Hospital food is widely criticised for its poor quality and lack of nutrition. As the NHS aims to become more sustainable, should hospitals switch to plant-based meals by default? Evidence suggests that a shift could benefit patient health and the environment - but how feasible is it?
A 2020 survey by the Patients Association asked people who had spent at least a night in a hospital within the last six months their opinions of hospital food, which were less than favourable. Only 20 per cent said the food they were served improved their stay, while 44.6 per cent said hospital food had made their experience worse. Almost half (48 per cent) of respondents were unsatisfied with their meals, and a large majority of comments pointed towards the nutritional content of the food as being the source of discontent. “Healthy food please” demanded one participant, while another asked for “provide simply nutritious food.”
The current state of hospital catering
This correlation is not surprising when compared with data from a 2016 survey of London hospital food, which revealed that only 30 per cent of hospitals cook food fresh on-site for adults (42 per cent for paediatric patients), with 17 per cent of hospitals serving patient food in ready meal packaging. Only 13 per cent of hospitals have a Soil Association Food for Life Catering Mark for their patient food, a mark of fresh, environmentally sustainable, and ethical food. This raises concerns as the NHS Constitution says that every patient has ‘the right to receive suitable and nutritious food’.
One Health is an integrated approach to health that recognises that human health, animal health, and ecosystem health are all interdependent on each other; that is, us, the animals, and the planet are all related via food and our consumption of it. Poor nutrition exacerbates ill health, climate change and the NHS’s already existing issues.
It is no secret that the NHS is in a critical state. Over a decade of ‘capital starvation’, understaffing, and budget slashes have left our health service deprived of the resources it needs to function properly, and as a result services often fall short of quality and efficiency targets. The NHS is particularly under stress as Britain faces two major challenges of decreasing public health and the climate crisis, exacerbated by poor funding and lifestyle factors that create a dangerous, expensive cycle.
The NHS & Net Zero
In 2020, the NHS became the world’s first health service to commit to net zero, and published a report where they outlined their roadmap to more sustainable future. In ‘Delivering a ‘Net Zero’ National Service’, the NHS acknowledge that food and catering services produce 1,543 ktCO2e each year, approximately six per cent of the NHS’s total emissions. Methods to rectify this include reducing food waste, ensuring suppliers have sustainable production and transportation practices, and locally sourcing produce. Despite mentioning that the “government’s EatWell plate recommends a diet with reduced processed foods high in sugar, salt and fats”, there is no mention of changing the food served in hospitals, even though a survey commissioned by Plant-Based Health Professionals UK (PBHP) revealed that 30 per cent of participants thought meat-free meals would be better for both the environment and health.
There is long-standing evidence that links animal farming with greenhouse gases, with 70 per cent of food-related emissions in the UK coming from red meat and dairy alone. Meat, specifically processed meat, is recognised as an International Agency for Research on Cancer (IARC) group one carcinogen – the same level as tobacco and gamma radiation – and poses a serious threat to health if consumed in large quantities, and yet a study by the PBHP looking at hospital food menus found that all of the menus analysed contained processed meat. Research found that if everybody were to adopt meat-free lunches just during the week, it would prevent over 7,000 deaths from cardiovascular disease each year. Reducing meat intake in countries with high-fat, high-protein diets (the ‘Western Diet’) is a crucial element to both public health and sustainability, and is particularly important in a hospital, an environment where wellness must take priority and where the national health system has made a pledge to be greener. Between 20 and 25 per cent of all deaths in adults have been associated with imbalanced diets, with one in ten Brits over 40 having type two diabetes.
Public attitudes
In June 2024, PBHP’s survey to gauge the general public’s attitudes towards changes in hospital menus revealed 64 per cent believed that hospitals should prioritise offering healthy meals, 74 per cent believed it is important to make dietary and lifestyle changes to reduce the risk of developing chronic health conditions, and 35 per cent supported the switch to plant-based menus. This is a staggering number considering only two per cent of the respondents were vegan. Another survey by PBHP conducted in May 2024 involving the staff at King’s College Hospital, 74 per cent of respondents gave adding dishes with lentils, beans, mushrooms, or tofu to menus as their response to improve hospital menus.
Plant based by default
61 per cent of respondents to this survey said they would be annoyed if they were unable to eat meat during their hospital stay, which is why a “plant-based by default” approach would be best, rather than outright banning meat in hospital catering. A plant-based by default method is not restrictive and uses choice architecture to encourage people to select plant-based meals during their hospital stays. Much like how vegans often need to ask to see a vegan menu in restaurants, a plant-based by default approach in hospitals would centre plant-based options, making people need to ask for meat options should they wish to. By making plant-based options the norm, institutions like hospitals can nudge individuals towards more sustainable and healthier eating choices without taking away someone’s freedom of choice.
In New York City, 11 public hospitals implemented plant-based menus by default in 2022, leading to a 35 per cent reduction in food-related carbon emissions in just one year, as well as cost savings of 59 cents per meal in 2023. Most importantly, patients who ate plant-based meals in 2023 gave a 90 per cent satisfaction rate. In the UK, the Conservative Animal Welfare Foundation have calculated that a plant-based approach in NHS hospitals could save the NHS £74 million, and even further savings for patients should they also wish to modify their diets once out of care. A reduction in meat consumption would benefit the NHS even if it takes place outside its estate: the Office of Health Economics recently estimated that if England were to adopt a plant-based diet there would be a net total benefit to the NHS of £18.8 billion each year.
Should the UK consider the switch, it is paramount that choice still remains an option for those who still want to eat meat or fish, and that the plant-based meals on offer contain a full nutrient profile. Some people may find transitioning to a vegan diet near impossible, such as those with coeliac disease, those deficient in zinc or B12, and those with allergies to foods often used as substitutes, like soy or nuts. If these remain priorities and policymakers take these into consideration, trialling plant-based menus by default in hospitals could be a solution to three big issues in the NHS: sustainability, poor patient satisfaction, and health.
