NHS Sustainability and Transformation Plans

Bill Wiggin Excerpts

Wednesday 14th September 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to be here today, and I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her post. I think this is the first time she has opened a debate in her present position, and I am pleased to be doing so for the first time myself. I believe that she was appointed about three weeks before me, and I think it would be fair to say that we are both on a steep learning curve.

I am also pleased that the hon. Lady has chosen the sustainability and transformation plans as the subject of the debate, because that gives me an opportunity to correct some of the misconceptions that she has just revealed, and, more importantly, to inform the whole House of the status of the NHS’s plans. Let me begin by reminding the House of their origins. The NHS’s own plans for the future, set out in the “Five Year Forward View” and endorsed by the Government—but not, as it happens, by the Labour party— recognised three great challenges facing the NHS: health and wellbeing, care and quality, and finance and efficiency.

[Bill Wiggin (North Herefordshire) (Con)]

May I congratulate my hon. Friend, and say how delighted I am to see him at the Dispatch Box fulfilling such a crucial brief? While he is on his steep learning curve, will he visit Hereford County hospital, so that he can understand the difficulties faced by rural patients and see what he can do to help us?

[Mr Dunne]

I am delighted to accept that invitation from my neighbour and friend, not least because many of my constituents look to Hereford County hospital for their acute care, but also because it is one of the hospital trusts that are in special measures, which is my specific responsibility. I look forward to seeing my hon. Friend there, perhaps even during the coming recess.

Junior Doctors: Industrial Action

Bill Wiggin Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. All of us in this debate have one simple thing to consider: what is the right answer for the people we represent? They understand that there are financial constraints and that the NHS cannot do everything, but they do want us to strive to make it safer and better the whole time. It is a surprise and a disappointment that we do not hear more of that language from the Labour party.

[Bill Wiggin (North Herefordshire) (Con)]

My constituents who are patients do not want this strike, and I do not believe that my constituents who are doctors want this escalation in industrial action. If it is the case that only 4% of doctors support this escalation, should the BMA not again check its mandate?

[Mr Hunt]

It absolutely should. The BMA has been out of step with both the British public and its own members this week. My hon. Friend’s own hospital in Hereford—Hereford county hospital—is in special measures. It has a huge number of problems, which it is working really hard to sort out, and we are helping it to sort them out. Is that not what we should be focusing on in the NHS, rather than having to do contingency planning for these damaging strikes?

Branded Medicines (NHS)

Bill Wiggin Excerpts

Thursday 4th December 2014 Commons Chamber

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I beg to move,

That this House has considered availability and pricing of branded medicines on the NHS.

I am most grateful to the Backbench Business Committee for providing this opportunity to raise an issue of continuing importance to Members and their constituents. The debate will be short, but I am sure that we will be able to put it on the record that there are areas of concern. The two Front-Bench teams will, I am sure, be keen not only to respond now but to take some of these matters forward in the future as the Minister and his colleagues have sought to do over the past couple of years.

Colleagues from the previous debate must not feel that they have trespassed too much on to our debate. Listening to the contributions, it was amply clear that it was important for Members to be able to represent their constituencies. I know that all colleagues are very happy that they had the chance to do that.

Let me set the scene. Over the many years that I have been engaged with health matters, one of the most persistent sources of frustration has occurred when our constituents have not been able to access the medicines that they need through the national health service. That can happen because of a lack of data, and the National Institute for Health and Care Excellence will not appraise such a drug at that point because it determines that it is not cost-effective and is not therefore approved for NHS use, or because local commissioning decisions are incorporated in a local formulary.

Since its inception, NICE has created a more consistent national basis for decisions on access to medicines, but the application of what is essentially an arbitrary cost-effectiveness threshold still means that patients can be denied access to some new drugs. That has been exacerbated by the chronic slowness of uptake of some new medicines across the NHS, because of a clinical conservatism—new drug treatments are viewed as an extra cost rather than an opportunity to improve outcomes—or a general bureaucratic lack of responsiveness to patients.

