It hardly needs saying that good nutrition is key to recovery in hospital. Studies back this up – for instance, research in France published in the journal Clinical Nutrition ESPEN last year, found that undernourished patients stayed in hospital for an average five days longer than those who were well-nourished.
But hospital food ‘can be tricky to get right because it needs to be hot and look and smell nice to make patients want to eat it, which is vital for their recovery,’ says Priya Tew, an independent dietitian and a spokesperson for the British Dietetic Association.
National standards to ensure food served in NHS hospitals is of good quality were introduced in 2022 after an independent review. These state that all NHS organisations must see ‘food as medicine’ and that hospital food must be a priority for NHS leaders.
And yet there are ‘fierce inconsistencies between NHS trusts in implementing the standards’, according to Rachel Power, chief executive of the Patients Association.
‘The quality of food in hospitals across the country needs to be consistently high – and it isn’t,’ she says.
‘One issue is that some hospitals have kitchens and can make fresh food on site, while others buy in food daily and reheat it on site.
‘It’s also key that each trust’s board places value on food and that there are measurements in place to make sure the meals are meeting the nutritional standards and look appetising, so patients want to eat them.’
The situation has improved since the review, says Rob Percival, head of food policy at the Soil Association: ‘The renewed emphasis on the importance of hospital cooking and fresh preparation coupled with tighter standards means that the story today is more positive – but provision may still be uneven and there’s a way to go.’
It’s also unclear whether trusts are being kept up to the mark by the Care Quality Commission (CQC). Mr Percival points to the need for a clear picture of ‘what hospital food is like across the country, including where the standards are failing to be met. At the moment that evidence isn’t being consistently gathered.’
The Soil Association went into a partnership with NHS England earlier this year to support 20 NHS trusts to achieve a Food For Life Served Here certification, which means they are delivering high-quality, sustainable, ethical, nutritious food containing locally sourced ingredients all prepared on site. The ultimate aim is for all NHS trusts to achieve this.
The historical trend of removing kitchens from NHS hospitals and bringing in pre-made meals has been ‘counterproductive’, explains Mr Percival.
‘While the meals are nutritionally balanced and cater for different patient groups, often they are not very appealing and are processed within an inch of their life.’
For hospitals without big kitchens, the best options are to have a small on-site facility where there is scope to prepare salads, soups and other things that can enhance or transform the brought-in meals to make them more appealing; or to have a local ‘hub’ kitchen where food is made and delivered to various nearby hospitals, he says.
So how good – or bad – is hospital food today?
In England an annual national external audit, the Patient-Led Assessments of the Care Environment (PLACE), is carried out across NHS trusts and food is one of the standards assessed – last year the national average for hospital food was 92.1 per cent.
For a snapshot of the standard of food being served to patients in NHS hospitals across the UK, in a unique experiment we asked nine patients – who all stayed in hospital during the same week – to take a photo of the main part of their evening meal.
We asked Priya Tew to assess them nutritionally and for their appeal. As she explains: ‘It’s important that hospital meals offer a good balance of protein (which is vital for repairing the body tissues and recovery after any illness, treatment or surgery); vegetables (for fibre, vitamins and minerals and antioxidants); and a carbohydrate component (for energy, which helps the body to heal).’
But food also has to be appealing, she adds, ‘as we do eat with our eyes’.
The experiences of our patients varied wildly. Find out which meals whetted the appetite and which drove them to a takeaway…
Cod in parsley sauce, carrots and mashed potatoes
With ice cream; cheese and crackers
‘None of the food I ate during my stay was brilliant but this meal was the worst – I wouldn’t give it to an animal,’ says patient Yvonne
Yvonne Jones, 54, a carer from Godalming in Surrey, spent two nights in Royal Surrey County Hospital, Guildford, with a low heart rate and other health issues.
Hospital catering: Outsourced to a company that provides food then steam-cooked on site. PLACE rating 97.9 per cent.
