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Mr. Drew: I shall be voting with the hon. Gentleman on the amendment. Not only am I unhappy about the level at which the decision will be taken, but I have received two letters, one from the Greater Manchester SHA and one from my SHA, Avon, Gloucestershire and Wiltshire, urging me to support the provisions on the basis that we should have a fluoridated water supply. How can those authorities carry out open, honest and democratic consultations when they are telling us which way to vote?
Mr. Wiggin: The hon. Gentleman makes an extremely important point. We want not only democratic accountability, but at least proper information to be provided to all people, so that they can decide how they would like their water supplies to be treated. Of course, that is difficult if the strategic health authority has already made that decision.
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Andy Burnham: The hon. Gentleman makes a point about the decision being in the hands of the wrong body. Why did the then Conservative Government leave the decision in the hands of the health authorities when they passed the Water (Fluoridation) Act 1985?
Mr. Wiggin: I do not think that they left the decision in the hands of the health authorities. [Hon. Members: "They did."] I thought that the decision was left in the hands of the water authorities. [Hon. Members: "No."] I thought that that was what the Government were seeking to change. Anyway, like the hon. Gentleman, I was probably at school at the time, so I was not privy to the full debate.
Mr. Wiggin: Hang on; let me answer the first question. The important point that the hon. Gentleman is trying to make is that the then Government probably acted—I am sure that they did—on the best scientific evidence at the time. One of the biggest criticisms of the Bill is that the York report has requested further research, but the Government have not carried it out. I can see that the hon. Gentleman is highly exercised, so I shall give way.
Andy Burnham: The hon. Gentleman asks me to explain further. The original Conservative legislation said that the health authorities would undertake the consultation, but that the water companies may choose to fluoridate on the back of the health authorities' request. The word, "may" is the loophole in the 1985 Act that people are exploiting to open a debate on the question per se, but the hon. Member responsible for that legislation—the right hon. and learned Member for Rushcliffe (Mr. Clarke)—is wholly in favour of the change that other hon. Members and I are proposing tonight.
Mr. Butterfill: May I just make it clear that the previous legislation left it free to health authorities to recommend fluoridation, but that it was up to the water authorities to decide whether to go ahead and, since most of them were worried about getting sued, they did not do so?
Mr. Wiggin: I shall make some progress not only because it is important that hon. Members have the chance to make their own speeches, but because we have moved on about 20 years, and there seems little advantage in debating what happened 20 years ago.
Mr. Kevin Hughes: Water authorities will not take the decision because they are not convinced that it is safe and they fear they will be sued if they do so. That is what they fail to say.
Mr. Wiggin: I am grateful to hon. Members for all their interventions. One of the Bill's fundamental flaws is that it does not give us the decision on fluoridation, but the rights and wrongs of what has happened in the past are not for us to debate. I would prefer it if they were, but that is not the case, so I must make progress.
I would prefer to see democratic decision making, so it is right that such powers should be in the hands of local authorises, as elected and accountable bodies. Strategic health authorities have an overwhelming bias in favour of fluoridation. Such an issue needs neutrality—the point made by the hon. Member for Stroud (Mr. Drew)—with each local community given an equal amount of information from both sides of the debate, so they can make up their own minds.
The right hon. Member for Manchester, Gorton (Mr. Kaufman) asked in an earlier intervention why local authorities should take that decision. The answer is that it must be in their interests to ask their electorate and, when they get the answer, to act accordingly.
Mr. Kaufman: My question was not why. I find it very attractive that local authorities should take the decision. What I am interested in having elucidated to me is by what process the local authority would make its decision.
Mr. Wiggin: I shall come to my amendments slightly later on, but I would prefer a proper referendum to be conducted—every household should be consulted. We are talking about mass medication, whether we want to call it that or not, so we must have mass consultation to go with it. That is the least that we can do.