That is deeply ironic as the UK is among the leading countries for drug discovery. We may represent only 3% of the international pharmaceuticals market, but we have been responsible in this country for 10% of new drug development, including such major innovations as monoclonal antibodies, which were first invented in my own constituency at the Laboratory of Molecular Biology.

As a coalition Government, we commit resources to world-leading research. Ministers have rightly sought both early access to new medicines and continuing support for research and innovation, but we continue to face institutional and cultural resistance. One of my objectives over recent years was to tackle that issue. I wanted to assure patients that, through the NHS, they could access the best and latest medicines and treatments. We wanted the NHS to adopt new innovation and technologies and to move away from a system in which the drug companies set a price that NICE and the NHS appraise and reject, leaving patients unable to access the medicines that their clinicians believe are best for them.

Instead, we should have a system that puts the patient at the heart of the service. If a clinician believes that a medicine is the right one for their patient, they should be able to prescribe it and the NHS and the pharmaceutical company should settle on a fair price, reflecting the value of that drug and a fair return to the costs involved in drug development.

[Bill Wiggin (North Herefordshire) (Con)]

One of the things my right hon. Friend will know probably better than anyone from his role as Secretary of State for Health and something that is not well understood by my constituents is that the NHS is one of the most exciting clients for anybody selling drugs and has the most efficient buy-in capability. Why does that not seem to come across to our patients and constituents, and what about medicines that used to work but now are not available? Will he cover that in his speech?

[Mr Lansley]

On the latter point, no, but drugs that move beyond patent become generically available to the NHS. On the former point, my hon. Friend is absolutely right. I often found this issue frustrating. The best way for drug companies to get their new medicines adopted internationally is to introduce them successfully into the NHS. As we move to a more systematic patient record system, the introduction of new treatments and medicines through the NHS will provide the strongest possible database of outcomes anywhere in the world, because of the character and scale of the NHS. So he makes a really important point.

The principle behind securing patient access to new medicines lay behind the proposal for a value-based structure of drug pricing. It was my intention that come the introduction of the new pharmaceutical price regulation scheme, which was to be negotiated for January 2014, a transition to a new price-setting mechanism would also be in place. As the House will recall, in the interim, we introduced the cancer drugs fund because patients in the UK had significantly worse access to new cancer medicines than patients in other countries. That contributed to our poor relative cancer survival rates, and we were determined that it should stop and that the lack of access to new cancer medicines should be tackled while a longer-term solution was developed.

In 2010, therefore, we introduced the CDF to meet that specific need over a defined period and within a defined budget. The achievement of the CDF has been vital. More than 60,000 patients have accessed the cancer drugs they need through the CDF over the past four years. I am immensely proud of that fact. However, the fund is not, and was never intended to be, a permanent solution. Over time, more cancer drugs will be introduced, and if we carry on like this, an increasing number will not be available other than through the fund. Some drugs, such as cetuximab, Avastin and abiraterone, have already been substantially provided through the CDF. If this continues, while other drugs are added, it will greatly increase the cost.

I welcome the Government’s commitment to the CDF through to 2016—it is needed while the pricing of drugs to the NHS is tackled—but that extension cannot continue indefinitely. I therefore call on the Government to reinvigorate the drive to a value-based assessment of new drug pricing and to incorporate that into the PPRS, so that while the Government and the NHS have control of the budget, the NHS can make all licensed new medicines available through the NHS. In addition, it would incentivise innovation in the pharmaceutical industry and result in a fair return to industry on the cost of drug discovery.

The CDF has been necessary and successful, but it was intended only as a bridge to a better scheme across the whole NHS. It cannot bear the weight that will fall on it if we do not reform the system for the pricing of medicines more generally. If we can see our way to that reform, the prospect of de-listing new or existing medicines to the CDF can be deferred. However, reform of drug pricing has not been progressed as it should have been, or as we hoped it would be.

The new PPRS did not incorporate a value-based assessment of the pricing of medicines payable by the NHS. It gave the Treasury a good deal, securing a real-terms reduction in the drugs budget, but a reduction via a rebate is not transparent to the NHS. Drug companies setting their own price for new medicines will continue to set prices that conflict with NICE cost-effectiveness thresholds.

