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Lord Stoddart of Swindon: My Lords, the noble Lord, Lord Maxton, in making the case for fluoridation also made the case against it. He made it quite clear that there is an alternative to mass fluoridation and mass medication: proper dental health being imposed by parents. Indeed, as he says, that is what happens with most middle-class parents.

The argument has changed over a long time. I have probably been around this issue even longer than the noble Lord, Lord Tomlinson. I was the chairman of the Land and Works Committee of the Thames Valley Water Board, as well as being a member of the local authority which was then responsible for public health. At that time, we were told that all children—about 15 per cent of the population—would benefit. But my local authority never took the view that it had to ask the water board, of which I was chairman, to fluoridate the water because it believed that there were other methods of inducing oral health. And so there are.

The noble Lord, Lord Tomlinson, said that all the arguments about fluoridation had been worked out in the Water Act 2003. I have to tell him that the issue will not go away just because Parliament passed an Act. There are a lot of people—more than the noble Lord thinks—who are still opposed to mass medication through fluoridating water. As the noble Earl pointed out, the York review criticised the quality of the research that had been carried out and had said that a minority of the population would benefit from fluoridating all water supplies.

The argument has now come down to benefiting not all children but just poor children. In that case, the problem is smaller than it used to be and should be easier to deal with by other methods such as the proper education of working-class or deprived children and inducing a better diet. Indeed, it would be far cheaper than fluoridating water to give children fluoride toothpaste and toothbrushes as well.
 
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The argument for mass medication is by no means a good one and is by no means accepted by the vast majority of the population. People like me will not be convinced that it is necessary to force 60 million people and countless million animals to ingest fluoride, flooding the environment with it, simply to benefit a small part of the population which could receive the same benefit by other means. That argument will not go away, no matter what the noble Lord, Lord Tomlinson, says.

The arrangements for consultation in the two orders are deficient. The 2003 Act and these measures affect everybody. Every individual will be forced to drink water which has fluoride—a poison—added to their water supply. Therefore, they are entitled to be consulted individually. No matter what the Minister says—I repeat what I said when we discussed the Bill that became the 2003 Act—there is no real substitute for referendums. I know that he disagrees, but that is the only way in which a proper consultation can take place when you are forcing mass medication on people. Not everybody reads the newspapers. I reckon that in my area, about 20 per cent read the local newspapers, so they will not be informed of what will happen to their water supplies. The arrangements for consultation will be in the hands of a small élite clique bent on inflicting fluoride, come what may.

What is more, there is no provision for all interested organisations to be informed. The anti-fluoride organisations will not be informed as a right, and I think that they should be. Taxpayers' money is going to be used to promote fluoridation and to issue propaganda—I call it that advisedly—to promote the policy, whereas those people who are against it or have reservations have to finance their opposition from their own pockets. That does not seem to be a fair situation. These points were made in the discussions on the 2003 Water Bill.

What about the Human Rights Act 1998? Is compulsory mass-medication—that it what it is—compatible with that? The Minister is going to tell us, if he has not already done so, that the legislation and these orders will be compatible, but that is what the Government told us about the measures that we are now discussing in the Anti-terrorism, Crime and Security Act 2001. That was said to be compatible with the Human Rights Act and was proved not to be. That is why we have had these days and hours of debate, trying to put that situation right. The Law Lords declared that, after all, Section 4 of that Act was not compatible with the Human Rights Act, so I am not at all sure that this measure is either. It may well be tested in the courts, and I hope that the courts will strike it down.

I understand that that is probably a minority view in the House tonight, and perhaps at other times as well. We can vote against such orders as these, but it is the practice not to do so. Like the noble Earl, Lord Howe, I will not seek to divide the House tonight.
 
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Lord Warner: My Lords, we have had an interesting rerun in some respects of the debates on the Water Act 2003. We have a bit of time while the Prevention of Terrorism Bill is printed, but I do not want to go over all that debate again. I agree with my noble friend Lord Tomlinson that we have had this discussion, Parliament has spoken, and an Act which was certified by the responsible Minister as compatible with the Human Rights Act 1998 has passed Parliament. We are talking about the narrower set of issues in the consultation regulations and in the indemnity regulations.

However, just to clarify one or two points on research, I remind noble Lords that the University of York report concluded that water fluoridation increased the number of children without tooth decay by at least 15 per cent. It also said that currently around 6 million people receive water which either has had its level of fluoride adjusted or is naturally fluoridated to around 1 milligram per litre. No ill effects have been identified. That was in the University of York report.

It did acknowledge that there might be improvements made in the quality of research that was available. The need for more good quality research was also accepted by the Government, who are committed to a continuing programme of research which takes account of the Medical Research Council's findings about the research necessary to strengthen the evidence base. That was not saying that there was no evidence base. As I have said, the University of York report was a strong endorsement of fluoridation, as well as acknowledging that there could be a need for a continuing programme of good quality research.

