Southampton is to become the first place in Britain to add fluoride to its water supply in more than two decades. After health chiefs this week backed the controversial plans, JON REEVE asks what happens next, and how much fluoridation will actually cost us.

The dust has barely settled on one of the most divisive health decisions Hampshire has ever seen, but work is already under way to put its outcome into practice.

South Central Strategic Health Authority (SHA) is now putting the wheels in motion that could see 200,000 people living in and around Southampton drinking fluoridated water before the end of next year.

But how much will the process cost, and how much has already been spent getting to this stage?

The SHA spent around £140,000 on its 14 week public consultation – well within its original £178,000 budget – but now the financial burden falls on other shoulders.

The Department of Health will pick up the tab for the capital costs of fluoridation, which involve building the plant that allows the dose to be added to water supplies.

Estimates produced for the SHA guessed that the bill will be around £471,000.

During the consultation, Southern Water did not express an opinion on the scheme, but did suggest the costs involved had been underestimated.

“We have evidence from installation of similar chemical dosing plants to suggest the capital costs estimated are low,” reads company feedback.

That shortfall, which will have to be made up from the public purse, is currently estimated at more than £100,000.

Even then, there will be further costs involved because of the limited lifespan of the equipment being used.

Best estimates currently envisage that all mechanical and instrumentation items will need replacing every five years, while the electrical and control equipment involved will last 15 years.

More hardy civil works are expected to survive for more than 20 years.

But after the decision was made, the regional director of public health, Professor John Newton was quick to play down fears that costs could spiral out of control.

He insisted that even with a six-figure addition in the estimates for the set-up fees, fluoridation makes financial sense.

“It makes very little difference to the position on cost-effectiveness, we’re talking about a small, perhaps about 20 per cent, change in capital costs,” said Professor Newton.

“But it is a very small amount of money compared to what the local Primary Care Trust spends on oral health in the community.

“And if water fluoridation is introduced it will reduce the level of dental ill health, it will reduce hospital admissions and it will reduce the level of dental treatment.

“The costs saved will be very considerable – much, much greater than the costs of introducing it in the first place.”

On top of the £500,000 set up costs, fluoridation will also require an annual outlay of around £60,500.

Southampton City Primary Care Trust, which proposed the scheme to improve dental health in the city, will have to pay the on-going fees involved – including buying the hexafluorosilicic acide that will actually go in the water.

Dr Andrew Mortimore, Southampton’s public health director said he believes fluoridation will prevent childhood tooth decay in a total of 36,000 teeth over 20 years.

In the same time, the PCT will pay around £1.2 m for upkeep of the scheme.

Dr Mortimore believes that will be money well spent, as was the £30,000 the PCT spent promoting fluoridation during the public consultation.

“Given the poor level of oral health in the city, it is important that the local NHS addresses this problem as part of its work to improve the health and wellbeing of Southampton people,” he said.

“Southampton City PCT has invested a large amount of money in recent years in oral health promotion work and in improving access to NHS dentists across the city, but tooth decay still remains a real problem.

“We’ve attempted a wide range of initiatives, but in the last eight years the situation has got worse, not better.”

So while no one knows for certain exactly how much taxpayers’ money will be spent on adding fluoride to the water, health chiefs insist with unwavering certainty it will represent good value.

Even if, with repairs, the total bill tops £2m over the next 20 years, they say that, put against Southampton’s annual dental health budget of £10 m, it is a just a drop in the ocean.

Do you agree with the decision to put fluoride into the city’s water supply?

No: 46%

Yes: 28%

Don’t Know: 26%

• Lee Emery, of Shirley. “I don’t agree with it because our basic human right of choosing how to live our lives has been taken away. Why should we be forced to live their way?”
• Paul Burniah, of Southampton: “It’s a lot of public money to be spent when people could just look after their teeth better.”
• Mrs. Mor O’Brien, of Southampton: “I can’t find any toothpaste without fluoride, so it’s everywhere anyway.”
• Joan Dorrington, of Southampton: “During the war we didn’t have sweets or sugar and I’ve still got my teeth, so there must be something in that.”
• Beccy Lawrence, of Finley. “I don’t agree with the fact that it’s forced medication. And I don’t like the fact that they’re not totally sure of the effects.”
• Tiffany Pennery, of Thornhill: “It could be a good idea but the health risks are worrying because I don’t know enough about it.”