Community Hospitals

Tessa Munt Excerpts

Thursday 6th September 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing this debate.

My part of Somerset has some fantastic community hospitals—Burnham-on-Sea, Glastonbury—but I would like to draw particular attention to Shepton Mallet, which provides a valuable and popular service to local people in my area of rural Somerset, despite the fact that several of its buildings are substandard as a result of serious under-investment. Many patients who cannot be treated at home are admitted to our community hospitals by local GPs, who love these places, instead of being sent to acute hospitals in Bath, Bristol, Yeovil and Taunton. Most of those journeys are about 20 to 25 miles, but local people accept that acute hospitals will be some distance away. There is no expectation that we should be able to access an acute hospital on our doorstep in such a rural area.

There are 174 communities in my constituency, and people will happily travel from them to those main hospitals. Some spend time in our local hospitals following treatment at an acute hospital—it is clearly a stage of recuperation—so that they can be close to their home, friends and family. My father was a patient, and he was a frequent visitor to Wells cottage hospital, which is now unfortunately closed. It was an essential part of his recuperation, and there were many happy visits that kept his spirits up and helped his recovery. People came to read or just talk to him.

The point will not have been missed that community hospitals help to free up scarce and much more expensive beds in the bigger hospitals. Some of our patients are there because caring for them in their homes has failed or is just not an option. Many patients are elderly or infirm, as often are their relatives, and visiting distant hospitals regularly is a great hardship, stressful and, for some, impossible. Public transport provision in Somerset is limited at best, diminishing in many areas and in most cases almost non-existent in rural patches, as a direct result of the withdrawal of support for public transport by the county council.

The latest Somerset joint strategy needs assessment on population changes shows rapid increases in elderly patient numbers in the county over the next 30 years—the expected lifetime of most of our NHS estate buildings. In round terms, the number of over-85-year-olds in the county has doubled in the past 25 years and is expected at least to double again by 2030. Two thirds of our NHS patients are already over 65.

The community hospital is cost-effective and provides an essential and popular service to the people of Shepton and those in what is a vast local area. Losing its beds would mean a significant reduction in the quality of services to the local community. Despite that, Shepton Mallet hospital is under threat of closure. An NHS review of community services for Shepton Mallet is taking place and is focusing on the 17 beds in the community hospital. There is no review of beds in the other 12 community hospitals in Somerset. Campaigners can only assume that Shepton is being singled out, because the NHS has not maintained the hospital properly, despite spending millions on new and other community hospitals. However, in one of the many meetings that I have held with the save our hospital beds campaign group, I was given figures from the NHS that showed that, even as late as this April, bed occupancy has been extremely high. Indeed, April’s figures show the occupancy rate at over 96%.

Last week I was at the summer fete in Glastonbury, and last month I was at the summer fete at Shepton Mallet hospital. I pay tribute to the leagues of friends of the Shepton Mallet and other community hospitals, and to Mid Somerset Newspapers, which publishes the Shepton Mallet Journal. The friends have done a fantastic job of rallying the people of Shepton and the local press, including the Journal, and have generated enthusiastic support for the save our hospital beds campaign over the past few months. I have received hundreds and hundreds of letters, e-mails and petitions, and have attended many meetings about the issue with concerned local people, which only goes to prove that the hospital is popular and greatly valued. There are now definite indications that the sheer weight of public concern expressed and the influence of our great GPs, working quietly behind the scenes, have had an effect. I pay particular tribute to the local GPs, especially Dr Chris Howes, who keeps trying to retire, but has been busier than ever finding a sensible, practical, realistic and workable solution to the problem facing Shepton. The first aim of the save our hospital beds campaign has been achieved, with the immediate threat of ill-considered cuts averted, and proper evidence gathering and an options appraisal process are now taking place. However, the hospital is not yet safe. Closure would result in short-term savings, but losing the beds would mean a significant reduction in the quality of service to the local community.

