon. Gentleman is making an interesting, if very backward-looking, point. Does he seek to examine the principle of current law, as I understand it, and to remove it? What has been wrong with that for the past 15 or 16 years?
Mr. Thomas: I am sure that the hon. Gentleman wants to hear precisely that argument, and I promise him that he will hear it from me, if he gives me a little time. To pick up one of his points, two views are reflected and two ways forward are offered. It is for the House to decide what it wants to do. A new clause and an amendment stand in my name—I have given the House a choice.
Let us examine the practical grounds for fluoridation first. I shall discuss the civil liberties aspects and whether we should compulsorily medicate the population later. I have no doubt that putting the measure into the Bill has been justified on public health grounds. That
justification is based on the York review, a Government-commissioned review of all the science, the studies, and the peer-reviewed investigations to date on the effect of fluoridation on the population. That review found several important facts, which I want to put on the record.7.15 pm
The review found that fluoridation appeared to reduce caries by 14 to 15 per cent.—that is, 0.4 per cent. of a tooth—but in the same context, it found that the science was poor and not without bias. The review also found that 48 per cent. of people living in fluoridated areas have dental fluorosis—a brown mottling of the teeth, which is medically accepted as a sign of fluoride overdose. We must not have too much fluoride in the water, and the Bill, by setting a limit on the amount of fluoride that may be put in the water, implicitly accepts that too much fluoride is possible, although it purports that there is an effective level.
Andy Burnham (Leigh): The hon. Gentleman says that fluorosis affects 48 per cent. of the population and results in brown mottling. Is he not aware that the most common appearance of fluorosis is a pearly appearance of the teeth, not brown mottling?
Mr. Thomas: I do not know about the hon. Gentleman's pearly gnashers, but as he knows, the 48 per cent. examined in the York review identified that as the effect on their teeth. It is the York review that says that, not me, and it is for individuals to judge for themselves. Fluorosis is fluorosis: it is evidence of too much fluoride in the body, and that is the end of it.
Mr. Kevin Hughes (Doncaster, North): Did not the York review find that there was a 15 per cent. increase in fluorosis? If there is a 14 or 15 per cent. improvement in the quality of teeth and a 15 per cent. decrease in the quality of teeth, especially children's teeth, because of fluorosis, does not the one cancel out the other? Is not the pro-fluoridation proposal an absolute nonsense?
Mr. Thomas: I tend to agree with the hon. Gentleman, except to say that I do not think that one cancels out the other. However, the two pieces of information are evidence that we should use when taking decisions as Members of Parliament. We should not simply swallow one line or another, but try to work out what we should do.
It is clear that the effects of fluorosis include not only the chalky or pearly appearance to which the hon. Member for Leigh (Andy Burnham) referred, but brown staining and pitting of teeth. Those are fairly severe effects. Are we proposing to put something in the water that will have that effect on 48 per cent. of the population? That serious question must be answered.
Mr. Andrew Robathan (Blaby): Did the hon. Gentleman receive, as I did a couple of days ago, a document from the British Dental Association and the British Medical Association in favour of introducing fluoride into water? It stated that in some areas that are
fluoridated the incidence of caries in children was twice as bad as in areas that are not. What conclusion does he draw from that?
Mr. Thomas: I think that the hon. Gentleman is referring to the document that I have in my hand, which I did indeed receive recently. It shows that although fluoridated areas tend to have better dental health—I should say better health in terms of caries, not dental health, because there is more to dental health than simply caries; gum disease and cancer and mouth cancer have to be considered as well—there are fluoridated areas that have an above-average incidence of decayed, filled or missing teeth among five-year-olds. The science is unproven.
To return to the York review, following its publication, four eminent members of the NHS centre for reviews and dissemination at York university—Professor Jos Kleijnen, Professor Trevor Sheldon, Sir Iain Chalmers and Professor George Davey-Smith—made the following statement in a letter to the then Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears):
- "As far as we are aware, no other review"—
- "of this topic is of comparable scientific standard, and we are concerned about some continuing misinterpretations of the evidence which could have implications for public policy."
Three points were made in the letter. The first is about the effectiveness of fluoridation in reducing caries—the very point raised in an intervention by the hon. Member for Blaby (Mr. Robathan)—and the letter states:
- "We could discover no reliable, good-quality evidence in the fluoridation literature world-wide. What we found suggested that fluoridation was likely to have a beneficial effect, but in fact the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth."
- "The evidence is weak, contradictory and unreliable".
The third point was on the safety of fluoridation:
- "Apart from an increase in dental fluorosis (mottled teeth)"—
- "we found no clear pattern among the possible negative effects we examined, and we felt that not enough was known because the quality of the evidence is poor"—
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