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The Countess of Mar: I support the noble Baroness, Lady Miller, in her first amendment—Amendment No. 8. Perhaps the noble Lords, Lord Hunt and Lord Newton—I am sorry; the noble Lord, Lord Fowler—will not mind my saying that, along with that of the Birmingham Mafia, my water has also been fluoridated for 40 years. I live in Worcestershire and am in the Severn Trent area. I totally oppose fluoridation, but I shall come to that issue later.

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If we are to have fluoridation, we need to have informed consent. In order to inform people properly, the necessary funding must be available. The noble Lord, Lord Stoddart, made clear the provisions that are required and I heartily endorse what he said. Like other noble Lords, I am sorry that this amendment has been tabled in this way and that our debate on it is so truncated. It is a very bad way to proceed, especially when the Minister and all his advisers know what a contentious subject this is.

Lord Monson: Although I oppose Amendment No. 1 for reasons that I shall come to before very long, I believe that these Liberal Democrat amendments will make a bad amendment slightly less bad. I still doubt that a majority has any moral right to compel a minority to ingest a contentious compound through its drinking water. But at least the amendments would ensure that fluoridation was not being imposed against the will of that majority. Frankly, I do not trust the NHS to do a proper job of reflecting public opinion.

Baroness Gardner of Parkes: I strongly support the idea of the National Health Service carrying out the consultation, and I strongly oppose Amendment No. 9, which suggests that local authorities should do it. Many points have been raised, but one that has not been made is that this issue would become a manifesto commitment for local authorities. We could end up with fluoride being put in and taken out of water time and again, and the situation would be hopeless for both the local authorities and the public.

Lord Dixon-Smith: Perhaps I may add a small word on this matter, and I apologise for delaying the Committee further. The issue is not how one consults the public. It is very easy to bombard the public with information and it is equally easy to bombard them with disinformation, if I may say so. The real issue is how one determines the view of the public. I believe that that point was made by the noble Lord, Lord Stoddart.

I want to say only that probably the biggest public consultation of all—I believe I can say this in this House where we are not elected—is a general election. From observation over many years, I believe we would all say that general elections occasionally throw up the most extraordinary results. But at least it is a public determination and one knows exactly the view of the public. It may be extraordinary but one knows their view. If that type of process does not take place, there will always be an element of doubt.

Earl Howe: Perhaps I may ask the noble Baroness a detailed question on her Amendment No. 9. Does she envisage that a local authority would have the discretion to decline a request made to it by a strategic health authority? It seems to me that that is the way the amendment reads. The request can be made but there is nothing in the amendment to say that the local authority must comply with the request.

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Baroness Byford: Before the noble Baroness responds, perhaps I may add one or two questions. I agree with all noble Lords who have said that we have got into an awful mess by dealing with the issue in this manner. However, I have a specific question about Amendment No. 10, which seeks to insert the words,


    "if public opinion is clearly in favour of such an addition".

Is the noble Baroness referring to a majority of the public—that is, more than 50 per cent—or does she have in mind a particular way of judging public opinion? Does she envisage that a target must be reached before public opinion cuts in? That is a matter to which I shall refer later.

I support the noble Baroness's Amendment No. 8 because I believe that whoever undertakes the consultation—whether it is a health authority, a local authority or whoever—will definitely need to have sufficient funding. Perhaps I may also ask the noble Baroness the Minister—indeed, I shall ask the noble Lord when we speak to Amendment No. 1—whether the Government have considered having a referendum, involving one person/one vote. How far will this matter go? If it is of help to noble Lords, my local newspaper, the Leicester Mercury, has run a nightly article throughout this week. According to the responses that it has received from its readers, 94 out of 100 are opposed to the inclusion of fluoride in water. Therefore, one should not assume that everyone supports fluoridation.

I shall give other figures later when we discuss the detail of this issue. However, I want to know at what level the consultation will cut in, what percentage will be involved and whether the exercise will obtain just a general view, as the noble Baroness inferred during the GM debate. If it is to be based on the GM issue, then I should be very anxious on my own account.

