My Lords, I welcome the amendments in this group, which focus on the need for universal access to dentistry and the introduction of fluoride into water. As my noble friend Lord Hunt said, they are about treatment and prevention, which are equally important when it comes to considering how we tackle tooth decay and oral health. I am grateful to my noble friend, the noble Baronesses, Lady Northover and Lady Walmsley, and the noble Lord, Lord Young, for their support for these amendments.
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As we all know, poor oral health does not just affect teeth; it impacts on our general health and well-being, and it affects what we can eat, how we communicate, and how and whether we can work, study and socialise, and it also affects our self-confidence. Yet tooth decay is largely preventable.
We find ourselves faced with a significant public health problem linked with considerable regional variation and inequality. A three year-old living in Yorkshire and the Humber is more than twice as likely to have dental decay as a three year-old who lives in the east of England, and one in three five year-olds in the north-west has experience of dental decay, compared to nearly one in five in the south-east of England. I therefore welcome Amendment 224, which pursues universal access to NHS dentistry. We all know, through both facts and personal and other experiences, the difficulty in getting to see a dentist. As has already been said, that issue predates the pandemic.
I would be interested in hearing the comments of the Minister on a recent British Dental Association membership survey showing that morale in the profession is at an all-time low. Obviously, unless this can be turned around, the drift of dentists away from the NHS will only accelerate. We have long-standing, systemic problems, and the added challenges posed by Covid-19 mean that there is potential for a further exodus of dentists from the NHS. That threatens not just access for patients but the long-term sustainability of NHS dentistry in general. It would be helpful if the Minister could address that in his response.
Turning to fluoridation, according to the Oral Health Foundation this is the single most effective public health measure for reducing oral health inequalities and tooth-decay rates, especially among children. It is effective and safe, and recommended by the World Health Organization, as referred to by the noble Baroness, Lady Northover. It is something that would benefit both adults and children, reduce health inequalities and offer a significant return on investment.
I heard in the debate that the noble Lord, Lord Reay, and the noble Baroness, Lady Bennett, do not share this view. I say to noble Lords—this has come up several times in the debate—that introducing fluoride into water is not an either/or matter; it is part of an overall strategy. I hope that what we are talking about today is how we can get to a place where we have a proper, all-round approach to preventing oral ill-health and treating it where there is a need for dental care. It is not whether we do or do not introduce fluoride into water, but whether it is useful.
I would just gently say this, to back up the point made by the noble Lord, Lord Young: fluoride is a naturally occurring mineral; it is found in varying amounts in soil, food and drink, and in drinking-water supplies. Of course, as we know, there are some parts of the country where the level of fluoride in the public water supply already reaches the target concentration of water fluoridation schemes, as a result of the geology of the area. In other areas, the fluoride concentration has been adjusted to reach this level as part of a fluoridation scheme. It would be a very strange act on our part to say that only those who are geologically blessed should have access to this support to prevent oral ill-health.
I hope that the Minister will be able to accept what I regard as sensible amendments to move us toward a strategy to deal with the treatment and prevention of oral ill-health.