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Session 2004 - 05 Publications on the internet Standing Committee Debates |
Third Standing Committee on Delegated Legislation |
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Column Number: 1 Third Standing Committee on Delegated LegislationThe Committee consisted of the following Members: Chairman: Mr. Roger Gale †Barron, Mr. Kevin (Rother Valley) (Lab)†Blunt, Mr. Crispin (Reigate) (Con) †Burnham, Andy (Leigh) (Lab) Burstow, Mr. Paul (Sutton and Cheam) (LD) †Evans, Mr. Nigel (Ribble Valley) (Con) Fallon, Mr. Michael (Sevenoaks) (Con) †Grayling, Chris (Epsom and Ewell) (Con) †Harris, Dr. Evan (Oxford, West and Abingdon) (LD) Hesford, Stephen (Wirral, West) (Lab) †Iddon, Dr. Brian (Bolton, South-East) (Lab) †Johnson, Miss Melanie (Parliamentary Under-Secretary of State for Health) †Mahmood, Mr. Khalid (Birmingham, Perry Barr) (Lab) †Ryan, Joan (Lord Commissioner of Her Majesty’s Treasury) †Starkey, Dr. Phyllis (Milton Keynes, South-West) (Lab) Vaz, Keith (Leicester, East) (Lab) †Ward, Claire (Watford) (Lab) Colin Lee, Committee Clerk † attended the Committee The following also attended, pursuant to Standing Order No. 118(2): Beresford, Sir Paul (Mole Valley) (Con)Williams, Mr. Alan (Swansea, West) (Lab) Column Number: 3 Monday 21 March 2005[Mr. Roger Gale in the Chair]Draft Water Fluoridation (Consultation) (England) Regulations 20054.30 pmThe Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I beg to move,
The Chairman: With this it will be convenient to discuss the draft Water Supply (Fluoridation Indemnities) (England) Regulations 2005. Miss Johnson: One of the Government’s main priorities is to reduce inequalities in health. There is a strong correlation between dental decay and social deprivation. Yet in deprived areas in which the water is fluoridated, people have as good oral health as residents in much better-off areas. However, we recognise that some people have strong views on fluoridation and it is fundamental to our policy that a strategic health authority should arrange for its drinking water to be fluoridated only when the local population is in favour. Fluoridation brings well documented health benefits. The 2002 review by the Medical Research Council confirmed the benefits of the reduction in tooth decay which were contained in the York report. It also highlighted additional benefits, including reducing toothache in young children and the consequent need for dental treatment under general anaesthesia, together with a reduction in dental treatment costs. It would usually be necessary to administer a general anaesthetic when extracting teeth from young children. Even then, that is a traumatic experience for both child and family, and the number of children undergoing tooth extractions under general anaesthetic in fluoridated areas such as Newcastle and Birmingham is half that in areas without fluoridation, such as Manchester and Leeds. Moreover, studies show that children in non-fluoridated areas are more than twice as likely to have had toothache during their lives as those in fluoridated areas. A study in the north-east showed that five-year-old children were five times more likely to suffer from a dental abscess in non-fluoridated areas than in fluoridated areas. Fluoridation does not only benefit children. Studies into adults in this country and abroad have shown that adults who live in fluoridated areas keep more of their own teeth longer and have fewer dental problems than others. I shall sketch out some of the detail of the regulations. Column Number: 4 Dr. Evan Harris (Oxford, West and Abingdon) (LD): Before the Minister goes into the detail, it is important to consider the evidence of the benefits. The York review issued a statement on 28 October 2003 saying that it had been misconstrued. It stated that the evidence was not that great and that more research and high-quality studies were needed before we could pray in aid the evidence base for clear evidence of health benefits. Generally speaking, I am with the Minister and am in favour of fluoridation, but the York report said that more good quality studies are required. The Chairman: Order. The hon. Gentleman’s contribution was fascinating, but it was entirely out of order. This is not a debate on the principles of fluoridation. It is a debate specifically on the regulations before us this afternoon. Miss Johnson: I take it that it would not be appropriate, therefore, for me to respond to the hon. Gentleman now. I shall do so outside the Committee. Dr. Harris: On a point of order, Mr. Gale. I seek your advice. The Minister makes statements about the quality of the evidence and the benefits of fluoridation. Is it out of order for us to refer to such matters? How can we engage in the issue? The Chairman: In so far as the hon. Gentleman is suggesting that I should have interrupted the Minister, he is probably correct. For that, I apologise. I endeavour to allow some flexibility in debates, but