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Baroness Gardner of Parkes: I am pleased that the Minister made those comments; they are at least a starting point. However, I should like to respond to the points made by the noble Lord, Lord Dixon-Smith, particularly his worry that too much fluoride will accumulate in the water. I believe that it is very important for him to appreciate that there is absolute control over water fluoridation in every area where it

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has been introduced. The level is never allowed to rise above one part per million. I cannot see why there would be any change to that.

Baroness Farrington of Ribbleton: I seek to assist the Committee. My understanding is that if the noble Baroness, Lady O'Cathain, were to withdraw her amendment, we would then deal with the amendments tabled by the noble Baroness, Lady Miller. After that we would be able to consider the Minister's Amendment No. 1. I do not believe that noble Lords wish to have a debate on the principle and issue of fluoridation three times.

Baroness Gardner of Parkes: I am not speaking about the general issue. However, I think I should say now—while we are speaking to Amendment No. 2, and after the noble Lord, Lord Dixon-Smith, spoke specifically to the point—that it is a misconception to believe that fluoride levels in the Thames will continually build up. Although that is only one of many minor points, I think it relevant to what has been said in relation to this group of amendments. It is important to realise that in all the years that fluoride has been in water, the maximum level has always been set at one part per million. There has been no change to that. So although the noble Lord says that we need to update all the arrangements, research has not demonstrated the need for change.

Lord Dixon-Smith: I think that I should be allowed to attempt to clear up the confusion that I appear again to have caused. I did not mention one part per million, and I certainly did not wish to imply that one might ever find oneself with water with more than one part per million of introduced fluoride. I should add that there are some natural water sources in which the level is considerably higher than that.

That said, my concern was slightly different. My concern was that upstream communities could vote to introduce fluoride and downstream communities would have fluoride in their water whether they voted for it or not. It may well be at much reduced concentrations, but the fact is that it would be there. That could be avoided if the fluoride—the Minister was not debating the principle, so he probably did not want to address this issue—was removed during the water cleaning process which such water would undergo before being returned to the watercourse. It is an issue, but it is nothing to do with the one part per million.

Baroness Gardner of Parkes: It is everything to do with the one part per million. I cannot accept that.

The Countess of Mar: I think that at the moment we are debating the technical amendments tabled by the noble Baroness, Lady O'Cathain. We have time to debate the one part per million or the 10 parts per million or whatever it is when we debate the Minister's main amendment, Amendment No. 1. I wonder whether the noble Baroness will kindly respect that.

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Baroness Gardner of Parkes: At the moment we are debating the second grouping of amendments. Is that not correct? We are debating Amendments Nos. 2, 3, 4, 5, 6, 7, 11, 12 and 13. That is what is before us at the moment. Therefore, I do not understand the point made by the noble Baroness. This is Committee stage. We could debate the matter backwards and forwards all night if we so wished. I do not so wish, but the point which my noble friend Lord Dixon-Smith reiterated about fluoride build-up makes one imagine that we are taking water straight out of the river and drinking it. All drinking water is treated before it reaches the consumer. Where I live in Oxfordshire the chlorine content of the water is so strong that I have to fill the kettle and leave it to stand over night or I could not drink the tea made with that water. There is no doubt that water is treated before it reaches the consumer.

Baroness O'Cathain: I beg leave to withdraw my Amendment No. 2.

Amendment No. 2, as an amendment to Amendment No. 1, by leave, withdrawn.

[Amendments Nos. 3 to 7, as amendments to Amendment No. 1, not moved.]

Baroness Miller of Chilthorne Domer moved, as an amendment to Amendment No. 1, Amendment No. 8:

    Line 146, after "below," insert "the Secretary of State shall ensure sufficient funding is available for a meaningful consultation to take place, and"

The noble Baroness said: The discussion between the noble Lord, Lord Dixon-Smith, and the noble Baroness, Lady Gardner of Parkes, exemplifies why the public may wish to become involved in any consultation on whether to fluoridate water.

Were the amendments that I have tabled to be accepted, I would not have any problem with the Government's Amendment No. 1. Were they not to be accepted, I would have a problem with Amendment No. 1, which is a technical amendment to which we shall return later. Consultation with the public is absolutely key to the matter. The government amendment has been tabled at a very late stage which precludes much discussion on it. We shall have to cram it all into a couple of hours this afternoon.

