‘We tend to think of this as a nutritional holiday,” said the dietician, as we looked down at the blue plastic tray on my four-year-old daughter Vida’s overbed table. Vida was about to start a long-awaited bone marrow transplant at a major London hospital, a process requiring an intensive chemotherapy programme that would affect her appetite and ability to eat. We needed to prioritise her weight over healthy eating, said the dietitian. It was mission Calories Over Carrot Sticks. In normal times, this would worry me profoundly.
Looking at that tray, it struck me that the food here would probably force anyone to take a nutritional holiday, bone marrow transplant or not. There was a plate of soggy battered fish and some cardboard-looking chips, long‑life apple juice, a bag of Quavers, Ambrosia custard, a KitKat and a token easy peeler. Vida wasn’t due to start chemo until the following day, but the fish and chips went untouched. For her first few weeks as an inpatient, I would order her the most basic offerings available in the hospital – an anaemic-looking omelette, overcooked pasta that collapsed on your tongue, a chicken breast so tough that it could have taken down a man – but Vida never tried more than a mouthful before pushing the food away.
British hospitals are not known for their food, and I know this all too well. Vida was born with a chronic blood disorder which required us to spend a couple of days in hospital for blood transfusions every month for four years, then to live there for six weeks during her bone marrow transplant in 2023, before spending at least two days a week there for almost a year after that. We have learned to have low expectations of the food in the (several) hospitals we use. Unlike many of the families with whom we shared the ward, we live in London, so during the inpatient stay, my husband could easily bring in food in Tupperware to heat up in the microwave; often, too, we’d resort to M&S. We were lucky to have these options.
The UK is not alone in dishing up disappointing meals to hospital patients. As the pictures and stories on these pages show: from Australia to Brazil, Kenya to Spain, the food served in state hospitals, where resources are squeezed, follows a common theme – unappetising, often bland, and made without the care that any cooking requires, but especially cooking for people whose health is compromised. And yet, it is possible. The simple but delicious offerings at the Kobe Red Cross hospital in Japan are restaurant quality, among them steamed rice with tofu balls or grilled fish with grated radish. In Taiwan, menus change weekly and meals are tailored to the patient, often following the principles of Chinese medicine – congee, warming soups, steamed vegetables. Meanwhile, in Swedish hospitals, food is cooked, often from scratch, on site, and – refreshingly – is considered to be “a prioritised part of care”.
There is something wrong with patients being served nutritionally dubious, unappetising meals at the very time they need good food most. It is such a no-brainer to feed people well in hospital. Isn’t good food a health intervention? Well, yes, but as Henry Dimbleby, who led the government’s national food strategy in 2021, told me last month, “quite a lot of the relationship between food and health is chronic”; eating healthily is to some extent a preventive measure, and needs to be woven into the fabric of someone’s lifestyle.
“The NHS is fundamentally drug and intervention based, and not at all prevention based,” Dimbleby says, and in a reactive healthcare system, by the time someone typically reaches hospital, a square meal won’t make much difference – unlike a prescription or an operation. The exception here is patients like my daughter, who are required to spend prolonged periods in hospital. Ours is a minority cohort. Unlike other examples of institutional catering, like school or prison meals, to which children and inmates are exposed most if not every day, people typically have a fleeting brush with hospital food before returning to their normal routine. It is inexcusably bad, but a novelty, and, like aeroplane food, something to chuckle about later.
Dimbleby thinks the dire state of British hospital food is “a reflection of our broader food culture”. He says that while the quality of British food is improving overall – witness the success of Tim Spector’s Zoe app, increased awareness of ultra-processed foods, and more consideration of food sourcing – there is still a long way to go and, on the whole, institutions are way behind wider society. The government, says Dimbleby, “is very happy to be quite firm about maths in schools, or to advise on hygiene standards in hospitals”, but it is reticent about food, as its immediate benefits are harder to measure. “We know there are two things that are needed for good health: food and exercise,” says Dimbleby, “but food is still seen as a woolly thing. Many more people die of diet-related disease than from car crashes.”
Naomi Duncan, the CEO of Chefs in Schools, a charity that has set out to revolutionise school catering with “mind-opening, society-changing food”, agrees. She says that across the public sector, we are measuring the wrong things. The key performance indicators, she says, are usually cost, timekeeping and hygiene – things that are easier to measure than how nourished a meal makes patients feel, or its freshness, or how much love has gone into making it. “We’re placing markers like health and safety above the nutrition of the food,” she says, “rather than measuring the other side, which is the patient looking at the food and thinking: ‘I can’t eat this.’” In many cases, it might be too late for a single meal to make a difference medically, but comfort food – a hot plate of something you really want to eat – brings immeasurable benefits. As Dr Tamal Ray, an NHS anaesthetist and former Great British Bake Off contestant, tells me, “The psychological side of recovery is a huge part of the physical side. It’s pretty miserable being in hospital, and good food can bring joy and interest.”
I am confident that everything I ordered for Vida in hospital met the requisite health and safety standards. Likewise, I’m sure the meals came within budget. But by any other measure, this was not successful catering. It did not nourish her, it did not satisfy her, and while I know someone spent time preparing it, it was hardly made with love. But how could it be when it was almost exclusively outsourced and made by a large catering company? “There are a small handful of catering companies big enough to handle these huge hospital contracts,” says Duncan, “and if they are willing to take all the financial and health and safety risks, but also have full control of menus and sourcing, that can probably seem like a good deal for hospitals. The problem is, this means hospital leadership don’t think the catering has anything to do with them.” Dimbleby agrees with Duncan that hospitals “don’t think of food as being part of their service”.
