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Water Bill [Lords]

Water Bill [Lords]

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Standing Committee D

Thursday 23 October 2003

(Afternoon)

[Mr. Bill O'Brien in the Chair]

Water Bill [Lords]

Amendment proposed [this day]: No. 213, in

    clause 61, page 76, line 30, at end insert—

    '(2A) Neither shall a water undertaker be required by subsection (1) above to enter into any such arrangements unless and until it has been ascertained (pursuant to the provisions of section 89 below) that at least 90 per cent. of the population residing within the area proposed to be fluoridated are in favour of the fluoridation of their water supply.'.—[Mr. Wiggin.]

2.30 pm

Question again proposed, That the amendment be made.

The Chairman: I remind the Committee that with this we are discussing the following:

Amendment No. 351, in

    clause 61, page 76, line 30, at end insert—

    '(2) With regards to Wales, neither shall a water undertaker be authorised by subsection (1) above to enter into any such arrangements unless and until a referendum on increasing levels of fluoridation has been held in accordance with the Political Parties Elections and Referendums Act 2000 seeking approval of the arrangements from the population residing in the area proposed to be affected.'.

Amendment No. 156, in

    clause 61, page 79, line 19, after 'below', insert

    'the Secretary of State must ensure funding is available for the consultation to take place as set out below, and'.

Amendment No. 110, in

    clause 61, page 79, line 21, after 'consult', insert 'all households'.

Government amendment No. 338.

Amendment No. 158, in

    clause 61, page 79, line 22, at end insert

    'then if public opinion is clearly in favour of such an addition'.

Government amendments Nos. 339 to 342.

Mr. Robert Key (Salisbury): I was describing how my constituency had been involved in this issue and how both general practitioners and consultants regarded it. As it happens, no fluoride is naturally found in or added to the water. The only place in the Wessex Water area where natural fluoride is found is in the vicinity of Laycock, where the borehole provides naturally fluoridated water to about 14,000 people.

I want to turn to the national position. We are talking as if we are about to launch a campaign to put fluoride in everyone's water. That would never happen. The British Dental Association points out that of the 659 parliamentary constituencies, only 64 have above-average rates of tooth decay in children up to five years old. We are talking about just under 10 per cent. of constituencies in this country, which means that 90 per cent. of constituencies would probably not see any reason even to hold a ballot, let alone have a local health authority propose that fluoride should be added.

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An NOP survey found that 67 per cent. of people in Britain think that fluoride should be added to water if it can reduce tooth decay, with 22 per cent. saying no. The same survey found that 42 per cent. of people think that fluoride is added to their drinking water already, when the real figure is that about 10 per cent. have fluoridated water. Most people also do not know that fluoride is present naturally in some water—only 28 per cent. of the population think that it is. The national situation gives us a picture that is less certain than some people would allege.

We have debated whether fluoride is a medicine. It has always been my understanding that, as with chlorine or calcium, it is a trace element that is important for human well-being. The process of natural fluoridation or the addition of fluoride could be seen as nanotechnology, and the question is how we get the fluoride to the teeth. That is where the scientific arguments, many of which have been deployed today, can be cited on both sides of the discussion. As the Medical Research Council study reports, it is true that some of the science has not been good or conclusive and that lots more should be done. However, that does not mean that we should stop people from having fluoride in or added to their water. We are in one of those endless scientific debates.

My other problem is that, although it would be better in theory if we could leave the issue to the private choice of parents and other adults, preventive medicine has not worked. The evidence for that is in the parliamentary answer from the Minister that I quoted earlier. My constituency has average rates of tooth decay in children, and no fluoride naturally occurs or is added to the water. If I were an MP for an area in which children suffered from poor dental health, if public education had failed for many years, and if fluoride were not already added to public water supplies, I would vote for fluoridation.

Some people would say that therefore, by implication, I would be opposed to fluoridation, but that is not the case. There is a compelling argument for walking by on the other side, saying, ''I'm all right, Jack,'' in Salisbury, and ignoring those in areas where there is no naturally occurring fluoride, or where there is particularly bad child dental health. However, I have decided that I am not prepared to pass by on the other side. It is a question of balance and judgment. I have decided that, in this instance, child health must take precedence over my scruples, prejudices and personal views on individual liberty and freedom.