Members might have noted that, yesterday, Roche won an appeal against NICE’s final appraisal of Kadcyla, a drug used to treat HER2-positive breast cancer. Roche won on the basis that NICE should have taken account of the PPRS but did not do so. It argued that as a budget control mechanism, the PPRS, through its rebate, could be argued to offset the relatively high cost of a medicine on introduction. Roche won the appeal, but I have to say that the NICE appraisal might none the less remain unchanged.

The rebate is not predictable; nor is it attributable to any particular drug. It goes to the Treasury, not to the NHS. So, in practice, any NHS purchaser of a high-cost medicine must fully absorb the cost, and the opportunity cost, that paying a high price implies. This case highlights the theoretical link between a NICE appraisal and the PPRS, and it demonstrates how the PPRS does not in practical terms serve to resolve the dilemma of how to introduce high-cost medicines in the NHS.

The PPRS deal showed how much the pharmaceutical industry in this country was willing to offer for a guaranteed rate of return and the ability to set prices at introduction here in the UK, which can then act as a reference price for a quarter of the drugs market across the globe. The current PPRS of course benefits the shareholders and the boards of the big pharmaceutical companies, which are able to maintain high prices throughout a quarter of the world on the back of high prices in the UK, even for those drugs that offer limited clinical benefit. The other beneficiaries are those in the Government who are able to plan spending on drugs a little bit better than they were before. The losers, unquestionably, are patients, who continue to be denied access to the drugs that their doctors think they need.

This is not the kind of price regulation we should have in future. Price should reflect the value of new medicines. A new drug that offers little or no benefit relative to the best available alternative for treatment should secure only a small price differential. New drugs that tackle unmet need or substantially reduce the burden of disease should enjoy a correspondingly substantial price premium. By such a means, we would incentivise innovation and drug development, particularly in relation to major unmet targets. We could also build a premium into pricing in areas in which drug development was most needed, such as early-stage dementia, new antibiotics or the treatment for some cancers, such as pancreatic and ovarian cancer.

The benefits of a value-based pricing system were set out in an OECD study six years ago. But the study recognised—as, subsequently, did we—that the principle had yet to be given practical effect. A year ago, the Minister responsible, Earl Howe, said that value-based assessment would be taken forward and that it would be brought in late this year. That is not happening. NICE was given the task of developing value-based assessment last year, but in September this year, it appeared to have put that on the back burner. That is just not good enough.

Without value-based assessment, NICE will continue to apply an arbitrary threshold to a measurement of the benefits of drugs which takes into account only the quality-adjusted life year gain—the QALY—and end-of-life addition, not the broader societal benefits or the need to promote drugs targeted at key areas of therapeutic need and to promote innovation.

We must look to the value beyond the QALY. We must ask NICE to design a clearer methodology for value, but not just through add-ons to its existing methodology. It should recognise the burden of disease in extending life and the importance of greater clinical and patient engagement. In developing realistic pricing, it could draw on the real-world mature outcomes data for drug use that the cancer drugs fund has given us. It must also draw on the work done by charities and by Sanofi to examine ways in which patient engagement with NICE could be supported. Qualitative judgment of innovation and patient benefits must form a part of this broader assessment, as well as the quantitative data relating to the QALY.

I congratulate Ministers for pushing the NHS to promote innovation. We had our report in December 2011 and more recently Ministers have launched the early access to medicine scheme. The Under-Secretary of State for Health, my hon. Friend the Member for Mid Norfolk (George Freeman), has been right not only to support that and the Medical Innovation Bill but to launch a review of how innovation processes can be enhanced in the NHS.

How perverse would it be if, at the same time, licensed and effective medicines were not approved or available through the NHS? In recent months, a number of drugs have not been approved by NICE, such as Kadcyla, Alimta for lung cancer and abiraterone for prostate cancer prior to chemotherapy. Several of those cases demonstrate the problem of paying for new personalised medicines, but we cannot see the difficult process of introducing new drugs being made even worse by the de-listing of drugs by the cancer drugs fund.

