Standing Committee D
Thursday 23 October 2003
(Morning)
[Mr. Bill O'Brien in the Chair]
Water Bill [Lords]
Clause 61
Fluoridation of water supplies
8.55 am
The Parliamentary Under-Secretary of State for Health (Miss Melanie
Johnson): I beg to move amendment No. 319, in
clause 61, page 76, line 28, leave out from 'until' to end of
line 30 and insert
'an indemnity with respect to the arrangements has been given by virtue of
section 90 below—
(a) to the water undertaker; and
(b) to any licensed water supplier which is entitled to one.'.
The Chairman: With this it will be convenient to discuss the
following:
Amendment No. 220, in
clause 61, page 80, leave out lines 6 to 9 and insert—
'(1) The Secretary of State shall indemnify every water undertaker which
enters into arrangements under section 87(1) above against all liabilities
that any such undertaker may incur in complying with such arrangements, other
than liabilities arising from the undertaker's own fault or negligence.
(1A) Subject to subsection (1) above, each indemnity shall be on such terms as
(with the consent of the Treasury) may be agreed between the Secretary of
State and the undertaker.'.
Government amendment No. 343.
Amendment No. 111, in
clause 61, page 80, leave out lines 10 to 15.
Amendment No. 221, in
clause 61, page 80, line 10, at beginning insert
'Subject to subsection (1) above'.
Amendment No. 222, in
clause 61, page 80, leave out lines 12 and 13.
Government amendment No. 344.
Miss Johnson: It is a pleasure to rise in the knowledge that
discussions have been going on for some time without me. The only other time
that that happens is when the Chief Secretary to the Treasury occasionally
appears in Committee for the Finance Bill, but I am afraid that I cannot claim
such status.
The amendments relate to the indemnities granted by the Secretary of State to
water suppliers that agree to fluoridate a water supply under arrangements with
a strategic health authority and water undertaker. They are of great
significance to the water industry, and as a general policy, we would not want a
water supplier that agrees to fluoridate to incur any additional liabilities
compared with one that does not have a fluoridation scheme.
Amendment No. 319 provides for licensed water suppliers to be given an
indemnity if they agree to fluoridate a water supply under arrangements made
between a strategic health authority and water undertaker. Although we do not
envisage strategic health authorities making arrangements with licensed water
suppliers to fluoridate, we would not want to discourage licensed water
suppliers from supplying water as well as water undertakers.
We want to ensure that there would not be any disincentive to a licensed water
supplier bidding to supply water in a fluoridated area. We originally thought
that the indemnity would be covered on the access agreement made between the
undertaker and licensed supplier. We now consider that it would be more
satisfactory if the licensed supplier had an indemnity in its own right.
Amendments Nos. 343 and 344 are consequential to amendment No. 319. Amendment
No. 343 provides for both a situation in which the licensee is distributing
water fluoridated by a water undertaker and one in which the licensee is
fluoridating water under an agreement with the undertaker.
I have some sympathy with amendment No. 220 and consequential amendments Nos.
221 and 222, but I cannot commit at this stage to indemnifying suppliers against
all liabilities. It is our general intention to give wide indemnities, but I
want to reserve our position until we start work on the regulations so that we
can tease out in greater detail how, for example, negligence on the part of the
water undertaker could be excluded. Regulations could also contain model
indemnities agreed by the Secretary of State and the Treasury, which the
strategic health authorities and water undertakers could insert into their
arrangements without needing Whitehall to go over the detail on every occasion.
The flexibility would be prevented by new subsection (1)(a) proposed in the
amendment.
Norman Baker (Lewes): Will the Minister give way?
Miss Johnson: No, I think that I will finish my remarks, and then the
hon. Gentleman may make his own.
On amendment No. 111, the Water Industry Act 1991 currently provides the power
for the Secretary of State to grant indemnities, but with little detail on what
they may cover. The Department has produced some model indemnities, but they do
not have any statutory force. We want to remedy that, but it would not be
appropriate to include the detail in the Bill.
In light of those assurances, I commend amendments Nos. 319, 343 and 344 to the
Committee, and I hope that Opposition Members will not press their amendments,
on the understanding that the issues will be addressed in the regulations, which
will be debated in the House under the affirmative resolution procedure.
