Water Bill [Lords]

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Mr. Wiggin: The strategic health authorities are fairly new. Who does the hon. Gentleman think is more accountable to the public, the current board of the water companies, which have a wide shareholder ownership and customer base, or strategic health authorities? The latter are neither elected nor even nameable in most cases.

Dr. Palmer: If I wanted a body to decide how to maximise the profit from the water supply, I think Severn Trent would be in a much better position to do so than the East Midlands strategic health authority.

Richard Burden: It should be on the record that the Opposition spokesman stated that a private company is more accountable than the national health service. It

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ends the debate about whether they want to privatise it.

Dr. Palmer: The logical conclusion of the view expressed by the hon. Member for Leominster is that responsibility for the local health service should be transferred to the management of the water supply company.

Mr. Siôn Simon (Birmingham, Erdington): Does my hon. Friend believe that the first and only single piece of shareholder power in the history of capitalism has gone to the hon. Member for Leominster's head?

Dr. Palmer: I will not speculate about the hon. Gentleman's thought processes, which have a logic that is not always perceived from the outside.

Mr. Wiggin: I am glad that I have caused the Committee so much amusement. We are talking about the power going the other way, from the shareholder board to the strategic health authorities. I am grateful for the interventions, as it shows that hon. Members are listening. I am keen to ensure that there is more accountability, not less. That is what I sought to tease out from the hon. Gentleman, despite the jibes from Labour Members.

Dr. Palmer: The hon. Gentleman is making serious points. Most people, when asked about fluoridation, say, ''Well, it's probably a good thing, although I don't understand all the details.'' Some, however, say, ''I'm a bit worried about it. It seems a bit spooky.'' Only a limited number of people, who are in a position to decide, having fully examined the arguments on both sides, feel totally confident about the issue. The call for a national referendum would not be as widely supported as the hon. Gentleman thinks. Most people would want a substantive consultation in which the health authority, working with local government, tried to ensure that the arguments were well understood, and that people had the chance to respond fully to the process.

I am not sure that asking people to vote is the best way to solve the matter. I do not feel able to assess every argument that has been advanced, and I have spent a lot of time reading up on the issue. What is needed is the best possible advice from health experts on both sides of the argument, and a health authority is probably the best place for it. If the hon. Gentleman is arguing for more democratisation of the health authorities, that is a separate issue, and we should discuss it.

Mr. Thomas: The logic of the hon. Gentleman's argument is that we would not vote on the issue in Committee. He said that he does not feel totally confident about the arguments. There must be a clear, accountable process by which to decide these matters, whether it is at local level in England, or Waleswide.

The real question is how the public are to be properly informed about the subject. What sort of choices will they be given? For example, will they be given a choice between fluoridation and a community dental service, with the reintroduction of the school dentist going to every school and ensuring that children brush their teeth properly? One is just as effective as the other.

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We are not arguing against the use of fluoride in the prevention of dental caries, but against the means of delivering it. We are arguing for the power of the individual to decide which means to use. The hon. Gentleman is on dangerous ground in suggesting that these things should be consulted on, when it should be a matter of individual choice. People should have that option.

Dr. Palmer: The hon. Gentleman is being uncharacteristically frivolous to suggest that the Committee would not be entitled to vote today as a consequence of my argument. I am not saying that we should decide yes or no to fluoridation. What we are deciding today, and what will be decided on the Floor of the House, is who should decide, which seems an entirely appropriate thing for the Committee and the House of Commons to decide. In fact, I cannot see who else would do that, except perhaps the Welsh Assembly. Who decides is a political decision, but thereafter it should be primarily a health decision, and a health decision should properly be taken by a health authority, not a privatised water board.

10.45 am

Mr. Swire: The problem is that the health authorities will have to rely on the contrary medical evidence on which the Committee has relied. They will have views, of course, but they may not coincide with the views of the local electorate, who might be more convinced, for instance, by the fact that 98 per cent. of western Europe has rejected water fluoridation. The evidence of the York review was mentioned, but how independent was that? It was funded by the Department of Health to the tune of £80,000 a year. You have to think carefully before you say that a health authority will have a better insight than anyone else in the argument.

Dr. Palmer: I note the hon. Gentleman's view that the Chairman needs to think carefully about that. I am sure that he will keep it in mind.

The difference between a health authority and us is that it is a health authority's job to assess health issues. With all due respect, very few of us have enormous medical expertise. I am not an expert on dentistry or the effect of different chemicals in the bloodstream. I can take a serious amateur interest in that, as can the hon. Gentleman, but I do not believe, although I may be underestimating him, that there are many research chemists and doctors on the Committee—I know there is one.

Several hon. Members rose—

Dr. Palmer: I am anxious not to monopolise the discussion; I see that my hon. Friends are looking a little nervous. I have had three requests for interventions and I give way to the hon. Member for Leominster.

Mr. Wiggin: I shall not delay the hon. Gentleman long. He is making the point that strategic health authorities know best, and although he may or may not be right, the real weakness in the argument is that they should not conduct the consultation process, because they come with an agenda. That is the real fear, but we shall deal with it later.

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Dr. Palmer: Yes. I have said that the serious point is how the consultation should be conducted and to what extent one should simply weigh and count the responses or consider the arguments. I agree that those are all serious issues, but we shall vote today on whether the decision should be taken by the strategic health authority or by the privatised water companies, and I just do not see the case for the latter.

Andy King: It is important to recognise that we are not considering this legislation such that the moment that it is passed every health authority will be expected to rush out and have referendums on the basis of where we are today. If the legislation is sound, it will be around for a long time, and I would expect and trust strategic health authorities to undertake the fullest possible consultation and to give a balanced view of the research available at the time. I certainly hope that more and better information will be available to health authorities when they consult communities.

Dr. Palmer: I entirely accept my hon. Friend's point and I share his trust, but let me reflect on the points made by a number of Opposition Members. If there were an amendment to spell out in greater detail what steps needed to be taken for the consultation, I for one would feel that that would be quite helpful on Report. However, the principle is who should decide, and the principle of the Bill seems entirely right.

Fluoridation is, by common consent, helpful to teeth. It does not appear that there is a danger from it. There is a reasonable case for asking people to accept health measures, if they do not impose a danger, in the national interest, or for placing a modest additional cost if they insist on evading such measures. The decision should be made by the strategic health authority.

Norman Baker: Let me come back to the question of who should decide. It is an important question. There is an argument that the individual should decide, not a Government body, health authority, water company or anybody else. It is a standard accepted philosophy that people have the right to decline medical treatment. The Minister will know that well from her portfolio.

We are getting into some sophistry as to whether fluoride is a medicine. I am happy to accept that it is not defined as a medicine under the Medicines Act 1968, but that is not terribly relevant in a sense. What is relevant is that the argument for the addition of fluoride to water is that a health benefit will be derived, and that that benefit will be the improved condition of teeth, and so on. Government Members have referred to that. The driving force here is one of health, and that constitutes a medical benefit. The hon. Member for Broxtowe, who I assume will vote in favour of fluoride on Report, identified it as a medical benefit although not necessarily a medicine. That is sophistry; the issue is whether people should have forced on them a health benefit that they do not want. I do not think that they should, even for their own good.

As to who decides, the individual should decide. That choice is not in the Bill.

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Mr. Simon: Just to explain that concept of ''force'', a tiny number of people have objections, apparently entirely unfounded, to the substance in question being in the water. If that tiny number of people choose to opt out of the water from their taps, how are they forced to drink it? We should let them get some other kind of water—for instance, bottled Hampshire water such as we have here.

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