Consultation outcome

Water fluoridation: seeking views on future consultation process - government response to consultation outcome

Updated 20 July 2022

Introduction

Tooth decay is a disease that affects people at all stages of life. It can reduce children’s ability to learn, thrive and develop and, in older and more vulnerable populations, tooth decay may impede people’s ability to nourish themselves and communicate.

Despite being largely preventable, tooth decay continues to be a significant public health problem in England, disproportionally affecting those from the more deprived communities. Tooth decay is one of the most common causes of hospital admission in children and the costs of treating tooth decay are substantial.

Around 6 million people in England live in areas with water fluoridation schemes, including many in parts of the North East, as well as the West and East Midlands. There are also water supplies in England, serving around a quarter of a million people, where fluoride is naturally at similar levels to those seen in water fluoridation schemes.

There is strong scientific evidence showing that water fluoridation is a safe and effective public health intervention to reduce the incidence of tooth decay. Evidence continues to show that tooth decay is lower in areas served by water fluoridation schemes.

The 2022 Health and Care Act, once the relevant provisions are commenced, will allow the Secretary of State, to establish new water fluoridation schemes or to vary or terminate existing water fluoridation schemes in England. Under the previous legislation, this responsibility was held by local authorities.

There will continue to be a legal duty to undertake a formal public consultation before introducing any new water fluoridation schemes or before varying (in prescribed circumstances) or terminating an existing scheme. Secondary legislation will set out the process for consulting. To inform the drafting of the secondary legislation we launched a public consultation seeking views on the suggested approach to future consultations. This began on 8 April 2022 and ended on 3 June 2022.

This government response to the consultation provides a summary of the responses received during the 8-week consultation period. It provides responses by question, before giving an overview of the themes that emerged from respondents’ free text comments. It also sets out how the government proposes to carry out future water fluoridation consultations and the next steps, in light of the feedback received.

Outcome

The government is grateful for the responses provided to the consultation and has considered them carefully.  The themes and concerns set out in the responses are summarised below.

The majority of responses from organisations, and just under a quarter of the responses from individuals, supported consultation restricted to individuals affected and/or bodies with an interest in proposals.  The majority of individuals who responded, however, favoured a national consultation. 

We propose therefore to lay before Parliament draft regulations which provide that eligibility to respond to future water fluoridation consultations will not be restricted to those individuals who are directly affected and/or bodies with an interest.

The draft regulations will require a number of factors to be taken into account by the Secretary of State when making a decision on a water fluoridation proposal following consultation, and, in particular, there will be a duty to consider whether additional weight should be given to representations made by individuals directly affected and/or bodies with an interest.

We believe this strikes the right balance of allowing the whole population to have a voice on any future proposals and in particular those who are directly affected.

We will proceed to lay the draft regulations, which will be subject to debate in Parliament, as part of the parliamentary process.

Background

The government held a public consultation between 8 April and 3 June 2022 to seek views on the future approach the government should take, when consulting on new water fluoridation proposals. The consultation was available via the gov.uk website and respondents could either submit their responses online or by post. Parliamentarians with an interest and a range of interested stakeholders including local authorities and dental and public health organisations were alerted to the consultation and details of how to respond.

The first question outlined our suggested approach to future water fluoridation consultation. We suggested only seeking the views of individuals who might be affected by a water fluoridation scheme (people living and working in an area) and/or bodies with an interest. This would mean that the views of individuals not directly affected and/or bodies without an interest would not be considered.

The second question sought views on a suggested alternative approach which would allow anyone who resides in England, and bodies with an interest, to respond to any future water fluoridation consultation, even if a future proposal only related to a specific area of England.

More information on what water fluoridation is, what a water fluoridation scheme is and where existing schemes are can be found at Water fluoridation: seeking views on future consultation process.

Questions in the consultation

The consultation questions were:

1. Do you agree that any future consultation should continue to be limited to individuals living in areas directly affected by any future water fluoridation proposals and bodies with an interest?

2. Should individuals living in areas not directly affected by, or bodies without an interest in, any water fluoridation proposals be able to respond to future consultations?

A free-text box allowed respondents to provide a justification for their answers.

Findings

This section is a summary of the findings of the consultation. It details the consultation responses characterised by respondent’s characteristics, such as age, location, and ethnicity. It also summarises the themes that emerged from the free-text responses to each of the consultation questions.

Characteristics of respondents

There were 1,228 responses to the consultation of which 72 (6%) were from organisations and 1157 (94%) were from individuals.

Characteristics of organisations

Organisations included those from the dental or oral health sector (44%), local government (26%), charity or third sector (11%), general health organisations (7%), business (4%), other (4%) and education (3%). Some organisations fitted in more than one category, so the total exceeds 100%.

