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Lord Fowler: I really will allow my noble friend to reply to that. I am afraid that the joke is entirely beyond me, and I suspect beyond my noble friend as well.

I intervene to return for a few minutes to the question of fluoridation because I have a slight feeling that we have been here before. In 1985 we introduced the Water Fluoridation Bill, which my noble friend handled so ably in the House of Lords—

Baroness Trumpington: Hear, hear!

Lord Fowler: I would like that to be put on record as well. I should perhaps have done it earlier. My noble friend will remember that that Bill was very fiercely debated, and I know that some opponents of it are still in the House.

We should perhaps recall why we introduced that Bill. It came directly from the judgment of Lord Jauncey in the Strathclyde case, which ruled that in Scotland fluoridation was ultra vires. The judgment did not challenge the safety of fluoridation, but rather the power of authorities to be able to use it. As a result, fluoridation in Scotland was ended. It also cast doubt on the position elsewhere in the United Kingdom. We sought to clarify the matter and effectively revert to the position as we had always thought it to be. We gave health authorities the

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power and responsibility to propose fluoridation in their own areas because we felt, and I still feel—the point was made by the noble Lord, Lord Hunt, on a previous amendment—that they were the most competent bodies to determine local health needs. It seems to me that that is what health authorities are about. Because some water authorities have challenged that, we are in the position we face today.

The Minister was fairly kind about the attitude of the water companies. My noble friend put their case in the most sympathetic way possible. I wonder whether, with a little more courage, the water authorities might not have been able to do more than they did. Irrespective of where fault lies, I am sure that the Government are now right to put the issue beyond all possible doubt.

The arguments on fluoridation are not remotely new. It was first proposed in the 1930s and introduced in North America in 1945. Two arguments have been made against it. The first is that it challenges the freedom of the individual. There is no doubt that, if fluoridation is carried out in a particular area, there is no choice about the water you drink. The same arguments of liberty were put on issues such as seat belts and crash helmets. There is a balance, and it is for everyone to make up their own mind. In my view, the good to be done outweighs any argument of individual liberty. That is the case here.

The second argument relates to whether fluoridation does good and whether there is any danger in it. On the issue of safety, I do not intend to go into all the arguments. As in the 1980s, I am entirely persuaded by the evidence and views of the Chief Medical Officer, the Chief Dental Officer and the British Dental Association. That is where I stand.

On the good that fluoridation does, perhaps I may refer to the West Midlands where I had a constituency for almost 30 years. The evidence from there seems overwhelming. As in so many other matters, Birmingham leads the country in this respect—at least I have the noble Lord, Lord Hunt, on my side on that issue. Like all Members of the Committee, I have received a number of representations. One letter from the West Midlands was from Dr Nigel Carter, the chief executive of the British Dental Health Foundation. He says that, from his personal experience, having practised on the borders of fluoridated Birmingham and the then non-fluoridated Sandwell at the end of the 1970s, it was possible to tell whether children were from a fluoridated or non-fluoridated area just by the condition of their mouth. While children from Birmingham were virtually decay-free, those from Sandwell often had multiple cavities and suffered many extractions. Dr Carter says that he is pleased to say that, following fluoridation of Sandwell's water in 1987, children in the area have moved from near the bottom of the dental health league to the top 10. That is significant evidence.

Strangely, that evidence was confirmed by the leader of Sandwell Borough Council, who pointed out that Sandwell has some of the most deprived wards in Europe where one would expect children's dental

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health to be correspondingly poor. Yet, after fluoridation, Sandwell ranks among the best. Again, John Charlton, the chairman of University Hospital Birmingham, says that water supplies in Birmingham have been fluoridated for almost 40 years and, as a result, dental health in Birmingham is among the best in the country. The letters go on and on.

My favourite letter is from one of my oldest political opponents in Birmingham, Sir Richard Knowles—Dick Knowles—whom the noble Lord, Lord Hunt, will know. He says that the ability of the upper House to straighten out legislation has been the main reason why, in a lifetime of politics, he supports a bicameral system. I hope that the Government Whips are listening to that support for our system. He says that 86 years ago he was born on a farm where natural fluoride existed in the local water, which is one of the reasons that his own teeth are so good. According to Sir Richard Knowles, the teeth of children in Birmingham are in better fettle than anywhere else in our country.