Mr. Bill Wiggin (Leominster): What a change to be in this rather
tropical atmosphere rather than the freezing conditions in which we were
considering what became known as the Ice Bill. The Minister has already made a
generous concession this morning by recognising the value of amendment No. 220,
and I am extremely grateful to her. If we can continue with this co-operation we
may have a better Bill.
The Minister talked about different policies for different water companies. Can
she confirm that the differences in the policies will not mean that people in
some areas are properly indemnified and in others they are not, or that if
consumers have evidence that fluoride in the water is doing them damage they
will be able to sue in some areas but not in others?
We want proper protection for consumers in all areas. I am therefore surprised
that the Government have chosen to go down this route of different policies.
Obviously, different insurance companies will provide different types of cover.
That may not be exactly what she meant and I would be grateful if she could come
back to that. She also talked about the phrase ''all liabilities''. Obviously,
when taken on its own it covers everything, but that is not the intention of
amendment No. 220; it is intended to refer to all liabilities connected to the
addition of fluoride to the water.
Miss Johnson: The hon. Gentleman will appreciate that his amendment
uses that phrase: hence my remarks.
Mr. Wiggin: That leads nicely on to the Minister telling us what
liabilities she proposes to cover and what will be excluded. What sums of money
will be put aside or paid by the Government to provide that sort of cover?
Anyone who drives a car knows that they have to be insured for pretty much
everything that they do when something goes wrong even though that can be well
out of their control. Yet at the same time it seems that the Government are
being a bit weaselly here about what they mean by all liabilities, although I am
sure that that is not what they intend. We need to know exactly what the
Government mean, what they will do, how much it will cost and what is not
included in the insurance liabilities.
This is just the tip of the iceberg. We cannot consider whether the Government
should be fluoridating in the first place unless we know exactly what that will
protect us against. After all, this is a balance. ''Proportionality'' is one of
my favourite words, thanks to the Minister for the Environment, who has remained
silent this morning, perhaps tragically. We are balancing the risk of tooth
decay in young children against a risk that may be faced by all people, whatever
their age.
I do not believe that science is sufficiently clear about whether fluoridation
is a good thing. If I am to be persuaded that it is, I must know that the
safeguards are in place. Unfortunately the Minister's statement is far from
clear about that. She has quite a lot of work to do to convince us not only that
the proper scientific work has been done, but that the proper protection is in
place. I look forward to hearing how she does that.
Mr. Simon Thomas (Ceredigion): I want to follow up on the hon.
Gentleman's comments. What was missing from the Minister's introduction was any
explanation of why we need to indemnify water companies against the addition of
fluorides into our water supply. Could it be because the product in question is
registered as a part II poison under the Poisons Act 1972? Could it be because
the Government's York report asked for further serious research to be undertaken
into IQ and congenital defects that may be associated with the addition of
fluoride to our water supply?
How will silicofluorides be brought into our food stream? That, in effect, is
what will happen if we take them into our water supply; we will ingest them
along with our food and drink. I do not know precisely how silicofluorides will
be brought into our food stream when they are still registered as a part II
poison, along with arsenic and paraquat. We need to indemnify water companies
against putting arsenic and paraquat in our water supply, and so we need to
indemnify them against putting fluoride in our water supply. Why do we need to
indemnify water companies? Could it be anything to do with the fact that the
Medicines Control Agency has refused to class silicofluorides as a medicinal
product? We are talking about putting something into our food and drink supply
that may do us harm.
The Minister is the Under-Secretary of State for Health, after all, so it would
be nice to hear a little bit about health in this context. Could she tell us
precisely what further high-quality research her Department has commissioned to
inform the debates of the Committee and the House on the addition of fluorides
to our water supply? What research, asked for in the York report, has been
commissioned on the possible negative effects on IQ and on congenital defects,
particularly Down's syndrome?
In the Minister's letter of 16 October—which, I take it, she sent to all
members of the Committee—she says that further high-quality research,
specifically asked for, has now been downgraded to a low priority. That is a
scandal; it is scandalous that, when the Government commission an independent
report into a possibly dangerous additive to our water supply, and that report
says that we need high-quality research on the possible effect of fluorides on
congenital brain defects, we do not get it.
Standing Committee D
Thursday 23 October 2003
(Afternoon)
[Mr. Bill O'Brien in the Chair]
Water Bill [Lords]
Amendment proposed [this day]: No. 213, in
2.30 pm
Question again proposed, That the amendment be made.