it is abundantly clear that some Committee members wish to widen the debate beyond the scope of the regulations. He will have to be satisfied that his remarks are on the record. Miss Johnson: The consultation regulations apply to situations in which strategic health authorities propose to enter into, vary, terminate or maintain arrangements with a water undertaker to fluoridate the water. The indemnity regulations provide for indemnities to be given to water undertakers that fluoridate water on behalf of a strategic health authority. Our intention behind the consultation regulations is to ensure that a strategic health authority conducts wide-ranging consultations in which the effects and safety of fluoride are fully explored, and that the SHA assesses the outcome of the consultations in an objective, transparent manner. On the detail, during the Department’s consultations on the regulations, it was stressed that we need to ensure that the “bodies with an interest” referred to in regulation 3, with which the strategic health authorities will be required to consult, covered all organisations for which fluoridation might have implications. That would include not only medical and dental organisations but, for example, food and drink companies that might need to consider whether the use of fluoridated water was compatible with their business aims and manufacturing processes. We will certainly refer to businesses in the guidance that we will issue on the implementation of the regulations. Our only reason for not being more specific is to ensure that we do not limit the scope of strategic health authorities to involve local bodies with an interest that
Regulation 3 describes the measures that the strategic health authority must take to publicise, and encourage debate on, its proposals. The requirement on the strategic health authority to publish its proposals in a local newspaper has been carried forward from the Water (Fluoridation) Act 1985. Newspapers are still widely read, but we intend strategic health authorities to be much more proactive in publicising their proposals and stimulating discussion. The guidance will cover that in more detail. Our administrative guidance will state:
which should cover the full range of modern communication techniques in conducting consultations. I am aware that not every family has a computer, but resources such as websites, helplines and focus groups can reach sections of the population that may not buy the local paper or read public notices in it. I am sorry if regulation 4 looks complicated. We wished to respond to the representations made during the passage of the Water Bill that fluoridation schemes should not be allowed to continue indefinitely without public re-appraisal. However, water distribution systems are complex engineering schemes that periodically require variation and maintenance. We have sought to strike a balance between allowing sufficient flexibility for relatively minor changes to be made without consultation and ensuring that major variations or investment decisions are not taken without consultation. Sir Paul Beresford (Mole Valley) (Con): I clearly have an interest in the fluoridation of water supplies. What worries me is that there is a list of hurdles for the health authorities which is rapidly coming to sound like a list of very close high-jumps. The Chairman: Order. The hon. Gentleman says he has an interest. For the sake of the record, is he declaring it? Sir Paul Beresford: Yes, although it might in fact end up being financially negative in the end. I am concerned because during the consultation, the health authorities will receive information from people who oppose fluoridation, and some of the opposition to it is extraordinary. I know this, having received a lot of such information myself. Presumably, the health authority, with its knowledge and medical advice, will be quite free to discard and ignore advice that is fallacious. Miss Johnson: Indeed. The hon. Gentleman makes an important point about the strategic health authority’s regard for the arguments presented to it. Clearly, people are entitled to hold whatever opinion and to advance whatever argument they wish on these matters, but some arguments are based on fact and others are based on suspicion, or indeed falsehood, and can be shown not to have the same weight— Column Number: 6 The Chairman: Order. I thought that I had made it abundantly plain that we must confine ourselves to the regulations, the scope of which is very narrow indeed. Miss Johnson: I am addressing the issue of cogency, which appears in the regulations, as, I think, was the hon. Member for Mole Valley (Sir Paul Beresford). However ineptly I am doing so, we are endeavouring to stick to your strictures, Mr. Gale. Cogency depends on the truth of the argument, and it is important that that is borne in mind when considering cogency issues as set out in the regulations. I was talking about the change under regulation 4. Where major