Water Bill [Lords]

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Richard Burden: I am certainly not suggesting something that is done by single transferable vote. Various mechanisms can be used. In this case, the extent to which we can generate discussion and debate will be as important as the final decision. We could use newspapers and the media, or citizens' juries, which have been pioneered in a range of areas. We need to think imaginatively about how the consultation is carried out, which is why it is best to examine the issue by means of the regulations that will be introduced, rather than trying to determine everything now. If the consultation was reduced to a local referendum, I suspect that that would generate a lot of heat, but not necessarily the discussion that people would like to see.

Mr. Swire: There are all sorts of pitfalls in holding a local referendum and consultation; no doubt some of them will be pointed out later. There are areas such as the constituency of my hon. Friend the Member for Tatton which are largely residential and full of prosperous people who go to another area to work. Would those people be consulted in the area in which they work, because they use the water there during the working day? The area in which they live may not have fluoridated water, because it falls under another strategic health authority. Those aspects must be taken into account.

Richard Burden: The hon. Gentleman is right. That is why it is complicated to work out how the consultation should be done, who should carry it out, and how people can be involved. However, we can all agree that the consultation must happen, and in a way that involves as many people as possible and generates as much knowledge as possible.

In conclusion, I return to where I started—to Birmingham, which has been the subject of a great deal of discussion in the Committee. My approach to the debate has been determined partly by the experience of Birmingham. The area has been fluoridated since 1964, so I was disconcerted when the hon. Member for Lewes said earlier that the jury was out on that. If that is the case, it is a hell of a long trial—the jury has been out for nearly 40 years.

Birmingham still has inequalities in dental health. On average, the dental health of children in lower

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income groups is worse than that of children in higher income groups. Fluoridation does not get rid of inequalities in dental health; I wish that it did, but it does not. Nevertheless, if one examines the statistics across social groups, one finds that 31 per cent. of children in Birmingham have had tooth decay up to the age of five, whereas in non-fluoridated Manchester, the figure is 62 per cent. Some 13 per cent. of five-year-olds in Manchester have had teeth extracted as opposed to 4 per cent. in Birmingham. When we consider extractions, we should remember the concerns expressed by hon. Members about the impact of general anaesthetics. Those things matter to me, and they cannot be ignored.

Perhaps I should take a deep breath before saying what I am about to say, because it may generate more correspondence, but neither the amount of correspondence that I have received from Birmingham people during my time as a Member of Parliament in the city, nor my experience of living there before I became an MP, has led me to believe that there is a huge desire among Birmingham people to get rid of the fluoride in their water supply.

I certainly have not detected any of the evidence apparently produced by groups opposed to fluoridation saying that fluoride has been proved to be dangerous to health. It is true that dental fluorosis is at a higher level in fluoridated areas than elsewhere, but evidence for the other things that we have heard about, whether in relation to bones, Down's syndrome or whatever, is simply not there in the Birmingham experience. It is right that those issues are researched, and that the York study drew our attention to the fact that the research so far is not as conclusive or detailed as it should be, but the idea that the report is somehow an argument against fluoridation of the water supply in areas where naturally occurring fluoride is insufficient simply does not stand up to close examination.

Talking about the extent to which fluoridation of drinking water supplies reduces dental caries, the executive summary states:

    ''The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score.''

The summary goes on to say that the extent of that is subject to debate, but there is no doubt that it says that the best evidence suggests that there is an impact. It also states:

    ''The best available evidence from studies following withdrawal of water fluoridation indicates that caries prevalence increases''.

Again, the document asks for more research, but it does say that the best evidence indicates that there is a link between fluoridation of water supplies and a reduction in tooth decay.

However, talking about allegations that somehow fluoridation causes extra bone fractures and bone development problems, and about cancer studies, the summary states that

    ''there is no clear association of hip fracture with water fluoridation.''

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It states that

    ''no clear association between water fluoridation and incidence or mortality of bone cancers, thyroid cancer or all cancers was found.''

The summary is not neutral on those issues.

The authors of the York report were right to complain about their findings being over-hyped by those campaigning for fluoridation, but we should not conclude from that that it found no evidence of a link between fluoridation and improved dental health, or that it in any way gave, or said that there was, evidence to suggest that some of the horror stories about the effects of fluoridation were founded on substantial evidence.

Yes, this is a controversial issue—it generates heat. Perhaps it is one of those anorak issues, but as lawmakers we need to consider the evidence and make a judgment about what is right in public policy terms. The evidence that I have read, and my experience in Birmingham indicates, that the amendment is wrong and the clause is right.

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): It is a pleasure to respond to a debate of the quality that we have heard this afternoon and, indeed, this morning. So often we do not do justice to these topics, but on this occasion all members of the Committee, on all sides of the argument, did considerable justice to the issues and spoke with considerable passion. They aired most impressively many of the arguments that needed to be aired on all sides. I shall endeavour to rise to the challenge of responding to the debate in like terms, and to talk about the main issues raised. I shall go through one or two of the amendments, but not in too much detail, because I am conscious that there are other issues still to be discussed in detail.

I believe that our reason for moving away from the water companies to the strategic health authorities as the vehicle for making decisions about this matter is right. Hon. Members have sketched out the issues involving the difficulties that the water companies had with existing arrangements. That did not result in what many of them had requested concerning the local authority interest in having water companies do things and concerning accountability.

We have already teased the hon. Member for Leominster (Mr. Wiggin) about his views on accountability in the private water companies, and I shall tease him no more. It is clear, however, that the strategic health authorities are the right bodies at the right level to make these decision. I shall explain why in more detail. They have a broader oversight of the health and health provision of their area than do the primary care trusts. People have argued that these decisions should be made at PCT level. The PCTs vary in size, and the mechanics of the engagement with water companies—which I shall come on to shortly—indicates that if things were done at PCT level, issues would be magnified many times. The strategic health authorities can, in my experience, rise to the challenge.

I shall give an example that has nothing to do with fluoridation—I must be careful what I say, because no

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decisions have been made and I am a Health Minister. In my constituency area, the strategic health authority has considered, through the PCTs, the future of hospital provision across Bedfordshire, Hertfordshire and north London. That is a big swathe of the area—as big as Somerset and Dorset together, or a number of the other conjunctions that hon. Members have cited as being covered by their strategic health authorities.

With the engagement of the PCTs and other councils at a local level, the strategic health authority has communicated with local people in all manner of ways about those proposals. Many views have been received through every avenue that one could hope to have used, including discussion and debate, meetings, the media, questionnaires, petitions, MPs and local authorities. I am not diminishing the importance of this debate by saying that the debate about the future of local hospital provision is probably an even more important question for people than that of whether the water is fluoridated. I am confident that strategic health authorities can rise to the challenge. That, together with the difficulties of the existing arrangements, is why we settled on them as the right vehicle for taking forward the measure.

My hon. Friend the Member for Stroud (Mr. Drew) asked about the Government's position on fluoridation. Our position is very clear: we think that there are strong oral health arguments for fluoride which make it a useful answer, if local communities want it. That is why we have taken this route.

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