I hope that in response to the debate Ministers will tell NICE to reinvigorate and make progress on the work on value-based assessment, while developing a new methodology in the way that I have described. The Government should work with industry to develop the pharmaceutical price regulation scheme, so that pharmaceutical companies can, within the overall framework, continue to set the price of their medicines at introduction but accept that the NHS should receive a rebate if, and to the extent that, a value-based assessment shows a lower price. That would lead to drug-specific rebates that could then be incorporated within the overall rebate for budget control purposes. In my view, such a system must be in place by 2016, so that the cancer drugs fund can be maintained between now and then and can be the bridge that it was intended to be, while having a realistic time-limited remit.

Only by pushing forward with such measures can we expect in future to offer doctors in the NHS the assurance that they can access the medicines and treatments they think best for their patients and give patients the confidence that the NHS, as a comprehensive free service, is able and willing to provide whatever treatment is in their best interests. I am grateful for the time and attention of the House.

Hospital Car Parking Charges

Bill Wiggin Excerpts

Monday 1st September 2014 Commons Chamber

[Jackie Doyle-Price]

The hon. Gentleman reiterates the point made by my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman). We have all learned a lot of lessons from poorly negotiated PFI contracts. It is worth noting that in Scotland and Wales, the movement to get rid of NHS car parking charges has not been limited by those contracts, and there are ways to see those contracts through.

[Bill Wiggin (North Herefordshire) (Con)]

My friend and neighbour, the hon. Member for Hereford and South Herefordshire (Jesse Norman), has already touched on the shocking situation that we have in Herefordshire, but it is made worse by the county council putting double yellow lines almost everywhere in the city. Ambulances do have to get through, but could not more be done by local authorities to ease the burden on patients?

[Jackie Doyle-Price]

Absolutely. It is always a good idea for public bodies to be more co-ordinated in how they approach such matters. No hospital acts in isolation, and car parking charges are often a function of how expensive local car parking is.

I welcome the recent announcement by the Department of Health to strengthen the guidelines given to NHS trusts on the implementation of car parking charges. They include the important provision that relatives of people who are seriously ill or in hospital for a long period should also be entitled to discounted or free parking. The guidelines are clear and welcome, but they do not go far enough. It is important that the House sends a clear message to the management of NHS trusts throughout the country that punitive car parking charges are wrong and will not be tolerated.

Cross-border Health Care (England and Wales)

Bill Wiggin Excerpts

Tuesday 25th June 2013 Commons Chamber

[Jesse Norman]

I am grateful to the hon. Gentleman for that intervention. There is co-operation at the moment between England and Wales, but I think that it would absolutely benefit from further examination of the situation he describes between Northern Ireland and Eire.

The fact that the Welsh Assembly Government Minister for Health and Social Services does not believe that choice is the basis of the health system in Wales means that my constituents do not have the choice of health care, hospitals or consultants that is their proper legal right.

Secondly, the Welsh NHS’s performance in meeting its own waiting time targets continues to deteriorate. In England the waiting time target is 18 weeks, but in Wales it is 26 weeks, and that is regularly missed. Some patients are not even treated within 36 weeks. For example, some 4% of patients are not treated within 36 weeks at Cardiff and Vale hospital, according to recent Welsh Government statistics for April this year.

Thirdly, the current set-up is giving rise to serious clinical concerns. Earlier this year, in evidence to the Silk commission on devolution in Wales, the Royal College of Surgeons, the British Medical Association and the Royal College of Nursing made the following submission:

“The Panel... acknowledged that increasing policy divergence between health services in Wales and England was a challenge, especially in regards to cross-border services. The Panel added that there was a need to strengthen commissioning arrangements to improve current delays for processing individual cases... It was also agreed that it made sense for some specialist facilities to be shared by both England and Wales; and to work together to deliver economies of scale and efficiency savings, including cross border sharing of procurement and use of high-tech equipment.”

However, as I have mentioned, that ban on hospital access for those patients is not merely grossly unfair to them but places further financial pressure on Hereford hospital.

