Draft Water Fluoridation (Consultation) (England) Regulations 2022 Draft Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022

Debate between Will Quince and Oliver Heald

Monday 24th October 2022 General Committees

[Will Quince]

My hon. Friend is right to push us on those issues. I will touch on them all, because it is about not just local authorities, metro Mayors and others having a say, but all those who live, work and study in an area. No doubt they will have strong views, notwithstanding me as a Health Minister having a view when it comes to tooth decay and the difference that fluoridation will have in that respect.

We launched a public consultation on 8 April that ran until 3 June. We sought views on whether future water fluoridation consultations should be restricted only to people affected locally and bodies with an interest, such as those referenced by my hon. Friend the Member for Bolton West—incidentally, that had been the case under legislation—or whether we should move to a model in which consultation would open to all, especially given the shift of responsibility from local authorities to central Government. Some people with strong views on water fluoridation may not live in a particular area but may have certain expertise or a particular interest.

We received 1,228 responses to the consultation; of those, 94% came from individuals and 6% came from organisations. The majority of respondents favoured a consultation open to all. The draft regulations will not restrict who can respond to any future consultation on water fluoridation, which I hope my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West agree is the right approach.

To come to the crux of my hon. Friend the Member for Bolton West’s points, we understand that the views of those who are directly affected and living, working and studying in an area in question are incredibly important. For that reason, the regulations also provide for consideration to be given, as part of the decision-making process, to whether additional weight should be given to consultation responses from those who may be particularly affected by any future proposals.

Public opinion and the extent of support for a water fluoridation proposal will continue to be important but, as my right hon. Friend the Member for East Yorkshire rightly pointed out, 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.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

In the consultation, were any of the representations made about the European convention on human rights, particularly articles 5 and 8?

[Will Quince]

The honest answer is that I am not aware of any, but no doubt my officials will look that up and I will be able to respond in my closing remarks.

The wider factors that have to be taken into account in the consultation include but are not limited to the strength of evidence underpinning an argument made by the respondents. It is absolutely right that due regard is given to those arguments and that they are properly supported by sound evidence.

On evidence, a point that my right hon. Friend the Member for East Yorkshire alluded to, we are committed to scientific evidence on water fluoridation. It has to underpin any proposal that we put forward. The Department continues to review scientific papers published both in this country and internationally as part of the continuous monitoring of the evidence. That includes papers on the epidemiology and toxicology of water fluoridation. 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 that are served by existing schemes.

--- Later in debate ---

[Will Quince]

I thank colleagues for their contributions, and the Opposition for their constructive response and the tone of their questions. I will focus on water fluoridation and then come to dental access, which is not entirely related, but is important and a priority for me.

Consultations seem to be the key issue, so let me focus on them. I am happy to meet my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West to discuss this issue at greater length as we progress toward consultations. On the additional weighting that will be given to local views, which is important, the regulations require the Secretary of State to take into consideration a range of factors when making a decision on water fluoridation. That includes giving consideration to whether the views are of individuals directly affected and constitute bodies with an interest. If they are, they should be given additional weight. There are clearly established public law principles that require public bodies to act lawfully, rationally, fairly and compatibly with the human rights of those affected by their actions. We would quite rightly have to justify any decisions taken on a future scheme as part of the decision-making process.

One of the questions asked was on the methodology of the extra weight given to local people as per the regulations. Under the Water Industry Act 1991, as amended, Parliament granted the Secretary of State the power and discretion to make decisions on future fluoridation steps in England, including establishing, varying and terminating fluoridation agreements. To give those powers additional weight, the Secretary of State will be bound by the regulations to do that in an appropriate manner, in accordance with the public law principles of rationality that I have just set out.

I remind the Committee that implied in the Secretary of State’s existing direction is the power to grant additional weight to any person or persons whom she deems fit. In effect, all this provision does is to compel the Secretary of State to give due consideration to doing so. As I say, I would be very happy to pick that point up in more detail with my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West.

Questions were raised about the duty of sampling water to ensure that a dosage is not too high. Clear regulations on water supply were laid in 2018. They allow up to 1.5 mg of fluoride per litre in public water supplies. I would be happy to write to my right hon. Friend the Member for East Yorkshire about how water authorities are held to account to ensure that water is monitored and that limit adhered to.

Finally, I hear what the hon. Member for Enfield North says about dental access. Access to dentistry is difficult in too many parts of the country, especially when people do not have ongoing relationships with a dentist. In July, we announced a package of improvements to the NHS dental system, which was detailed in our plan for patients. The Committee will have noted that the Secretary of State has her A, B, C and D priorities, and D stands for doctors and, importantly, dentists. As the Minister with responsibility for primary care, I can tell the hon. Lady that dentistry is a priority for me. I know that the delivery of dental care suffered considerably during the pandemic, but it continues to improve as we recover. Many dentists are already delivering at or above 100% of their contracted activity, but I recognise that we need to go further, and I am meeting stakeholders in the profession to see what further steps we need to take.

[Sir Oliver Heald]

Were any consultees concerned about human rights issues, and would that impact on consulting and on the way in which the measures on sampling and so on are implemented?

[Will Quince]

I was not avoiding my right hon. and learned Friend’s question, but I do not have an answer for him as my officials have not been able to find one in the short time that they have had. I will certainly commit to writing to him and to any other Committee member who is interested. Of course, if people made challenges or raised concerns on those grounds, they would be given weight as part of any consultation.

I understand that this is an emotive subject and that there are strong views on either side of the debate. That debate has already been had as part of the passage of the Act, but I trust that my answers—notwithstanding the one that I have failed to deliver for my right hon. and learned Friend the Member for North East Hertfordshire—have provided some reassurance on the benefits of water fluoridation and, in particular, on the importance of the consultation regulations. The regulations reflect the consultation responses from the public, and will not restrict those who want to respond to future public consultations on water fluoridation schemes.

I hope that my answers have also provided some reassurance on removing the requirement of the CQC to issue statutory guidance on mandatory learning disability and autism training. Let me be clear: that will not leave service providers without clear information. It will not be removed until it has been replaced with the code of practice.