About the author: Dr Barry Cockcroft CBE is the former Chief Dental Officer for England and current chair of the British Fluoridation Society.
About the publication: The Probe provides news, comment, analysis and features covering all aspects of the UK dental sector.
Although the Health and Care Bill is still to complete its passage through the parliamentary process, the clauses that relate to water fluoridation are past the point where they can be challenged and, barring something quite exceptional, should become law when the Bill becomes an Act in the coming months. All over the country, the NHS has been appointing shadow Integrated Care System boards in anticipation of the completion of the legislative process, so it would take something quite unprecedented for this not to happen. There is much to commend in the Bill but much of it has been resisted by the opposition, and debate and discussion has been fierce. However, the clauses relating to fluoridation have been supported by both main sides of the political divide based on the overwhelming evidence that this is the best way to close the gap between the haves and have nots when it comes to caries prevalence.
Following the debates was interesting, listening to the few opponents quoting from the report by Lord Jauncey in Scotland, which prevented fluoridation being implemented years ago in Strathclyde, especially given that the judge made his decision “with regret” and not based on any evidence that water fluoridation was not effective or caused any harm, but on a technicality in the legislation relating to water supplies in Scotland. In fact, for those of us who have been supporters of water fluoridation for years, there are many wonderfully supportive quotes in his report – not to mention that Strathclyde is an area that would massively benefit.
One of the benefits of putting down amendments to proposed legislation is that Ministers can go a little further on what is intended and, after the head of Dental Public Health in the DH Office for Health Improvement and Disparities quite rightly pointed out at the British Fluoridation Society conference in October that the Bill does not commit to expanding the coverage of water fluoridation, the Government committed to making progress within three years during debate, which is very welcome.
There have been false dawns in relation to this subject in the past. The privatisation of the water companies in the 80s undermined the intention behind the 1985 legislation, and the Lansley reforms scuppered progress in the 2000s, but I feel there is a real opportunity now and the profession must get behind the politicians and dental public health leads as this moves forward. There must have been a huge amount of work behind the scenes to get these clauses into the Bill and keep them there safely through the process. I am sure huge credit must go to Sandra White and, later, Anna Ireland, together with their teams, for getting this far.
There will still need to be some form of consultation, hopefully national, so that non-evidence-based claims of either harm or ineffectiveness can be dismissed. The statement by the four UK CMOs last September has been hugely helpful and may also encourage the governments in the Devolved Administrations to follow England’s lead. Strathclyde would certainly benefit!
There will also be a need for work to be done locally when proposals are made and engagement events are possibly arranged. I have seen at first hand the impact unsubstantiated claims of harm can have on a population, and dental teams will need to be ready to inform people of the evidence locally when needed.
When I started in practice in the mid-70s, I worked in an area where some of the water was fluoridated, and some was not. We could usually tell from which of these areas children came from just by looking at their teeth.
Now, nearly fifty years on, with an older population almost all dentate, the benefit is just as important for that generation. Good prevention lasts for life and at a time when the NHS is going to come under huge financial pressure, the fact that water fluoridation is also the most cost-effective preventive intervention must surely have played some part in internal discussions.
I was massively encouraged when the Green Paper on prevention was published in 2019, despite there being no direct reference to oral health. It is great to see that those in a position to do so have placed oral health inequalities on the agenda and done something about it.
People wanting to learn more about the subject, and possibly help, should look on the British Fluoridation Society website (bfsweb.org) and possibly even join the society. Membership is free!