Food represents a substantial and yet often overlooked contributor to the carbon footprint of healthcare systems. In the National Health Service (NHS) in the United Kingdom, it is estimated to generate approximately 1.54 MtCO2e annually, which represents around 6% of total emissions. ¹ Despite the significant role that food and catering can play in helping the NHS to achieve net zero by 2045, ² sustainability efforts have often focussed on minimising food waste and sourcing ingredients locally, rather than addressing the inherent differences in carbon emissions between different food options, particularly the substantially lower environmental impacts of plant-based compared against meat-based options. ³ Therefore, it is vital that food policy also start to consider the types of meals offered, whilst simultaneously improving the understanding of how patients and staff engage with sustainable, plant-based diets. ⁴

Despite a greater emphasis on improving the quality of patient meals in recent years, current assessments of hospital food have revealed widespread dissatisfaction among patients and staff, with concerns relating to food quality, nutritional value, portion size, and limited choice. ⁵ Feedback from patients have also repeatedly highlighted significant variability in standards across different trusts. ⁶

Importantly, these issues highlight a major opportunity for change, particularly when trying to conciliate not only improving the quality but also the sustainability of the food provided in NHS trusts. In particular, moving away from meat-based dishes towards plant-based diets may offer additional health co-benefits by increasing the intake of fibre, complex carbohydrates, and micronutrients. ⁷ Such action could lead to a reduced risk of chronic diseases such as cardiovascular disease and diabetes, ⁸ whilst simultaneously reducing carbon emissions as for example, a vegan diet has only 30% of the environmental impact of a high-meat diet. ³ Culturally, vegetarian and vegan diets are also becoming increasingly common and widespread, with initiatives such as Meat-Free Mondays promoting the uptake of plant-based meals in a wide range of organisations. ⁹ 

To assess the impact of introducing more plant-based meal options within an acute NHS trust, Oxford University Hospitals (OUH) NHS Foundation Trust implemented two phases of a “Meat-Free Mondays” pilot during the months of January 2025 and January 2026. The initiative involved collaborating with catering service providers to redesign hospital menus and increase the availability and variety of meat-free meal options on offer at the hospital restaurants for the month, with plant-based meals presented as the default option. This was implemented across the John Radcliffe, Churchill, and Nuffield Orthopaedic hospital sites, and utilised targeted communication campaigns aimed at both patients and staff to increase awareness and promote the benefits of a plant-based meal.

Feedback collected from 87 participants in the initiative revealed several important insights into introducing plant-based meals in an acute healthcare setting. The three main drivers of trying the plant-based options were quality, sustainability, and cost. The initiative was particularly praised for widening inclusivity, increasing menu variety and visibility of meat-free meals, and creating an opportunity to be more sustainable within a healthcare setting. For many staff and visitors, the initiative successfully acted as a reminder to consider the environmental impact of dietary choices as well as the health co-benefits of plant-based options.

However, the pilot also identified several important considerations for longer-term implementation. Customers perceived the reduction in meat-based options as limiting personal choice and autonomy, particularly when changes were introduced without substantial prior engagement. Others questioned whether catering should be a focus for sustainability initiatives, given the wider systemic challenges facing NHS organisations. The initiatives also highlighted limited awareness and understanding of the links between food, climate change, and health, suggesting that further education and awareness may be needed. Overall, these responses emphasised that transitioning towards more sustainable plant-based food options involves not only logistical considerations, but also broader cultural change and public engagement. Ensuring that future such initiatives are framed around expanding choices, improving food quality, and promoting the health and sustainability benefits may be preferable to focusing on reducing meat intake, which can be perceived as an restriction.

Our experience at OUH Trust suggests that transitioning to sustainable, plant-based diets in the NHS requires significant engagement with both patients and staff to be successful in the long term. Reducing cost of meals, strengthening promotion activities and increasing the variety of plant-based meals may help encourage greater uptake of meat-free options moving forward. ¹⁰ As the NHS progresses towards net zero, introducing plant-based options as a default option represents an impactful way in which healthcare organisations can both support healthier and more sustainable diets for patients and staff.

References

1. Food and nutrition. NHS England. https://www.england.nhs.uk/ahp/greener-ahp-hub/specific-areas-for-consideration/food-and-nutrition/ (accessed 5 June 2026).
2. Delivering a Net Zero NHS. NHS England. 2022.
3. Scarborough P, Clark M, Cobiac L, et al. Vegans, vegetarians, fish-eaters and meat-eaters in the UK show discrepant environmental impacts. Nature Food 2023; 4(7): 565-74.
4. Making Plant-Based Meals the Default: For A Healthier, More Sustainable NHS. Plant-Based Health Professionals UK. 2025.
5. NHS patients face worse food and smaller portions. The Telegraph. 2026 24 April 2026.
6. Independent review of NHS hospital food. Department of Health and Social Care, 2020.
7. Medawar E, Huhn S, Villringer A, Veronica Witte A. The effects of plant-based diets on the body and the brain: a systematic review. Translational Psychiatry 2019; 9(1).
8. Kahleova H, Levin S, Barnard N. Cardio-Metabolic Benefits of Plant-Based Diets. Nutrients 2017; 9(8): 848.
9. Meat Free Mondays. https://meatfreemondays.com/ (accessed 5 June 2026).
10. Summary of Research into Increasing Consumption of Plant-Based Foods. Greener by Default. https://www.greenerbydefault.com/research (accessed 5 June 2026).

Authors

Dr Jason Yun
Jason is a ST3 Public Health Specialty Registrar currently working at Oxford University Hospitals NHS Foundation Trust. His interests include sustainable healthcare, population health and health policy.

Natasha Guildford
Natasha is a Macmillan Specialist Dietitian at Oxford University Hospitals NHS Foundation Trust. Her interests include sustainable nutrition and leads the Sustainable Food Group.

Dr Cat Pinho-Gomes
Cat is a Honorary Consultant in Public Health at Oxford University Hospitals NHS Foundation Trust. Her interests lie in environment/climate & health and gender inequalities, and she co-leads the implementation of the Climate & Health Strategy at the Faculty of Public Health

Declarations of Interests
We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.