Why are hospitals, places people rely on to restore their health, serving food that makes them sick?

The NHS Constitution states that the NHS  ‘is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health.’

Few patients or staff would claim that the NHS in its current form is achieving these aims. Far from a health service, the NHS is currently a sickness service, trying to mop up a flood of chronic disease and poor physical and mental health, whilst the tap of the social and commercial determinants of health is left running.

Too often ‘the highest levels of human knowledge’ is assumed to mean technological solutions. But whilst we are distracted searching for a magic bullet from technology and AI, an evidence-based, effective intervention which can improve the health of patients and staff, reduce our environmental impact and save the NHS money, is being overlooked. This intervention is the normalisation of plant-based meals in healthcare.

Report after report, task force after task force, position statement after position statement, (including the latest Darzi Report) tells us that a focus on prevention, is the key way to ensure that the exponential demand for NHS services does not lead to the NHS being completely overwhelmed.

The NHS Long term plan reminds us that ‘Every 24 hours, the NHS comes into contact with over a million people at moments in their lives that bring home the personal impact of ill health. This Long Term Plan sets out practical action to do more to use these contacts as positive opportunities to help people improve their health.’ These words have not translated into action.

The new government has committed to a ‘prevention first revolution’ in which ‘People will have the power and information to stay well, supported by a proactive government that recognises the value of good health.’ We welcome this commitment but are yet to see plans for how this will be achieved and are concerned by the lack of focus on food and nutrition.

Healthcare professionals play a crucial role in supporting people to live long healthy lives by supporting a shift from current Western diets, high in meat and ultra-processed foods, to diets centred around healthy plant-based foods including fruits, vegetables, whole grains, beans, nuts, and seeds. This shift is essential when overwhelming evidence shows that dietary risk factors are a leading cause of chronic illness from diabetes to heart disease, strokes, cancer and dementia.

NHS leaders have also recognised that the health of individuals and the population is dependent on the health of the planet and therefore committed to achieve sustainability and environmental goals. This aligns with global healthcare aspirations for a ‘One Health’ approach, which sets out the ways in which human, planetary and animal health are intertwined. This is an integrated, unifying approach that addresses the full spectrum of disease control – from prevention to detection, preparedness, response and management. It recognises the threats from antimicrobial resistance and pandemic risk, driven by intensive animal agriculture, as well as water and air pollution, soil health and the impact of extreme weather events on healthcare infrastructure.

In institutional catering, animal-based meals are the norm, while plant-based meals (vegetarian or vegan) are often a single option or are only available upon special request. If we were to reverse this norm, making plant-based meals the default choice with animal-based meals available upon request we could leap forward with aspirations for prevention of disease, reduction in carbon footprint and environmental degradation and even reductions in cost. This approach has already been successfully implemented by the organization Greener By Default, which supported 11 hospitals in New York City in adopting this model. After two years, over 50% of patients chose the plant-based option, with excellent feedback, and there was a 36% reduction in catering emissions, alongside cost savings of 59 cents (46 pence) per meal. Importantly, a plant-based by default approach does not restrict choice; instead, evidence-based behavioural techniques help people make healthier and more sustainable choices. Plant-based meals are also inclusive of all cultural, traditional, religious, and ethical preferences and can be free of common allergens.

Plants First Healthcare is advocating for healthcare institutions, including NHS hospitals, to adopt this proven approach to accelerate necessary changes in our food environment. This initiative is endorsed by the UK Health Alliance on Climate Change, which has called for policymakers and healthcare institutions to lead food system transition. Healthcare settings should be places where we showcase and support the ideal way of eating to patients and staff, utilising this teachable moment. At present we are sending contradictory messages, telling patients and staff that they should adopt a healthy diet but then providing food which features processed meat, fried chicken, fish and chips, refined grains, and high-sugar snacks. The NHS provides over 199 million meals per year for patients, staff and visitors, 199 million opportunities to deliver optimal nutrition and nutrition education. It is time we lead by example.

The complexities of food provision in hospitals, particularly when meals are provided by external caterers and commercial retailers on site, pose significant challenges. However, these challenges should not hinder change. Some hospitals have in house catering and can make this change quickly. But those with commercial providers can also make rapid change if this commitment is made and help from organisations with experience in supporting the transition is accepted. The NYC hospital initiative was conducted in collaboration with the catering company Sodexo, which is now extending this initiative to university dining halls.

There are no downsides to normalising plant-based meals in catering, and we hope all health leaders and healthcare professionals, regardless of their personal dietary preferences, will support this initiative in the name of health. Given the strong evidence of benefit, it would be wrong not to implement a plant-based by default approach in healthcare.

Therefore, as a first step, we urge the health community to sign and share our open letter to healthcare leaders, hospital CEO’s, sustainability managers and lead dietitians asking for their support to implement plant-based meals as the default option in their institutions.

Then take action in your workplace. Identify key stakeholders in your institution or hospital. These will include the catering manager, in-house chef or external catering provider and nutrition, dietetics lead and sustainability manager. Start a discuss around patient and staff food provision aligning your conversation with your institution’s health and sustainability strategic goals. Leverage your local ‘Green Champions’ network and run staff events or challenges to showcase delicious, nutritious plant-based food. Greener by Default offers support in the UK, with a campaign team ready to help you achieve your goals. They are already working with the Royal National Orthopaedic Hospital in London, along with their catering partner ISS, helping to implement simple changes within their staff cafeteria to increase the number of plant-based meals on offer and support people to choose these options.

Together we can implement the most effective health intervention the NHS has ever seen and turn our sickness service into a health service.

 

Authors

Dr. Laura-Jane Smith

Dr LJ Smith is a Respiratory and Internal Medicine Consultant at King’s College Hospital, specialising in airways disease, integrated care and Lung Cancer. She has a Diploma in Clinical Education and has written 2 books on Respiratory education. She is also a Certified Lifestyle Medicine Physician. She is the Clinical Lead for Sustainability at King’s College Hospital and the BTS Trustee for Sustainability. She leads work on air quality, inhaler recycling and plant-based food and is involved in many other sustainability projects within and outside King’s. She campaigns on climate and social justice with Medact.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Board member and Trustee of the British Thoracic Society; Member of Medact; Member of Plant-Based Health Professionals UK (All unpaid roles).

Dr Shireen Kassam

Dr Shireen Kassam is a Consultant Haematologist, Certified Lifestyle Medicine Physician and Visiting Professor of Plant-Based Nutrition. She is founder of Plant-Based Health Professionals UK, a community interest company that provides education on healthy plant-based diets. Her first book, Eating Plant-Based, Scientific Answers to Your Nutrition Questions, co-authored with her sister Zahra, was published in January 2022. She has also co-edited the textbook Plant-Based Nutrition in Clinical Practice, published in September 2022.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Founder and Director of Plant-Based Health Professionals UK