investment in new plant is needed which goes beyond maintenance or health and safety requirements, it will be necessary to check whether the costs are justified by the benefits to oral health. The strategic health authority will need to consult on cost-benefit in accordance with the regulations. Hon. Members have raised issues to do with regulation 5. It will not surprise them to learn that, during our consultations, more comments were received on that regulation than on any other aspect of the measures. We remain of the view that decisions on fluoridation should not be made in referendums. There are many reasons for that. One very important reason is that a lot of the relevant dental and oral health issues concern children, who, of course, do not have votes. There is a strong correlation between tooth decay and social deprivation, and we want SHAs to take account of the views of people from lower social classes. However, let me dispel any suggestion that we have diluted our commitment that fluoridation schemes will only be introduced where the local population are in favour of them. Regulation 5 requires SHAs to take account of the extent of the support for their proposals. They must also consider the cogency of the arguments that are made. A host of disinformation is put about on fluoridation, which is likely to be recycled in the consultations. In the past, the Department has received identical standard letters citing a link between fluoridation and commonly occurring illness or disability, for which there is no published research evidence. The SHAs will need to scrutinise the responses received and weigh the arguments in favour of and against proceeding. Dr. Harris: Having regard to your wise view that we do not want to go too far into the health arguments for and against fluoridation, Mr. Gale, I wish to point out to the Minister that regulation 5 states that the authority needs to be
Does she accept that health arguments, even if they are based on published evidence, need to be based on studies of sufficiently high quality, and does she propose to help health authorities meet that requirement by ensuring that those high-quality studies are performed, as called for in the York report? Miss Johnson: We will take the action that we have said we will take on the basis of the York report. However, both the chief medical officer and the chief
On the indemnity regulations, we are often asked why, if the Government are confident that there are no risks to health from fluoridation, we need to indemnify water companies against claims that arise from fluoridation schemes. The answer to that is that companies are commercial organisations with the core purpose—indeed, it is possibly their only purpose—of supplying water. As fluoridation is a public health measure, the SHAs pay the companies the full cost of fluoridation and, in accordance with good business practice, they need to be able to indemnify the water companies, regardless of how remote the possibility of there being any claims. Schedule 1 contains a model indemnity. As one would expect, the water industry would like a very wide indemnity. For public policy reasons, it cannot cover criminal liability, and the industry must bear the cost of any negligence. However, we have gone as far as we can to meet the industry’s concerns. The indemnity covers the defence costs of a water undertaker or supplier that successfully defends a prosecution for an offence which relates to the fluoridation of water. Moreover, provided there has been no fault or negligence, it covers any civil liability that arises in respect of fluoridation, even if that liability arises in circumstances which can also give rise to a criminal offence. I do not propose to go into the detail of other aspects of schedule 1. I hope that my explanation of the regulations has been helpful and that they will be agreed to. 4.44 pmChris Grayling (Epsom and Ewell) (Con): As you rightly said, Mr. Gale, this subject has been controversial. We cannot and should not revisit the arguments, as the decision on it has been made by a free vote of the House. The regulations set out some detailed, technical aspects that the health service would have to follow in order to introduce water fluoridation into those parts of the country that are without it. The Minister will be aware that many of us are considerably worried about the technical workability, or otherwise, of some aspects of the proposals. Members of the Committee will have different opinions about that. It is clearly not a single party or cross-party issue. MPs’ views differ regardless of what party they represent. I wish to deal with some workability questions and to challenge and to understand the Minister’s thinking about matters that cause particular concern, so that we and those listening to the debate can understand what the Government believe will happen. I start with consultation, the real nub of the process. If fluoridation is to happen only in areas where the public have given their consent to its introduction, the Committee will agree that the processes to be undertaken must be absolutely robust and rigid. We