Lord Dixon: I support the noble Baroness's amendment because the health authority would already have made up its mind. It would promote the question. At least the local authority would be impartial. A local authority is also democratically elected and the people know who they are dealing with. My experience of health authorities is that, when they hold consultations, they usually do so at a time of day when people cannot be present and, invariably, no one turns up for the consultation. Therefore, I am opposed to fluoridation and I hope to speak to Amendment No. 1. But certainly I believe that this amendment would improve that amendment a little if it were eventually agreed to.

Lord Warner: I hope that I shall be able to clarify some of the issues for noble Lords on some of these amendments. With regard to Amendment No. 8—the money item—I appreciate the noble Baroness's concern to see that consultations are adequately funded. However, I believe that she may accept that it would be contrary to the general policy on funding in the NHS to try to ring-fence elements of an SHA's budget. Certainly the Government are committed to shifting the balance of power in the NHS downwards to SHAs and PCTs. We feel that they must be free to determine their own spending priorities.

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Indeed, this provision in relation to fluoridation concerns local choice and local priorities. Nevertheless, in the regulations we shall set down the procedures that the SHA has to follow in undertaking consultation. As I said earlier—I do not wish to detain the Committee by going through what I said in the earlier part of my remarks on Amendment No. 1—the regulations will deal with the dissemination of the proposals to fluoridate. We will use the press, radio, TV and leaflet drops. There will be consultation involving public meetings, discussions on local TV and radio, help lines, websites, and there will be an objective means of measuring the public opinion which could have a basket of indicators. I shall say a little more on that. I do not believe, in the context of the regulations, that there is any chance of strategic health authorities doing that in a hole-in-the-corner manner.

While I recognise the pressures on funding in the NHS, dare I remind noble Lords that over the years 2003–04 to 2007–08 expenditure on the NHS will increase on average by 7.4 per cent a year over and above inflation. That is a total increase over the period of 43 per cent in real terms. By 2007–08 we shall be allocating 84 billion to the NHS and near 2 billion of that sum will be spent on dentistry. So strategic health authorities with high levels of dental decay in their population are likely to be attracted by long-term savings in dental treatment offered by fluoridation. There are some incentives for them to find the money for the consultation processes.

On Amendment No. 9, we certainly want local authorities to play a full part in the consultation, but essentially this is a public health matter, as many noble Lords have said. We believe that the matter has to be owned by the health service. That is not to under-estimate the contributions that local authorities are capable of making at all stages of the consultation process. It would be surprising if something like this consultation was taking place in a particular local authority area and it stayed shtoom and did not involve itself in the process of consultation at all. As I have said, in the regulations we shall give the details of how they could help publicise the proposals, organise public meetings and help with the measurement of public opinion. There would be nothing to stop local authorities being fully engaged in that process.

We intend that the regulations on consultation will require strategic health authorities to seek the views of the local authority. That will ensure that local authorities in effect have a statutory role in the consultation process. I hope that in the light of that assurance, and the kind of assurances that I have given, the—

Lord Stoddart of Swindon: I have listened closely to what the Minister has said, but I cannot be assured by him saying that the regulations will include proper methods of consulting the general public. Nothing in his speech tells the Committee that all the information will be impartial and that there will be opportunities for opponents to put their point of view with the aid of public money and public facilities. He has not

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answered my questions as to whether there will be referendums and, if not, why not, and if there are to be referendums who will supervise them. A whole range of questions need to be answered. If they cannot be answered at this stage, I sincerely hope that they will be answered when the Bill goes to the other place. Otherwise, the whole business will be entirely unsatisfactory and the public will be completely and utterly conned by the consultation process.

5.45 p.m.

Lord Warner: I believe that if the noble Lord reads Hansard tomorrow he will see that I spelt out in some detail what kind of territory will be covered in the regulations. He may recall—perhaps he missed this point in my opening remarks—that I said that the regulations would be subject to the affirmative resolution procedure. So there will be plenty of time for the noble Lord to put his points on this issue when the regulations are produced—


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