I finish by asking the Minister for an assurance that the coalition Government are committed to ensuring that local people and local doctors, as well as other health professionals, are consulted fairly and fully about any changes to the role and ownership of our popular, local and essential community hospitals, and that she agrees that none should be closed without agreement and very good cause indeed.

NHS Annual Report and Care Objectives

Tessa Munt Excerpts

Wednesday 4th July 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

Over the past year, the Department of Health has made statements about the fact that radiotherapy is eight times more effective than drugs. It is said that the cancer drugs fund is £100 million underspent and the figures of £150 million and £750 million have been mentioned in connection with new radiotherapy and radiosurgery services. Will the Secretary of State consider transferring at least that underspent funding into radiotherapy and radiosurgery services so that new services in the south-west do not depend on charitable funding?

[Mr Lansley]

I am grateful to my hon. Friend. The issue is important. In the cancer outcomes strategy, we responded positively to the recommendations of the National Radiotherapy Advisory Group. There was a £400 million programme for the support of radiotherapy; more recently, I have added to that a commitment to build two new centres for proton beam therapy. From about 2015, patients requiring such therapy will not have to go abroad to access it.

My hon. Friend makes an important point. In the early part of this year, we made additional resources available to the NHS supply chain so that more radiotherapy machines could be readily available for purchase or lease through the NHS without costs being incurred over the same period. I will look at what my hon. Friend has said. I think that in the cancer outcomes strategy we have set out all the investment in radiotherapy that we think is clinically indicated, but I will continue to review it.

Stereotactic Body Radiotherapy

Tessa Munt Excerpts

Wednesday 8th February 2012 Commons Chamber

[Tessa Munt (Wells) (LD)]

I asked for this debate because for nearly 12 months I have been questioning the Department of Health about why the latest radiotherapy techniques and equipment to treat cancer patients are not being used by our NHS. I have pressed hard on this subject because, like Cancer Care UK and many other respected organisations, I believe radiotherapy is underused in the front line for curing cancer.

This country has a history and a habit of resorting to pumping cancer patients full of pharmaceuticals. Do not get me wrong, I am not knocking cancer drugs—many are highly effective and a great help to patients, and many cancer patients are alive today thanks to them. However, a lot of those drugs also have some pretty horrific side effects, and patients are often reluctant to take them for that reason. So in reality, throughout the latter part of the last century, heavy doses of drugs or death were almost the only choices that cancer patients had.

Although there has been plentiful use of drugs throughout the last 60 years, the uptake of radiotherapy as a front-line treatment has been slow. Radiologists have told me that one reason for that is they have not been as successful at lobbying as the pharmaceutical companies, but that is a matter for another debate. The main reason why there was resistance to using radiotherapy in the past was its method of delivery—single large beams of radiation being fired into the body to ensure that the tumour at which they were aimed was radiated. Unfortunately, those large beams also radiated an awful lot of healthy tissue around a tumour, especially if the tumour was moving, and frequently caused more damage than good. Patients often complained that the side effects of radiotherapy were worse than the cancer.

During this century, there have been huge advances in the delivery and accuracy of radiotherapy treatment. Around the world, radiosurgery is being used increasingly to cure cancer as a front-line treatment. Stereotactic body radiotherapy treatment, or SBRT, uses multiple very fine beams of radiation locked directly on to just the tumour. With some new technologies the beams move as the tumour moves, ensuring that the surrounding healthy tissue is not harmed and only the tumour is radiated.

Unfortunately, in the UK we are failing to embrace the new technologies that allow for the effective use of SBRT to treat cancer patients. We are falling behind both Europe and the US. On 22 November last year, I asked the Secretary of State for Health in the Chamber how many radiotherapy centres in this country were providing SBRT to cancer patients. When he told me the figure was 25%, I must admit to having been surprised—not as surprised, I would add, as some of the medical professionals I know, who found the figure unbelievable, but that was what he said.

