The report of this successful two-year project shows how hospitals can contribute to happier patients and staff, a better environment and more business for local farms and food companies, just by changing the food they buy and serve. By the end of 2005, one of the four London hospitals in the project was buying almost 15% of their food from local and/or organic sources, with the others making progress and more hospitals wanting to join in. However, there were problems too, and the report outlines how they were overcome, and what more government needs to do to make sustainable food in hospitals the norm, rather than the exception.

Summary

There is widespread agreement that our current farming and food system undermines, rather than underpins, the environmental, social and economic aspects of sustainable development. Aspects of the food and farming industry contribute to environmental damage, diet-related diseases, job losses and the balance of payments deficit.

At the same time, there is growing public concern that the food paid for by taxpayers' money - for example, provided in our schools, care homes and hospitals - provides very poor value for money and also undermines sustainable development.

In recognition of this, government has introduced a range of positive policies to improve the sustainability of our food and farming system, and to raise the quality of public sector catering, including in hospitals. Unfortunately, progress in turning these policies into practice is slow and uneven.

The reasons for the disappointing progress include lack of money, unhelpfully complex rules on how it can be spent, , shortage of time and the practical difficulties of finding new suppliers of sustainable food and incorporating it into public sector catering.

This project - run over two years by Sustain: the alliance for better food and farming in partnership with the Soil Association - aimed to tackle these problems, focusing on four hospitals in London. The goal was to increase the proportion of sustainable food in the hospitals to 10% of their routine catering.

The hospitals were:

• Ealing General
• Royal Bethlem, Beckenham and Lambeth
• Royal Brompton
• St. George's

These hospitals ranged in size (250 to 1100 beds), type (general and specialist), London location and, of course, type of catering operation.

The project drew on the expertise of a large network and acted as a "dating agency", finding suitable suppliers of sustainable food to match the particular needs of each hospital, and solving problem (including transport, distribution and continuity of supply) as and when they arose. New supplies arranged by the project included apples, beef, eggs, milk and a range of vegetables.

Importantly, the project also undertook a wide range of training events and promotional activities - such a farm visits and celebratory food events - to "sell" the idea to everyone involved, including not only the catering team but also patients and their visitors, and hospital staff.

Independent evaluations of the health and economic effects of the project have been done and, although not complete at the time of writing, early indications are that these have been very positive.

• No health changes would be expected from such a short project, but there have been improvements in knowledge about and support for more healthy and sustainable food.
• Some sustainable food suppliers in London and the South East have increased their businesses, and - without increasing hospital food budgets - the project has improved food quality and variety, service levels, and staff and customer satisfaction.

One hospital exceed the project target of 10% and now spends over 13% of their budget on local and/or organic food. Two others did not meet the target but did make some encouraging progress towards it, and only one failed to make any changes at all, due to a number of specific difficulties.

A number of valuable lessons were learned in the course of the two-year project, which lead to the following recommendations to Government:

• Funding is needed for the kind of practical help this project offered. This funding will not be needed indefinitely. Once potential purchasers and suppliers have been "matched" and any practical problems ironed out, the systems should continue to work.
• Conflicting policy signals need to be tackled. It is not helpful on the one hand to extoll the virtues of sustainable food in the public sector, and on the other insist on budget cuts. While sustainable food is not inevitably more expensive, it will certainly not be cheaper.
• All hospitals should have the equipment and staff to be able to cook food from scratch. Without these facilities there is no flexibility to allow for the changes needed gradually to increase the proportion of sustainable food.
• Investment is needed to ensure that a wide variety of sustainable food is available everywhere in the country, and that the transport and distribution infrastructure is adequate.
• Vigorous and imaginative marketing is needed to support the efforts of those who are already promoting more sustainable food in hospitals, and to convince more people to engage in this vital task.