Daily Echo - Health Chief demands a rethink on fluoride

By Rachel Masker
rachel.masker@daifyecho.co.uk
A HAMPSHIRE health watchdog is demanding a rethink of the controversial decision to add fluoride to tap water in Southampton and other parts of the county.
Now the boss of a top county health committee has written to those behind the scheme calling for it to be scrapped.
Councillor Anna McNair Scott, chairman of the health overview and scrutiny committee, said it was "inappropriate in the extreme" for South Central Strategic Health Authority to proceed.
The Tory county councillor said strong public opposition remained to the scheme to fluoridate the drinking water supplied to almost 200,000 homes.
She said the latest figures on children's dental health in Southampton showed the need for fluoridation as a way to reduce tooth decay had been "overstated" when it was requested by city health chiefs.
As revealed by the Daily Echo last October, research showed the proportion of five-year-olds in the city suffering tooth decay had fallen dramatically, and is now virtual the same as averages.
The figures also showed a decline in the number of teeth affected by disease, giving Southampton better results than Birmingham - where fluoride has been added to the water since the 1960s. The councillor said the results
backed up reservations published in the York Review - the most comprehensive study of fluoridation, published a decade ago - about the benefits of the practice.
Mrs McNair Scott also believes the £400,000 cost of fighting a judicial review of the decision to proceed with fluoridation is a significant expenditure when "primary care trusts are already struggling to maintain frontline services.
A high court judge is to examine claims lodged by Southampton resident Gerealdine Milner that health chiefs ignored public opinion. The case could be heard at the Royal Courts of of Justice before the end of the year.
In her letter to the authorities Mrs McNair Scott said: My purpose in writing to you is to formally request that the strategic health authority board reconsiders its decision to proceed with these plans taking account of the new evidence that has emerged and its stewardship responsibilities in relation to the use of public funding.
"To proceed with this proposal against the wishes of the population affected would seem to be inappropriate in the extreme at a time when real pressures ai-e beginning to emerge in public sector finances."
In a letter of reply, Andrea Young, chief executive of South Central Strategic Authority, said it would be inappropriate to comment on public support for fluoridation as the case was now subject to judicial review. But she said the authority was pleased children in the region generally have better dental health than many other parts of the country.
The health boss added: "However the regional data does hide significant pockets of poor dental health in some of the big towns and cities in our region."
She also warned against using the latest dental figures for comparisons with previous statistics because of a change in the way the survey was carried out.
Ms Young continued: "The strategic health authority takes its responsibility for the use of public funds extremely seriously.
"Having followed the relevant legislation and Department of Health guidance, it reached the conclusion that health arguments in favour of fluoridating the water supply in Southampton and south west Hampshire outweigh the arguments against fluoridation. It remains of that view."
10,000 opinions
More than 10,000 people submitted their opinions during a public consultation with 72 per cent of those living in the targeted area - covering parts of Southampton, Eastleigh, Tottpn, Netley and Rownhams - saying they were against fluoridation.
Totton South and Marchwood county councillor David Harrison said: "The strategic health authority is now spending large sums of taxpayers' money trying to defend the indefensible which is about imposing something that the public doesn't want.
"They have ignored the results of their own consultation which again involved the investment of large sums of taxpayers' money."


Letter from Anna McNair Scott, chairman of the health overview and scrutiny committee, at Hampshire County Council, to Andrea Young, chief executive of South Central Strategic Authority
Dear Andrea
It is now over a year since the SHA Board took the decision to approve the request of Southampton City PCT to add fluoride to the drinking water in parts of Southampton and South West Hampshire.
You will be aware of the strong opposition to this proposal that Hampshire County Council expressed: I would wish to reaffirm that our objections, on the grounds of both evidence base and ethics, given the strength of local opposition, remain. There have been a number of developments since the decision taken by the Board that have prevented the implementation of the proposal, and in our view further weakened the grounds on which the SHA felt it was acceptable to proceed. Firstly, a judicial review case is pending and the initial support expressed by a minority of elected representatives, including MPs and Local Authorities, has evaporated in the face of the continued opposition that has been expressed by the population affected.
Because of the support of the Southampton City Council, the SHA Board felt able to disregard the assurances of Ministers, and indeed the Prime Minister, that fluoride should not be added to drinking water unless this was supported by the public. This support no longer exists. Secondly, the recently published figures of children's dental health in Southampton are evidence that the case of need put forward by the Southampton City PCT and dental health professionals was overstated.
The reservations, clearly expressed in the York supply in addressing health inequalities are reinforced by this evidence. Thirdly, I have previously questioned the infrastructure and maintenance costs of the proposals and have not received clear answers. The consultation process has incurred significant expenditure and, regardless of the outcome, the judicial review will add a further £400,000 to this total.
The uncertainty about the added value the scheme will bring for the target population coupled with the added costs of physical implementation would suggest that it would be wrong for the board not to revisit its original decision. My purpose in writing to you is to formally request that the SHA Board reconsiders its decision to proceed with these plans taking account of the new evidence that has emerged and its stewardship responsibilities in relation to the use of public funding. To proceed with this proposal against the wishes of the population affected would seem to be inappropriate in the extreme at a time when real pressures are beginning to emerge in public sector finances. PCTs are already struggling to maintain front line services and this is likely to escalate. I look forward to receiving confirmation of the action you are taking in response to this letter by 17 May 2010.
Anna McNair

SHA response from chief executive Andrea Young
Dear Cllr McNair Scott
Plans to add fluoride drinking water in Southampton and South West Hampshire
Thank you for your letter dated 12 April 2010, formally requesting the South Central Strategic Health Authority's (SHA) Board to reconsider its decision to proceed with plans to fluoridate water in Southampton and parts of South West Hampshire.
I note your comment on the view of Hampshire County Council. As you mention in your letter, the SKA'S decision to instruct Southern Water to fluoridate the local water supply is now subject to judicial review proceedings. In light of this, it would be inappropriate to discuss your comments regarding support for the proposal at the current time.
With regard to the issue of data on the dental health of children in Southampton, the SHA is pleased that children in the NHS South Central region have, on average, better dental health than many other places in England. However, the regional data does hide significant pockets of poor dental health in some of the big towns and cities in our region. With regards to the dental figures published recently, you will note some important caveats contained in the full report. One of the main points to note is that for the first time, positive consent for examinations was required for this survey. In previous years, parents were advised the examinations were taking place, and, unless a parent objected, the examination went ahead.
The report authors stated: "This is the first survey of this type where parents of children were required to give consent and therefore bias resulting from non-response cannot be ruled out. As a result, direct comparisons with previous surveys should not be made. Non-respondents were more likely to be from deprived areas, where there is a tendency for children to have higher levels of dental decay. Data was weighted to take this into account, but it may be that non-respondents had different levels of dental decay over and above that which may be explained by deprivation alone."
It is therefore not prudent to base decisions solely on this information, especially when there had been no corresponding fall in tooth extractions under general anaesthetic for children under five years old during the same time period.
The SHA takes its responsibility for the use of public funds extremely seriously. Having followed the relevant legislation and Department of Health guidance, it reached a conclusion that the health arguments in favour of fluoridating the water supply in Southampton and South West Hampshire outweigh the arguments against fluoridation. It remains of that view.
Andrea Young Chief executive