The York report concluded that there is no reason to believe that fluoride is harmful to health. I believe that strategic health authorities are better bodies to take decisions than water companies or local authorities. If water is to be fluoridated, water companies must be indemnified. For many years, water companies have been unwilling to move on this issue, for very good reason, and I therefore welcome the indemnity clause that the Government have included.

Even if the Government receive sufficient support for clause 61, however, the whole scheme may founder on practical grounds. First, it is unlikely that many health authorities will want to ask for fluoridation

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and, if they were to do so, the water companies would face practical problems. I have discussed that matter with Wessex Water, the major water company in my constituency. It was pointed out to me that its network of mains distribution crosses strategic health authority boundaries. What would the company do if it found that one health authority said, ''Please fluoridate'' and the other ones said, ''Don't.''? That is one practical reason why the scheme may founder—inside or outside the law courts.

I listened carefully to the debate, and I have come to the conclusion that, whatever my reservations and the sincerely held reservations of some of my constituents, the clause to permit fluoridation of the water supplies should be added to the Bill. However, if that happens, there must be the widest possible local consultation. That is what the amendment is about. I suspect that it is a probing amendment—90 per cent. is a jolly good figure to ask for because it sets you thinking. However, I also think that the attempt to improve the health of children's teeth should not be scuppered by a minority of adults who feel passionately that their preference for libertarianism must prevail.

I am surprised that the Government have not been able to tell us what arrangements they propose for consultation, and they have simply said that those will follow in regulations. It is a common problem faced in both Houses—part of the parliamentary process—that Governments tend to leave things to statutory instruments that will follow later. No doubt some of the relevant statutory instruments have not even been drafted yet. I scrutinised the Export Control Bill last year, and there were more than 40 regulations that were to follow it, but at least those were available to us in draft form for the debates in Standing Committee. The Government have a duty to prepare those draft regulations as quickly as possible, so that we can see what is proposed for consultation. In my opinion, they should have done so already.

Mr. Hugo Swire (East Devon): I am most grateful to my hon. Friend for giving way and appreciate his concern for children. Is he aware of the report by Mr. Ortiz-Peres and colleagues, which concluded that very low doses of fluoride inhibit the response of follicle-stimulating hormone to inhibin B, and linked that to reduced sperm production? If we were to follow his line of argument, there might be no children in future who need their teeth fixing.

Mr. Key: I saw that article, but that argument would not apply to me, since I had a vasectomy many years ago—[Interruption.] Hon. Members may not have wished to know that, but now they do. My hon. Friend's remark illustrates the point that the science is open to discussion. There is no certainty in the science, but the balance is strongly in favour of the fluoridation of water having no general adverse effects. Most of life is about taking a judgment on things, and on balance, in my judgment, the clause should be added to the Bill.

Dr. Brian Iddon (Bolton, South-East): I represent a constituency where the dental decay in children is probably some of the worst in the country. The hon.

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Member for Tatton (Mr. Osborne) has already referred to Bolton. I, too, have the table that was circulated to hon. Members showing the number of decayed, missing or filled teeth per five-year-old child. Bury, the neighbouring town to mine, is top of the table. Several of the Manchester constituencies are at the top of the table. The three Bolton constituencies are at Nos. 57, 58 and 59; mine is No. 57. I am ashamed of that, frankly. It is terrible that 70 per cent. of the children in my constituency have serious dental decay at the age of five.

I must admit that, as the hon. Gentleman said earlier, Bolton has taken a decision about fluoridation, but it did so in 1968, and that was the old Bolton borough, not the present Bolton metropolitan borough council, which is much larger. There was not a referendum such as we have been discussing. Bolton seems to be out of step with Greater Manchester. There are 10 towns or cities in Greater Manchester, and at that time Bolton was the only one that decided against. Seven decided in favour and two, Wigan and Bury councils—we should bear it in mind that Bury is right at the top of the table—had not taken a decision at that stage.

In the late 1960s and early 1970s, most of the people in Greater Manchester who had been consulted voted for fluoridation, but that has not happened and children still suffer. By the age of five, the average Bolton child will have experienced quite a lot more than 2.5 decayed teeth, which is much greater than the national average. The situation is far worse in my constituency, which has some of the highest levels of deprivation in the three Bolton constituencies. Some of the wards in my constituency are some of the most deprived in the country.

I listened carefully to the hon. Member for Salisbury (Mr. Key). He said that he could take an attitude of ''We're all right, Jack'' in his constituency, but he does not and I am pleased that he considers the people of my constituency and many others where dental decay is at such a high level that all hon. Members should be ashamed. Parliament must try to do something about that.

