Water Fluoridation

Questions (183, 184, 185, 186)

Dara Calleary

Question:

183. Deputy Dara Calleary asked the Minister for Health if he will provide details of the product specification of fluoride which is added to the public drinking water supply; if he will further provide details surrounding the organisation which has given approval to the fluoride product meeting standards for human consumption; and if he will make a statement on the matter. [42549/13]

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Dara Calleary

Question:

184. Deputy Dara Calleary asked the Minister for Health his views that the on-going adding of fluoride to the public drinking water supply is justified in view of the fact that 98% of European countries have rejected the practice on health grounds; and if he will make a statement on the matter. [42550/13]

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Dara Calleary

Question:

185. Deputy Dara Calleary asked the Minister for Health if he will provide details of the action that has been taken to address the European Commission 2011 report on fluoridation which stated that children here are getting unsafe doses of fluoride every day; and if he will make a statement on the matter. [42551/13]

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Dara Calleary

Question:

186. Deputy Dara Calleary asked the Minister for Health the precise details of health studies on fluoridation of water which have been carried out by his Department as per the Health Act 1960 which requires that It shall be the duty of future Health Ministers to carry out such studies; and if he will make a statement on the matter. [42552/13]

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Written answers (Question to Health)

I propose to take Questions Nos. 183 to 186, inclusive, together.

Water fluoridation and the use of appropriate fluorides is a major plank of public health policy in Ireland in the prevention and management of tooth decay. In 2002 the Forum on Fluoridation, which was established to review this policy, concluded that the fluoridation of public piped water supplies should continue as a public health measure.

Fluoride may be added to public water supplies either in the form of hydrofluosilicic acid complying with the specifications for that substance in Schedule 1 to the Fluoridation of Water Supplies Regulations 2007 (SI 42 of 2007) or in such other form as may be approved by the Minister. Chemifloc Ltd. is the company contracted by the HSE for the supply and delivery of hydrofluosilicic acid for the purpose of water fluoridation. Fluoride is sourced as a primary product in Spain, mined directly from a raw material source - the mineral fluorospar. It goes through a purification process to conform to tightly controlled specifications under the requirements of CEN Standard I.S.EN 12175:2001 to produce hydrofluosilicic acid, specifically used as the mineral additive, fluoride, to water. This process is conducted by a company in Spain - Derivados del Fluor. The fluoride is added to the public water supplies at water treatment plants throughout the country by the local authorities acting as agents for the health authorities as provided for in the Health (Fluoridation of Water Supplies) Act 1960.

The Fluoridation of Water Supplies Regulations 2007 requires that a daily test is carried out at water treatment plants by the local authority water services staff to determine fluoride content. Monthly fluoride testing is carried out by the HSE and the Environmental Protection Agency also carries out testing which requires monitoring of fluoride levels in water supplies.

Some European countries use an alternative systemic approach to fluoridation such as salt fluoridation or milk fluoridation in their public health programmes. Others use fluoride mouth-rinses and/or tooth-brushing or painting of teeth with fluorides. Additionally, all European countries promote the widespread use of fluoride toothpastes.

The USA, Canada, Australia, New Zealand, United Kingdom, Israel, Malaysia, Singapore, Hong Kong, Argentina, Chile, and Colombia actively fluoridate water supplies. Over 204 million people (approximately 66% of the population) in the USA receive fluoridated water with coverage having increased by around 24 million people between 2002 and 2012.

No claim associating water fluoridation at the optimal level with negative health effects has been substantiated. A known side effect at this level is enamel fluorosis, which is a cosmetic or aesthetic condition which refers to the way teeth look and is generally easy to treat. This is in contrast to the treatment of tooth decay which may on occasion involve the use of general anaesthesia and hospitalisation. Fluorosis has been rigorously monitored in Ireland and changes in fluorosis levels were responded to by lowering the levels of fluoride in water from 2007 and advising on the appropriate use of fluoride toothpaste.