Within a few days, the cancer tsar repeated that same figure in a letter to The Times. Thus, 25% suddenly became received wisdom for the standard of provision of SBRT in England. I therefore asked the Secretary of State in a written question on what evidence he had based his statement. “Not really sure,” was the reply. The evidence was based on an “informal study” conducted by the National Cancer Action Team. NCAT also said it believed there were more than 20 machines in the country that could deliver SBRT.

I am not a fan of Government policy making based on “informal studies” and vague beliefs, so I conducted my own, very formal study on the availability of SBRT in the UK. Under the terms of the Freedom of Information Act, I wrote to every hospital in the country that provides radiotherapy and asked each a series of questions about its ability to deliver SBRT. I am pleased to say that 57 replied—all but the Royal Shrewsbury hospital—and very helpful they were too.

For the record, I shall share the data with the Minister, so he can pass them on to the Secretary of State. In 2011, only seven centres in England and one in Scotland treated cancer patients with SBRT. There were no centres in Wales or Northern Ireland. Only four of the centres conducted a large enough number of procedures to comply with national radiotherapy implementation group recommendations. Therefore, 14% offer SBRT and just 8% are compliant. The total number of patients treated in those centres was just 323. That figure is not surprising when we consider that, according to the hospitals, there are only seven machines in the country capable of delivering SBRT—a good deal fewer than the number NCAT believes there are.

The Minister will not be surprised that my questioning did not stop there. I had also asked what indications the centres treated with SBRT. The data became even more interesting. Those centres using the Elekta or Varian systems treated only lung cancer. Centres using the CyberKnife system treated lung cancer, but they also treated liver, prostate, spine, breast, myeloma, sarcoma, head and neck, and ovarian cancers.

I asked the centres what their estimates for SBRT treatment in 2012 were. Again, they were very helpful in providing that information, and I place on record my gratitude to them for it. The centres estimate that approximately 725 procedures will take place in hospitals planning SBRT programmes for this year: 48 using the Varian system; 195 using the Elekta system; and 385 using CyberKnife system. The remaining 97 procedures were claimed as “estimates” by centres that have not conducted any SBRT in the past, and which do not appear—from their responses—to have suitable equipment for conducting such procedures.

I must admit that I found that last statistic, and the fact that only four centres conducted the number of procedures necessary to comply with the NRIG recommendations, very alarming. I, for one, would not wish to be treated at a centre where the team carries out only half a dozen procedures each year. How can it possibly have any expertise in such a complex treatment process if the staff so rarely conduct the procedure? For the Minister to allow that to continue would be contrary to the aims of the new Health and Social Care Bill and all that the Secretary of State has said about concentrating resources in centres of excellence to improve patient outcomes.

A number of other things alarmed me when I read the returns from the centres. On numerous occasions, the Minister has assured me that work is in hand by NCAT to establish a national tariff, or price tag, for SBRT, and yet, while the centres tell me they would welcome a national tariff, they also tell me that no progress is being made towards it. In fact, the vast majority have not even been consulted about establishing one. One of the most well known and respected centres has gone further, and said that

“a national radiotherapy tariff without SBRT would be seriously flawed and its fitness for purpose questionable.”

Will the Minister comment on that?

[Naomi Long (Belfast East) (Alliance)]

The hon. Lady is aware of a case involving Brian Withers, my constituent. He has been able to access the treatment, but has had to self-fund to do so. One reason it was not included in his clinical pathway was that it was argued that there was no clinical trial evidence for it in his situation. Does she agree that part of the problem is that SBRT is treated as a novel treatment for cancer as opposed to the development of an existing one? Therefore, without the tariff, people from other regions will not be able to access it on a routine basis.

[Tessa Munt]

I could not agree more. As the hon. Lady and others are well aware, I have spoken with her constituent, Mr Withers, and it is clear that radiosurgery is a well-established and proven therapy—it is just that we have to wait to get it.

