Water Fluoridation (Consultation) (England) Regulations 2022

Lord Reay Excerpts

Tuesday 25th October 2022 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, in moving that these regulations be approved, I shall also speak to the Health and Care Act 2022 regulations.

The water fluoridation provisions of the Health and Care Act will come into force on 1 November, and in doing so will transfer the power to initiate new schemes, or to vary or terminate existing schemes, from local authorities to the Secretary of State. Public consultation will continue to be an important aspect of proposals, and the focus of today’s debate is the draft consultation regulations, which set out the process that any future consultations must follow. We know that some have strong feelings on the subject of water fluoridation and consultations relating to it, and we were keen to gather public opinion before laying these draft regulations. We therefore launched a public consultation on 8 April, which ran until 3 June 2022, seeking views on whether future water fluoridation consultations should be restricted only to those affected locally and bodies with an interest, as has previously been the case, or whether they should now be open to all, given the shift of responsibility from local authorities to central government.

We received 1,228 responses; 94% came from individuals and 6% from organisations. The majority of respondents favoured a consultation which is open to all. The draft regulations do not therefore restrict those who can respond to any future consultation. However, we understand that it is those living, working and studying in the areas in question who are directly affected, which is why the regulations also provide for consideration to be given, as part of the decision-making process, to whether those who may be particularly affected by any future proposals should be given additional weight.

Although public opinion and the extent of support for a water fluoridation proposal will continue to be important, consultations are not referendums. It is right that regulations provide for a range of other factors to be taken into account when considering a water fluoridation proposal. This includes, but is not limited to, the strength of evidence underpinning any arguments made by respondents. It is right that due regard is given to those arguments that are properly supported by sound evidence.

We are committed to scientific evidence surrounding water fluoridation underpinning any proposal. The department continues to review scientific papers published both in this country and internationally as part of the continuous monitoring of the evidence—including those on the epidemiology and toxicology of water fluoridation —and every four years the department will continue to publish a summary report on our knowledge, in line with the Secretary of State’s responsibility for monitoring the effects of the water fluoridation arrangements on the health of the populations served by schemes. I provide assurance that, if the balance of evidence in favour of water fluoridation as a public health measure were to change, a review of the current water fluoridation policy would take place.

Another important element in deciding to proceed with a water fluoridation proposal is the cost-benefit analysis of such proposals. Any new proposal will have to demonstrate that the benefit to health will represent good value for the investment of public money proposed.

We want more of the country to benefit from water fluoridation, and many noble Lords may be aware that yesterday we announced, subject to the outcome of this debate and future consultations, that funding has been secured to begin expansion across the north-east into Northumberland, County Durham, Sunderland, South Tyneside and Teesside, including Redcar and Cleveland, Stockton-on-Tees, Darlington and Middlesbrough. I know that the local authorities in these areas are strong supporters of water fluoridation. In accordance with the regulations we are debating, we will hold a public consultation on this proposal next year. This expansion would enable an additional 1.6 million people to benefit from water fluoridation, which will help to reduce the level of tooth decay in the area and over time will reduce the number of children who need to be admitted to hospital for tooth extractions.

I turn now to the draft Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022, starting with mandatory training on learning disability and autism. People with a learning disability and autistic people experience poorer health outcomes in comparison to the general population. There is a need to address the significant and persistent health disparities faced by this group of people. That is why the Government have introduced, from 1 July 2022, a requirement in the Health and Care Act for CQC-registered service providers to ensure that their employees receive specific training on learning disability and autism. Introducing mandatory training on learning disability and autism is intended to ensure that health and social care employees have the skills and knowledge to provide safe, compassionate and informed care. The Act also creates a duty for the Secretary of State to publish a code of practice which will outline how to meet the new requirement on mandatory training. The code of practice is being developed and we expect to publish a draft for consultation early next year.

The consequential amendment proposed today seeks to remove the requirement for the Care Quality Commission to issue statutory guidance about the mandatory training requirement, by amending Section 23(1) of the 2008 Act. This carve-out clause should have been applied during the passage of the Health and Care Bill. If the Act is left unchanged, registered service providers will have two sets of guidance: statutory guidance issued by the Care Quality Commission and, subsequently, the code of practice issued by the Secretary of State. Removing the requirement for the CQC to issue statutory guidance will mean that registered providers will have a single source of guidance once the code of practice is published. The Care Quality Commission has agreed to keep all its statutory guidance, which was published on 1 July 2022, available to registered service providers until the code of practice is published.