[Bill Wiggin (North Herefordshire) (Con)]

My hon. Friend and neighbour is making an important and powerful speech and should be congratulated on securing the debate. Does he agree that when one has a national border next to one’s county, it should be treated like a coastline, because it is not the Minister’s responsibility to control the health service in Wales? But if we do not have proper funding we will suffer as a result of not only our rurality but our sparsity, and once again people living in the marches will be at a disadvantage. We have the Barnett formula, but should we not have something similar for people on the Welsh border?

[Jesse Norman]

I am grateful to my hon. Friend and neighbour for that kind intervention. I share his view that the situation needs to be addressed, and it needs to be addressed in the spirit of amity and co-operation between the two sides.

In 2009-10 I commissioned an independent study of the funding of public services in Herefordshire relative to other suitable comparators across the country. I was only a parliamentary candidate at the time and such a study had never before been undertaken, but it seemed obvious to me that Herefordshire suffered from a serious shortfall in public funding and I was determined to get to the bottom of the matter. The results were astounding—even frightening. The study found that Herefordshire had been underfunded by no less than £175 million over the previous five years across all public services. In health care, the underfunding was £44 million, or roughly £9 million a year. It is no coincidence, I suggest, that Hereford hospital is currently running a deficit of almost exactly that amount. It is that deficit that is being worsened by the denial of choice to cross-border patients in my constituency and elsewhere.

Why did that funding shortfall occur? The reason is that the NHS funding formula is systematically skewed against areas that are highly rural and have a large population of older people, and systematically favours urban areas with younger populations. The formula does not recognise the relatively high cost of delivering services in sparsely populated areas, as my hon. Friend the Member for North Herefordshire (Bill Wiggin) indicated, and it does not adequately recognise the special costs imposed by caring for older people—particularly the over-85s, the very oldest in our society. Research by Professor Sheena Asthana at the university of Plymouth indicates that the areas of greatest health care need are those with the highest proportion of over-75s. However, the current funding formula is focused on deprivation rather than on need for health care. That means that less funding is available to treat older people with chronic diseases.

Nationally, 17% of people are aged 65 or over. In Herefordshire, the figure is already 22% and pensioners will make up a third of the population by 2030. In 2010-11, Herefordshire had the highest proportion of over-75s in the west midlands, and the most patients per 100,000 on the cancer register.  It also had the lowest cancer spend per cancer patient per year—a little over £5,000—and was in the lower half of the per capita allocations.

By contrast, the Heart of Birmingham PCT had the lowest proportion of over-75s in the region, and the fewest patients per 100,000 on the cancer register.  However, the spend per cancer patient per year there was not £5,000 but more than £10,000—nearly double that in Herefordshire. Thus the effect of the funding formula is that Heart of Birmingham has twice as much funding per cancer patient as Herefordshire, for a much lower incidence of cancer. That is not merely unfair; it is a monstrous injustice.

I conclude by asking the Minister three questions. First, will her Department amend the cross-border protocol and reintroduce patient choice for English residents registered with GPs in Wales? Secondly, will she acknowledge the strain that the protocol places on hospitals such as Hereford hospital? Thirdly, will she press her Department to make the case to NHS England for a fairer funding settlement, which will give older people—not merely in Herefordshire, but up and down the land—the funding for cancer and for other health care that they so richly deserve?

--- Later in debate ---

[Anna Soubry]

I am grateful for that intervention and for the wise words of the hon. Member for Strangford (Jim Shannon), who, as ever, brings a great depth of experience to these matters. Yes, we will certainly take that on board.

All this came about because of a meeting between me and my officials, the Welsh Secretary and my hon. Friend the Member for Forest of Dean (Mr Harper). As a result of that meeting, I have asked NHS England to work locally with GP practices in the border counties to review their practice boundaries with the aim of providing additional choice of GPs to those who do not currently have it. I am keen that all English patients are able to access an English GP if they wish or that they can register with a Welsh GP if that is their choice and they are aware of the impact of that decision. I have also asked NHS England to review the protocol as it currently stands.