Patient’s verdict: Yvonne says: ‘The fish was meant to be cod but it looked pink, didn’t taste like cod and had a rubbery texture which was hugely off-putting. I could only manage one mouthful. The carrots and potato also had a strange texture and taste, but the sauce wasn’t too bad – although the whole meal was cold. The ice cream and cheese and biscuits were fine.
‘None of the food I ate during my stay was brilliant but this meal was the worst – I wouldn’t give it to an animal.’
Expert verdict: Dietitian Priya Tew says: ‘The main meal doesn’t look the most appetising and we do eat with our eyes. But in essence the correct amounts of carbs, protein and vegetables are there (each around a third of the meal). You can see some watery liquid on the plate which is probably due to the steaming method of reheating food.
‘It’s important to have desserts in hospital to get more energy in the form of calories – and they bring pleasure, which is important too. But living off desserts is not ideal.
‘Cheese and crackers are also a good choice as they contain protein and carbohydrate and it’s a useful snack to save for later in the evening.’
Roast pork, mashed potato and cauliflower
With leek and potato soup; Strawberry whip
‘I was so hungry I ended up ordering a KFC takeaway – my visitors met the delivery driver in reception. I did the same two other times,’ says patient Lewis
Lewis Thomlinson, 26, a roadside technician from Manchester, was in Tameside Hospital near Manchester for eight days after a suspected heart attack.
Hospital catering: Food is freshly made in the hospital’s kitchen. PLACE rating 83.3 per cent.
Patient’s verdict: Lewis says: ‘The soup was lukewarm though probably had the nicest flavour of everything in the meal – but I only had a mouthful because it was so thick.
‘The mashed potato wasn’t bad but the pork was dry, hard and had a lot of fat – again I had just a mouthful. I ate one piece of cauliflower but it was overcooked, like mush.
‘The dessert, which I thought would contain strawberries, had an artificial flavour so I didn’t eat much.
‘I was so hungry I ended up ordering a KFC takeaway – my visitors met the delivery driver in reception. I did the same two other times.
‘I could tell some of the meals had been sat there for ages because they weren’t warm and the food was clumped together.’
Expert verdict: Priya says: ‘This meal is balanced in terms of carbs, protein and veg but doesn’t look very appealing because there’s a lot of beige. Adding some peas or another coloured vegetable would have brought it to life and made it more likely that the patient would have eaten more.
‘Soups in general are a good choice for getting more fluid – people often don’t drink enough in hospital or go in dehydrated. This will also provide key nutrients such as vitamins C and B6.’
Jacket potato with tuna mayo
With apple puree
‘A jacket potato is not always a safe option in hospital – they’re not always warm and can be a bit hard or dry,’ says nutritionist Priya
Matt Woods, 44, from Greenwich, south-east London, runs a private education company. He spent 11 nights at the Queen Elizabeth Hospital in Woolwich with acute pancreatitis.
Hospital catering: Outsourced to a catering company, and reheated on the wards. PLACE rating 96.6 per cent.
Patient’s verdict: Matt says: ‘The potato was warm and soft with crispy skin and the tuna mayo was tasty with a good consistency and did the job. The apple puree also went down well.
‘I’m probably more well placed to cope with hospital food than most because I used to be in the RAF, so I’m used to school dinner-style food like this. The catering staff tried to accommodate my needs but the main surprise was the NHS didn’t really give any dietary advice or support, given I was in for a gastrointestinal ailment.’
Expert verdict: Priya says: ‘This could have done with some vegetables or salad to make it more balanced. However, a jacket potato with tuna is a nutritious meal, with carbohydrates and plenty of fibre in the potato skin (it can be harder to find good sources of fibre in hospital meals). The apple puree provides a portion of fruit; a whole apple would be more nutritious, but can be more difficult to eat. So while not exciting, puree is still a brilliant choice.
‘But a jacket potato is not always a safe option in hospital – they’re not always warm and can be a bit hard or dry.’
