Water Bill [Lords]

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Richard Burden (Birmingham, Northfield): Birmingham has been referred to so many times that it would be remiss of me if I did not rise to say something. In doing so, I am conscious of how the hon. Member for South Cambridgeshire (Mr. Lansley) referred a couple of sittings ago to putting on his anorak to deal with some amendments. Moreover a commentator who was talking about politics in general and politicians in particular said that one should always be rather suspicious about people who get over-excited about fluoridation. Having received some of the letters and representations that my hon. Friend the Member for Bolton, South-East mentioned, I know what that commentator means.

We are not immune as politicians. The same commentator said that people should be really worried about politicians who think that the two crucial things to debate are fluoridation and proportional voting systems. I wish to talk about fluoridation, and I chair the all-party group on electoral reform, so I have to take a deep breath in case I get too excited about this. It is important to be clear what the issues are, both in relation to the amendments and the general question. Other Members have said this, but it bears repetition. This is not a discussion about whether fluoride should be added to water supplies. My hon. Friend the Member for Broxtowe (Dr. Palmer) hit the nail on the head when he said that it is a discussion about who decides whether fluoride should be added.

If the situation stays the same—and if clause 61 is not passed, it will stay the same—a private water company, and not a health body, will make the decision. The issue is not theoretical, because the Water (Fluoridation) Act 1985 has been on the statute book for a long time and it is not true that local and district health authorities have never made any representations or requests to fluoridate water supplies when it was important for public health. About 50 health authorities submitted such requests, but not one fluoridation scheme has been put into effect. We cannot run away from that fact.

The discussion appears to be about who decides and democracy, and I am aware that the people who have campaigned vigorously against fluoridation have taken on board the issue of democracy. However, I did not hear them complaining when the health authorities, which represented local people, sometimes with help from local councillors, were trying to get a debate going and had their efforts thwarted by water companies' decisions.

I do not blame the water companies for that. All sorts of pressures pushed them into those decisions, but it is interesting that the campaign for ''democracy'' grows when a decision could be made that leads to the fluoridation of the water supply. We should not ignore the fact that the objective of the people who have been most vociferous is not to secure democracy or freedom of choice but to stop fluoridation schemes. If we lose sight of that, we will miss something important.

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The question is about who should decide, and in the next group of amendments, we will talk about local authorities. At this stage, I want to say only that although no Member who has spoken has said that it is anything other than a health issue, some people are saying that fluoridation—and fluoridation only—should not be decided through the channels appropriate for all other health issues. Are we saying that because fluoridation is controversial? If so, what do we do about other controversial issues? Public health campaigns about HIV and AIDS are sometimes controversial. Minority campaign groups sometimes do not want primary care trusts or other parts of the health service to take action on such issues, because they are controversial. Should they come out of the health sphere? I do not think so.

The accountability of strategic health authorities should be considered. As was mentioned earlier, it would be good if PCTs were fully involved in the consultation undertaken by strategic health authorities. There may also be a case for working out whether the current model of strategic health authority is right. However, that is not an argument for today. The argument for today is whether fluoridation should be tackled as a health issue. If so, the national health service mechanisms should be adopted.

Mr. Osborne: With the greatest respect to the hon. Gentleman, who makes the decision is the issue. We are trying to work out the best vehicle for determining local opinion, and strategic health authorities as presently constituted are not the best vehicle. It may be a health decision, but it could be determined nationally by the Department of Health and Parliament and then implemented through organisations and devices that are better able to gauge local opinion.

Richard Burden: I do not agree. As far as I know, we all agree that circumstances vary from area to area, according to issues such as standards of dental health and the incidence of naturally occurring fluoride. As such, there cannot be a national approach other than an enabling national approach, and this clause is the right kind of enabling clause. If we are to enable anyone on a health issue, we should enable the national health service mechanism. It should be required to consult, involve people, and generate a debate locally, which is why involving the primary care trusts is a sensible idea. However, in terms of the framework, strategic health authorities are the right vehicle.

Mr. Ian Liddell-Grainger (Bridgwater): I come from Devon—I mean Somerset. I see the hon. Member for South Dorset (Jim Knight) over there, and, although the strategic health authority for Somerset and Dorset is small, it covers a massive area. That is not the right body to do the work. I mentioned Devon because I am from West Somerset, which extends into Devon. The strategic health authority and issues including cross-border piping were brought up earlier, but I do not think that the proposed system would work. It is a

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health matter, but strategic health authorities are too big and unwieldy to deal with it.

Richard Burden: We are being pushed in two directions. We all agree that we must ensure that local people can give their views and be consulted properly. That is important, and it is right to try to achieve that at the level closest to those people. That is why I argue that primary care trusts should be involved. Whether it follows that consultation should be organised at that level is a different question.

The fact that the supply of water does not necessarily follow administrative boundaries, whether they are local authority or health authority boundaries, might cause us more problems. If we have more local consultations, which are disconnected from each other, there will be greater complexity in the cross-boundary issue.

I will wait with interest to see the regulations that will come out, but I believe that we must empower bodies in the national health service, and give them the responsibility for organising consultation at the most appropriate level to reach a decision on fluoridation. We must ensure that, in the context of those responsibilities, the mechanisms for consultation and involvement are as local as possible. There is no contradiction between those two ideas.

Mr. David Drew (Stroud): I am listening carefully to my hon. Friend, and we agree on many things, including electoral reform. However, we do not agree on this. We would all like the NHS to be better at consulting and making decisions after consultation. Can the Minister give me an example of when the NHS has achieved that degree of consultation on such an issue? I do not know of one.

Richard Burden: My hon. Friend is right to be sceptical about the ability of institutions in the national health service to consult properly, and the regulations that emerge will be important to ensure that they do. The requirements to have discussions and involvement on fluoridation may provide a model for greater consultation in the future. If they are going to continue, strategic health authorities will have to tackle that. In the structure of the NHS, primary care trusts at local level may be improving their skills at local consultation and planning of health services—something I want to see. Bringing that together at the strategic, sub-regional level is important whether or not there is fluoridation of water, and whatever happens to the Bill. If the Bill can be used to further that process, I welcome it.

Mr. Osborne: We are not, as the hon. Gentleman is suggesting, debating a method for improving strategic health authorities. I would guess that less than one in a thousand of my constituents knows that they fall under the responsibility of the Cheshire and Merseyside strategic health authority. SHAs are not well known organisations. We have all, as Members of Parliament, seen their efforts at consultation, which seem to involve writing to MPs, primary care trusts and other bodies. They have no experience of carrying out a genuine consultation with members of the public.

Richard Burden: Again, I give the same answer: that is why the regulations are important. In consultation

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with local people, the important factors will be whether they are aware that they are being consulted, the level of information that they have, and the debate that is generated. People will not be bothered about whether the local authority or the strategic health authority conducts the consultation. That is important for us, because we need to work out the mechanisms through which it is done, but the important thing at local level is that the debate takes place.

3.15 pm

Mr. Wiggin: If I can bring the hon. Gentleman back to the amendment, may I ask him how he envisages that the consultation will be carried out? Will it be a referendum, or will it just be a process of seeking opinion? Will every household be consulted? How does he think that it would take place? It would be interesting to hear his point of view, with his electoral reform hat on.

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