I have asked the Welsh Government to review their policy on out-of-area treatments to consider an exception for English residents—specifically, that GPs operating from branch surgeries in England should be exempt from the requirement to seek prior approval for English resident patients to be referred to hospitals in England. These are all matters of concern not only to constituents of my hon. Friend the Member for Hereford and South Herefordshire but to others. We have heard about that from my hon. Friend the Member for City of Chester (Stephen Mosley) and my hon. Friend the Member for North Herefordshire (Bill Wiggin), and of course I know of the concerns of my hon. Friend the Member for Forest of Dean.

I am informed that since the meeting with the Welsh Secretary and my hon. Friend the Member for Forest of Dean, NHS England has had several further meetings with colleagues in the Welsh Government and local health boards based in Wales to discuss these concerns so that they can be addressed. There have been constructive discussions with Aneurin Bevan local health board, which has confirmed that it will undertake a review of the application of its policy on out-of-area treatment. I understand from NHS England that work will continue on this review over the next few months, and I will of course keep everybody fully informed and up to date on any progress.

[Bill Wiggin]

Will my hon. Friend give way?

[Anna Soubry]

Of course, but quickly.

[Bill Wiggin]

I am most grateful to my hon. Friend. I am really heartened by the positive things she has said, and I congratulate her on the work she has done. Will she also look at the impact of cross-border patient numbers on hospitals, which also badly affects us in Herefordshire?

[Anna Soubry]

Indeed. I will come to the effect on Hereford hospital, but I am more than happy to write to my hon. Friend about his specific point. The usual rules apply: if there are questions that I have not answered I will of course write to any hon. Member.

We have asked the Welsh Government to request that other local health boards along the border in Wales should similarly review the application of their own policies for out-of-area treatment affecting patients in the same circumstances. In many of those areas patient numbers are much smaller, but that does not matter; these are important issues for these individuals.

In the light of the further legal advice that NHS England is seeking, I am advised that it will review the protocol with the Welsh Government in view of my concerns and those of other hon. Members, the updated legal advice, the outcome of the local health boards’ reviews of the application of their policies on out-of-area treatment, and feedback that we have received from local NHS bodies on the operation of the protocol. The review will be undertaken in the autumn following completion of the reviews by the local health boards.

My hon. Friend the Member for Hereford and South Herefordshire is concerned that the policy of the Welsh Government that those who are registered with a Welsh GP must use Welsh NHS services will have a direct impact on the viability of Hereford hospital. I share his concern, but I understand that a number of other factors affect the viability of the hospital and the Wye Valley NHS Trust.

I was a bit concerned when I read the next part of my brief, because it has been worded in an interesting way by my very able officials. It states that those factors include

“the drop in the numbers of young people locally leading to a lack of activity in maternity services”.

I am not sure what “lack of activity” young people have been guilty of. I think that what is meant is that there are not as many young people in the area, because there is undoubtedly a higher proportion of retired elderly people in the population. It is obvious that if there are fewer young people, people are less likely to be having babies and are therefore less likely to use maternity services. I am sure that activity remains at a high level.

As my hon. Friend is aware, Wye Valley NHS Trust published a strategic outline case in March this year, setting out the options for its future form to create a clinically sustainable model for local people. I have been advised by the NHS Trust Development Authority that it has been working with the trust to develop a full business case, which it expects to receive for consideration by the end of this month. Again, I make it very clear that I am more than happy to revisit this issue with my hon. Friend and others following the outcome of that process.

Hospital Food (Animal Welfare Standards)

Bill Wiggin Excerpts

Wednesday 12th December 2012 Westminster Hall

[Neil Parish]

I thank the right hon. Gentleman for that intervention. In a minute, I will comment on various hospitals. He shows that hospitals can deliver high welfare standards, source a lot of their meat and egg products nationally and serve up good-quality meals, and that it can be done on a reasonable budget. The other argument is that the hospitals will turn around and say, “We only have a limited budget, and we have got to make it go a long way.” However, some hospitals manage to get a good deal and good welfare standards, and then produce good food.

I emphasise that I am not here to knock hospitals and the NHS. I only want to improve the welfare standards for the meat and eggs served in our hospitals. Our health service does a very good job, but sometimes—dare I say it—patients might like slightly tastier meals when in hospital. It would certainly improve our view of life, even if it does not cure us instantly. It can have a positive effect.

