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Earl Baldwin of Bewdley: I support the previous speakers on the points they made and the amendments tabled by the noble Baroness. It is important that this should be decided by the elected local authorities. As the noble Baroness said, it is more than a simple matter of fluoridation and healthcare. Tessa Jowell, as Minister for Public Health some years ago, was sympathetic. The thinking then was that it should not be the responsibility of health authorities, with the endemic pro-fluoridation culture which is hard to get away from, but the elected local authorities. I hope that the Minister takes the point seriously.

It is important to involve all shades of opinion in any consultation process. We had a very good principle on the York systematic review in which I took part. There was an advisory panel overseeing the whole process, drawn explicitly from supporters and opponents of fluoridation. That meant that both sides of the argument could be put. Any bias was spotted and corrected as we went along, and neither side was at a disadvantage at any stage of the process. I have reason to believe, having been in correspondence with him, that the Chief Medical Officer may be sympathetic to the view that it is important to include all shades of

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opinion in the consultation process, both in terms of putting forward their points of view and in drawing up the necessary questions and agenda, which are too readily set by the pro-fluoridation people.

I had intended to say later, and shall say now, that in an area which, in the words of one mainstream journal,

    "has probably brought out as much extremism as any other issue in the modern history of science"—

on both sides—and where,

    "hardly any individual interested in the issue . . . can be classified as neutral",

even-handedness is crucial at every stage. I hope that the noble Lord will give the matter serious consideration.

Lord Hunt of Kings Heath: I begin by declaring an interest as a former member of the British Fluoridation Society and an active supporter of its work. I am also an adviser to the Birmingham and the Black Country Health Authority.

Perhaps I may respond to the points made by the noble Baroness, Lady Miller. She strayed into issues in relation to the principle behind the debate. I regret that we have not been able to have a debate on the principle before coming to the detailed amendment. I do not think that this has been a very sensible approach. We find ourselves extremely frustrated in talking about the nitty-gritty of consultation without coming to a view on the whole issue of fluoridation. It is not a very sensible way to proceed.

Perhaps I may respond to the point made by the noble Baroness, Lady Miller, about strategic health authorities. She said that they should concentrate on breast-feeding and diet and other ways to improve oral health in contrast or in substitution for fluoridating the water. She went on to say that areas where water is to be, or has been, fluoridated might not take other action to improve oral health.

Baroness Miller of Chilthorne Domer: I thank the noble Lord for giving way. I think he will accept, if he looks at the record, that I said that those would be the long-term issues but that fluoridating water might not encourage a strategic health authority to take energetic steps in that direction.

Lord Hunt of Kings Heath: I am grateful to the noble Baroness for that clarification. But if we take the City of Birmingham authority, which fluoridated the water about 40 years ago, we see that the public health dentistry programme in that city and in the Black Country is probably one of the most progressive in the country as a whole. The fact that it has taken a proactive role in promoting fluoridation indicates that it is dedicated to the dental health of children. Not only does Birmingham have the advantage of fluoridation; we also have very strong dentistry provision and a very strong public health dentistry service. I do not accept the argument advanced by the noble Baroness.

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On the issue of consultation, the noble Lord, Lord Stoddart, and the noble Baroness, Lady Miller, are right to stress that consultation is very important. But we have heard from my noble friend that affirmative regulations will be laid as regards the detail of that consultation.

As to the question of whether local authorities or the NHS should be responsible for consultation, the NHS is the public health authority in this country. If local government had a broad responsibility for public health, I could understand the point that the noble Baroness makes. But it is the health service that has responsibility for promoting and improving the general health of the population locally. Surely it follows that it should be the National Health Service itself which conducts that public consultation.

It is not as though the NHS is without experience in conducting consultation. It does so time and again on the major reconfiguration of services and on restructuring. It has a long history of consultation. It is subject to judicial review if it gets it wrong. I really do not think it would help if, on this important public health measure, we suddenly said that we do not have faith in the NHS to conduct public consultation properly and that we should hand it over to local government. I believe that in this area we should trust the NHS to do a proper job.

Lord Chan: I support the noble Lord, Lord Hunt. I declare an interest as honorary president of the north-west centre of the UK Public Health Association, and your Lordships know my association with the NHS.

The areas that I know best, in the north-west of England, are the very areas that are not fluoridated and where there is without doubt concern, particularly in regard to child health and child dental health. These issues have not been improved by dietary interventions or even through interventions in terms of better maternal health. Therefore, one looks at long-standing issues such as the high expense to the National Health Service of children with dental decay. Those who are under five need a general anaesthetic before they can have teeth taken out. In Manchester, 1,500 such operations are carried out every year, and there is a waiting list of about 500. At the Liverpool dental hospital, the figure for general anaesthetics for children under five is 1,300. The cost is enormous. We could be doing many more operations or carrying out much better interventions if we did not have this expense.

Baroness Andrews: We are dealing with a specific amendment in this instance. The three amendments tabled by the noble Baroness, Lady Miller, are specific to questions of funding and public consultation. I suspect that the noble Lord is making his speech in response to Amendment No. 1 and the general debate on the principle of fluoridation.

Lord Chan: I beg the pardon of the House. I was coming to consultation. Patients' forums, and the neighbourhood forums that we have set up in the North West function as a useful way of consulting

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people. There is no doubt that that is a helpful approach. There are also forums looking specifically at sections of the population such as ethnic minority families where the incidence of dental decay is high—particularly among Chinese children.

5.30 p.m.

Lord Fowler: I shall seek to deal with the amendment on public consultation. Part of the confusion on this amendment arises because it is not an amendment to the Bill but, clearly, that is what it should be. I say that with the assurance of someone who, in 1985, introduced the Water (Fluoridation) Bill. I and my Minister for Health at the time, Ken Clarke, took it through all its stages. I am not sure whether the noble Lord, Lord Stoddart, was one of the opponents of that legislation. He signals that he was. I thought that I had remembered correctly—I still have the scars. I believe that possibly a record was reached on the length of speeches made then.

It is a little difficult to deal with the issue of public consultation before we have dealt with the principle of what we are doing, and therefore I believe that the whole Committee is in some difficulty on that. Although I understand what has happened, frankly I consider it to be a curious way to get the legislation through. I am not at all sure that it will prove to be the best way because one reason we are dealing with this legislation is that we say that the old legislation did not work. But we shall see.

I agree emphatically with the noble Lord, Lord Hunt, about the issue of public consultation. We are both Birmingham Members, or part of the Birmingham Mafia, so perhaps that is not totally surprising. However, I am not at all sure that I want local authorities—certainly some of the local authorities that I lived under—to organise the public consultation on this matter. We are dealing with health authorities. They are the public health authorities. They have the expertise; they are aware of the arguments; they are able to give the facts; and, above all, they are able to give the advice. People look to health authorities for that expertise and advice.

I should much prefer the public consultation to be organised by public health authorities and not by local authorities. Local authorities have quite enough to do. Personally, I am fairly sceptical as to whether they do it fantastically well, and I certainly do not want to place another extraneous job and duty upon them. I believe that that is what health authorities are there to do and I back the Bill so far as concerns that matter.

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