The Chairman: I remind the Committee that with this we are discussing
the following:
Amendment No. 351, in
clause 61, page 76, line 30, at end insert—
'(2) With regards to Wales, neither shall a water undertaker be authorised by
subsection (1) above to enter into any such arrangements unless and until a
referendum on increasing levels of fluoridation has been held in accordance
with the Political Parties Elections and Referendums Act 2000 seeking approval
of the arrangements from the population residing in the area proposed to be
affected.'.
Amendment No. 156, in
clause 61, page 79, line 19, after 'below', insert
'the Secretary of State must ensure funding is available for the consultation
to take place as set out below, and'.
Amendment No. 110, in
clause 61, page 79, line 21, after 'consult', insert 'all
households'.
Government amendment No. 338.
Amendment No. 158, in
clause 61, page 79, line 22, at end insert
'then if public opinion is clearly in favour of such an addition'.
Government amendments Nos. 339 to 342.
Mr. Robert Key (Salisbury): I was describing how my constituency had
been involved in this issue and how both general practitioners and consultants
regarded it. As it happens, no fluoride is naturally found in or added to the
water. The only place in the Wessex Water area where natural fluoride is found
is in the vicinity of Laycock, where the borehole provides naturally fluoridated
water to about 14,000 people.
I want to turn to the national position. We are talking as if we are about to
launch a campaign to put fluoride in everyone's water. That would never happen.
The British Dental Association points out that of the 659 parliamentary
constituencies, only 64 have above-average rates of tooth decay in children up
to five years old. We are talking about just under 10 per cent. of
constituencies in this country, which means that 90 per cent. of constituencies
would probably not see any reason even to hold a ballot, let alone have a local
health authority propose that fluoride should be added.
An NOP survey found that 67 per cent. of people in Britain think that fluoride
should be added to water if it can reduce tooth decay, with 22 per cent. saying
no. The same survey found that 42 per cent. of people think that fluoride is
added to their drinking water already, when the real figure is that about 10 per
cent. have fluoridated water. Most people also do not know that fluoride is
present naturally in some water—only 28 per cent. of the population think that
it is. The national situation gives us a picture that is less certain than some
people would allege.
We have debated whether fluoride is a medicine. It has always been my
understanding that, as with chlorine or calcium, it is a trace element that is
important for human well-being. The process of natural fluoridation or the
addition of fluoride could be seen as nanotechnology, and the question is how we
get the fluoride to the teeth. That is where the scientific arguments, many of
which have been deployed today, can be cited on both sides of the discussion. As
the Medical Research Council study reports, it is true that some of the science
has not been good or conclusive and that lots more should be done. However, that
does not mean that we should stop people from having fluoride in or added to
their water. We are in one of those endless scientific debates.
My other problem is that, although it would be better in theory if we could
leave the issue to the private choice of parents and other adults, preventive
medicine has not worked. The evidence for that is in the parliamentary answer
from the Minister that I quoted earlier. My constituency has average rates of
tooth decay in children, and no fluoride naturally occurs or is added to the
water. If I were an MP for an area in which children suffered from poor dental
health, if public education had failed for many years, and if fluoride were not
already added to public water supplies, I would vote for fluoridation.
Some people would say that therefore, by implication, I would be opposed to
fluoridation, but that is not the case. There is a compelling argument for
walking by on the other side, saying, ''I'm all right, Jack,'' in Salisbury, and
ignoring those in areas where there is no naturally occurring fluoride, or where
there is particularly bad child dental health. However, I have decided that I am
not prepared to pass by on the other side. It is a question of balance and
judgment. I have decided that, in this instance, child health must take
precedence over my scruples, prejudices and personal views on individual liberty
and freedom.
The York report concluded that there is no reason to believe that fluoride is
harmful to health. I believe that strategic health authorities are better bodies
to take decisions than water companies or local authorities. If water is to be
fluoridated, water companies must be indemnified. For many years, water
companies have been unwilling to move on this issue, for very good reason, and I
therefore welcome the indemnity clause that the Government have included.
