Water Bill [Lords]

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The Chairman: Order. I draw hon. Members' attention to the fact that this is a narrow amendment. I appeal for co-operation in keeping to it.

Norman Baker: You will certainly have that from me, Mr. O'Brien. This is exactly the issue that I want to address. A strategic health authority is not the appropriate body to be solely involved in this. First, it is unelected. Secondly, it is unaccountable to the local community. It is accountable only through the Secretary of State, which is not a direct mechanism for the local community. The word ''local'' has been emphasised by all sides.

Thirdly, fairly or otherwise, a strategic health authority will be perceived to be biased. Health bodies have largely made up their minds that fluoridation of water is a good thing. When they are responsible for the consultation and perhaps for co-ordinating the material that is sent out, they will be open to accusations that the material is loaded because it quotes this but does not quote that. The material may be entirely balanced but those accusations will still be made against them. That is why it is important, if we are not to be derailed on this, that the body that carries out the consultation is seen to be neutral. That is why many of us prefer local authorities here. Amendment No. 157 differs slightly from the Conservative amendment. The Conservatives want to

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use local authorities throughout. We suggest that the health authority should

    ''request the local authorities within its area''.

That is a subtle difference. We recognise that there is a strategic view—and we are trying to go along as far as we can with the Government on that—to find some common ground. However, we are saying that the process itself should be carried out by local authorities, even if a health authority initiated it, so that the accusations—which will be made—of bias and distance, and of unelected bodies being involved, can be dealt with in a sensible way. That would mean that we could get on to discussing in the communities whether fluoride should be added to water, rather than whether the body carrying out the work is biased. That suggestion is intended to help the Minister.

Local authorities and people on the ground have independence, and they have taken on board local opinion. They may not be skilled or have the necessary qualifications, but they are in touch with local people and they will listen carefully to them. The value of that must not be undermined. The strategic health authorities may wish to be the co-ordinating bodies, but they must involve local communities in a democratic way, and there is no evidence at the moment that they will do that.

4.15 pm

I say to the hon. Member for Leominster that I do not know where my strategic health authority is—I will discuss that with my hon. Friend the Member for Guildford. It could be said that I should know and that it is remiss of me not to. [Interruption.] Apparently, my hon. Friend does not know either. We represent constituencies in Sussex and Surrey, and neither of us knows where our health authority is. I am occasionally in touch with the authority, but I do not know where it is based, although I know that it is somewhere near me.

Sue Doughty: To clarify that point, it is not that my hon. Friend and I do not talk to our strategic health authorities but, because of the geographical situation, their officials tend to come to London to talk to us. We converse with them, and e-mail and phone them, but we do not know where they are based.

Norman Baker: That is exactly the case. [Hon. Members: ''They will know where the base is tomorrow.''] Yes, my hon. Friend and I will know that tomorrow: I shall go and check it tonight. I think that it is nearer my hon. Friend's constituency than it is to mine, but she might prove me wrong.

We converse with and write to the authority's officials. If we do not know where they are, that does not suggest that they are very local; and if they do not impinge on our consciousness in that way, it is likely that, with the best will in the world—and regardless of whatever snide remarks people might want to make about Liberals—they will not have impinged on the consciousness of most people in the area, for whom they purport to speak on this important issue.

I ask the Minister to recognise that if the issues that I am raising are taken on board, that will aid the process rather than hinder it.

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Mr. Drew: I shall take note of your advice, Mr. O'Brien, and speak entirely on why we need to re-localise this process and re-link with local government. Before anyone asks, I know exactly where my area health authority is. It is in a huge black hole: that is how things have ended up because Bristol, Bath and Swindon are involved. I will add nothing more on that sore point, except to say that I am in regular contact with that authority.

This is an important matter. I hope that the hon. Member for Leominster will press this amendment to a Division. Where we come from in relation to this debate is important. Some of us genuinely believe that one of the problems with our health service is that it is not accountable enough. The mechanisms are not in place whereby it can easily find out what its population wants in terms of health.

