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Lord Monson: As the noble Baroness mentioned me by name, before she sits down will she say why children in the industrial cities of France, Germany, Belgium, Sweden, Portugal, the Netherlands and so on do not seemingly have the dental problems to which she referred? Why are medical establishments in those countries not keen on fluoridation?

Baroness Cumberlege: I have to confess to being something of a Euro-sceptic. The noble Baroness, Lady Gardner, dealt with that point very well indeed. Other countries are so different, not only culturally but in their diets and everything else, so I am not sure that the comparison is very useful.

Lord Stoddart of Swindon: It is now confirmed that this measure should have been introduced in a Bill and

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not by means of an amendment to another Bill. We have spent a lot of time on it, and we are going to spend a lot more time on it. I wish that the matter had been brought forward in a proper way by means of a Bill.

I return to the point about consultation, which has not been properly cleared up. The proposition seems to be that the people who carry out the consultation will be the very people who are in favour of one side of the argument. That simply cannot be right. It would be like the Labour Government being put in charge of the next election and being able to use taxpayers' money for their literature and campaign and denying it to all the other parties. Perhaps the Minister would like that—I would have liked it, once upon a time, before I was expelled from the party. But never mind about that.

The fact of the matter is that we need assurances before the Government introduce their proposal. Will the Minister tell us what consultations he will have with various people about the consultation process? That is my first question.

The measure will lead to the removal of individuals' rights to refuse compulsory medication. That is recognised in all democratic societies as a fundamental and inalienable right. The purpose of the amendment is said to be the improvement in the dental health of children—not even all children but particularly children of poor families. It is not to save children or others from life-threatening illnesses. Indeed, the outcome of better dental health in children can, as we have already heard, be achieved by other means. We have been told that a toothbrush and toothpaste would cost 10 per annum, as against 50 pence for fluoridation. But 10 per annum is only 19 pence per week—the cost of a Mars bar. If the child did not have the Mars bar, that would help the child to retain his teeth. So there are other means of bringing about the same result.

Why, then, should the whole population—children and adults—be forced to drink fluoridated water? There will be no alternative. One cannot do otherwise than drink fluoridated water. One has no option, as water is a life-supporting property, to which there is no alternative. Indeed, as we have heard, people could be ingesting a substance that could do them harm. Furthermore, it could bring about apathy in certain parts of the population about personal dental hygiene. People may say, "Oh well, we have fluoride in the water now, we needn't worry about looking after our teeth as the Government are doing it for us".

What about the damage to the environment? The average daily consumption per person is roughly 32 gallons, of which less than a gallon is ingested. By children, that is much less than a gallon. Thirty-one gallons goes to the land, the rivers and the sea and, as the noble Countess, Lady Mar, has pointed out, to lots of animals as well. That could do them all very grave harm. Have any studies been done to discover exactly what damage will be done to the environment?

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We know that fluorides used in water are toxic. They are also classified as dangerous substances under the EU dangerous substances directive of 1976. However, there is no indication of that in pro-fluoridation literature. An article from the Guardian on 27th June headed, "Failure to test chemicals 'puts lives at risk'". There are 30,000 chemicals identified by the European Commission as not tested, and fluoride happens to be one of them. Those issues must be considered before the measure is brought into law.

What about human rights? There is no doubt that water fluoridation is a medical intervention by the state. It is not a water treatment process but a medical intervention. We do not know for certain what are the long-term adverse effects of administering an unregistered medicinal substance. Have the Government considered the implications of the articles in the European human rights charter, which do not permit the administration of a medicine or medical treatment? Have they considered our own Human Rights Act 1998, which implemented the European convention into British law? Have they considered all the legal implications? In my view, the legal and human rights implications are very serious and—if the Government are faced with litigation involving damage to health and/or the environment—could be highly costly to the taxpayers.

I do not want to carry on for too long although others have done so at very great length. The proponents have not spared this House of their opinions, but I shall spare them of many more of mine. I believe that compulsory medication should not be imposed even if a large majority should be in favour of that. In a democracy, minorities, too, have rights. In respect of compulsory mass medication, a minority of one should be sufficient to prevent it being implemented.

Finally, I say to noble Lords who support this measure: do not forget, this might be the thin end of the wedge. People might want to put other substances into the water. Noble Lords who are in favour of this mass medication might find those substances offensive to them and perhaps harmful to them. So we are in fact creating a precedent tonight that we may very well regret.

Lord Hunt of Kings Heath: The noble Lord says that we are creating a precedent tonight. However, as we heard from the noble Lord, Lord Fowler, and the noble Baroness, Lady Trumpington, no new precedent is being set. Parliament debated this matter in 1986—

Baroness O'Cathain: 1985.