I have grave misgivings about the drafting of Amendment No. 1, notwithstanding what the Minister has just said about public consultation. I say, "Lucky Wales" with its elected Assembly with which the relevant decision will rest. However, in England the strategic health authorities are not well placed to undertake any kind of public consultation. It is not part of their main job; they are not experienced in it and the public are not used to strategic health authorities undertaking public consultation. In contrast, elected local authorities undertake public consultation all the time. They have experience of dealing with very difficult issues such as local planning issues when dealing with local plans. They are ideally placed to undertake public consultation. If the public in a particular area are not happy with the way in

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which a local authority conducts itself, they can vote it out of office. That does not apply to a strategic health authority, which is appointed by a Minister.

Strategic health authorities have a vested interest in slanting public consultation—I am not saying that they would—in one direction. Of course, strategic health authorities believe that fluoridation is a good thing. The many letters that I have received on the subject from the medical establishment suggest that that feeling is widespread. I do not want to challenge that, but I believe that the public have a fundamental right to do so for the following reasons. Water fluoridation is a step in a different direction where informed consent for medication is no longer required; it just arrives through one's tap whether one likes it or not. One cannot opt out of it. That is a fundamental change.

I have no doubt that if strategic health authorities had the funds and the time, they would approach the issue of children's tooth decay from a different angle. We have heard that often children's teeth are in a worse state in areas of greater deprivation. I believe that, if strategic health authorities had sufficient funds and time, they would devote more attention to the diet of pregnant mothers, the promotion of breastfeeding, suitable diets for babies and young children and doing something about vending machines in schools and the consumption of fizzy drinks and sweets. I accept that those are all long-term issues. However, once fluoridation is introduced, the incentive for strategic health authorities to do something about those other issues, which result in many other health problems, is much reduced as one of the obvious factors resulting from a bad diet has been removed, and the expense that goes with that for the relevant strategic health authority.

My amendment seeks to ensure that the Secretary of State,

    "shall ensure sufficient funding is available for a meaningful consultation to take place".

It is far from clear to me who will pay for it. As we know, health authorities are strapped for cash as it is. Will they spend an awful lot of money on consultation, the answer to which they are already convinced should be yes? I do not believe that they will do so unless the Secretary of State ensures that that is done.

Nothing in the Bill suggests how public opinion would be measured at the end of such a consultation process. The GM debate reveals that the Government do not know how outcomes of consultation should be measured. I do not believe that they have produced a formula. The Minister will tell me that it is for the independent steering group to do that. He will also say that it is for strategic health authorities to determine how to measure public opinion. But I consider that we need to state on the face of the Bill that public opinion is clearly in favour of the change that we are discussing; otherwise, the matter is unclear and strategic health authorities can go ahead and public consultation will count for nothing. I beg to move.

Lord Stoddart of Swindon: It might be convenient for me to say at this stage what I would have said on the original new clause. I believe that we are in a state

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of confusion about that. I should have preferred that this very important matter involving compulsory medication was dealt with in a Bill rather than a new clause to a Bill which is reaching the end of its passage through this House. Then we could have had a proper Committee stage, a Report stage and a Third Reading. That was the proper way for this measure to have been introduced. It is much more important than people realise.

In the speech that I would have made, had we been having a Second Reading, I was going to raise the question of consultation. I would have asked a number of questions. What sort of consultation is it going to be? Are there, for example, going to be local referendums? If so, who will arrange them? By whom will they be conducted? Will they be conducted under the auspices of the Electoral Commission and, if not, how is strict fairness to be achieved? As the noble Baroness pointed out, in any consultation procedures we need to be sure that fairness is achieved. What facilities will be given to opponents of fluoridation to state their case? Will equal amounts of public funds be made available to them as to the supporters of fluoridation? Will health authorities be under a restriction as to the use of taxpayers' money to promote fluoridation when opponents may not have such access to public funds? Indeed, if there are to be referendums, how will voting be conducted and, as I say, by whom? Those are important questions. I do not know whether the noble Lord intends to answer them now or at a later stage, but I hope that he will be able either to satisfy the noble Baroness as to her amendments, or, if not, that they will be put to a vote. It is extremely important, indeed essential, that if debate is to be carried out it is done on a proper basis—a basis that people can understand and in which they feel able to take part in.

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