Regulation 3 refers to the arrangements that an SHA shall take when publishing details of the steps that it plans to take. The Minister will be aware that SHA areas are sometimes confusing creatures. They cross boundaries; they reach across regions. Acute hospital services in my constituency are covered by the South West London strategic health authority. Primary care services in my constituency are covered by the Surrey and Sussex strategic health authority. My constituency is also served by two water companies: the Sutton District Water Company and Thames Water. The sources of water for the constituency are different. They come from wells and downs and from the main supplies in the Thames Water area. Regulation 3 sets out how consultation will take place and be publicised. It refers to
The Minister knows that in an SHA area such as mine—and I suspect in hers in Hertfordshire—there is no clear-cut, single media channel by which to reach members of the public. The nearest might be the distributed free local papers but, in many areas, distribution networks do not deliver information to people. I wish to probe her on how she believes that an SHA will distribute information to all households, so that people truly understand the implications of what will happen. That is especially important, given that the national health service does not always have a good record when it comes to managing consultations effectively. I draw from experience in my constituency when, recently, consultation on the future of acute services was based fundamentally on a single consultation document. The responses were set out by the NHS. The NHS strategy was formulated on the back of the consultation exercise. It centred very much on the set of questions that was asked in the documents, yet significant parts of the area did not receive them. We must be absolutely certain that the NHS will be able to—and will—fulfil a commitment to ensure that each household sees what is proposed and has the opportunity to express a view about it. I am reasonably reassured by regulation 5 and the way in which it sets out some safeguards, although my view might differ from that of my hon. Friend the Member for Mole Valley. I should be interested to know what the Minister believes that SHAs will—and can—do to ensure that such an important issue is brought to the attention of each household, so that all householders have the opportunity to respond to it. Will the Minister reassure us that only a clear-cut result from the consultation will be taken into account? I argue that it must be an overwhelming result, otherwise SHAs should not proceed with the steps regarding fluoridation arrangements as set out under regulation 5. A consultation with a split of 49
I wish to press the Minister on how the issue will be handled across SHA areas. I have described the circumstance in my constituency. Where two SHAs have a different role in the same geographical area, who will be responsible—which SHA will become the lead body? Where an SHA crosses a community boundary, such as the London boundary, where will responsibility fall? What steps will the SHAs take to ensure that primary care trusts are within the loop, too? Where an SHA crosses a boundary, or where it has only partial responsibility for the NHS in its area, what steps will the SHA take to ensure that, before it moves ahead at all, it is certain that the local health community in its area is on board and understands and supports what is being proposed? I want the Minister to touch on the issue of potential liabilities. Her regulations set out broad-ranging safeguards for the water companies, as should be the case. However, what is the ultimate scope of the potential liability in areas such as my constituency, where the water supply comes from pure natural mineral water sources, and where the water quality is probably better than that of the mineral water bought off the shelf in Tesco? There is a possibility that a chemical additive will be put into water. Has the Minister sought to quantify the potential liability that the Government are taking on if something goes wrong? Medical and health care history is littered with liabilities that seemed inconsequential at the start, but which ended up as substantial. What risk assessments has the Minister conducted on the liabilities she is taking on as a result of the regulations? Has she sought to place any limit on them? Has she taken expert advice to ensure that taxpayers will not face a substantial bill? Sir Paul Beresford: If my hon. Friend’s homework had gone a little further, he might have realised that the safeguards are reflected in the fact that fluoride in water has been utilised for generations throughout the world, both artificially and—for many natural water supplies—since time began, and that there have been no side effects