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Taiwan

One of the best meals of my life was the platter of food that I ate in a Taipei hospital after I gave birth to my son last year. There was tofu braised in five-spice, shiitake mushrooms, steamed cauliflower with diced carrot, and sauteed spinach with ginger. It was paired with plenty of liquid: rice porridge, black sesame soup, and vegetable broth peppered with daikon.

I had just had an emergency C-section, and the anaesthesia had yet to wear off. But I was ravenous. I devoured every morsel in front of me. I hadn’t eaten a proper meal in days.

In retrospect, the hospital food was bland and underseasoned, which is typical of hospital food in Taiwan. Hefty amounts of spice, sugar and salt are frowned upon; they are believed to irritate the gut. But the meal was exactly what I needed after major surgery. I didn’t even notice that there was no meat. I was at Adventist hospital in Taipei, a privately owned Christian hospital, where all the food is vegetarian and low in fat, salt and sugar.

What distinguishes all hospital food in Taiwan is the diversity of textures, colours, ingredients and flavours. “We need to ensure that the food is nutritionally balanced,” says Lin Shu-chi, head of nutrition at Adventist.

Meals are modified based on a patient’s condition. I wasn’t given cold foods like fruit or raw vegetables as, according to traditional Chinese food therapy principles, these would impair recovery. Instead, I was fed soft, warm dishes like scrambled eggs. “In western countries they might serve more bread and dairy products, while in Asian countries we prefer rice and hot dishes,” says Lin. “Our cooking methods also differ. We prefer steaming, boiling and stir-frying.”

I wiped clean every dish during my three days in hospital. It wasn’t because the food was especially tasty. It was that my body needed nourishment after nine months of gestating a tiny human. And this time, all the food I ate was just for me. Clarissa Wei

Kenya

Photograph: Edwin Ndeke/The Guardian

Meals at Kenyan hospitals are much like those in homes across the country. From a typical breakfast of bread or porridge with tea to the maize meal staple ugali served with sauteed greens and beef stew, it’s comfort food familiar to many.

But pressure on public hospitals to cut costs means tasty food is at the bottom of the priority list. For breakfast, the porridge can be lumpy and the tea watered down, but it tends to be the patients’ favourite meal of the day, since things go downhill from there.

The afternoon and dinner menus are a throwback to life in Kenya’s public boarding schools: meals that are easy to cook in bulk and affordable, like rice, cabbage and beans, sometimes served in sectioned silver metallic plates.

In paediatric units, or private wards and clinics, food is tastier, served more beautifully, and usually accompanied by fruit, such as watermelon slices. In public wards, it is dull and unappealing. The vegetables are limp, the ugali grainy and the meat sparse. Some patients pick at their food before going to the canteen for packaged snacks or the teatime favourite mandazi, a sweet fried bread.

Hospital nutritionists say that the bland food is a deliberate choice: it is low in fat, sugars and oil, and caters to a broad range of health needs. Staff usually avoid the food served to patients and eat at local restaurants.

Some patients manage by holding out for home-cooked meals brought by their families. “My husband brings chapati. He knows it’s my favourite,” says 28-year-old maternity patient Winfred Mbithe, adding that the meals keep her fuelled as she cares for herself and her newborn. “It’s my best time of the day.” Caroline Kimeu

UK

Photograph: Christian Sinibaldi/The Guardian

Picture a hospital meal. If you’re British, you’ll probably be imagining something beige, encased in microwavable plastic. In 2019, a bad batch of sandwiches killed seven patients in several hospitals in England, cementing the UK’s reputation for truly dreadful hospital food. Actual poisoning is thankfully rare, but every few months an unappetising dish will go viral on social media. Earlier this year, a man in Glasgow was served a plate of turkey and potatoes so hideous that the local NHS health board was moved to issue a public apology.

This August, I visited St Thomas’ hospital in south London, where the chefs are trying to serve more tempting food. Unlike most British hospitals, where the catering staff bulk-buy frozen ready meals and warm them up, St Thomas’ cooks make meals on site – 2,933 of them every day. Philip Shelley, a senior operational manager for NHS England, showed me round the kitchen, where everything is supersized. A bolognese was bubbling away in a pan so big it looked like a bathtub. I walked past a chef stirring a basin of bechamel sauce with a 2ft-long whisk.

Friday is fish and chips day, and the portion I tasted was comforting, but didn’t look that nutritious. And while the food had been cooked on site, I was told it was made three days previously, then sealed in plastic and frozen. Apparently all NHS meals at the hospital are batch-cooked ahead of time to make juggling thousands of meals a day easier. St Thomas’ fee-paying patients, however, eat food cooked from scratch. On my tour, I spotted an area where a lone chef was plating up trays of smoked salmon and melon for the private ward. The contrast appeared stark.