During the same period, in stark contrast, setting mandatory standards for food served in other public institutions has proved highly successful. For example, the introduction of mandatory school food standards by the Government in 2005 led to a dramatic improvement in the quality of school meals, ensuring that children who opt for them get healthy, tasty and varied options. The introduction of mandatory nutritional standards for food served in Scottish hospitals in 2008 and Welsh hospitals in 2011 resulted in a significant improvement in the healthiness of patient meals, and it has been at the forefront of the Scottish and Welsh Governments’ efforts to tackle the effects of poor diets on health, particularly in relation to heart disease, stroke and type 2 diabetes.

Although the introduction of mandatory food standards worked in those settings, the use of voluntary guidance for hospital food has not succeeded to the same degree. Hospitals in England spend a third of their food budget and £167 million of taxpayers’ money every year on meat, dairy products and eggs. Approximately £1 in every £4 spent on hospital food in England is spent on meat, and approximately £1 in every £10 is spent on dairy. That represents a vast amount of public expenditure, which the Government can use to ensure that taxpayers’ money is invested in rewarding farmers who have adopted ethical farming practices rather than those rearing animals in unacceptable conditions.

It also helps to ensure that most of the meat, eggs and dairy produce that feeds patients in hospitals is sourced from Britain, and locally, I hope. Some hospitals are proving that it can be done on budget. A handful of NHS hospitals in England already only serve food that meets the animal welfare standards I am advocating, proving that doing so is both practical and affordable. For example, Nottingham University Hospitals NHS Trust, and Braintree community hospital and St Margaret’s hospital in Essex, have all been—

[Bill Wiggin (North Herefordshire) (Con)]

Will my hon. Friend give way?

[Neil Parish]

I certainly will. I knew it was a mistake to pause.

[Bill Wiggin]

I congratulate my hon. Friend on securing the debate. I hope that my intervention gives him an opportunity to find his place in his speech.

My hon. Friend will have read the excellent speech about care made by the Secretary of State for Health. Does he not agree that this is the perfect opportunity to increase the quality of food for patients while delivering top-quality care for them? It is a win-win situation for the Government, if they follow my hon. Friend’s argument.

[Neil Parish]

I thank my hon. Friend for his intervention, which gave me the chance to find my place in my speech. I agree with him. Before he arrived in the Chamber, we were making the point that food produced under high welfare standards has the benefit, in many cases, of being that bit tastier for patients. We are also asking for a slightly more varied menu—dare I say it—in some hospitals, because that will be the key.

I re-emphasise that I am not criticising hospitals and the NHS in any way. I am asking them to use the good practice that many hospitals are providing throughout the country. We need many more hospitals to do that.

All eggs served by the hospitals I mentioned before my hon. Friend’s intervention are cage-free, and those hospitals will be working to improve the animal welfare of their food, including serving chicken and pork that is either organic or meets RSPCA welfare standards. Nottingham University Hospitals NHS Trust spends less on its higher welfare food than other hospitals spend on food reared to low or no standards of animal welfare.

Hospitals that have been given a Good Egg and a Good Chicken award by Compassion in World Farming for buying RSPCA welfare chicken, pork and cage-free eggs include the Royal Marsden NHS Foundation Trust and the Royal Brompton and Harefield NHS Foundation Trust in London, York Teaching Hospital NHS Foundation Trust, North Bristol NHS Trust and Scarborough and North East Yorkshire Healthcare NHS Trust. I should probably have included West Berkshire community hospital, and I shall ensure that I do so next time. Although those hospitals show what can be achieved on an NHS budget, the standards they have achieved have not been replicated throughout the country, despite one in every 10 patient meals being thrown in the bin. Mandatory standards are needed.