It is all very well people saying, ''Well, you can go out and buy a toothbrush and fluoridated toothpaste.'' The reality is that these parents do not, for whatever reason. Perhaps they are poorly educated. They probably ain't got the brass, and putting food on the table is more important than going out and getting a toothbrush and fluoridated toothpaste. The fact is that many parents do not educate their children about correct dental health procedures, and I do not see why those children in my constituency should suffer because of the neglect—that is what it is, I suppose—of the parents who are meant to be looking after them.

In total, 70 per cent. of Bolton's children suffer dental decay at a very early age. I was sitting next to a dentist the other evening, when I addressed the Royal Pharmaceutical Society's annual dinner in Bolton. He was very pro-fluoridation. At his practice in Manchester—I did not ask him which part of Manchester—he sees children with teeth in terrible condition. Two years ago, he could have done

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something about that—he could have extracted them—but he can no longer do so. Children come into his surgery in intense pain, but there is little that he can do. He certainly cannot extract the teeth, because we have banned general anaesthetic in general practice, and dentists now have to refer people to a clinic.

I am told that a few extractions are done at Bolton Royal hospital, but most such children in Bolton go to the Manchester university dental school. Last year, it gave general anaesthetics 1,500 times to extremely young children—I stress the extremely young bit—and on top of that there was a waiting list of 500. Hon. Members who are anti-fluoridation should consider the suffering of those children who cannot have their teeth out immediately in general practice. I accept that they can be given antibiotics or other palliative care, but for curative care they have to wait to be seen at a centre such as the Manchester dental school where the teeth can be extracted. It is shameful that there are so many children in Britain with such poor dental health that some as young as two or three have to have teeth out.

I take the point made earlier that things might be better if the dental system was improved. But even if it were, and there were more NHS dentists and people did not have to queue for appointments, it would not be much better than it is at present in the deprived parts of my constituency.

2.45 pm

I have considered all the arguments, for and against. I appear almost as an Aunt Sally on the National Pure Water Association's website, as people are invited to write to me, which they do. Some of the letters I receive can only be described as fanatical. For example, hexafluorosilicic acid, the main chemical used to fluoridate water, is described as a waste, poisonous product from the phosphate fertiliser industry. One would believe that we were putting children up chimneys to scrape the stuff out. The letters are almost out of this world, and certainly fanatical. I do not say that all members of the NPWA are fanatics, but a minority of people write the most absurd things. If they want to persuade me to their point of view they should not write such letters, but I respond to them all.

I make my point to the British Fluoridation Society, too, because those on both sides of the argument have circulated pictures and so on. Both organisations are a bit over the top, but especially the NPWA.

Why are hexafluorosilicic acid and its disodium salt being used to fluoridate water? As a chemist, I have given that question careful consideration. The NPWA would say, ''If fluoride is already in water, that is okay; it is natural.'' Belladonna is natural, but I would not dream of taking it. Calcium fluoride comes out of the rocks in the earth but it is insoluble in water. There could not be more than about three, four or five parts per million calcium fluoride in water because of its lack of solubility, so it would be impossible to use calcium fluoride to fluoridate water in a rapidly flowing stream going through the treatment works.

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The fluoride used in toothpaste is called sodium fluoride. All fluorides when they enter water are ionisable and they end up as fluoride ions; when we talk about, fluoride, that is what we mean. We use hexafluorosilicic acid and its disodium salt because the former is a liquid; it is soluble in water and easy to titrate to one part per million or whatever concentration Parliament decides. It is easy to add to water in that concentration. Of course, I would prefer to use the natural stuff, but it could not be put accurately into the water while it is flowing through a treatment works, and the same applies to sodium fluoride. It is okay in toothpaste, but it could not be added to water.

I am concerned about hexafluorosilicic acid, but only a trace—one part per million—is being added. At that level in many areas there are already a fair number of chemicals in water, including fluoride, although I do not want to name them all. In some areas, fluoride occurs at such a high level that the water has to be diluted with unfluoridated water in order to get it down to one part per million.

On behalf of my constituents, especially the children, I ask hon. Members to look at the figures and think about the suffering of children, which we can easily prevent. I ask members of the Committee to support fluoridation and not the wrecking amendment.

 
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Prepared 23 October 2003