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Birmingham Children’s Hospital. Credit: Oosoom https://en.wikipedia.org/wiki/User:Oosoom

The problem

Hospitals – like many other public sector and large institutions – are under pressure to improve catering sustainability. Transforming the food offer, including by reducing meat and increasing plant-based meals, has been recognised as a key part of the NHS approach to ‘Delivering a ‘Net Zero’ National Health Service’.

Increasing the sustainability of menus involves a balancing act encompassing a range of outcomes: appeal & satisfaction, safety, nutrition, cost, and operational practicality. The Birmingham Children’s Hospital (BCH) catering team has expertise in some, but not all, of these outcomes. Their previous attempts to introduce more sustainable dishes, while maintaining costs and nutrition, have negatively impacted patient satisfaction because the dishes were unfamiliar or unappealing.

While the hospital is keen to improve its inpatient meals, it is isolated from the work taking place in other institutions such as schools, early years, universities, and not able to benefit from the learning which could inform its catering activities.

The intervention

Menu changes, informed by multi-dimensional outcome expertise and evidence: safety, nutrition, operations (BCH), sustainability and appeal.

The research

Research question

Can changes to inpatient paediatric menus improve the sustainability of dishes, while optimising nutrition and appeal and not increasing cost?

Theory of change

Research approach

Key outcomes examined will include nutritional quality, environmental footprint, and changes in purchasing patterns. We will consider patient satisfaction, plate and kitchen waste.

This will be a natural experimental study. We will conduct quantitative analysis of hospital menu and patient satisfaction data, to determine baseline nutritional, economic, environmental, satisfaction levels of existing hospital dishes. We will collect qualitative data on the catering process, actors, other contextual influences, and conduct a process evaluation to examine fidelity, acceptability and feasibility in the hospital context, and any unintended consequences.

Modelling approaches will be used to assess potential health and environmental impacts.

Outputs and impacts

We will produce

  • papers reporting the results of menu changes (menu selection, nutritional, environmental, cost, satisfaction impacts),
  • modelled impacts on health and environment, process and economic evaluations.
  • a paper on process evaluation, including enablers and barriers.

We will input to a paper on contributions to system change.

We intend to develop a multi-outcome menu development tool to design and analyse dishes against a range of outcomes.

Research team