Mr. Simon Thomas: The right hon. Member for Manchester, Gorton (Mr. Kaufman) makes an important point, but it is also important to note that the Bill does not specify what the current consultation with the strategic health authorities—or, indeed, in Wales, with the National Assembly—should involve, so that criticism should be channelled at the Bill as well.
Mr. Wiggin: I agree with the hon. Gentleman, and I shall come to that in speaking to my amendments.
Richard Burden: The hon. Gentleman sees this as a health issue. Does he think that any other health issue should be decided by local authorities, rather than by part of the health service?
Mr. Wiggin: The hon. Gentleman puts his finger on the real misunderstanding. He talks about a decision being made by a local authority or by a strategic health authority; I am talking about local people being able to take that decision. That is why I would prefer local authorities to make the decision. They start from an unbiased position, so they can undertake proper consultation without pursuing their own agenda, and they are elected and accountable. None of those things applies to strategic health authorities, so we need to move on from whether they should make the decision or whether local people should make it. That is why the hon. Gentleman and I will not agree, but he can now understand why his comments are not the same as mine and are not relevant. It does not matter what other health decisions are made by local authorities because they are not covered by the Bill.
Mr. Bailey: The hon. Gentleman has not said what would happen if there were different types of local
authority in an area—a county council, a district council or even a district council and a parish council—and they were at odds with each other.
Mr. Wiggin: The hon. Gentleman makes an important point. We have referred to local authorities, but I imagine that the county council would be involved in my area, for example. I have a unitary authority in Herefordshire, but a county council and a district council in Worcestershire, both of which are in my constituency. There are difficulties, but why would strategic health authorities do a better job? They are not accountable and not elected. [Interruption.] I will not ask the hon. Gentleman to respond, but I am sure that he will comment on that in his speech. In answer to his question, my feeling is that, so long as an authority conducts proper consultation, it will be able to make the decision. As the Minister said in Committee, the majority of people must be in favour of fluoridation before it takes place.
Mr. Alan Williams: Will the hon. Gentleman give way?
Mr. Wiggin: I will. I have been very generous; I do not see why I should stop now.
Mr. Williams: I appreciate that fact, and I am grateful to him for giving way. Does he not understand that he is giving the argument away? Either we believe in compulsory medication or we do not. If we do not believe in compulsory medication, it does not matter whether it is done by the Government, by a quango or by a local authority, it is still wrong. I believe that compulsory medication is wrong in all circumstances.
Mr. Wiggin: I am grateful to the right hon. Gentleman for that intervention, but it is wrong to say that I am giving the game away or behaving in any way like that. That is not what I seeking to do with my amendments. I want to ensure that the Bill, which only deals with whether fluoridation may or may not take place, guarantees accountability—that is the bit that is missing.
Mr. Kaufman: Will the hon. Gentleman clarify whether, regardless of the fate of any other amendment, he will nevertheless press amendment No. 6 to a Division, because that amendment refers to consulting all households?
Mr. Wiggin: I would love to press amendment No. 6 to a Division. I cannot confirm whether I will do so because we will be under a lot of time pressure; otherwise, the Bill will not receive a Third Reading. If we are successful with amendment No. 8, however, perhaps it will be possible to press amendment No. 6 to a Division. That is an important point, and I am grateful to the right hon. Gentleman for making it.
Amendments Nos. 34, 35, 36, 37, 38, 39, 40, 42 and 46 all relate to the same purpose: including the water undertaker in the decision-making process. The Bill only takes account of the health authority in such decisions, and those amendments would enable water companies, as well as health authorities, to initiate variations in arrangements to accommodate changes in
circumstances, including operational emergencies. Under the Bill, only health authorities can request changed arrangements, but it is only fair that water undertakers should also apply the same provisions. There should be statutory provision for water undertakers to make arrangements for changes in their obligations to take on operational contingencies. Those amendments would ensure that the water company, as well as the health authority, could request such a provision.Amendment No. 37 would ensure that the decision on the level of fluoridation concentration could be taken by the water company, as well as the health authority. It is only fair that water companies have an input into what concentration of fluoride should be added.
