My Lords, I thank my noble friend Lady McIntosh for her clear introduction to Amendment 156. The first thing for me to underline is the point she made: the water fluoridation provisions in the Bill will simply transfer the power to initiate fluoridation schemes from local authorities to the Secretary of State. The Bill does not compel the expansion of fluoridation. Any future proposals to establish new schemes would be subject to funding being secured and public consultation, and I will come on to both those things in a second.
The noble Baronesses, Lady Finlay and Lady Merron, are quite right that the evidence is strong that water fluoridation reduces the incidence of tooth decay for both adults and children, but nobody is complacent about public health. We will continue to be under a legal duty to monitor the health effects of water fluoridation on populations with schemes and to report no less than every four years. Monitoring the evidence is a continuous process and involves colleagues from multiple disciplines, including toxicology.
The law here is explicit. Water companies are required to comply with legislation to protect employees, consumers and the environment from harms. The Town and Country Planning (Environmental Impact Assessment) Regulations 2017 and other legislation set out the thresholds and criteria for which an environmental impact assessment is already required in relation to developments. The installation of water fluoridation plants in some areas may fall within scope. Furthermore, the Environment Act 2021 will, when brought into force, place a duty on Ministers of the Crown to have due regard to the policy statement on environmental principles in our policy-making; hence new and revised policies will need to take into account their impact on the environment. I would like again to reassure your Lordships that the evidence is kept under review.
My noble friend referred to the case of McColl v Strathclyde, in which I think she said she was involved. Perhaps I could just state for the record that the plaintiff’s arguments in that case about the safety and effectiveness of fluoridation were all explicitly rejected by Lord Jauncey, who found that there was no convincing scientific evidence supporting that position. Since that ruling by Lord Jauncey, 38 years ago, it remains the case that there is no convincing scientific evidence of water fluoridation being harmful to health. Indeed, were we not to have any fluoridation, there would still be areas of the country where fluoride is naturally present in drinking water at a similar level to that achieved by a fluoridation scheme.
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My noble friend suggested that a useful alternative to fluoridation might be a scheme such as those we see in various areas of the country—she mentioned Scotland—where toothbrushing is supervised. Certainly, daily supervised toothbrushing programmes can be entered into by local authorities and there are already schemes around the country; Public Health England publishes guidance to support local authorities interested in entering into such schemes. However, we are not necessarily dealing with an either/or; water fluoridation works well with other oral health improvement programmes such as supervised toothbrushing. Water fluoridation also benefits both adults and children and, unlike other approaches, does not rely on behaviour change.
My noble friend asked about costs. Any expansion plans in this area will be subject to funding being secured, as I mentioned, and the cost of a new scheme is bound to vary depending on the size of the area to be fluoridated and the number of water fluoridation plants that might be needed. However, I suggest to her that one should not simply look at cost; based on Public Health England’s current return on investment tool, water fluoridation in areas of high deprivation offers a projected return on investment after five years of £35 for every £1 spent on operational costs.
My noble friend asked about the consultation process and how this will be tackled. We will carry out a public consultation to gather views on future consultations. Following that consultation, we will be required to set down in secondary legislation how we will consult on water fluoridation proposals in the future. These regulations will be subject to the affirmative procedure and will be debated in Parliament during the coming year.
Finally, any future public consultation on expansion would also include information on the impact of any proposals on health, the environment and cost-benefit analysis. I hope that these reassurances will satisfy my noble friend, at least in part, and that she will feel able to withdraw her amendment.