Ham, mashed potato and swede
With chocolate mousse
‘This is a bit of an odd combination of foods, and it looks like it needed some gravy to bring them together and make sure the meal wasn’t dry,’ says nutritionist Priya
Jenn Evans, 48, a retired traffic controller from Boston, spent 20 days in the Pilgrim Hospital Boston in Lincolnshire after emergency surgery for a stomach abscess.
Hospital catering: Made in kitchens on site. PLACE rating 87.9 per cent.
Patient’s verdict: Jenn says: ‘I’d have liked more ham, but other than that everything was delicious and hot.
‘The swede tasted fresh, the mashed potato was fluffy and the chocolate mousse was very tasty and creamy – so all in all it was a satisfying meal.
‘You can choose small, medium or large sizes and I opted for medium, so I may have got more ham had I chosen large.
‘Food here has been like proper home-cooked meals and helped me feel better.
‘However, I have dietary needs which weren’t always met. For example, I was placed on a high-protein diet to aid my recovery, but there were no extra protein options on the menu.’
Expert verdict: Priya says: ‘This is a bit of an odd combination of foods, and it looks like it needed some gravy to bring them together and make sure the meal wasn’t dry and difficult to eat.
‘When you order ham you might expect it to be more like gammon, whereas this looks like sandwich ham.
‘Ham is a processed meat, high in salt and nitrates, and so not something you should eat every day.’
Vegetable cottage pie with peas and sweetcorn
With minestrone soup; Cheese and crackers
‘The food was a highlight in my day and nothing was too much trouble if I needed extra things outside set mealtimes, such as toast or hot chocolate,’ says patient Caroline
Caroline Hanson, 66, a retired wealth manager from Newcastle, spent 11 days in the Queen Elizabeth Hospital in Gateshead with pneumonia.
Hospital catering: Made in kitchens on site. PLACE rating 91.9 per cent.
Patient’s verdict: Caroline says: ‘There were many vegetables and legumes in the pie, including kidney beans and peas, as well as the vegetables on the side. It tasted really nice and fresh. The soup was also very nice and substantial, so I felt pleasantly full. The cheese and crackers were tasty, too.
‘You can choose small or large portions, and because I wasn’t as active as normal, my appetite went down so I chose the small ones.
‘Each course here is served one at a time, so everything stays hot and there’s plenty of choice.
‘The food was a highlight in my day and nothing was too much trouble if I needed extra things outside set mealtimes, such as toast or hot chocolate.’
Expert verdict: Priya says: ‘This meal is nicely balanced, with plenty of veg (including in the soup). While there aren’t many carbs in the small amount of potato here, important for energy, Caroline did choose the small portion.’
Pasta bolognese, garlic bread and mashed potato
With strawberry jelly
‘In general, the food wasn’t great during my stay – most of the meals were bland and tepid or cold,’ says patient Andy
Andy Bhoy, 54, a retired tailor from Glasgow, spent six days in the Queen Elizabeth University Hospital Glasgow after a stroke.
Hospital catering: Meals are prepared at two other hospitals in the same health board and reheated on wards.
Patient’s verdict: Andy says: ‘In general, the food wasn’t great during my stay – most of the meals were bland and tepid or cold. The worst was baked eggs (vile!), served two nights in a row.
‘But this happened to be one of the better days. The pasta was hot and surprisingly delicious, despite looking a bit slopped on the plate. I also got a slice of half-cooked garlic bread which I didn’t eat.
‘The desserts were usually ice cream tubs or jelly which were nice enough – if boring – and I usually ate them.’
Expert verdict: Priya says: ‘Making dishes like this look gourmet can be difficult when you’re cooking for a large amount of people. So it looks a bit sloppy, but at least there’s enough sauce to make it easy to eat.
‘I’m not sure why it’s served with garlic bread and potatoes, which seems like a lot of carbs. I’d have preferred to see vegetables or salad.
