Water companies have statutory and regulatory duties to protect and improve public health and actively take steps to meet them. These include completion of risk assessments and the sampling of drinking water supplies that may cause the supply not to be wholesome. “Wholesomeness” is defined in the Water Supply (Water Quality) Regulations 2016 as water which does not contain any microorganism, parasite, or substance at a concentration or value which would constitute a potential danger to public health.

Where a water company is also legally required to add fluoride to water supplies to improve public health, it must do so in a way that complies with the Drinking Water Inspectorate’s Code of Practice on Technical Aspects of Fluoridation of Water Supplies 2021.

Protecting and improving public health is also a priority in the Government’s planned reforms for the water sector. A new taskforce, led by the Chief Medical Officer for England, will support the Department for Environment, Food and Rural Affairs, providing independent and technical advice on public health risks from water and opportunities to improve water treatment and protection.

The maintenance and expansion of water fluoridation schemes are set out in the Water Industry Act 1991 and associated regulations. These provide the requirements that apply to water companies where my Rt Hon. Friend, the Secretary of State for Health and Social Care, proposes to enter, vary, or terminate arrangements for fluoridation of water.

There are no current plans to change these requirements through new regulations. However, the White Paper A New Vision for Water published in January 2026 confirms that, as long term reforms to the water industry are delivered, the Department for Environment, Food and Rural Affairs will work in partnership with the Department of Health and Social Care to support delivery of 10-Year Health Plan, which includes assessing further expansion of water fluoridation where oral health outcomes are poorest.

The White Paper A New Vision for Water published in January 2026 sets out the Government’s plans to implement the recommendations of the Independent Water Commission. This includes an integrated water regulator to deliver fair and effective regulation that protects and improves public health. A drinking water quality advisory group, including scientific and public health experts, will be given responsibility for making regular recommendations for updating drinking water regulations to ensure value for money whilst helping protect and improve public health.

A New Vision for Water sets out that public health will be considered in new water frameworks and regulations. This will support delivery of shared outcomes, like those in the 10-Year Health Plan, which commits to assessing the further rollout of water fluoridation in areas where oral health outcomes are worst. We will also expand community water fluoridation in the north east of England from 2028 so that it reaches 1.6 million more people by April 2030. We will also refurbish older, existing water fluoridation schemes in England, benefitting a further six million people by 2030.

The 10-Year Health Plan for England confirmed that we will assess the feasibility of the further rollout of water fluoridation where oral health outcomes are worst.

The National Dental Epidemiology Programme (NDEP) for England: oral health survey of 5 year old schoolchildren 2024 showed Yorkshire and the Humber to have the second highest prevalence of tooth decay by region in England.

We are currently engaging with Yorkshire Water on whether water fluoridation arrangements would be operable and efficient. This requirement must be completed before any subsequent decision and public consultation to fluoridate drinking water in South Yorkshire.

Water fluoridation at levels recommended in the United Kingdom is a safe and effective intervention to reduce tooth decay and inequalities in dental health.

The Government’s 10-Year Health Plan for National Health Service recovery and reform prioritises prevention.

As part of this strategy, the Government is expanding fluoridation schemes in north east England, aiming to reach 1.6 million more people by April 2030. We will assess further rollout in areas where oral health outcomes are worst.

Water fluoridation is an evidence based, effective public health intervention for improving the oral health of children and adults. The 2022 Health Monitoring Report showed that five-year-olds were less likely to experience dental caries, and less likely to experience caries of high severity, in areas with a fluoridation scheme. Further information is available at the following link:

https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2022

The 10-Year Health Plan sets out our plans to expand water fluoridation in the north east of England by 2030, and that we will assess further rollout in areas where oral health outcomes are worst.

The US National Toxicology Program conducted a systematic review of the published scientific literature on the association between fluoride exposure and neurodevelopment and cognition. It concluded that there is “moderate confidence” that levels of fluoride intake, such as those approximated to be from drinking water concentrations greater than the World Health Organization’s (WHO) drinking water Guideline Value of 1.5 milligrams per litre, were associated with lower IQ in children. The target dose for fluoridated drinking water in England is below this value, at one milligram per litre.

There is no convincing evidence for adverse health effects from exposure to fluoride in drinking water below the WHO Guideline Value or the United Kingdom’s drinking water regulatory limit of 1.5 milligrams per litre. This value is intended to be protective of health for the whole population for a lifetime of exposure. My Rt Hon. Friend, the Secretary of State for Health and Social Care has a legal responsibility to monitor health impacts of fluoridated drinking water, and the next report will be published in 2026.