In an answer to a parliamentary question, I was told that a price tag would not be set up until 2014. NCAT must be the only organisation in the NHS that believes it should take three years from the point that an esteemed committee recommends a national tariff until one can be implemented. From what they tell me, the centres do not believe it, and I do not believe it, and I do not think that the Minister believes it. The question of establishing an SBRT tariff, as recommended in the report from NRIG last April, is not just a question of the administration involved in setting up some codes so that the NHS can cost it; this lack of tariff has a direct impact on cancer patients’ lives.

Let me tell the Minister about my friend Kerry Dunn, a 42-year-old mother from Somerset who was diagnosed with cancer. Last September, her clinicians in Bristol concluded that the only treatment available that could save her life was SBRT on CyberKnife. The CyberKnife experts in London agreed. Her clinicians applied for funding from North Somerset primary care trust, but it took them two months before it refused. It said no because, according to it, there was not enough evidence to suggest that CyberKnife would work.

It is important that the Minister fully understands the train of events in this case. Kerry Dunn’s clinician in Bristol, one of the leading oncologists in the country, believed that CyberKnife could treat her, and the clinicians in London, who routinely use CyberKnife to treat cancer, said that they could treat her, but the bean-counters on North Somerset PCT thought otherwise. Kerry Dunn told me what had happened at the beginning of December. She and her family were in absolute despair over this decision. Once I had contacted North Somerset PCT and after the local press had, separately, taken an interest in her case, the PCT allowed Kerry Dunn to appeal its decision. Three weeks after the first decision, the PCT changed its mind and agreed her funding for CyberKnife.

If Members were expecting a happy ending to this story, I am sorry to disappoint them. Kerry went straight back to the CyberKnife people in London, but her tumour had grown so much that they could no longer treat her. Kerry and her family now face an uncertain future. Three months earlier, there was considerable hope that she would beat her cancer.

The Minister will know as well as I do that if the NRIG report had been implemented last April and an SBRT tariff set at that time, North Somerset PCT would not have delayed approval for Kerry’s treatment and she would be a much healthier woman than she is today. Over the past 12 months, the Department of Health has painted a very different picture of the provision of SBRT in the NHS. I must say to the Minister that I am shocked by the disparities between what the Secretary of State has told me and what all the hospitals have told me in answer to my freedom of information requests. Knowing the Minister as well as I do, I trust that it has more to do with his officials keeping him in the dark than their misleading hon. Members.

In conclusion, I would like some answers from the Minister today. Will he instruct the National Cancer Action Team to conduct a full review of the SBRT facilities available in the NHS? That review should establish whether hospitals are using technology that is fit for purpose and can treat a wide range of tumours with SBRT, and whether hospitals are conducting the number of procedures needed to comply with the NRIG recommendations. Will he commit to speeding up the process of establishing an SBRT tariff in line with the NRIG recommendations, and will he start immediately by asking NCAT to establish a costing code? Finally, I would like a commitment from him to investigate why decisions to fund SBRT by PCTs can ignore clinical opinions of medical professionals when assessing the need for treatment for people such as Kerry Dunn.

--- Later in debate ---

[Paul Burstow]

No. Many points have been put to me, and to be fair, I now need to respond to them.

Currently, eight centres are active in providing these services, but I recognise and appreciate the work my hon. Friend has done, and we will certainly need to review carefully the information she has presented tonight.

CyberKnife can deliver only SBRT and cannot deliver conventional radiotherapy. Large, expensive radiotherapy delivery systems such as these are purchased by public tender. After vigorous and rigorous evaluation of the many different systems available to deliver this treatment, many hospitals around the country have chosen systems provided by other manufacturers, as they enable them to provide flexible, accurate and cost-effective radiotherapy and radio-surgery services. The promotion of CyberKnife over other alternatives does a disservice to other manufacturers that are successful in providing equipment to trusts, and distorts the nature of the debate.

