From salmon mould to Moroccan tabbouleh: hospitals diets and patient nutrition

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Patient nutrition in hospitals has been a concern for generations. While hospitals led the way in medical research in the early 20th century, they also had a role to play in raising awareness about nutrition and the importance of food for overall health.

In 1943, The King's Fund published its first memorandum on hospital diets, which provided hospitals with advice on the quality and quantity of the food they served and how best to prepare nutritionally balanced meals. Recommendations included provision of cooked breakfasts and suppers for patients as part of a diet that did not need to be supplemented by ‘extras’ brought in by patients’ relatives. The memorandum also declared that patients should leave hospital ‘enlightened as to the most beneficial and suitable diet for his needs and circumstances’.

Interest generated by the first memorandum indicated that there was a need for a further study of hospital catering, so The King’s Fund established the Committee on Hospital Diet to investigate standards of hospital nutrition. King George VI, the Fund’s President, appointed the Committee in October 1943 and it met regularly over the next 16 months.

Information gathered by the Committee suggested that, in many hospitals, those responsible for feeding patients were aware of the importance of good catering in its widest sense. In a number of cases, hospitals were making a real effort, in spite of considerable difficulties, to improve conditions.

A plate with gravy or sauce slopped over the side will go far to kill appetite
Second Memorandum on Hospital Diets, 1945

A second memorandum on hospital diet was published in 1945 to help hospital authorities to bring their catering arrangements in line with modern standards. It included recommendations on the appearance of food so as not to harm appetites: ‘A plate with gravy or sauce slopped over the side will go far to kill appetite,’ it said.

A separate memorandum, which included recipes and tables of food nutrition values, was published the same year to assist in the practical work of menu planning and cooking. Recipes for familiar foods such as fish cakes, vegetable hot pot and gateaux were joined by more peculiar-sounding dishes, including Russian pie, rum baba and salmon mould.

Rum baba recipe

After the National Health Service was established in 1948, The King’s Fund set up several schemes to provide advice to hospitals, including the Hospital Catering Advisory Service. Advice included how to make the most of rationed commodities after World War II. While this advice emphasised the importance of maintaining a good level of dietary nutrition, it also outlined how much catering staff were entitled to draw from the rations of each patient and provided information about when commodities would come off ration, allowing catering departments to plan ahead.

The Hospital Catering Advisory Service also looked at 'special diets' – dietary regimes for people with conditions such as diabetes, obesity and gastric reflux. The resulting advice was designed to provide simple explanations about what these diets set out to do and how to provide them. It was particularly useful for catering staff in hospitals where there was no dietician. The recommendations given in this report for a diabetic’s breakfast are particularly interesting when compared with today’s guidance. Breakfast foods included bacon and egg, ham, cod’s roes, haddock, herring and egg in contrast with the current Diabetes UK guidelines which suggest porridge, bran flakes, fruit, toast and crumpets.

The Fund published more research and guidance, with memoranda on light diets, therapeutic diets, catering in convalescent homes and further advice on general hospital diets and the costs of feeding patients in 1969 – around £4.00 per day in current money, compared to £10.48 in 2013/14.

Meal costs 1969

The Fund’s interest in hospital nutrition continued: later research focused on how hospital staff could promote nutritional awareness to patients and encouraged nurses to see the role of health educator as a vital part of their jobs. It also assessed the extent to which dietary initiatives contributed to patient wellbeing. There was growing recognition that patient nutrition was linked to clinical outcomes.

Sustainability and the environmental impact of hospital catering also became a concern in later years. In 2004, The King’s Fund commissioned the Better Hospital Food Programme to identify opportunities for managing food procurement sustainably and promoting healthy eating in acute hospitals. The final report for this project included a framework to help organisations assess their procurement and catering practices, and also recommended policies, menu designs and contract specifications.

Interest in diet, nutrition and general wellbeing is now stronger than ever. Hospital food has attracted the interest of celebrity chefs such as James Martin who hosted a BBC TV series in which he aimed to transform hospital food. Patients eating salmon mould in 1945 may well wish Martin and his Moroccan tabbouleh were around 70 years earlier.

More information

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