Lettter from Liz Vaughan to DoH
Jerry Read
Department of Health
325 Richmond House,
79 Whitehall,
London SW1A 2N
Open Letter for distribution
Dear Mr Read:
Re: Costs of implement drinking water fluoridation and impact on NHS services.
Member councils of UK Councils Against Fluoridation (UKCAF) have expressed concern over the costs of implementing drinking water fluoridation. In particular they fear the impact it will have on SHA budgets, since it is the SHAs that will be footing the bill.
The British Fluoridation Society website states: "In the UK the total cost of water fluoridation is borne by the NHS." Lord Warner was quoted in Hansard: 08 March 2005 Water Fluoridation (Consultation) (England) Regulations 2005: "As fluoridation is a public health measure, the strategic health authorities pay the companies the full
cost of fluoridation."
UKCAF member councils are aware that most SHAs are currently operating in the red and can barely afford to maintain current levels of medical services, also that these SHAs are under pressure to balance their books, causing further contraction and threats to services.
In these circumstances, it seems clear that water fluoridation could only be implemented at the expense of essential medical services, such as life saving cancer drugs, heart surgery, transplants, MRSA infection control, etc.
Our enquiries regarding the costs of fluoridation, made to dental health officers and SHAs, have exposed the fact that no one in a decision-making capacity has any idea of the overall price tag - yet they appear eager to initiate public consultations, after which water companies will be obliged by law to implement fluoridation. This, surely, is putting the cart before the horse? Devoting NHS monies to promote "consultations", when the people promoting fluoridation have no idea if they can afford to implement the scheme, is financial irresponsibility of the highest order.
As far as on-going running costs are concerned, we have heard the estimate of £0.50 per person per year bandied about for many years. We are also aware that the estimated start-up costs for fluoridating London were £22M in 2003. Our investigations indicate that the initial start-up costs can run between £500K - £1.0M+ per fluoridation facility. These estimates do not include:
1. water company feasibility studies,
2. water company oversight of design, engineering and construction of
these facilities,
3. ongoing maintenance and running costs; and
4. neither do they include the - no doubt considerable - legal costs which
would inevitably be incurred when contracts have to be agreed between
several SHAs, and/or water companies.
For instance, the East Yorkshire SHA (which is making noises about fluoridation) also covers North Yorkshire and North Lincolnshire. However, while all of Yorkshire is served by Yorkshire Water, North Lincolnshire is served by Anglian Water and Severn Trent. Yorkshire Water has 85 water treatment plants on an interconnected grid
system - fluoridate one area and you have to fluoridate all of Yorkshire; therefore, fluoridation requires the simultaneous co-operation of all three strategic health authorities in Yorkshire - to begin with.
In order to fluoridate, the East Yorkshire SHA has to choreograph consultations, not only with the SHAs in West and South Yorkshire, but also with the Lincolnshire SHA, which would be receiving fluoridated water from Anglian Water, and Nottinghamshire SHA. Now we have four SHAs involved.
Severn Trent handles all of Nottinghamshire's water, but also extends further South into other SHAs' territories. So for a fluoridation scheme to work in East Yorkshire, it will involve the co-ordinated efforts of at least four SHAs and three water companies - probably more.
[Wearenottakingotheroverlapsintoconsiderationforthesakeofbrevity.]
In the absence of a firm quotation, our best estimate of the start-up costs of fluoridating Yorkshire alone is about £85M, which will have to come out of the NHS budget. The scheme will take from 3 - 5 years to implement - barring unforeseen engineering problems which may arise. Supposing this cost is shared equally between them, the bottom line cost to each of Yorkshire's three SHAs will be about £28M.
Such a sum would make significant inroads into health budgets which are already severely stretched. UKCAF member councils do not see how it could be met without cutting services.
The British Fluoridation Society and "fluoride information.com" at Manchester University both state that "Government grants" will be forthcoming to help pay for fluoridation. We have found no mention of this, either in the Water Act 2003, or in Hansard.
Having legitimate concerns about the implications for health service provision, we wish to raise the following questions:
1. Does DoH intend reimbursing SHAs the costs of implementing
fluoridation, so the schemes do not come at the cost of cuts in essential medical services?
2. If so, will this be 'new money' allocated to DoH specifically to pay for
fluoridation?
3. If not, how much money from existing budgets has been earmarked for that purpose?
4. Fluoridation of drinking water has the perceived benefit, after five years, of inhibiting one cavity on one surface of on one tooth (molars have five surfaces and the front teeth have four surfaces) - but only provided that a dental hygiene education program is simultaneously implemented (at further cost).
During those five years, people continue to suffer from toothaches - many are already unable to find a dentist. How much money is fluoridation going to drain from the already understaffed and under-funded NHS dental service?
We appreciate your attention and response to our concerns.
Yours sincerely
Liz Vaughan, Cllr.