Let me be clear: timely access to high-quality radiotherapy for cancer patients in this country should improve cancer outcomes and survival. That is why we have made a commitment to expand radiotherapy capacity by investing about £150 million more over the next four years. That will increase the utilisation of existing equipment, support additional services and ensure that all high-priority patients with a need for proton-beam therapy get access to it abroad.

Significant progress has been made in improving radiotherapy services since the publication of the National Radiotherapy Advisory Group report in 2007. The collection of the radiotherapy dataset, which the hon. Member for Easington (Grahame M. Morris) talked about, has enabled us to establish more accurately than ever before the measure of the number of patients being treated with radiotherapy, and to identify and address unacceptable and inexplicable variations around the country. Almost all patients referred for radiotherapy treatment receive that treatment within the waiting time standards. This improvement in waiting times, compared with historical waiting times, saves lives each year. New modelling tools have been developed that allow local services to model the needs of their populations and to predict demand and ensure that they have capacity to treat all patients who will benefit from the treatment without unnecessary delay as demand changes over the years.

However, there can be absolutely no room for complacency, and we realise that more work needs to be done to identify why the variations that the hon. Member for Easington has talked about in terms of referral rates in some parts of the country have existed. The dataset shows that some variations in access rates between cancer networks persist, and there is currently lower uptake in certain parts of the north that cannot be explained by variations in cancer incidence. That new dataset allows local commissioners to examine their referral practices in detail, and I understand that networks in the north-east are looking at capacity and travel times to start to address the concerns that the hon. Gentleman has brought to the House tonight.

Access to advanced radiotherapy techniques needs to be improved, particularly intensity modulated radiotherapy. Experts estimate that around a third of all treatments given with the intention of cure should be delivered by IMRT. Some centres are already delivering at that rate, but many are far below it. All centres have equipment that is capable of delivering that technique and a national training programme has been rolled out. We now need to ensure that IMRT, as well as image guided radiotherapy, is offered to all patients who might benefit.

As we have heard, radiotherapy treatment involves the delivery of a dose of radiation to a cancer tumour. That dose is delivered to each patient in fractions or treatments and the number of fractions delivered varies with the type of cancer. The ultimate goal in radiotherapy is to deliver the treatment to the tumour with pinpoint accuracy, thus sparing surrounding tissue and requiring as few fractions, or treatments, as possible—in other words, to treat and cure more cancers with shorter courses of radiotherapy and fewer side effects. For that reason, radiotherapy is continuously evolving with innovations and the development of new techniques and technologies that move us increasingly closer to that goal, but those new developments need to be evaluated in clinical studies.

It is a challenge for providers and commissioners to keep up with the evolving nature of radiotherapy treatment and to ensure the evaluation and adoption of new techniques. The royal colleges and other professional bodies provide guidance to their members to assist the continuous update of clinical practice. Commissioners in turn need to ensure that they are aware of sources of updated guidance. The radiotherapy community in this country can be rightly proud of its ability to deliver clinical studies and explore the use of delivering radiotherapy in fewer fractions. Indeed, the role of the Royal College of Radiologists and the National Radiotherapy Implementation Group in producing such guidance is absolutely crucial.

Let me come back to stereotactic body radiotherapy, which is an important example of specialist radiotherapy technique. It allows radiotherapy to be given to smaller target areas in higher doses with fewer treatments. Its greatest potential is in its possible use as an alternative to surgery and, because of its precision, to treat and potentially cure cancers that would otherwise be untreatable. However, as has been mentioned, it is regarded as a novel technique and it provides a very high dose of radiation per treatment. With conventional radiotherapy, a patient might receive their dose over 20 to 25 visits, but with SBRT that dose is delivered in five or six. More treatments need to be delivered within clinical studies so that clinicians can carefully follow up in both the short and long term to confirm the efficacy of the treatment and study any side effects. Side effects have been mentioned in the context of drugs, but we need to be conscious that there can also be side effects from radiotherapy and not be so anxious to expose people to risks if we are not confident. We should apply the standards of clinical trials to this area. It would be wrong for this Government to promote any form of treatment before the evidence has been collected. Evidence is about more than just making speeches in the House—it is also about looking at the clinical evidence.