The Chief Medical Officer and the Chief Dental Officer were asked to advise on the implications of the MRC report for government policy on fluoridation. Their advice and recommendations for research will inform a continuing programme. It is worth bearing in mind that the Department of Health commissioned the University of Newcastle's School of Dental Sciences to undertake a study into the bio-availability in naturally and artificially fluoridated drinking water. That study was published in July 2004 on the University of Newcastle's website. I am sure that noble Lords who have a fascination and interest in this subject will be able to read the research on that website. It concluded that there was no statistically significant difference in the absorption of fluoride between artificially and naturally fluoridated water or between soft and hard water. I do not want to go into the details, but that demonstrates the Government's continuing willingness to carry out research in this area and to make that research available in the public arena.

A number of people have expressed concerns about the consultation process. It has never been our intention that the majority of responses should be interpreted as meaning that the issue will be settled by a head count. I do not want to go over all the ground again, but for the reasons that I gave in my opening speech and in the debate on the Water Act, we do not
 
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consider that referendums are appropriate here. However, there is no question of strategic health authorities being able to proceed on the basis of representations from one group of people or another. If we want to be conspiracy theorists, I suppose the argument would be that the dental profession would try to capture the ground in this area.

The strategic health authorities have to weigh up all the arguments on all the views that are put forward and they have to take account of the cogency of the arguments. Part of that cogency argument is taking account of the research evidence, particularly where there is evidence showing that there is no association between fluoridation and a wide range of illnesses like cancer, thyroid disease or osteoporosis. People have made those claims. In the consultation process it is important that the weight of research evidence is taken into account in weighing the cogency arguments that are provided for in the regulations. We have to recognise that there will be some who are under misapprehensions about this matter.

The department will also issue guidance on the approach to consultation. I certainly accept the argument that representations opposing fluoridation on the grounds that it is a form of mass medication which breaches human rights, have some cogency, if people want to argue that. But we would expect the strategic health authorities to weigh against those arguments the opposing view that any breach is justified by the benefits of a population-based approach to reducing dental disease. That is another counter-argument and the evidence of those two arguments has to be weighed by the strategic health authority in considering whether to proceed.

I can confirm that it is our intention, when consulting on proposals to fluoridate, that the strategic health authority should publish a summary of the current research evidence with its sources and details of where additional information can be obtained. The Government have no intention of imposing fluoridation in any area. Our policy throughout has been that decisions must be taken locally, following well informed consultation on the issues involved.

The noble Earl, Lord Howe, raised issues about the strategic health authority being required to show a majority in favour. As I have tried to say, we do not consider a head count alone is the most appropriate means of reaching a decision. The noble Earl raised the question of what happens if only 20 per cent of residents respond? The strategic health authority will have to look at the issues and weigh the responses from the interested bodies to ensure that the weight of opinion is in favour. I would argue that that is a demanding requirement.

The noble Lord, Lord Colwyn, asked "What about Wales?" and raised the border issues. I understand that the Welsh Assembly will in due course be considering similar regulations for any proposals for fluoridation schemes in Wales. There may be a need for the
 
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Assembly and this Parliament to consider whether a third set of regulations is required for any schemes that cross the border between England and Wales.

I can understand that a number of Members of this House may be a little dissatisfied if I quote from a letter which I, and I suspect a number of noble Lords, received from the British Fluoridation Society. It says,

"We believe that the draft regulations provide a sensible and workable framework by which strategic health authorities must consult on future water fluoridation proposals".

However, I think that it is worth looking at the heading of the letter, which points out very clearly that the society has a president and vice-presidents from across the political spectrum. This is not a party political issue, and these regulations command a wide spectrum of political support.

I was asked whether it is not sufficient to ensure that people clean their teeth, because there is enough fluoride in toothpaste. We have been over this ground. The big difficulty is in ensuring that families in deprived areas can buy the toothpaste and will establish regular brushing regimes.

I cannot mention too often the point that is covered in Regulation 3. This was brought out very strongly in the consultations conducted by the department on these regulations, in which we stressed continually that this regulation makes it clear that bodies with an interest have to be consulted. Under Regulation 3, strategic health authorities will have to demonstrate that they have consulted all the organisations for which fluoridation may have implications. There is therefore a clear requirement in that area.

A couple of points were raised on the subject of the indemnity regulations. The noble Earl, Lord Howe, raised the issue of existing schemes. I can inform the House that the Secretary of State will issue new indemnities, in the form of the schedule to the regulations, to those water companies with existing schemes.

The issue of the cost of indemnities was raised by the noble Baroness, Lady Barker. No association has been established between fluoridation and ill health, so no claims have been made. So far, the indemnities have been invoked in respect only of actions by opponents of fluoridation: for example, refusing to pay their water bills. This may be an interesting piece of information for the noble Baroness. Since 1997—and these are about the only data we have in this area—one payment of some £400 was made to a water company which had prosecuted a resident for non-payment. We are talking about quite small sums of money which have been paid out so far. We do not have any other information that I can put in the public arena in terms of the future costs of the indemnity regulations.

We have been over this ground many times. I believe that, with the guidance we will be providing, these consultation regulations provide a satisfactory way forward for implementing the legislation that was put in place under the Water Act 2003.
 
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I reiterate that the Government have no intention of imposing fluoridation in any area. It has been our policy throughout, and continues to be our policy, that decisions must be taken locally, following well-informed consultations on the issues involved.

On Question, Motion agreed to.

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