Hospital food should reflect the ethical concerns of the British taxpayer. The introduction of mandatory RSPCA welfare standards for hospital chicken, pork and cage-free eggs is an affordable way to ensure that chickens, pigs and hens that have been reared for patients’ meals are given a good quality of life. It would also ensure that hospital food reflects the ethical concerns of British shoppers who, in a report by the Department of Environment, Food and Rural Affairs last year, specified that the welfare of chicken, pigs and hens was an increasingly important influence on their purchasing habits. The report found that 75% of UK households said that the animal welfare standards of egg and chicken meat production is an “important issue”, 65% of households “actively seek” higher welfare eggs, and 50% seek higher welfare chicken when shopping. The increase in sales of RSPCA Freedom Food pork by a staggering 116% in 2010-11 also shows that a growing number of consumers consider pig welfare to be an important issue.

RSPCA welfare standards ensure that animals reared for food have been cared for and live a good quality life. It sends the right signal to the farming community, which is keen to have high animal welfare standards and wants to encourage people to pay that little bit extra for production, because there are extra costs for extra welfare. Again, this needs to be brought to people’s attention.

RSPCA accreditation ensures that food has been produced from animals that are reared to welfare standards exceeding legal minimum requirements and guarantees that they are cared for and enjoy a good quality of life. Farm animals reared to RSPCA welfare standards are provided with space to move around, comfortable places to rest, an interesting enriched environment that allows them to express natural behaviours, good health care and ready access to appropriate feed and water. The standards cover large and small farms and animals that are reared outside and indoors. The standards exclude some of the worst farming practices that are still allowed even here under UK law, including the use of so-called enriched poultry cages for egg-laying hens—these are quite controversial—which provide each hen with less usable space than an A4 sheet of paper. The standards also prevent producers from rearing chickens that are genetically selected to grow quicker, and forced to live in crowded and dark conditions.

To protect pigs, the standards prohibit farmers from keeping them on slatted or concrete floors and putting pregnant pigs in restrictive farrowing crates both before and after they give birth. Sometimes there can be an argument for putting a pig in a crate during birth, just to save the piglets, but certainly not afterwards.

As hon. Members may have seen in the supermarket, all meat, dairy products and eggs produced to RSPCA welfare standards are approved by the RSPCA’s Freedom Food assurance scheme, as shown by the logo on the packaging. Hospital food that meets RSPCA welfare standards is good value and affordable for caterers. Although RSPCA Freedom Food-certified chicken, pig meat and cage-free eggs may cost more than alternatives produced from animals reared to no welfare standards, they remain affordable for hospitals. In fact, figures from the retail sector show that RSPCA Freedom Food chicken, pork and cage-free eggs can sometimes be cheaper. For example, RSPCA Freedom Food barn eggs from Sainsbury’s cost the same as cage eggs from Tesco and Asda. I am not promoting different supermarkets. Sainsbury’s RSPCA Freedom Food chicken thighs and drumsticks are 22% cheaper than Sainsbury’s chicken and thighs that meet farm-assured standards.

The overall picture shows that hospitals can expect to pay more for food that meets RSPCA Freedom Food standards, but not by as much as we might think. Paying more money for a higher standard of welfare is a price worth paying.

To recap, substantial benefits would be achieved by introducing mandatory RSCPA welfare standards for hospital chicken, pork and eggs. Those standards would end the postcode lottery in the animal welfare standard of hospital meat, dairy and eggs, in which some hospitals serve much higher quality products than others, and would ensure that patients can be confident that good animal welfare production processes are used in all hospitals, in whatever part of the country. Taxpayers’ money would be invested in rewarding British farmers who are producing great food to high standards of animal welfare, and there would be a guarantee that hospital food meets the standards that many Britain consumers actively seek when shopping for themselves. Hospital chicken, pork and eggs would be served with clear information about the animals used to produce the food and where it is reared.

We can work together now, providing good food for patients in hospitals and ensuring that it is produced to high welfare standards. I am keen that farmers who produce high-quality food to high welfare standards have a market for their food, so that we encourage the right kind of production. There is a win-win situation for the Government in ensuring that they target taxpayers’ money on buying higher welfare standard food, making sure that patients in hospitals have good quality food to eat, and ensuring that farm production in this country carries on to meet the high welfare standards that the public at large expect of farmers. I look forward to the Minister’s comments.