My Lords, I have spoken previously in the House in Committee and at Second Reading of the Health and Care Bill about how the Government’s water fluoridation policy is considered to be misguided by numerous eminent scientists in the UK and overseas, including government advisers. They warn that fluoridation causes a variety of health ailments, including damage to the foetal brain. I hope to offer my noble friend the Minister some constructive comments on how
to improve the water fluoridation consultation process, which is unsatisfactory and inadequate in many respects.
First, the consultation should be more prescriptive as to the minimum level of publicity required from the Secretary of State to promote the policy. The current framework gives scope for minimal effective publicity, as the media requirement is merely defined as that which the Secretary of State considers appropriate. In comparison, in the case of public health initiatives concerning Covid, the NHS has texted those patients registered and sent letters to relevant individuals based on their ages. The same has applied to screening tests for various cancers. In addition to the NHS database, local authorities have council taxpayer databases and electoral register databases, which could be used for public information notifications. It is particularly straightforward to do that on a locality-by-locality basis, as would apply for fluoridation schemes. There could also be a specification for notices in local papers and in the national press.
Secondly, the consultation period is quite short, given that the public are expected to gather information and evidence, analyse data, review scientific evidence, carry out cost-benefit exercises and marshal arguments on a variety of aspects of a given scheme. Six months would be a more reasonable period.
Thirdly, no objective process is stipulated whereby the Secretary of State can realistically assess
“the extent of support for the proposal”
under Regulation 5(1)(a). What about the extent of opposition to the proposal? There should be a requirement for independent public opinion-polling and also canvassing of the views of parish, borough, city and county councillors. A local referendum should be considered. It stands to reason that, if a local proposal is to have any real democratic legitimacy, the view of a majority of the local populace should not be overridden.
Fourthly, it is difficult to see how the Secretary of State can gauge the cogency of arguments, ethical considerations or scientific evidence without being guided by a panel of relevant experts. These should be recruited independently from the Department of Health, by nominations from bodies such as the royal institutes or other professional bodies for engineers, statisticians, accountants, economists, scientific research bodies, toxicologists, ethicists and the like. They should be similar to commissions of inquiry or standing advisory bodies, chaired by legally qualified personnel.
Fifthly, Regulation 5(1)(b) should prescribe that particular weight should be given to representations made by individuals who would be affected by the proposal. Conversely, it is difficult to see why any weight should be given to anybody with an economic interest in favour of a proposal, because a public interest health policy should not promote private economic interests.
Sixthly, as far as “capital and operating costs” are concerned, in Regulation 5(1)(c), the relevant costs are the full range of costs, including establishment costs, insurance costs, admin costs, consultation costs, any
extra security costs, extra wear and tear or corrosion costs, monitoring costs, safety training costs, additional computer software costs and many others. A narrow compass on these costs would generate some very misleading results.
On Regulation 5(1)(c), it is no good looking at the above costs in isolation: there has to be a comparative cost-benefit analysis, taking into account a range of alternative options such as no scheme, a lesser or more targeted scheme, alternative dental preventive health schemes such as providing fluoride via milk or tablets or topically, public education or in-school training, and so forth. This should include an analysis of the successful Childsmile programme in Scotland, which, through education and dentist visits to schools has been shown to reduce tooth decay in children.
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Point eight: for Regulation 5(1)(d) there should be explicit reference to mental as well as physical health, given the large amount of anxiety and other untoward psychological effects these sorts of schemes might generate.
Point nine: there should be consideration of whether the proposal promotes human rights, is proportionate in a democratic society, takes account of those with protected characteristics within the meaning of the Equality Act—those with disabilities, different religious groups, et cetera—and promotes social cohesion and whether it enhances or diminishes trust in public institutions. There should also be consideration of localism, as different communities have different attitudes, and schemes imposed by central government can create local resentment if not attuned to local circumstances. The question of human rights is important considering that water fluoridation effectively represents the imposition of medicine without consent. Some European countries have rejected the policy because they believe that it conflicts with medical ethics and best practice.
Finally, references to “available scientific evidence” should be supplemented by attaching particular weight to the latest evidence and should specifically include international evidence. The Secretary of State should be required to list the evidence that has been taken into account and state what evidence has been discounted and for what reason. In the last few years, an increasing number of international peer-reviewed studies have highlighted the distinct correlation between water fluoridation and serious health ailments, particularly with regard to the developing foetus. We would be committing a disservice to the public if all the latest available research was not analysed effectively.