All new techniques, including advanced radiotherapy, need to be justified on the grounds of cost and clinical effectiveness. Last year, the National Radiotherapy Implementation Group, published guidance, which has been mentioned, on the use of SBRT, including a clinical evidence review, and concluded that there is a substantial evidence base for the clinical effectiveness of SBRT in early stage lung cancer for patients who are unsuitable for surgery.

There are about 1,000 patients in the country who would benefit from that sort of procedure. There are ongoing clinical trials examining the use of the technique for other cancers, but they have yet to confirm its benefits for those cancers. For that reason, the national radiotherapy implementation group recommended that any patient receiving SBRT should receive it in a clinical study to enable the evidence to grow, and at specialised centres treating high volumes of patients with the necessary quality assurance safeguards in place. The implementation of the recommendations cannot be rushed, and the welfare of patients should be paramount in the introduction and use of novel techniques. Staff must therefore be thoroughly trained in this technique.

My hon. Friend asked me to consider a number of issues. I will certainly undertake to examine the tariff programme to establish what more can be done to expedite it, but I should point out that it is no small task to introduce new tariffs in the NHS. In 2012-13 we are mandating the use of the necessary resource groups and currencies in regard to contracting for external beam radiotherapy, and that is an essential first step. I hope that when my hon. Friend has a chance to sit down with officials, they will be able to talk in more detail about the work that is being undertaken to make progress with the implementation of tariffs.

It is possible that there will be a significant increase in demand for this treatment in the coming decades, but many tumours will continue to be treated better with conventional radiotherapy, and in particular with intensity-modulated and image-guided radiotherapy techniques.

[Tessa Munt]

May I clarify one point? I understand that the group recommended the setting of a tariff, but that the Department of Health will not set it until 2014. There is an acceptance of the technology, but there is also a delay of two years, and in that time people might die.

[Paul Burstow]

There are already local arrangements for the contracting of these services. Specialist centres can use the opportunity to include people in clinical trials, so that we can demonstrate that this is a worthwhile treatment for many cancers. At present, the evidence suggests that it is beneficial only in the case of inoperable lung cancers. I hope that, as we progress, we shall be able to demonstrate that this is not the only technology, and that CyberKnife is a brand, not—

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Tessa Munt (Wells) (LD)]

There are 3,000 cases each year of early stage inoperable lung cancer, but as yet no national stereotactic body radiotherapy treatment for lung cancer. What number of patients does the Secretary of State consider to be the appropriate threshold at which he will instruct his Department to establish a national lung cancer tariff?

[Mr Lansley]

I am grateful to my hon. Friend for that question. I do not think I am in a position to say what figure is appropriate, but the national clinical director for cancer has already indicated to the NHS that he wishes us to develop a national tariff for stereotactic radiotherapy. A quarter of centres across the country already provide it, and our intention is to ensure that that is supported by a national tariff as soon as possible.

Hospital Food

Tessa Munt Excerpts

Tuesday 14th June 2011 Commons Chamber

[Joan Walley]

I am most grateful Madam Deputy Speaker.

The first tranche of what will be 100 dignity and nutrition reports into individual hospitals found that in four of the 10 hospitals investigated, the nutritional needs of patients were not being met. The reports also stated that the quality of hospital food remains a long-standing concern. This highlights both the extent of the problem and the importance of the Care Quality Commission’s role in monitoring and reporting on hospital performance in relation to nutrition. I believe that its resources should be increased so that it can carry out more such checks and fulfil the delivery board’s recommendation of strengthening inspection and regulation. I also believe that the CQC should be made fully accountable for how that work is done.