Both Duncan and Dimbleby are adamant that good hospital food is possible if those steering the ship make it a priority and work alongside the kitchen to deliver it. The Royal Marsden NHS Foundation Trust, a specialised cancer service, operates a tailor-made approach to food for its paediatric patients. “We have a team of specialist dieticians, on-site chefs and ward-based catering staff, so we can provide bespoke, freshly cooked food for children during their time here,” says Eleanor Bateman, divisional director for cancer services. She tells me about their homemade chicken dippers, the Halloween-inspired drinks, making their own pizza and fruit kebabs, and the hospital’s beloved ice-cream cart, adding, “The team delight in finding ways to make food fun and ensure patients receive the right diet and nutrition during their cancer journey.” Appetites may well be compromised during and after chemotherapy, but I have no doubt that strategies like these, which engage patients with their food imaginatively and emotionally, and include them in the act of preparing it, accelerate their return to eating – and their discharge.
Dimbleby and Duncan agree that it is very difficult to make decent margins on food. But, as anyone struggling with the cost of living who likes to cook from scratch will know, it is not impossible to make good food cheaply. When food writer Diana Henry was an inpatient at the Whittington hospital in London earlier this year, she posted several photos of her NHS meals on Instagram, often with glowing captions: “Moroccan vegetable tagine and it is delicious,” reads one, “I met the head of catering today … When he was dealing with teenage cancer sufferers he was able to knock two weeks off their stays in Great Ormond Street because they loved the food. They got better quicker and put on weight. There they had a state-of-the-art kitchen and 15 chefs. Here, he has nothing like that, but he has big plans to improve everything within his resources.”
And gold standard hospital food can be profitable, as shown by facilities management consultancy Neller Davies, which has overhauled the food at several hospital trusts since the pandemic – notably at Ashford and St Peter’s hospitals in Surrey. Prices for staff food dropped by 15%, salads and healthy options became available for £2 or less, and sales increased from £450,000 a year to a total of over £2m in the first three years. The hospitals are about to roll out a scheme for patient food, too, using small and medium enterprise suppliers. Meanwhile, the new patient catering facility at St Richard’s hospital in Chichester, West Sussex, saw Neller Davies collaborate with the trust’s dietitians to produce up to 6,000 meals a day on site using fresh ingredients, for a range of dietary requirements. These are then frozen. Orders are taken two hours before a meal and heated up slowly. A good measure of the reception this has received is the 50% reduction in food waste. Prue Leith, who was an adviser to the government’s hospital food review, declared it “the best institutional food [she had] ever eaten”. Duncan says: “Ideally, we’d do without the ‘freeze’ bit, but at least it’s being controlled in-house, real ingredients are going in, made by humans into tasty food.” Not perfect, maybe, but a far cry from the reheated mini-trays of ready-meals with an orchestra of E numbers.
One of the best meals I have eaten this year was at Woodmansterne school in south London; Vida had been readmitted to hospital for a week, and I left her with her dad so I could meet Duncan to see and taste what chef Jake Taylor could do with his sub-£1 food budget for each meal (significantly less than the food budget per meal at most hospitals). I ate a Thai curry with vegetables and bean curd, rice, flatbread, winter leaf salad and ginger cake, and it was all the kind of comfort food I needed after several days on a paediatric ward. What if, I thought, we were able to get food like this at our hospital? It would have changed so much – and not only for patients, but families, visitors and, importantly, staff. Woodmansterne had its own sizeable kitchen, although not all schools do; similarly, not every hospital has its own catering facilities. This doesn’t need to be an issue, says Duncan, who is piloting a central production model for schools that don’t have a kitchen. It’s just about knowing what travels well.
“Across the public sector, we see food as a risk to be managed – a safety risk, a financial risk – not as a tool for health and education,” says Duncan. On this point, I have often thought that most hospital catering is a missed opportunity to introduce patients to how delicious and exciting healthy food can be, irrespective of how long they have to stay. For a nation with 2.8 million people out of work due to four conditions – cardiovascular disease, type 2 diabetes, musculoskeletal problems and mental health, “the first three linked to bad diet and the other exacerbated by it”, says Dimbleby – people’s captive exposure to institutional catering is a chance to model a new way to eat.
Vida’s transplant meant replacing her bone marrow (or “blood factory”) with her brother’s donated stem cells, and involved many potent medications over many months. Her “nutritional holiday” involved intravenous feeds, a special milk fed to her through a nasogastric tube, and a lot of marshmallow bribes. She was immunosuppressed and isolated at home for nearly a year, but is now, finally, a happy schoolgirl. Having spent her first five years feeling below par at best, and with very little interest in food, she now has quite the appetite. Her growing love of food is wonderful to see, but also hard work: I often feel we are undoing some of the messages she received about eating in hospital. Perhaps she is no different from other five-year-olds in thinking that her hunger can be satisfied with Haribo sweets, or that chips and crisps followed by ice-cream is a balanced meal, yet I can’t help but feel that her treatment has gone some way to distort her perception of what constitutes healthy food. The memory of those meals doesn’t keep me up at night – I’m just happy my daughter is here and well – but the fact that it is possible to do so much more with so little gives me a rumbling dissatisfaction that will not be sated by a bag of Quavers.