Most of the organisations that submitted a response operated in England (66%). Organisations that operated across the UK accounted for 22% of responses while those that operated in the devolved nations accounted for 7% in total (Scotland 3%, Wales 3%, Northern Ireland 1%). Organisations that operated outside of the UK made up 5% of responses. These categories were not mutually exclusive and there were only 2 organisations who reported that they did not cover England.

Characteristics individuals

Half of individual respondents were female (50%), males made up 32% of the responses and people who preferred not to disclose their sex accounted for 18%.

The age of individual respondents varied. People from the 55 to 64-year old age band submitted the most responses (26%). A relatively high proportion of responses were also received from those aged 35 to 44 and 45 to 54 (20% and 24% respectively). The proportion of 65 to 74-year-olds who responded was 13%. Less than 10% of all the responses came from those aged 16 to 24 (1%), 25 to 34-year olds (6%) and those aged 75 and over (2%). Some individuals preferred not to say which age band they fell into (8%).

Most individuals reported that they lived in England (93%), a further 3% lived in Scotland, 3% lived in Wales and 1% lived in Northern Ireland. A small proportion of respondents resided outside the UK (1%). A total of 85 people responded from the devolved nations or outside the UK.

Most individual respondents reported their ethnicity as white (70%). Some individuals preferred not to disclose their ethnicity (24%), and some classified themselves as other ethnic group (2%). The number of respondents from non-white ethnic groups were relatively low compared to other groups who responded at 74 people in total, making up 5% of respondents from the following groups black, black British, Caribbean or African groups (1%), Asian or British Asian (2%) or mixed or multiple ethnic groups (2%).

Most individual respondents (66%) reported no physical or mental health condition lasting 12 months or more with 14% reporting a condition and 21% preferring not to say.

Summary of responses by question

Do you agree or disagree that any future consultation should continue to be limited to individuals living in areas directly affected by any future water fluoridation proposals and bodies with an interest? Consultation question: 1

Summary of responses

When asked whether any future consultation on water fluoridation should continue to be limited to individuals living in areas directly affected and bodies with an interest:

• all respondents (including both individuals and organisations): 71% disagreed, 26% agreed, 3% did not know whether they agreed or disagreed
• organisations: 65% agreed, 34% disagreed, 1% did not know whether they agreed or disagreed
• individuals: 73% disagreed, 23% agreed, 3% did not know whether they agreed or disagreed

Responses from individuals

Sex

• female respondents: 71% disagreed, 25% agreed, 4% did not know
• male respondents: 72% disagreed, 27% agreed, 1% did not know
• respondents who preferred not to disclose their sex: 80% disagreed, 14% agreed, 6% did not know

Age

• 16 to 24 age band: 67% disagreed, 33% agreed, 0% did not know
• 25 to 34 age band: 67% disagreed, 31% agreed, 1% did not know
• 35 to 44 age band: 71% disagreed, 24% agreed, 4% did not know
• 45 to 54 age band: 73% disagreed, 24% agreed, 3% did not know
• 55 to 64 age band: 76% disagreed, 21% agreed, 3% did not know
• 65 to 74 age band: 74% disagreed, 24% agreed, 2% did not know
• 75 and above age band: 71% disagreed, 24% agreed, 5% did not know
• respondents who preferred not to say which age band they fell into: 76% disagreed, 18% agreed, 6% did not know

Ethnicity

• white ethnic groups: 72% disagreed, 26% agreed, 2% did not know
• Asian or British Asian ethnic groups: 70% disagreed, 20% agreed, 10% did not know
• black, black British, Caribbean or African ethnic groups: 50% disagreed, 50% agreed, 0% did not know
• mixed or multiple ethnic groups: 88% disagreed, 8% agreed, 4% did not know
• other ethnic groups: 77% disagreed, 23% agreed, 0% did not know
• respondents who preferred not to disclose their ethnicity: 77% disagreed, 17% agreed, 6% did not know

Location

• England: 73% disagreed, 24% agreed, 3% did not know
• Scotland: 88% disagreed, 6% agreed, 6% did not know
• Wales: 72% disagreed, 17% agreed, 10% did not know
• Northern Ireland: 92% disagreed, 0% agreed, 8% did not know
• outside of the UK: 67% disagreed, 22% agreed, 11% did not know

The presence of a physical or mental health condition lasting at least 12 months

• respondents who reported a physical or mental health condition lasting at least 12 months: 76% disagreed, 23% agreed, 1% did not know
• respondents who reported that they did not have a condition lasting at least 12 months: 72% disagreed, 25% agreed, 3% did not know
• respondents who preferred not to say whether they had a condition: 74% disagreed, 20% agreed, 6% did not know

Themes

The reasons given for preferring a national or local process were repeated across the 2 questions so are detailed in the separate themes’ section below.