With that evidence of success, it seems that the challenge is to go further. Surely, dental decay is a disease that is largely preventable. But, despite substantial improvements in dental health over the past 30 years, there remain many areas of England where there are considerable numbers of children with the disease, which can cause pain and infection. That is the challenge that the Department of Health and this country face. There is an overwhelming case for more action. I support wholeheartedly the amendment.

Lord Livsey of Talgarth: Several issues must be examined in this debate. The main objections in principle are ethical and scientific. The noble Lord, Lord Fowler, accurately described the situation concerning children in Birmingham. I have no doubt that the condition of their teeth has improved; I do not contest that. However, there are other ways of securing good teeth; for example, what was the effect of the withdrawal of school milk on the condition of children's teeth?

We are talking about the risk to adults. For example, what effect does drinking fluoridated water have on older people whose bones are weak? What is the effect of using fluoridated water in washing machines and dishwashers? The noble Countess, Lady Mar, asked about farm animals. Those questions must be answered to the satisfaction of Members of the Committee and the community.

The ethical dimension is one of civil liberties, as mentioned earlier. There is a principle of informed consent to medical treatment as an individual. The Patient's Charter restates the patient's right to give or withhold consent to treatment, as does the EU Convention on Human Rights and Biomedicine 1997.

To some extent, the scientific arguments have been put. I do not want to speak for too long, as many Members of the Committee wish to participate. Already in this debate the York committee's report has been prayed in aid of fluoridation. I agree with the noble Lord, Lord Fowler, about health authorities,

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medical officers and others who have long advocated fluoridation. However, I am concerned that, as a result of the York scientific committee on the subject, the chairman, Professor Trevor Sheldon, has considerable worries about how the York report has been interpreted.

I shall quote from an open letter from Professor Sheldon, a scientist of the highest integrity, to interested individuals and scientific bodies about his concerns over how his research was interpreted. He says:

    "In my capacity of chair of the Advisory Group for the systematic review on the effects of water fluoridation, recently conducted by the NHS Centre for Reviews and Dissemination, the University of York, and as its founding director, I am concerned that the results of the review have been widely misrepresented. The review was exceptional in this field in that it was conducted by an independent group to the highest international scientific standards and a summary has been published in the British Medical Journal. It is particularly worrying, then, that statements which mislead the public about the review's findings have been made in press releases and briefings by the British Dental Association, the National Alliance for Equity in Dental Health and the British Fluoridation Society. I should like to correct some of these errors.

    1. Whilst there is evidence that water fluoridation is effective at reducing caries, the quality of the studies was generally moderate and the size of the estimated benefit, only of the order of 15%, is far from 'massive'.

    2. The review found water fluoridation to be significantly associated with high levels of dental fluorosis, which was not characterised as 'just a cosmetic issue'.

    3. The review did not show water fluoridation to be safe. The quality of the research was too poor to establish with confidence whether or not there are potentially important adverse effects in addition to the high levels of fluorosis. The report recommended that more research was needed.

    4. There was little evidence to show that water fluoridation has reduced social inequalities in dental health".

We can argue about that one way or the other, because I am not entirely sure that I agree. It continues:

    "5. The review could come to no conclusion as to the cost- effectiveness of water fluoridation, or whether there are different effects between natural or artificial fluoridation.

    6. Probably because of the rigour with which this review was conducted, these findings are more cautious and less conclusive than in most previous reviews.

    7. The review team was surprised that, in spite of the large number of studies carried out over several decades, there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken, providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation".

Professor Sheldon was the head of the research team conducting the York University research. I am not saying that he is totally right, but I would like the Minister to address those points in his reply and tell us whether what Professor Sheldon says is important to the debate that we are having on this final form of the legislation.

6.30 p.m.

Lord Tordoff: Before the noble Lord sits down, I would like to say that, although he speaks from the Front Bench for this party, he is not speaking on behalf of the party. Many of us would certainly not go along the line that he is taking. I have always taken the view that if we put chlorine atoms into the water,

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fluorine atoms will not make much difference, but that is a fairly unscientific scientific remark. I dissent from my noble friend Lord Livsey of Talgarth on this matter and will vote for the Government.

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