This is one of the issues about which I think that there would be a great deal of public interest. It might not be on the same scale as the interest in genetically modified organisms, but some people might be surprised to find that many members of the public, when they listen to the arguments, will be very interested in the debate. It is a gut-reaction issue that will take off. It might not have taken off in other Members' areas yet, but it has certainly taken off in mine.

I passionately believe that if we look at the Berlin wall—to borrow the words of a previous Secretary of State—between social care and the NHS on a day-to-day basis, it is clear that in recent times we have never arrived at an acceptable relationship between them. I am talking about local government and the NHS. Because of that wall, we will have real problems when we need to try to find out what people think about this issue.

The Conservative amendment is right. I accept that parliamentary draftsmen might have to try to make more sense of it, but it is at least a stab at trying to reconnect with what should be happening. There should be a mechanism whereby we can genuinely convince people that fluoridation is right.

I listened carefully to the scientific advice that my hon. Friend the Member for Bolton, South-East spoke about, and I shall not demur from that powerful case. However, that case must be made to the general public before we fluoridate their water, rather than afterwards in the hope that they go along with it. That is where local government has more expertise, although it often feels excluded from health matters. We have given local government responsibility for the economic and social well-being of its community, and there is nothing more connected with such matters than what we are discussing. It connects with what the Government are trying to do.

I passionately support the foundation hospitals debate. Apart from being about mutualism, which I, as a co-operator, believe is a different way to run services, it is also about trying to connect with the population by making them members and giving them a stake in how a public service is run. There are different arguments about that in different parts of the health service. The foundation hospitals debate connects

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directly with the current debate. If things are put in place through local government, people will feel much more empowered and will be more likely to vote. There is no better way to proceed. That is better than having a false consultation process. With the best will in the world towards my hon. Friend the Minister, I have to point out that she may not be there to make a decision on different areas in which there may be confusing results.

The alternative way would be much more straightforward; it would take note of what people say. If we are serious about having such debates—and are doing more than pretending to listen to people's views—let us proceed according to some form of democratic accountability. Otherwise, people will feel that they have not been listened to, and that consultation had been taken just to reinforce the decision.

Miss Johnson: I want to make it clear that appointments to strategic health authorities are made by the NHS Appointments Commission. That is done independently through the usual proper Cabinet Office procedures and those appointments are externally advertised.

On amendments Nos. 301 and 157, I should like to reassure hon. Members who have contributed to the debate that we have resolved that local authorities should play a major part in reaching decisions on whether an area should fluoridate. I do not agree with what hon. Members said about the strategic health authorities. I shall not rehearse the argument about their connection with their area and the role that they can play. There have been some pertinent developments in the organisation of the health service and the relationship between it and the local authorities in recent times.

One such development took place under the Health and Social Care Act 2001. All the county councils, London boroughs and unitary authorities have established local authority overview and scrutiny committees. The strategic health authorities and primary care trusts are required to consult those committees where there are to be significant changes to health services. We need to put a ring-holder in the Bill and name a ring-holding organisation. I am convinced that the strategic health authorities are the right ring-holding organisations; none the less, they must engage with the wider community in a meaningful way, including engaging with the local authorities and playing a major part in the decision and consultation-making processes for such matters. The strategic health authorities are, in any case, required to consult the local authority scrutiny committees.

My experience of talking with people in local authorities about health and public health matters is that already much stronger links are being made in many areas between local authorities and health authorities, including strategic health authorities and primary care trusts. Those committees represent a forum for the SHAs to sound out local authorities on the proposal to fluoridate, and to enlist their co-operation in organising the wider public consultation; they represent a very important avenue. I was a local authority member for some 16 years, and

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I would not want to downplay the importance of local authorities.

In terms of the democratic processes involved, it is important to stress that neither the views of SHA members nor those of local authority members should determine whether an area is fluoridated. As we have all been saying, it should be determined by the views of the local population.

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