Lastly, I turn to virginity testing and hymenoplasty. Safeguarding vulnerable women and girls is a top priority for the Government, which is why we were one of the first countries in the world to ban virginity testing and hymenoplasty. Virginity testing and hymenoplasty have no scientific merit or clinical indication and are a violation of human rights. These degrading and intrusive acts have an adverse impact on women and girls’ physical, psychological and social well-being. They can lead to extreme psychological trauma in the victim, including anxiety, depression, post-traumatic stress disorder and suicide, and physical trauma including damage to the hymen and vaginal wall, bleeding, infection and sexual difficulties. As such, we are proud that the Health and Care Act 2022 made carrying out, offering, and aiding and abetting virginity testing and hymenoplasty illegal.

As these are new offences, certain changes to other legislation are necessary to protect vulnerable groups. The Scottish Government have requested a change to be made to the Foster Children (Scotland) Act 1984, which contains a list of matters which disqualify a person from fostering a child in Scotland. The consequential amendments proposed today would add to that list the conviction of an offence of virginity testing or hymenoplasty in relation to a child. The change would also flow through to assessments by adoption agencies in Scotland under The Adoption Agencies (Scotland) Regulations 2009 in relation to the suitability of prospective adopters.

The 2009 regulations require those suitability assessments to be carried out by reference to a range of information, including whether the prospective adopter or any member of their household has been disqualified or prohibited from keeping a foster child under the 1984 Act. This change would have the effect of disqualifying or enabling the disqualification of individuals convicted of virginity testing or hymenoplasty offences from fostering or adopting in Scotland.

Similar changes were made to English and Welsh law in negative regulations under the Health and Care Act 2022. Scottish provisions on this matter are set out in primary legislation requiring an affirmative procedure. It was unfortunate that we were not able to make this amendment in the Health and Care Bill, as the need for the change was not identified during the Bill’s passage, but the priority is to put in place these restrictions now. This change will help to protect girls and young women from so-called honour-based abuse.

[Lord Reay (Con)]

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.

Health and Care Bill

Lord Reay Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Reay (Con)]

My Lords, I have added my name in opposition to Clauses 147 and 148 standing part of the Bill—tabled by my noble friend Lady McIntosh of Pickering and supported by the noble Baroness, Lady Jones of Moulsecoomb. These clauses enshrine the Government’s intentions to expand the rollout of water fluoridation throughout the UK. In case the House should decide that they remain, I will also speak to Amendments 259B and 259D in my name, which would make the implementation of the policy conditional on an environmental impact assessment and the analysis of recent US Government-funded, peer-reviewed studies.

My noble friend Lady McIntosh apologises for not being present in the Chamber today, as she has been pinged. However, she wanted me to convey her support of Amendments 259B and 259D.

It is most unfortunate that the important topic of water fluoridation has not been granted a full debate of its own in this House. That it has been slipped in by these back-door clauses does a huge disservice to the issue and detracts from the important debate over the Health and Care Bill itself. These clauses in effect ride roughshod over the current status quo on water fluoridation in terms of legal precedent; they also ignore the existence of effective alternative strategies for fighting tooth decay, as practised not only in Scotland but in most other countries in the world.

While roughly 10% of the population lives in artificially fluoridated communities, it is true that no areas have been added since the late 1980s. Successive Governments have tried to increase the coverage but have failed, including in Southampton a few years ago, because the measure meets stubborn resistance from local communities, who do not wish to be mandated to drink fluoridated water. In Scotland, Lord Jauncey in the case of McColl v Strathclyde Council 1983 concluded that fluoridation amounted to illegitimate medical treatment via the public water supply. Since then, the health service in Scotland has focused on other measures to improve children’s oral health, with a considerable degree of success.

The government policy paper used to support the insertion of these two unfortunate clauses appears to report only what the fluoridation proponents want Ministers to hear: namely, that the practice benefits teeth and poses no threat to the rest of the body. However, four high-quality US Government-funded studies published since 2017, all peer reviewed, looked at the effects on the brain. Each one reached concerning conclusions. The first of these studies, by Bashash et al, appeared in the high-impact journal Environmental Health Perspectives in 2017. This mother-child cohort study showed a four-to-five-point loss of IQ in offspring associated with maternal fluoride intake, typically experienced in a fluoridated community. Some 300 mother-baby pairs were followed for 12 years, with a mother’s fluoride exposure measured directly via urinary fluoride level, and the paired offspring’s IQ was measured at four, and at six to 12, years of age.

Since this study a further three, similarly robust US- Government funded studies—Bashash 2018, Green 2019 and Till 2020—all point in the same direction: damage to the infant brain, IQ loss, and/or increased ADHD symptoms associated with fluoride exposure at the doses experienced in artificially fluoridated communities—which, I might add, were at lower fluoridation levels than those considered for the UK, with 0.7 ppm versus 1 ppm. According to Dr Philippe Grandjean from Harvard University,

“Fluoride is causing a greater overall loss of IQ points today than lead, arsenic or mercury.”


