The Health and Care Act (2022) has an important bearing on the future of water fluoridation.
What the Act will do
Evidence supports water fluoridation as an effective public health measure that has the ability to benefit both adults and children, reduce oral health inequalities and offer a significant return on investment. There is also no evidence of health harms from the levels of fluoride used in English schemes, nor the slightly higher levels allowed naturally. Despite this, no new schemes have been implemented for nearly 40 years.
Since 2013 local authorities have had the responsibility, through the Water Industry Act 1991, to propose and consult on new community water fluoridation schemes and variations to or termination of existing schemes. Local authorities have, however, reported difficulties with the current process and there is the added complication that local authority boundaries are not coterminous with water flows. If the water supply crosses into neighbouring authorities it requires the involvement of several authorities in the development of schemes, which may be complex and burdensome.
In light of these challenges, the purpose of the water fluoridation clauses in the Act is to give the Secretary of State the power to directly introduce, vary or terminate water fluoridation schemes. The revenue costs of the schemes would also transfer to the Secretary of State. This will allow central government to directly take responsibility for fluoridation schemes. Any future decisions on new fluoridation schemes will be subject to funding being secured.
The Secretary of State will continue to be responsible for reimbursing water undertakers for costs associated with water fluoridation schemes, however the Act provides the Secretary of State with a power to make regulations that could disapply this requirement in certain situations (to be specified in those regulations). Regulations made using this power would be subject to consultation and an affirmative resolution procedure to ensure there is appropriate scrutiny of any such proposal.
The Act will also allow regulations to be made which would provide for future cost sharing with public sector bodies such as the NHS or local authorities. These regulations would be subject to consultation with any affected parties.
The Act will also transfer the requirement from local authorities to the Secretary of State to consult water undertakers on whether any fluoridation scheme, or variation or termination to existing schemes are operable and efficient, prior to undertaking any public consultation.
The duty to consult on any future schemes will transfer to the Secretary of State and will allow for regulations to be made to provide more detail on the process and any requirements for consultation (and circumstances where consultation is not required). This will allow for consultations to be undertaken directly by central government.
The Act will also allow for current water fluoridation arrangements held with water undertakers to be updated.
For details see https://www.legislation.gov.uk/ukpga/2022/31/part/6/crossheading/fluoridation-of-water-supplies/enacted The fluoridation sesction is at the bottom of the act.
Further information on the logistics that follow from the Act are awaited