I dont agree with Dr Annett's judgement that it is a 'reasonable...means' and would much prefer that full consideration is given to the ethical issues involved right from the off as opposed to just looking at technical matters. Issues like this should be looked at as a whole, as all its various aspects interact.
It may just be inexact writing but I'm also somewhat concerned at this statement '...NHS Bristol will ensure that the public have every opportunity to understand why fluoridation could be an effective public health intervention...' because its far from sufficiently balanced by the words that follow '...and also learn of some of the concerns people may have.' - not the strong emphasis on looking at both sides without bias that I would advocate. Having said this I have since had a message from NHS Bristol which makes reference to presenting a balanced case for and against and asking me if I would be interested in featuring in this process (which I've said yes to).
Dear Mr Vowles,
Re: Fluoridation of Bristol’s Water Supply
Thank you for your recent correspondence regarding the potential fluoridation of Bristol’s water supply.
To avoid any confusion, I assume the release to which you are referring is titled: “Call for public consultation on fluoridation”. This release (or rather statement) was issued by the Department of Health on February 5 2008.
However, you are correct about NHS Bristol considering the fluoridation of Bristol’s drinking water. In recent months, NHS Bristol and our neighbouring PCTs have considered whether the fluoridation of drinking water could be a reasonable and cost-effective means of improving overall dental health and help reduce dental inequalities.
Dr Annett has concluded that it could, and he is recommending that the PCT request NHS South West to commission a technical feasibility study.
At this stage I would like to reassure you that no decisions have yet been made. Requesting a feasibility study is the first step in a process which may, or may not lead to a decision to fluoridate Bristol’s water.
If, and only if, the feasibility study supports fluoridation then the next stage of the process is a rigorous and transparent public consultation where we seek the views of as wide a representation of Bristol’s (and the surround areas) population before any decision is made.
We are committed to ensuring that the debate will be an open and transparent process ensuring the public have their say and will make final representations based upon the consensus of the views of the population. The consultation is externally regulated, and we are bound – by a legal and moral obligation – to ensure that we consult as widely and as completely as possible, and that it is the citizens of Bristol and potentially the wider neighbouring regions that make this important decision.
Throughout the process NHS Bristol will ensure that the public have every opportunity to understand why fluoridation could be an effective public health intervention and also learn of some of the concerns people may have.
If the feasibility study confirms that fluoridation is feasible and cost effective in treatment of water for Bristol, NHS Bristol’s opinion that the population – particularly those in deprived areas – would benefit from a combination of fluoridation of the water and the ongoing commitment to raising awareness of dental health issues which NHS Bristol demonstrates.
If implemented, the fluoridation of Bristol’s water supply will sit alongside a great deal of ongoing pro-active, community facing initiatives we have at improving dental health.
Interestingly, in the near future we are running a campaign aimed at filling NHS Dental entitlements at surgeries throughout Bristol – it may surprise you to note that a large number of surgeries struggle to attract enough NHS patients to their doors.
I appreciate you contacting me and hope that I have answered some of your questions and outlined more clearly the decision making process for fluoridation.