along the lines that he is talking about. If he had taken a look at the record of the debate on this subject in the House, he would have seen that I mentioned a similar situation that arose in New Zealand. It might be of interest to him. When water supply was fluoridated there, there was uproar. There were aches and pains, and the flavour of tea changed. However, about six weeks after all those new aches and pains arose and the complaints about the tea were made, it was announced that something had gone wrong with the machinery, and fluoride had not been put into the water supply after all. Chris Grayling: I listen to my hon. Friend’s comments with interest. However, he knows that there have been significant medical objections to the proposal from different groups, which may or may not
It is important to bear in mind that we live in a litigious society, where the full gamut of the law—and not merely UK law, but international law—often opens up legal channels that might not have been open in the past. When a Government take on a substantial liability, it is sensible for them at least to have some sense of what they are taking on. That is why I would be interested to hear the Minister comment briefly on what risk assessments have been conducted. Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): To pursue the hon. Gentleman’s point that there may be some people who would allege that there is a harm, there are, of course, people who allege that the world is flat, but I have never heard that anybody has successfully pursued a legal case on that basis. Many of the claims that are made about fluoride would similarly lack any credence in a court of law, and therefore could not be deemed to lead to any liability. Chris Grayling: The hon. Lady trivialises the concerns of some of those who objected to fluoridation. Many groups, such as those concerned about bone diseases, fear that fluoridation has an adverse affect. As you rightly pointed out, Mr. Gale, it is not for me or the Committee to form a judgment about whether those arguments are right or wrong. However, it is not imprudent to ask the Government to give us some sense of what work they have done to assess the risk involved in taking on a blanket indemnity against any liability in future. That is what they are doing under these regulations. Andy Burnham (Leigh) (Lab): Does the hon. Gentleman accept that the United States of America, which is both the most health-conscious and the most litigious society on earth, is approximately 80 per cent. fluoridated? If the concerns that he outlines had any substance, would not those problems have emerged into plain view in the United States? The Chairman: Order. We are teetering on the brink of order. Chris Grayling: In a changing world, where knowledge evolves week by week, it is simply prudent for any Government taking on a legal liability and issuing a legal indemnity to have some sense of what they have taken on. My question to the Minister is simply this: what work have the Government done to quantify and to assess the risk underlying these regulations? Broadly speaking, I have no real problem with the direction in the two sets of regulations, subject to the points that I raised and clarification from the Minister. I certainly will not seek to divide the Committee on the regulations, but I would be interested to hear the Minister’s clarification. She will agree that it is essential that, if any steps are taken down this road, they be taken with the full knowledge, acceptance and
Several hon. Members rose— The Chairman: Order. I face a slightly difficult issue of order. Ordinarily, the Chairman would call members of the Committee before other Members who are present and who wish to speak. However, I happen to know that the right hon. Member for Swansea, West (Mr. Williams) wishes to attend the Public Accounts Committee, so I am sure that the Committee will understand if, without setting any kind of precedent, I call him next. 4.57 pmMr. Alan Williams (Swansea, West) (Lab): That is kind of you and your colleagues, Mr. Gale. I apologise for any to-ing and fro-ing, but the Public Accounts Committee does not have a quorum, which is why I am anxious to get back. I do not want to address the basic issues. As has been said, this is not the Committee for that. The hon. Member for Oxford, West and Abingdon (Dr. Harris) referred to the requirement for closer and more detailed analysis. That is borne out in the explanatory memorandum. On the issue of indemnities, for example, it says:
although the British Fluoridation Society, which is not exactly on my side of the argument, says in its publication that the latest opinion poll, from 2003, shows that 67 per cent. are in favour. Clearly, that is a majority, but the minority is not tiny, as is suggested in the explanatory memorandum. The remaining 33 per cent. represent 20 million people. That cannot be dismissed as a tiny minority. |
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