Information Officer
UK Councils Against Fluoridation
Croft End
Lowick Bridge
Cumbria
LA12 8EE
Department of Health
325 Richmond House,
79 Whitehall,
London SW1A 2N
Open Letter for distribution
Dear Mr Read:
Re: Costs of implement drinking water fluoridation and impact on NHS services.
Member councils of UK Councils Against Fluoridation (UKCAF) have expressed concern over the costs of implementing drinking water fluoridation. In particular they fear the impact it will have on SHA budgets, since it is the SHAs that will be footing the bill.
The British Fluoridation Society website states: "In the UK the total cost of water fluoridation is borne by the NHS." Lord Warner was quoted in Hansard: 08 March 2005 Water Fluoridation (Consultation) (England) Regulations 2005: "As fluoridation is a public health measure, the strategic health authorities pay the companies the full
cost of fluoridation."
UKCAF member councils are aware that most SHAs are currently operating in the red and can barely afford to maintain current levels of medical services, also that these SHAs are under pressure to balance their books, causing further contraction and threats to services.
In these circumstances, it seems clear that water fluoridation could only be implemented at the expense of essential medical services, such as life saving cancer drugs, heart surgery, transplants, MRSA infection control, etc.
Our enquiries regarding the costs of fluoridation, made to dental health officers and SHAs, have exposed the fact that no one in a decision-making capacity has any idea of the overall price tag - yet they appear eager to initiate public consultations, after which water companies will be obliged by law to implement fluoridation. This, surely, is putting the cart before the horse? Devoting NHS monies to promote "consultations", when the people promoting fluoridation have no idea if they can afford to implement the scheme, is financial irresponsibility of the highest order.
As far as on-going running costs are concerned, we have heard the estimate of £0.50 per person per year bandied about for many years. We are also aware that the estimated start-up costs for fluoridating London were £22M in 2003. Our investigations indicate that the initial start-up costs can run between £500K - £1.0M+ per fluoridation facility. These estimates do not include:
1. water company feasibility studies,
2. water company oversight of design, engineering and construction of
these facilities,
3. ongoing maintenance and running costs; and
4. neither do they include the - no doubt considerable - legal costs which
would inevitably be incurred when contracts have to be agreed between
several SHAs, and/or water companies.
For instance, the East Yorkshire SHA (which is making noises about fluoridation) also covers North Yorkshire and North Lincolnshire. However, while all of Yorkshire is served by Yorkshire Water, North Lincolnshire is served by Anglian Water and Severn Trent. Yorkshire Water has 85 water treatment plants on an interconnected grid
system - fluoridate one area and you have to fluoridate all of Yorkshire; therefore, fluoridation requires the simultaneous co-operation of all three strategic health authorities in Yorkshire - to begin with.
In order to fluoridate, the East Yorkshire SHA has to choreograph consultations, not only with the SHAs in West and South Yorkshire, but also with the Lincolnshire SHA, which would be receiving fluoridated water from Anglian Water, and Nottinghamshire SHA. Now we have four SHAs involved.
Severn Trent handles all of Nottinghamshire's water, but also extends further South into other SHAs' territories. So for a fluoridation scheme to work in East Yorkshire, it will involve the co-ordinated efforts of at least four SHAs and three water companies - probably more.
[Wearenottakingotheroverlapsintoconsiderationforthesakeofbrevity.]
In the absence of a firm quotation, our best estimate of the start-up costs of fluoridating Yorkshire alone is about £85M, which will have to come out of the NHS budget. The scheme will take from 3 - 5 years to implement - barring unforeseen engineering problems which may arise. Supposing this cost is shared equally between them, the bottom line cost to each of Yorkshire's three SHAs will be about £28M.
Such a sum would make significant inroads into health budgets which are already severely stretched. UKCAF member councils do not see how it could be met without cutting services.
The British Fluoridation Society and "fluoride information.com" at Manchester University both state that "Government grants" will be forthcoming to help pay for fluoridation. We have found no mention of this, either in the Water Act 2003, or in Hansard.
Having legitimate concerns about the implications for health service provision, we wish to raise the following questions:
1. Does DoH intend reimbursing SHAs the costs of implementing
fluoridation, so the schemes do not come at the cost of cuts in essential medical services?
2. If so, will this be 'new money' allocated to DoH specifically to pay for
fluoridation?
3. If not, how much money from existing budgets has been earmarked for that purpose?
4. Fluoridation of drinking water has the perceived benefit, after five years, of inhibiting one cavity on one surface of on one tooth (molars have five surfaces and the front teeth have four surfaces) - but only provided that a dental hygiene education program is simultaneously implemented (at further cost).
During those five years, people continue to suffer from toothaches - many are already unable to find a dentist. How much money is fluoridation going to drain from the already understaffed and under-funded NHS dental service?
We appreciate your attention and response to our concerns.
Yours sincerely
Liz Vaughan, Cllr.
Information Officer
UK Councils Against Fluoridation
Croft End
Lowick Bridge
Cumbria
LA12 8EE
posted by Bill at
9:24 AM
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