Should consultation responses be considered from individuals living in areas not directly affected by, or bodies without an interest in, any future water fluoridation proposals? Consultation question: 2

Summary of responses

When asked whether any consultation responses should be considered from individuals living in areas not directly affected by, or bodies without an interest in, any further water fluoridation proposals:

• all respondents (including both individuals and organisations): 77% agreed, 19% of respondents disagreed, 4% did not know whether they agreed or disagreed with the proposal
• organisations: 58% disagreed, 38% agreed, 4% did not know whether they agreed or disagreed
• individuals: 80% agreed, 17% disagreed, 4% did not know whether they agreed or disagreed

Responses from individuals

Sex

• 79% females agreed (16% disagreed, 4% did not know)
• 77% males agreed (20% disagreed, 2% did not know)
• 85% of respondents who preferred not to disclose their sex agreed (11% disagreed, 4% did not know)

Age

• 16 to 24 age band: 78% agreed, 22% disagreed, 0% did not know
• 25 to 34 age band: 71% agreed, 26% disagreed, 3% did not know
• 35 to 44 age band: 79% agreed, 16% disagreed, 5% did not know
• 45 to 54 age band: 78% agreed, 17% disagreed, 4% did not know
• 55 to 64 age band: 84% agreed, 15% disagreed, 1% did not know
• 65 to 74 age band: 78% agreed, 16% disagreed, 6% did not know
• 75 and above age band: 76% agreed, 24% disagreed, 0% did not know
• respondents who preferred not to say which age band they fell into: 80% agreed, 15% disagreed, 5% did not know

Ethnicity

• white ethnic groups: 78% agreed, 19% disagreed, 3% did not know
• Asian or British Asian ethnic groups: 85% agreed, 10% disagreed, 5% did not know
• black, black British, Caribbean or African ethnic groups: 50% agreed, 50% disagreed, 0% did not know
• mixed or multiple ethnic groups: 92% agreed, 8% disagreed, 0% did not know
• other ethnic group: 86% agreed, 14% disagreed, 0% did not know
• respondents who preferred not to disclose their ethnicity: 82% agreed, 12% disagreed, 6% did not know

Location

• England: 79% agreed, 18% disagreed, 4% did not know
• Scotland: 91% agreed, 6% disagreed, 3% did not know
• Wales: 90% agreed, 3% disagreed, 7% did not know
• Northern Ireland: 92% agreed, 0% disagreed, 8% did not know
• outside of the UK: 78% agreed, 22% disagreed, 0% did not know

The presence of a physical or mental health condition lasting at least 12 months

• respondents who reported a physical or mental health condition lasting at least 12 months: 79% agreed, 18% disagreed, 3% did not know
• respondents who reported that they did not have a condition lasting at least 12 months: 80% agreed, 17% disagreed, 3% did not know
• respondents who preferred not to say whether they had a condition: 80% agreed, 15% disagreed, 5% did not know

Themes

The reasons given for preferring a national or local process were repeated across the two questions so are detailed in the separate ‘themes’ section below.

Themes

The free-text box allowed respondents to provide a comment to explain their answers and respondents raised several topics in response to the questions. The responses were analysed, and broad themes were identified by one reviewer. This was then reviewed and checked independently by 2 further reviewers. These were grouped into discreet themes.

Several themes emerged across the 1228 responses. There was much overlap in the answers to questions 1 and 2. Often the responses to question 2 reiterated responses to question 1 or suggested that we view their response to question 1 as a response to question 2.

Themes are summarised below.

Differences between organisation and individual responses

Despite the majority of individuals favouring a national consultation and the majority of organisations favouring consultation that would be restricted to individuals affected and/or bodies with an interest, similar themes emerged from the responses of both organisations and individuals. Individuals were more likely to focus on the rationale of their response to the question of whether the consultation should be a local or a national process. Organisational responses tended to be broader and included further consideration of the consultation process, in particular:

• how to ensure the consultation process gathers credible evidence
• the need to ensure that people who are less likely to engage in a consultation, are supported to respond
• who to involve and who not to involve, for example, whether to involve bodies with an interest outside of the UK

Local consultation process

There were many reasons why respondents advocated for a local consultation process. Frequently mentioned themes are summarised below:

• local issues affect local people so local views are the ones that matter
• a national process would allow people who are not directly affected by the water fluoridation proposal to have influence over a decision that affects others

National consultation process

There were many reasons why respondents advocated for a national consultation process. Frequently mentioned themes are summarised below:

• proposals on water fluoridation are in the national interest so everyone should be able to have their say
• people move around between areas, and will in the future, so any water fluoridation proposal will affect more than just the people who reside there - for example, people may move to an area in the future, may spend time there on holiday or may work or study in an area they do not live in
• people and organisations from outside the local area may provide evidence and information that could be useful

Water fluoridation

A number of respondents expressed their views on water fluoridation as a public health intervention. While we recognise that there are a range of views on this topic, the questions in this consultation did not seek views on water fluoridation so we have considered these responses to be outside of the scope of the consultation response.