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Mr. Brian H. Donohoe (Cunninghame, South): May I refer my hon. Friend to a letter written by the Secretary of State on 6 November, which states:

Why does she accept that regional health authorities should undertake consultation but not local authorities, given that local authorities are democratically elected, while health authorities are quangos of this Government?

Miss Johnson: Let me point out that my right hon. Friend the Secretary of State also said:

That is the case for just the reason that hon. Members have advanced—strategic health authorities have a strategic role in public health. That is why they are ultimately the right place in that regard. I shall deal with the question in more detail and return to the question of local authorities in a moment.

Several hon. Members rose—

Miss Johnson: I need to make some progress, as I have but 10 minutes. My hon. Friend the Member for Leigh (Andy Burnham) is right about dental health inequalities. I draw hon. Members' attention to a letter in yesterday's edition of The Times that was signed by my right hon. Friends the Members for Darlington (Mr. Milburn) and for Holborn and St. Pancras (Mr. Dobson), the right hon. and learned Member for Rushcliffe (Mr. Clarke) and Lord Fowler, all of whom were Secretaries of State for Health, and all of whom were supporting the fact that people should be able to choose fluoride under the existing clause. I do not need to point out that that is a very unusual collection of individuals who do not always bat together: in this case, it is important that they are doing so.

Mr. Morley: It is a dream ticket.

Miss Johnson: As my hon. Friend says, it is a dream ticket.

On compulsory medication, the hon. Member for Cheadle (Mrs. Calton) is right to say that as fluoride is a naturally occurring substance, fluoridation is no more medication than is exposure to many other trace elements. We need some fluoride in our diet; many vegetables, among other things, contain trace elements of it, just as water contains many trace elements.

We commissioned the University of York to review the evidence and, in response to its criticism of the quality of some of the evidence, we asked the Medical Research Council how it might be strengthened. It came to the conclusion that many of the suggested areas for

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further research were very low priorities, because the existence of many of the harms that hon. Members have mentioned could not be proved.

Mr. Kidney: After the MRC's response, the Government commissioned a study on one recommendation and asked the chief medical officer and the chief dental officer to report on the others. Does my hon. Friend have the results of that research, and can she share them with us before we vote?

Miss Johnson: We have provisional advice on the outcome of the research on bio-absorption of fluoride. The results are very encouraging. As they are still being peer reviewed, it would not be appropriate to discuss them now, but all the evidence will be available to local communities when strategic health authorities discuss the matter under the provisions of the Bill, if it is supported by the House.

On international comparisons, 400 million people in 60 countries benefit from optimally fluoridated drinking water, either naturally occurring or adjusted. That includes 64 per cent. of people in the US, 43 per cent. in Canada, 75 per cent. in Israel and 61 per cent. in New Zealand.

Mr. Butterfill: Can the Minister confirm that in certain parts of the United States and, indeed, Europe, fluoride-treated water has been withdrawn?

Miss Johnson: No, I cannot. Indeed, in Los Angeles, fluoridated water was recently introduced to a large additional population. I am not sure to what the hon. Gentleman refers.

The effectiveness of fluoride in reducing tooth decay is not as the hon. Member for Ceredigion suggests. The York study said that fluoridation would result in 15 per cent. more children having no tooth decay, which is better than the 15 per cent. reduction that he describes. In the end, it comes down to a balance of judgment. Hon. Members mentioned the 1,500 to 2,000 children in the Manchester area who have their teeth extracted under general anaesthetic each year and may thereby be placing their lives at unnecessary risk. That could be avoided by going down the path that the clause advocates in enabling those communities to decide for themselves. Six million people in this country drink fluoridated water. New clause 1 would remove that ability even from those who currently use fluoridated water. I hope that hon. Members of all parties are well aware of that.

There is 40 years' experience of fluoridation.

Mr. Kevin Hughes: If we were to hold a vote on fluoridation in Doncaster in which 40 per cent. voted against it and 60 per cent. in favour of it, what advice would the Minister give to the 40 per cent. who did not want fluoride in their water? What would they do?

Miss Johnson: My hon. Friend knows that we do not propose to hold referendums. However, whenever local opinion is in favour of something, some people will not support it. That is probably true in Birmingham where water is fluoridated.

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The York report suggested that approximately 15 per cent. more people in fluoridated areas had fluorosis, not 48 per cent., the figure that I believe that the hon. Member for Ceredigion cited. From his considerable experience of dentistry, the hon. Member for Mole Valley described the way in which the matter is regarded and how minor it often is.

Amendment No. 8 deals with the involvement of local people. The Secretary of State for Health circulated a letter to all hon. Members that stated that we were in sympathy with the amendment to the extent that we are resolved that local authorities should play a major part in reaching decisions about whether an area should fluoridate. The views of local authorities will need to be taken into account at every step of the consultation. We are convinced that decisions should be owned at strategic health authority level.

Mr. Drew: Will the Minister give way?

Miss Johnson: I shall in a moment. As part of our modernisation programme, borough councils, unitary authorities and all the county councils have established overview and scrutiny committees, which have a remit to consider health services. We accept that local authorities have an important role in those matters.

Mr. Colin Challen (Morley and Rothwell): Will my hon. Friend clarify whether the results of any public consultation would be binding on health authorities under the Bill?

Miss Johnson: We are clear that health authorities should accede to the proposal to ask for fluoridation in their area if consultations ascertain that the local population is in favour of it. I was a local authority member for 16 years and I do not believe that local authorities are the right vehicle for the decision. In many cases, local authorities do not cover large areas. There is already an issue about the coterminosity of water companies with strategic health authority areas. The logistics, the size difference, the potential bureaucracy of bringing authorities together and the problems that some hon. Friends have outlined of local authorities running the process rather than being key components, as we envisage them, mean that the proposal is wrong.

Strategic health authorities are responsible for health decisions and it is therefore right that they are able to pursue the matter as the overall ring holder.

Norman Baker: Does the Minister envisage a one-size-fits-all solution in a strategic health authority or can local communities express their views such as the possibility of different solutions in the same health authority area?

Miss Johnson: That is an interesting point. We believe that the solution should apply to a strategic health authority area, but there will be issues with the water companies about boundaries and the relationships with them.

Mr. Donohoe: Will the Minister give way?

Miss Johnson: I want to move on to make one or two additional points. I have had little time to contribute to the debate.

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In Bolton, 70 per cent. of five-year-olds have experienced tooth decay. On average, each child has more than three decayed teeth. There is no fluoridation in the north-west. In the west midlands and Crewe, only 23 per cent. of five-year-olds have experienced tooth decay. I believe that the case has clearly been made for allowing local communities to decide, and we are enabling them to do so.

I would like to draw Members' attention to the comments of the hon. Member for Salisbury (Mr. Key), who said in Committee that he had decided that he was not prepared to pass by on the other side, and that this was a question of balance and judgment. He said:

I urge other hon. Members to do likewise.

It being Nine o'clock, Mr. Deputy Speaker put the Question already proposed from the Chair.

The House divided: Ayes 181, Noes 284.

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