Another recent study in 2015 by Professor Stephen Peckham, an adviser to the Select Committee on Health and Social Care, chaired by Jeremy Hunt, showed that incidences of hyperthyroidism are nearly twice as likely to report high prevalence in the West Midlands, which is a fluoridated area, in comparison to non-fluoridated Greater Manchester. Professor Peckham’s study has been omitted from the policy paper’s references. So, too, has the conclusion of the important 2015 Cochrane review, which found as follows: no strong evidence that fluoridation reduced tooth decay in adults; no strong evidence that tooth decay increased when fluoridation was halted in a community; and, contrary to claims from promoters that fluoridation helps low-income children, it found:

“There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across”


socioeconomic status. All these scientific findings are extremely important, but I find it very worrying that they appear either to have been ignored or dismissed by the authors of this policy paper. Amendment 259D commits the Government to have these four US studies reviewed by expert toxicologists.

I turn to the matter of why fluoride in the UK is not considered a medicine when the WHO has recently classified it as such. Why do the Government refuse to do the same? They contend that water fluoridation has a medical benefit in terms of reduced tooth decay. Could it be that by defining fluoridation water as medicine, the Government then submit themselves to regulation and scrutiny? The MHRA is responsible for the licensing requirements for medicinal products. If fluoridated water were treated as a medicine, individuals would then have the absolute right to refuse the administration of water fluoridation by choice, and industrial-grade fluoridating chemicals would not be allowed. Of course, if it were defined as a medicine, it could not be administered without consent. When fluoride is delivered via toothpaste, the individual has a choice in the matter. When it is carried through the public water supply, there is no individual choice and the ingested fluoride goes to every tissue in the body, including those of the unborn child. This is particularly unfortunate for lower-income families, who cannot take avoidance measures such as bottled water or filters. Moreover, there is no assessment of individual health, size, dose, physical and mental state. Contrary to the direction of modern medicine, whereby treatments are increasingly tailored to the individual, water fluoridation is a crude, one-size-fits-all strategy.

The legality of the Government’s determination to avoid defining water fluoridation as medicine is questionable. The Supreme Court of Canada in the Municipality of Metropolitan Toronto case in 1957 held that fluoridation was using the water supply for a medicinal purpose, which was separately reaffirmed by Lord Jauncey years later. The Lord Jauncey decision explains why Scotland has no communities with artificial fluoridation. The Scottish health department, to its credit, instead has developed an exciting programme called Childsmile. This is a programme of early education on both dental hygiene and diet. It involves both schools and parents and has proved successful and cost effective. Not only has dental decay been reduced but the overall health of children in terms of fighting sugar consumption and obesity has been improved. This programme is relevant to the cut and thrust of the Bill but it has been ignored in the policy paper. Given the success of Childsmile in Scotland, can the Minister say whether the Government will consider a rollout of this programme throughout the UK?

It is conservatively estimated that only 2% of the water supplied by water companies is consumed by domestic users. This would mean that 98% of the water containing fluoride would re-enter waterways, with the potential for damaging plant and aquatic life and entering the food chain. Under the EU dangerous substances directive, fluorides are classified as deleterious to the aquatic environment. Last month, the Environmental Audit Committee in the other place published a report concluding that a chemical cocktail is polluting English rivers and putting public health and nature at risk. We must refrain from adding fluoride to the toxic mix. I add that, in addition to the toxicity of fluoride itself, contaminants such as lead and arsenic are often present in the industrial-grade fluoridation chemicals used. These frequently derive from the hazardous waste of the phosphate fertiliser industry. Given the repercussions for the environment, our waterways, animals, fish and other wildlife from this policy, it seems surprising that Defra does not appear to have been involved in the decision-making process for water fluoridation. Perhaps the Minister can explain why.

Last year, we heard the Secretary of State for Health and Social Care announce that £10 million will be charged to water bill-payers for the rollout of water fluoridation. However, I suggest that it will cost taxpayers considerably more. Greater Manchester has around 22 treatment plants, which would need to be refitted for £1 million to £2 million each. Using a back-of-the-envelope calculation, to cover parts of the UK not already fluoridated will conservatively cost in excess of £300 million, excluding chemicals or running expenses. The policy paper fails to reveal how much the proposals will actually cost.

Perhaps the Minister can share with us the forecasted costings of rolling out water fluoridation throughout the UK in terms of plants, chemicals and other extraneous expenses. In addition, have Her Majesty’s Treasury, the Public Accounts Committee or any respected independent bodies such as the Office for Budget Responsibility or the IFS scrutinised the real costs and their effect on the public finances and health budget? Will these unknown extra costs be met by cuts to NHS dental departments or other parts of the health budget? This money would be far better spent on early intervention on dental hygiene and diet, as in the Scottish Childsmile programme.