‘Jelly can be sugary, but it has got a high liquid content which helps to maintain good hydration levels.’
Sausages, mash, cauliflower and peas
With apple pie and custard
‘The hospital food was extremely forgettable and just filled a hole,’ says patient Ben
Ben Deighton, 40, a former electrician from Sheffield was in Royal Hallamshire Hospital in Sheffield for 11 days due to complications from functional neurological disorder (FND).
Hospital catering: Food is made on site and heated trolleys are used on the wards. PLACE rating 96.9 per cent.
Patient’s verdict: Ben says: ‘The sausages were hot but weren’t cooked enough for my liking – I prefer them browner – so I left them and just ate the vegetables (which were overcooked but at least were something to eat).
‘The mashed potato tasted powdery and I only ate it because I was starving.
‘The pudding fared better, with tasty custard and apple pie, but there was more pie than apple so it was stodgy.
‘The hospital food was extremely forgettable and just filled a hole.’
Expert verdict: Priya says: ‘At first glance this looks like a balanced meal, and there’s also a lot of gravy so the meal isn’t dry.
‘But sausages are processed meat so it’s best not to have them more than once or twice a week.
‘The pudding is a great choice – potentially there’s a portion of fruit in there from the apple, and custard provides milk. And if it tastes good, that’s even better.’
Chicken casserole
With orange juice
‘I hadn’t chosen the chicken casserole but it was all I was offered. When I saw it I was astounded – it looked like it had been regurgitated,’ says patient Jayne
Jayne Tingle, 47, a personal trainer from Bolton, was in the Royal Bolton Hospital for one night after a hysterectomy and surgery for a prolapsed bladder.
Hospital catering: Outsourced to different companies and reheated on trolleys. PLACE rating 89.5 per cent.
Patient’s verdict: Jayne says: ‘I was given this meal six hours after surgery, having not been able to eat since the previous night, so after nearly 24 hours I was starving.
‘I hadn’t chosen the chicken casserole but it was all I was offered. When I saw it I was astounded – it looked like it had been regurgitated. I couldn’t find any chicken in it, and the tiny bit of the sauce I tried tasted horrible.
‘The vegetables also looked very unappealing. It wasn’t a meal that would help me recover after a big operation.
‘In the end I asked a friend to bring something in for me (a sandwich from Subway), as I couldn’t take pain relief on an empty stomach.’
Expert verdict: Priya says: ‘The good thing is there are quite a lot of vegetables, but it’s not clear what’s in the rest of the meal and I can see why Jayne might have been disappointed. The vegetables look like a mix of frozen veg, and whilst as nutritious as fresh, they can be watery.
‘Although sugary, the fruit juice – providing a portion of fruit – will also contain vitamin C to help absorb iron from the rest of the meal.’
Chicken and leek bake with chips, peas and carrots
With apple crumble and custard
‘Overall I enjoyed the food here though sometimes it didn’t look as good as it tasted – as it did on this day,’ says patient Leanne
Leanne Yeomans, 33, from Birmingham, was in Good Hope Hospital in Sutton Coldfield for 15 days with a lung infection.
Hospital catering: Food is prepared in a production unit at a different trust hospital, delivered daily and kept warm in trolleys. PLACE rating 96 per cent.
Patient’s verdict: Leanne says: ‘Overall I enjoyed the food here though sometimes it didn’t look as good as it tasted – as it did on this day. This looked quite sloppy on the plate. But it had a lot of flavour. The vegetables and chips were well cooked and everything was warm.
‘The apple crumble was tasty and seemed nutritious because the topping had oats in.’
Expert verdict: Priya says: ‘It’s hard to get these sorts of dishes looking like they would in a restaurant. And while chips aren’t the healthiest option, there are a lot of vegetables here – on the side, and in the chicken and leek bake – and protein, so it’s still a pretty balanced meal.
‘The apple crumble is a good option, providing a portion of fruit and fibre from the oats. And the generous amount of custard provides a good source of calcium and protein.’