The European Commission Report 2011 to which the Deputy refers is presumably the Report of the Scientific Committee on Health and Environmental Risks (SCHER). It states that a narrow margin exists in children between achieving the beneficial effects of fluoride in reducing dental decay and the potential adverse effect of dental fluorosis. This is true regardless of the source of fluoride, whether from water fluoridation or other sources, such as ingested toothpaste. The maximum fluoride concentration allowed in fluoridated water in Ireland is 0.8 mg/l. The SCHER conclusions derive from concentrations exceeding 0.8mg/l; 1.5mg/l and 3mg/l. It cannot be inferred from these conclusions that children here are exposed to unsafe doses of fluoride on a daily basis.

The impact of water fluoridation on caries levels in Ireland has been regularly assessed in both national and local surveys since its introduction in the mid 1960s. The national studies which have been undertaken are Children's Dental Health in Ireland 1984; Oral Health of Irish Adults 1989-1990; Oral Health of Irish Adults 2000-2002; North South Survey of Children's Oral Health 2002. In addition, regional studies were undertaken in the 1990s and a cross border study in 2006. All show a substantial benefit of fluoride in terms of a reduction in tooth decay. At present a research project "Fluoride and Caring for Children's Teeth " (FACCT) is being conducted by the Oral Health Services Research Centre, University College Cork and supported by the HSE.

The Irish Expert Body on Fluorides and Health, established in 2004, continuously monitors new and emerging issues on fluoride and its effects. It advises that the balance of scientific evidence worldwide confirms that water fluoridation, at the optimal level, does not cause any ill effects and protects the oral health of the population. The opinion of the Expert Body is supported by major international scientifically validated reviews. The effects of fluoride on health and related matters are kept under constant review.

Services for People with Disabilities

Questions (187)

Michael Colreavy

Question:

187. Deputy Michael Colreavy asked the Minister for Health the legislative basis for placing a person of unsound mind in a group home; the basis for setting charges relating to the care of such a person; the procedures used to ensure the proper and accountable management of the person's financial resources. [42555/13]

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Written answers (Question to Health)

Under the Health Act 2004 the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services, including residential services for people with a disability. Charges for those in receipt of long-stay residential care are governed by Regulations made under section 53 of the Health Act 1970 and supported by national implementation guidelines published by the HSE.

In May of this year I launched National Standards for Residential Services for Children and Adults with Disabilities. The Standards seek to ensure that residential services have all the necessary safeguards and protections for people with disabilities as well as ensuring that the unique and complex needs of each individual person are met in an appropriate manner by service providers and their staff.

In relation to access to financial accounts of service users, the standards specifically state that each person should be supported to take responsibility for their own financial affairs. The standards request service providers to ensure service users have easy access to personal monies and control their own financial affairs in accordance with their wishes. In addition, where service users need support to manage their financial affairs, they may nominate a person to be entrusted with this responsibility. Nominated persons are required to keep an account of all monies spent and if such persons are also staff members, they are also accountable to the person in charge as well as the service user concerned.

The regulations required to underpin these standards in law are now complete and the scheme of registration and inspection of residential services for people with disabilities is expected to commence in the coming weeks.

Ambulance Service Provision

Questions (188)

Peadar Tóibín

Question:

188. Deputy Peadar Tóibín asked the Minister for Health what the pre-hospital emergency key performance indicators are for the region containing County Meath for the past five years; and what the ambulance services KPI's are for the region containing County Meath for the past five years [42612/13]

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Written answers (Question to Health)

The HSE publishes monthly performance data, including performance information for pre-hospital emergency response times at national level. This information is collected from data reported at regional level within the National Ambulance Service and is available to management for information and decision-making in relation to local service provision. In relation to your query regarding pre-hospital emergency KPIs for the region containing County Meath, as this is a service matter, I have asked the HSE to respond directly to the Deputy.