Health and Care Bill

Lord Reay Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Reay (Con)]

My Lords, I extend a warm welcome to the noble Lord, Lord Stevens, although like my noble friend Lady McIntosh, I respectfully disagree on the topic of water fluoridation, a measure that I strongly oppose and that I will focus on tonight.

It is disappointing that mandatory fluoridation has been slipped, virtually unnoticed, into the nether regions of such an important Bill, without its own debate and without proper scrutiny. Moreover, it all seems very rushed. I stand before noble Lords today not as a scientist or a connected party of a lobby group but as someone who has grave concerns about the risks posed by widespread water fluoridation. I contend that high-quality evidence that has come to light in North America since 2017 suggests that fluoride can damage the developing brain and reduce IQ. I conclude that water fluoridation has not been adequately researched by those who have initiated the Bill. The practice cannot be considered safe and should not be extended throughout the country.

In Europe the only countries that have agreed to water fluoridation are Ireland and the UK, with 10% population coverage, with Spain, Poland and Serbia having done so to a very minor extent. In studies in 1999 and 2001, the Centers for Disease Control and Prevention acknowledged that fluoride’s benefits are mainly topical, not systemic. There really is no need to swallow fluoride or put it in drinking water, when topical treatments like fluoridated toothpaste are available.

Children, particularly bottle-fed babies, are unfortunately being overexposed to fluoride. Infants consuming formula mixed with such water receive the highest exposure to fluoride by body weight—a dosage 100 to 200 times higher than a breastfed baby. This overexposure leads to dental fluorosis, or discolouration of the enamel, when the permanent teeth erupt. Since we have now learned that fluoride crosses the placental membrane, it is evident that the foetus receives an even higher exposure than a bottle-fed infant at a more vulnerable time.

Proponents claim that over 60 years of research has demonstrated that the measure is safe and effective. However, most of that research has focused on the hard tissues: the teeth and bone. It is only recently that high-quality research has focused on other tissues, with disturbing results. According to recent US Government-funded studies published in leading global journals—Bashash, 2017 and 2018; Green, 2019; and Till, 2020—fluoride has the potential to damage the developing brain of both the foetus and the infant, leading to lowered intelligence and increased symptoms of ADHD. Making these observations even more alarming is that the damage was observed in fluoridated communities in Canada—a country that fluoridates at 0.7 parts per million, versus 1 part per million in the UK. The Till paper showed an IQ decline of 9 points among bottle-fed children in fluoridated versus non-fluoridated communities. These findings are so serious that they make any discussion of dental benefits of this practice moot. You can repair a damaged tooth but not a damaged brain.

The irony of the Bill’s proposals is that they will harm most those whom they seek to help. Those most likely to suffer from poor nutrition, and thus most likely to be vulnerable to fluoride’s toxic side-effects, are the less well-off, who are the very people being targeted by the proposed fluoridation programmes. We should be spending our efforts trying to increase the access to dental care for low-income families and invest in programmes such as Childsmile in Scotland.

In his written evidence to the recent White Paper, Professor Stephen Peckham, government adviser to the current Select Committee on Health in the other place, chaired by Jeremy Hunt, stated that

“if the Secretary of State was looking for ways to improve oral health then water fluoridation should not even be considered given its lack of effectiveness. More attention should be given to schemes such as Childsmile in Scotland which has been proven to reduce inequalities, reduce admissions for tooth extractions and provide broader public health benefits beyond oral health. Such a scheme links very clearly to addressing obesity issues as well”.

Professor Peckham rebuts government claims in the White Paper that water fluoridation is proven to improve oral health and reduce oral health inequalities. He argues that such claims are based on inconclusive evidence and studies predominantly carried out pre 1975, before the wide use of fluoride toothpaste. Peckham further argues:

“We should not be considering any new schemes given the increasing amount of evidence linking fluoridation to harmful health effects.”


Only eight years ago, the Government made a decision to transfer decisions on this issue from the NHS strategic health authorities to local government. The specific reason given was that local communities should have a stronger say. This Bill reverses that position and reverts to the centralisation of control with the DHSC.

Surely, if health measures are to be imposed on the individual and if the community’s final say in the matter is removed, the scientific evidence should show overwhelmingly that the measure is both beneficial and safe. In the case of water fluoridation, I do not believe it is either. At the very least, I urge a delay in proceeding with this measure until the National Toxicology Program in the US—which for the last five years has been undertaking a systematic review of the fluoride neurotoxicology studies—publishes its report, expected in early 2022. The public will not easily forgive us for rushing ahead without availing ourselves of the best scientific research on the matter.