I want to discuss regulation because that is ultimately the best means of improving hospital food. It is remarkable that there are still absolutely no legal standards governing the quality of the 330 million meals served in the NHS each year. In its report, “Yet more hospital food failure”, published earlier this year, Sustain’s “Good Food for Our Money” campaign surveyed dozens of Government-backed initiatives to improve the quality of hospital food. Alas, it found that those initiatives have cost at least £54 million of taxpayers money and have achieved improvements in only very few isolated cases. The reason is simple: they have all been voluntary, so except in those few isolated cases they have been largely ignored. Let us contrast that with the successful attempts to improve the food served in schools, where meals have to meet legal nutritional standards. A survey by Consensus Action on Salt and Health—CASH—in October 2010 showed that most meals served to children in hospital could not legally be served in a school because they contained too high a level of salt and saturated fat. The reason for the success in schools is simple: minimum nutritional standards in schools are legally binding, but in hospitals they are purely voluntary.

To date, successive Governments have failed to send a clear message to hospital caterers that the quality of their food is critical to patient health and the sustainability of our food system. It is not asking for the impossible. For many years, the Royal Brompton hospital in Chelsea has practised a progressive approach to its food procurement, providing nutritious and appetising meals prepared from fresh ingredients, which enables patients to recover faster.

Unfortunately, the Government’s ideological commitment not to introduce more regulation, regardless of its merit, is a serious block to improving hospital food. I return to Government buying standards. The coalition Government have at least recognised that voluntary initiatives have limited effect; they do not work across the board and over time. As a result, they will introduce Government buying standards that set compulsory minimum standards for food served in central Government institutions. I hope it will be soon, as the standards were promised for March 2011, and we have waited for more than a year. They were promised by the Conservative party pre-election; they were welcomed by the coalition Government and were the subject of a great deal of Department for Environment, Food and Rural Affairs civil servant attention throughout 2010. The work also involved the Department of Health to integrate badly needed health standards for food served in central Government institutions. The integration of health and sustainability standards for food bought with public money was an innovative and much needed approach, and should act as an inspiration for the wider catering sector to follow suit. Tackling health, ethical and environmental issues together should save the country money and be of great benefit to food producers and the environment.

The real issue for me is that even when the Cabinet Office home affairs committee signs off the Government buying standards, they will not apply to hospitals and hospital food. That is the heart of the concern. On the day the Government are revising the Health and Social Care Bill and recommitting it to further scrutiny, should the Health Minister not be exploring with colleagues at DEFRA and in the Cabinet how the long-promised Government buying standards can be extended to hospital food? If that is ruled out, surely there should be urgent discussions with the NHS Future Forum, the National Audit Office and expert groups, such as Age Concern and Sustain, which have a track record on this matter, with a view to tabling amendments to the Bill so that we have minimum standards for nutrition in hospital food.

[Tessa Munt (Wells) (LD)]

There is another part to the equation. I have worked in further education colleges and it would seem logical that when we train chefs they should take a module on the specifics of nutrition for people in hospital. That is a different element. Does the hon. Lady think we could focus on that to improve standards?

[Joan Walley]

I am glad to take that intervention. It is an extremely important point. Basic minimum standards should be applied to schools and in future to hospitals, but that will not happen by accident. It will happen only if we put in place all the necessary education, training and skills. Whoever is responsible for providing the food needs to be trained. I agree that that is a third dimension to the issue.

I apologise to the House for having lost my voice because of my cold. In conclusion, surely there is no other institution where it is more vital to serve healthy, wholesome food than in our hospitals. That is important in so many ways—for the recovery of patients, staff morale, and the atmosphere that fills the wards. When hospitals serve good nutritious food, everyone benefits. I therefore call on the Government to introduce minimum nutritional, environmental and ethical standards for hospital food that will radically improve the quality of food served, reduce costs to the NHS and improve the health of the nation.