Even if the Government receive sufficient support for clause 61, however, the
whole scheme may founder on practical grounds. First, it is unlikely that many
health authorities will want to ask for fluoridation and, if they were to do so,
the water companies would face practical problems. I have discussed that matter
with Wessex Water, the major water company in my constituency. It was pointed
out to me that its network of mains distribution crosses strategic health
authority boundaries. What would the company do if it found that one health
authority said, ''Please fluoridate'' and the other ones said, ''Don't.''? That
is one practical reason why the scheme may founder—inside or outside the law
courts.
I listened carefully to the debate, and I have come to the conclusion that,
whatever my reservations and the sincerely held reservations of some of my
constituents, the clause to permit fluoridation of the water supplies should be
added to the Bill. However, if that happens, there must be the widest possible
local consultation. That is what the amendment is about. I suspect that it is a
probing amendment—90 per cent. is a jolly good figure to ask for because it
sets you thinking. However, I also think that the attempt to improve the health
of children's teeth should not be scuppered by a minority of adults who feel
passionately that their preference for libertarianism must prevail.
I am surprised that the Government have not been able to tell us what
arrangements they propose for consultation, and they have simply said that those
will follow in regulations. It is a common problem faced in both Houses—part
of the parliamentary process—that Governments tend to leave things to
statutory instruments that will follow later. No doubt some of the relevant
statutory instruments have not even been drafted yet. I scrutinised the Export
Control Bill last year, and there were more than 40 regulations that were to
follow it, but at least those were available to us in draft form for the debates
in Standing Committee. The Government have a duty to prepare those draft
regulations as quickly as possible, so that we can see what is proposed for
consultation. In my opinion, they should have done so already.
Mr. Hugo Swire (East Devon): I am most grateful to my hon. Friend for
giving way and appreciate his concern for children. Is he aware of the report by
Mr. Ortiz-Peres and colleagues, which concluded that very low doses of fluoride
inhibit the response of follicle-stimulating hormone to inhibin B, and linked
that to reduced sperm production? If we were to follow his line of argument,
there might be no children in future who need their teeth fixing.
Mr. Key: I saw that article, but that argument would not apply to me,
since I had a vasectomy many years ago—[Interruption.] Hon. Members may not
have wished to know that, but now they do. My hon. Friend's remark illustrates
the point that the science is open to discussion. There is no certainty in the
science, but the balance is strongly in favour of the fluoridation of water
having no general adverse effects. Most of life is about taking a judgment on
things, and on balance, in my judgment, the clause should be added to the Bill.
Dr. Brian Iddon (Bolton, South-East): I represent a constituency where
the dental decay in children is probably some of the worst in the country. The
hon. Member for Tatton (Mr. Osborne) has already referred to Bolton. I, too,
have the table that was circulated to hon. Members showing the number of
decayed, missing or filled teeth per five-year-old child. Bury, the neighbouring
town to mine, is top of the table. Several of the Manchester constituencies are
at the top of the table. The three Bolton constituencies are at Nos. 57, 58 and
59; mine is No. 57. I am ashamed of that, frankly. It is terrible that 70 per
cent. of the children in my constituency have serious dental decay at the age of
five.
I must admit that, as the hon. Gentleman said earlier, Bolton has taken a
decision about fluoridation, but it did so in 1968, and that was the old Bolton
borough, not the present Bolton metropolitan borough council, which is much
larger. There was not a referendum such as we have been discussing. Bolton seems
to be out of step with Greater Manchester. There are 10 towns or cities in
Greater Manchester, and at that time Bolton was the only one that decided
against. Seven decided in favour and two, Wigan and Bury councils—we should
bear it in mind that Bury is right at the top of the table—had not taken a
decision at that stage.
In the late 1960s and early 1970s, most of the people in Greater Manchester
who had been consulted voted for fluoridation, but that has not happened and
children still suffer. By the age of five, the average Bolton child will have
experienced quite a lot more than 2.5 decayed teeth, which is much greater than
the national average. The situation is far worse in my constituency, which has
some of the highest levels of deprivation in the three Bolton constituencies.
Some of the wards in my constituency are some of the most deprived in the
country.
I listened carefully to the hon. Member for Salisbury (Mr. Key). He said that
he could take an attitude of ''We're all right, Jack'' in his constituency, but
he does not and I am pleased that he considers the people of my constituency and
many others where dental decay is at such a high level that all hon. Members
should be ashamed. Parliament must try to do something about that.