Amendments Nos. 36, 38, 39, 40 and 42 would place the water companies on the same footing as health authorities in a disagreement over a requested variation. Water undertakers should be able to appeal to the Secretary of State and relevant authorities when the terms of a requested variation cannot be agreed. Again, that relates to the point made in amendments Nos. 34, 35 and 37 that express statutory provision should be made whereby water companies can request variation of their obligations to accommodate operational contingencies.
Amendment No. 41 would require that in the references of disputes under section 87B, the Secretary of State or the Welsh Assembly should be empowered to ensure that new or revised fluoridation schemes are operable and efficient. If a scheme failed to be so, entry into the arrangements would be refused.
Amendment No. 46 would add to the circumstances under which suspension of, or variation of, fluoridation takes place, and suggests the addition of necessary changes to source of supply. The boundaries of operational supply zones often have to be varied to accommodate seasonal changes in weather patterns and other operational exigencies.
Amendment No. 6 is very important. It seeks to ensure that every person affected by the proposed fluoridation scheme must be consulted, or at least invited to participate in the consultations. I had to concede that invitation because the Government do not intend to hold the proper referendum that I would have preferred. Consultation literature must be sent to every household in the affected area. In Committee, the Under-Secretary said:
- "That is the sort of thing that we have in mind."
- "we believe that some sort of door-to-door consultation must be part of the overall consultation."—[Official Report, Standing Committee D, 23 October 2003; c. 461.]
On amendment No. 47, Water UK believes that, in relation to fluoridation of water supplies, there should be statutory provision by the Secretary of State for specifying construction and operational standards. This code of practice, prepared by the Secretary of State for water undertakers, is in the interests of safety and of the avoidance of arguments over the standards that have to be met and paid for. The amendment would provide clear assurances in that regard.
Amendment No. 48 is very similar to amendment No. 7, except that it adds a subsection (2) to accommodate licensed water suppliers in indemnity arrangements against all liabilities incurred in fluoridation. Amendment No. 7 would ensure that the Secretary of State grants indemnities to water suppliers that agree to fluoridate a water supply under clause 58; we should surely welcome that. In Committee, the Minister stressed that a water supplier that agrees to fluoridate should not incur any additional liabilities, compared with a water supplier with no fluoridation scheme. She is right, but my amendment seeks to be sure of exactly what liabilities are covered in the indemnity, what is excluded, and the costs. It should be expressly provided that the Secretary of State must indemnify water companies against all liabilities that they may incur as a consequence of fluoridation, other than those arising from their own fault or negligence. We want proper protection for consumers in all areas.
Amendment No. 48 adds to amendment No. 7 by attaching subsection (2) in order to accommodate licensed water suppliers. Of course, the question arises of why indemnities are needed in the first place. Is it because there is a risk associated with mass water fluoridation? And it is because of that risk that water companies must be protected against future action? However, just because we recognise that the Government may know of the dangers of fluoridation—hence the indemnity—does that mean that we can skip over the harmfulness of fluoride? As has been said, fluoride is a class 2 poison. We should not legislate without the necessary high-quality research. The high-quality research that the York review itself requested has not been undertaken; indeed, in Committee the Minister told us that it was marked as "a low priority". We need to assess the proportionality of the risk of tooth decay in children, and the risk posed by fluoride for people of all ages. The scientific research is
contradictory, and the satisfactory evidence is non-existent. The safeguards are clearly not in place. The matter is in no way resolved, so the clause in question should not be included. Giving an indemnity to water companies does not detract from the doubt and uncertainty that surrounds the issue; and it certainly is not a reason why we should accept fluoridation.I want to know how much the proposed indemnities will cost, what legal advice is being taken, and whether the Bill fulfils its human rights obligations.
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