Lord Hunt of Kings Heath: In 1985, based on the arguments, Parliament decided that, if proper processes were gone through at local level, the water supply could be fluoridated. The problem is that the mealy-mouthed water authorities and then the water companies refused the requests of health service authorities which had gone through a proper process and proper consultation. All this amendment seeks to do is ensure that, after the proper processes have been

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gone through, those water authorities and companies can no longer thwart the decision of those public health authorities.

Baroness Byford: I apologise for intervening. I followed what the noble Lord, Lord Hunt, said. However, I think he was being slightly unkind to the water companies. What is being proposed now is that the companies will be indemnified. Perhaps there would not have been such a delay if there had been such a proposal on the earlier occasion. I was not in Parliament in those days, so I was not part of that argument. However, I think that the noble Lord's slighting of the water companies was a little unjustified.

Lord Hunt of Kings Heath: I am sorry to delay the Committee, but the fact is that some water authorities, and I think of Severn Trent in particular, were prepared to take the right decision. I am very sorry that other water authorities, particularly the one that covered the North West, did not take a similar position. The fact is that children in Manchester and the North West have suffered terrible oral health because of those authorities' failure to take the right decision.

Lord Colwyn: Like the—

Lord Stoddart of Swindon: My Lords—

Lord Colwyn: Is the noble Lord still speaking?

Lord Stoddart of Swindon: Let us get it right. The noble Lord, Lord Hunt, intervened on my speech—which in fact was coming very quickly to a close. He really must be answered.

Noble Lords: No.

Lord Stoddart of Swindon: The longer that noble Lords interrupt me the longer it is going to take. They know that I will not be intimidated.

Under the 1995 Act, it was not absolutely compulsory. Now it is going to be made compulsory. The water undertakers will not be able to refuse to do it under any circumstances if the local health authority insists on it after consultation. I only hope that the consultation will be proper.

7.45 p.m.

Lord Colwyn: Like my noble friend Lord Fowler, I have a strong sense of deja vu this evening. I apologise for extending the debate and I think that it is going to be a very late evening. I have been involved in debates on fluoridation regularly over the past 30 years in your Lordships' House. My debating opponents have changed but the arguments have not. My noble friend—if I may call him that—Lord Baldwin knows that I suffer a certain amount of inner conflict with my connections with complementary medicine. However,

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as a practising dental surgeon, I support the simple legislative process that would allow the addition of small amounts of fluoride to bring the water concentration to one part per million for 25 per cent to 35 per cent of the population, targeted at areas where tooth decay rates are unacceptably high. The proposed removal of the decision from water companies to local communities should make that simple public health issue much easier. However, the opponents of fluoridation have a knack of getting their way. I hope that this amendment will put an end to that.

Sir Donald Acheson's report, the Independent Enquiry into Inequalities in Health, acknowledged that although dental health had improved, there were still serious inequalities. This Government came to power with promises to reduce inequalities in health. Dentists looked to the Government to address the problems of high decay rates in deprived areas and to make NHS dentistry available to all patients who wanted it. Some 80 per cent of dental disease can be found in only 20 per cent of the population. That is the poorest 20 per cent.

Although I can understand the moral issue against the concept of forced medication, it is the adjustment of the level of a natural ionic content. Is it morally right to deprive children in some of our poorer communities a better quality of life by improving their dental health? Is it morally acceptable to allow children to suffer the pain and discomfort of decayed teeth and allow them to experience the trauma of tooth extraction, sometimes under general anaesthetic, when we know of a simple way of adjusting the concentration of a naturally occurring element that goes a long way to alleviating these problems?

We are not discussing the majority of children whom your Lordships may know. We are trying to help children who may not own a toothbrush, have no access to toothpaste and have inappropriate diets. I spent many years of my own dental career treating some of these children, and the memory of some of the difficult cases will stay with me all of life. It is virtually impossible to remove teeth from children as young as two, three, four or five with a local anaesthetic. Sedative techniques are not ideal for young children, so general anaesthetic is the only option.

As we have heard, each year thousands of children have general anaesthesia for the extraction of decayed teeth. All general anaesthetics are potentially dangerous. Although relatively rare, patients do die under general anaesthesia. The most recent figures that I have are that, in 1998, three children died under general anaesthetic having deciduous teeth removed. As my noble friend Lady Gardner reminded us, general anaesthesia is not allowed now in general dental practice, so those children are referred to hospital, specialist or community centres. In the days when general anaesthesia was used in general practice, I removed teeth from young children who had to be forcefully anaesthetised. It is not an experience that I would wish on dentist, surgeon or patient. It can leave a child with a long-standing fear of dentistry.

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Apart from the avoidance of suffering among children and anxiety among their parents, any reduction in demand for paediatric general anaesthetics would free up a huge amount of scarce anaesthetic expertise and financial resource. I have heard nothing new this evening except the usual misconceptions. The time has come to create a democratic way of enabling communities, not water companies, to take the decision.


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