It is all very well people saying, ''Well, you can go out and buy a
toothbrush and fluoridated toothpaste.'' The reality is that these parents do
not, for whatever reason. Perhaps they are poorly educated. They probably ain't
got the brass, and putting food on the table is more important than going out
and getting a toothbrush and fluoridated toothpaste. The fact is that many
parents do not educate their children about correct dental health procedures,
and I do not see why those children in my constituency should suffer because of
the neglect—that is what it is, I suppose—of the parents who are meant to be
looking after them.
In total, 70 per cent. of Bolton's children suffer dental decay at a very
early age. I was sitting next to a dentist the other evening, when I addressed
the Royal Pharmaceutical Society's annual dinner in Bolton. He was very
pro-fluoridation. At his practice in Manchester—I did not ask him which part
of Manchester—he sees children with teeth in terrible condition. Two years
ago, he could have done something about that—he could have extracted
them—but he can no longer do so. Children come into his surgery in intense
pain, but there is little that he can do. He certainly cannot extract the teeth,
because we have banned general anaesthetic in general practice, and dentists now
have to refer people to a clinic.
I am told that a few extractions are done at Bolton Royal hospital, but most
such children in Bolton go to the Manchester university dental school. Last
year, it gave general anaesthetics 1,500 times to extremely young children—I
stress the extremely young bit—and on top of that there was a waiting list of
500. Hon. Members who are anti-fluoridation should consider the suffering of
those children who cannot have their teeth out immediately in general practice.
I accept that they can be given antibiotics or other palliative care, but for
curative care they have to wait to be seen at a centre such as the Manchester
dental school where the teeth can be extracted. It is shameful that there are so
many children in Britain with such poor dental health that some as young as two
or three have to have teeth out.
I take the point made earlier that things might be better if the dental
system was improved. But even if it were, and there were more NHS dentists and
people did not have to queue for appointments, it would not be much better than
it is at present in the deprived parts of my constituency.
2.45 pm
I have considered all the arguments, for and against. I appear almost as an
Aunt Sally on the National Pure Water Association's website, as people are
invited to write to me, which they do. Some of the letters I receive can only be
described as fanatical. For example, hexafluorosilicic acid, the main chemical
used to fluoridate water, is described as a waste, poisonous product from the
phosphate fertiliser industry. One would believe that we were putting children
up chimneys to scrape the stuff out. The letters are almost out of this world,
and certainly fanatical. I do not say that all members of the NPWA are fanatics,
but a minority of people write the most absurd things. If they want to persuade
me to their point of view they should not write such letters, but I respond to
them all.
I make my point to the British Fluoridation Society, too, because those on
both sides of the argument have circulated pictures and so on. Both
organisations are a bit over the top, but especially the NPWA.
Why are hexafluorosilicic acid and its disodium salt being used to fluoridate
water? As a chemist, I have given that question careful consideration. The NPWA
would say, ''If fluoride is already in water, that is okay; it is natural.''
Belladonna is natural, but I would not dream of taking it. Calcium fluoride
comes out of the rocks in the earth but it is insoluble in water. There could
not be more than about three, four or five parts per million calcium fluoride in
water because of its lack of solubility, so it would be impossible to use
calcium fluoride to fluoridate water in a rapidly flowing stream going through
the treatment works.
The fluoride used in toothpaste is called sodium fluoride. All fluorides when
they enter water are ionisable and they end up as fluoride ions; when we talk
about, fluoride, that is what we mean. We use hexafluorosilicic acid and its
disodium salt because the former is a liquid; it is soluble in water and easy to
titrate to one part per million or whatever concentration Parliament decides. It
is easy to add to water in that concentration. Of course, I would prefer to use
the natural stuff, but it could not be put accurately into the water while it is
flowing through a treatment works, and the same applies to sodium fluoride. It
is okay in toothpaste, but it could not be added to water.
I am concerned about hexafluorosilicic acid, but only a trace—one part per
million—is being added. At that level in many areas there are already a fair
number of chemicals in water, including fluoride, although I do not want to name
them all. In some areas, fluoride occurs at such a high level that the water has
to be diluted with unfluoridated water in order to get it down to one part per
million.
On behalf of my constituents, especially the children, I ask hon. Members to
look at the figures and think about the suffering of children, which we can
easily prevent. I ask members of the Committee to support fluoridation and not
the wrecking amendment.
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