“Ms Hoxha has not, as far as we are aware, received the necessary daily clinical monitoring required for patients refusing food and is at risk of sudden electrolyte disturbance, hypoglycaemia and cardiac arrest,” the letter said.

“After speaking with family, our understanding is that Ms Hoxha had low blood sugar, at around 2.7, for significant periods of time yesterday. This constitutes a medical emergency.

“Given that Ms Hoxha’s hunger strike is now at a critical stage, we must therefore insist that NHS England exercises its commissioning oversight.”