The 'consultation' with only one answer

The 'consultation' with only one answer
Why ask people what they think if you then do the opposite, wonders Philip Johnston.
By Philip Johnston
Last Updated: 5:05PM GMT 01 Mar 2009
Local people should be able to decide whether their water is medicated Photo: PA When a public body says it is to carry out a consultation exercise, what does that suggest to you? Naively, I once believed that it involved asking people what they thought about a particular policy, setting out all the facts in an objective fashion, and if those likely to be affected did not like what they saw to drop or modify the original plan. It turns out, however, to mean nothing of the sort.

Ask the people of Southampton and its environs in south-west Hampshire. They have just been the subject of a "consultation" on whether to add fluoride to their water supply. There were 10,000 responses, 78 per cent of which were opposed. The local health authority carried out a telephone poll, which also showed a majority against. But it is going ahead anyway. Not only is this an affront to any concept of local decision-making, it is a breathtaking piece of social authoritarianism. Whether or not fluoride helps reduce tooth decay is irrelevant. Medication should not be added to the water supply; and especially when the people who drink it say they do not want it.

The history of this episode is especially revealing about the way the public has become utterly disenfranchised in a world where bureaucrats arrogantly assume they know what is good for the rest us. Although many people believe they already have fluoride in their tap water, only around six million actually do. Most of them live in the West Midlands and the North East, where artificial fluoride was first added about 40 years ago and around half a million are in areas where fluoride occurs naturally in the water. Successive governments have always wanted to increase coverage, believing it would be good for dental health. But the water companies did not want to fluoridate the supply, fearing they would be sued. They also did not consider public health to be their responsibility.

Matters came to a head in the early Nineties when health authorities in the North East, claiming the support of 70 per cent of the local population, proposed a fluoridation scheme, only for it to be rejected by Northumbria Water. So the Government decided to change the law. The 2003 Water Act gave the 28 strategic health authorities in England and Wales the power to order fluoridation, with water companies indemnified against any legal liabilities. There was one proviso: there would have to be a thorough consultation before proceeding. If artificial fluoride is safe, what do the water companies need to be indemnified against? Furthermore, the law was changed to prevent the water companies thwarting the wishes of local people; yet it is now being used to do the precise opposite. This is democracy EU style: you can give any answer so long as it's yes.

What is a consultation for? This one was carried out purely and simply because the legislation said it had to be. The process was heavily skewed in favour of acceptance. The local health authority and the Government bombarded the people of Southampton with scientific information purporting to show that fluoridation was safe and efficacious. Yet still a substantial majority did not want it to happen.

The reason is pretty obvious. They did not like the idea of forced mass medication. The Government maintains that because fluoride is preventative this is not medication, but that is just casuistry. On that basis, why not put statins or anti-depressants in the water? Supporters say that chlorine is added without anyone making a fuss; but that is to make the water safe to drink, which is a different matter altogether. Fluoride can be obtained from toothpaste should people wish it.

With some justice, opponents say the consultation exercise was a sham and the health authority was intent on proceeding come what may. The arrogance of this decision is quite astonishing. The facts were put out for people to see and the issue was straightforward enough: do you want fluoride or not? More than three quarters said no, which is a pretty conclusive proportion opposed by any measure. But then again, what do the local people know? They are obviously too stupid to understand the concept of adding a substance to the water supply; and they only have to drink it.

Opponents say there are potential health risks from fluoridation, including bone cancer and hip fractures in older people. Supporters say this is rubbish and that it is safely used in other countries. But this debate is now something of a sideshow set against the refusal to acknowledge the strength of local feeling against the proposal. It is possible to argue against enforced medication whether or not it is good for us. And when people, presented with both sides of the case, make it clear that, on balance, they would rather not have an artificial substance added to their water, it is outrageous simply to ignore them and carry on regardless.

It is apparent that Southampton is the vanguard of an attempt to fluoridate the whole of England (Scotland decided not to pursue fluoridation more than four years ago). It is reported that health authorities in the North West, Derbyshire, Bristol, and Kirklees in West Yorkshire are among those preparing to press ahead with similar proposals. But if you live there, don't worry. You will all be consulted first.