Water fluoridation is an evidence based, effective public health intervention for improving the oral health of children and adults. The 2022 Health Monitoring Report showed that five-year-olds were less likely to experience dental caries, and less likely to experience caries of high severity, in areas with a fluoridation scheme. Further information is available at the following link:

https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2022

The UK Chief Medical Officer also concluded that water fluoridation is effective and should complement, not substitute, other effective methods of fluoride use. The UK Chief Medical Officer’s statement on water fluoridation is available at the following link:

https://www.gov.uk/government/publications/water-fluoridation-statement-from-the-uk-chief-medical-officers/statement-on-water-fluoridation-from-the-uk-chief-medical-officers

My Rt Hon. Friend, the Secretary of State for Health and Social Care has a duty to monitor the effects of water fluoridation schemes on health, and to publish reports at intervals no greater than four years. Health monitoring reports published in 2014, 2018, and 2022, taken alongside the existing wider research, show that there is no convincing evidence for adverse outcomes, including for bladder cancer or osteosarcoma, due to fluoridation schemes. These findings are consistent that water fluoridation, at levels recommended in the United Kingdom, is a safe and effective public health measure to reduce dental cavities. The next health monitoring report will be published in 2026.

My Rt Hon. Friend, the Secretary of State for Health and Social Care is responsible for reimbursing water undertakers for the reasonable costs associated with water fluoridation schemes. In the financial year 2023/24, these costs were £4,109,521 in revenue and £348,351 in capital for the estimated six million people in England covered by such schemes.

An impact assessment was completed as part of the proposals to expand the existing water fluoridation scheme in the North East of England, to a further 1.6 million people. This sets out a net present social value of the proposal of £201 million over 40 years, and accounts for estimated benefits through dental health care cost savings, productivity gains, and quality of life benefits to individuals. My Rt Hon. Friend, the Secretary of State for Health and Social Care has a duty to monitor the effects of water fluoridation schemes on health, and to publish reports at intervals no greater than four years. The findings of monitoring reports published in 2014, 2018, and 2022 are consistent that water fluoridation, at levels recommended in the United Kingdom, is a safe and effective public health measure to reduce dental caries.

Water fluoridation is an effective population measure that reduces tooth decay. It should be used to complement other effective methods of increasing fluoride use, as set out in the statement by the UK Chief Medical Officers, which is available at the following link:

https://www.gov.uk/government/publications/water-fluoridation-statement-from-the-uk-chief-medical-officers/statement-on-water-fluoridation-from-the-uk-chief-medical-officers.

On 7 March 2025, we confirmed plans, following public consultation, to expand provision of water fluoridation in the north east of England. The outcome report is available at the following link:

https://www.gov.uk/government/consultations/community-water-fluoridation-expansion-in-the-north-east-of-england

There are no current plans for a national water fluoridation strategy. Any decisions on the future expansion of water fluoridation will be based on oral health needs, funding, and will be subject to public consultation.

Fluoride is a naturally occurring mineral found in water and some foods. The amount of naturally occurring fluoride in water varies across the United Kingdom due to geological differences. Drinking water regulations contain a standard for fluoride which is a maximum of 1.5 milligrams per litre. This is the same level as the World Health Organisation health-based guideline value for fluoride in drinking water. If the standard of 1.5 milligram per litre is breached, the Drinking Water Inspectorate has the power to take enforcement action to require the water company to rectify the breach.

In some areas of England, the level of fluoride is adjusted through a water fluoridation scheme to improve dental health. In these areas, the target level for fluoride is one milligram per litre, well within the regulatory limit. There is a legal duty to monitor the effects of water fluoridation schemes on health and report on it every four years. Previous reports are available at the following link, with the next due to be published in 2026:

https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2018

The Drinking Water Inspectorate has published an advice leaflet on fluoridation of drinking water which can be found here:

https://www.dwi.gov.uk/consumers/learn-more-about-your-water/fluoridation-of-drinking-water/

There are no current plans to support a fluoridation scheme in Macclesfield. Public consultation is required on proposals for new, or the expansion of existing, community water fluoridation schemes. The Water Fluoridation (Consultation) (England) Regulations 2022 set out the requirements, and are available at the following link:

https://www.legislation.gov.uk/uksi/2022/1163/contents/made.