Very few UK hospitals serve fresh, made-to-order food to non-paying patients. Alder Hey children’s hospital in Liverpool is the only hospital in the UK to have a chef in every ward, so a child can order pancakes, or feta and tomato pasta, and have it cooked from scratch and served within minutes. Shelley would like to see kitchens like Alder Hey’s installed on every hospital ward in the UK, but estimates that such a transition would take a decade.

Part of the problem, he says, is a tendency in the UK to undervalue food. “The average British high street has much worse food than one in Spain or France.” But while scratch-cooking and quality ingredients may seem indulgent, the irony is that improving hospital food could save the NHS money. Cooking fresh food on site is cheaper than buying ready meals from outside catering companies (which cost the NHS about £2.10 to buy in). Inedible meals also end up wasting taxpayers’ money. Last year, 3,600 tonnes of NHS food was thrown away as plate waste – if hospital food gets better, less of it will end up in the bin. Kitty Drake

Spain

Photograph: Anna Huix/The Guardian

The Germans Trias i Pujol hospital is a vast complex in Badalona, a satellite town north of Barcelona. Here, 1,500 meals a day are prepared in-house by a contract catering firm supervised by facilities manager Yolanda Fernández and dietician Elisabeth Llorens.

They offer about 40 menus a day, taking into account the patients’ condition and religion (Badalona is one of Spain’s most multicultural cities), not to mention the growing number of allergies and intolerances.

“The hospital has a double function,” says Fernández. “Recovery and teaching people to eat better. But as the average stay is seven days, we’re limited in what we can do.”

The hospital follows a Mediterranean diet, with special dishes prepared for local festivals. Breakfast is likely to be wholemeal bread, yoghurt, ham, cheese and fruit, with omelette, cereal or brioche. For lunch and dinner, patients have three options per course. First course lunch choices include soups, salad, pasta and rice dishes. For the main course, vegetable goulash, roast chicken, tuna escabeche or meatballs. The hospital follows the Spanish tradition of serving paella or other rice dishes on Thursday, and fish on Fridays.

Starters on the dinner menu include green bean and potato salad, spinach with pine nuts and raisins, potato omelette and mushroom soup. Main course choices include salmon with almond cream and rice, hake with pistou, pork sausage with onions and green beans, and a hamburger or chicken with cheese and raisins. Dessert is usually fruit and yoghurt.

The food sounds appetising, but the Spanish have high expectations when it comes to cuisine – ones that are hard to meet when making 500 meals at a time. Stephen Burgen

Japan

Photograph: Kazuma Obara/The Guardian

The dinner served to patients at Kobe Red Cross hospital would not be out of place at a decent Japanese restaurant.

The centrepiece is a bowl of takikomi gohan – steamed rice with chicken, kinoko mushrooms, strips of deep-fried carrot, seasonal herbs and green peas. It’s accompanied by grilled fish with grated radish, tofu balls with okra and carrot in a light soy-based dressing, spinach and shimeji mushrooms, a mug of cold wheat tea and a slice of butter-free matcha cake with a sweet-bean filling.

The menu changes every week, with an emphasis on traditional Japanese cuisine, according to Hiroko Komada, head of nutrition at the hospital, in a nod to older patients who may not be familiar with more “exotic” food.

“The patients are feeling anxious as it is – especially if they are due to have an operation or a major examination – so we try to reflect what they would eat at home,” says Komada, who plans the menus a month in advance with input from medical colleagues.

The hospital is not alone in Japan in enjoying a reputation for above-average meals, partly due to the success of its insurance-based universal healthcare coverage and a cultural emphasis on simple food cooked from scratch. In recent years, several foreign residents have drawn attention to how much better they have eaten during hospital stays in Japan than in their home countries. One woman’s photos of the beautifully arranged meals she ate during her stay at a maternity ward – full of mouth-watering combinations such as omuraisu (rice omelette), macaroni salad, chicken soup, squid rings, fruit and green tea – went viral.

Komada says that the food is not to everyone’s liking, with some patients dissatisfied about modest portion sizes and a lack of fast-food favourites such as ramen and fried chicken. “For the most part, though, they eat everything with no complaints,” she says. Justin McCurry

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Sweden

Photograph: Christopher Hunt/The Guardian

Six years ago, catering at Södersjukhuset, or Sös, one of Stockholm’s largest hospitals, underwent a culture change. They got rid of their longtime supplier, built their own kitchen and created a new system. Today, they cook and rapidly chill meals on-site, ready to be heated in the wards as and when they are needed – they last for up to 10 days without losing taste or texture.

Dishes such as bean chilli with rice and fried vegetables, chicken tikka masala, and meatballs with cream sauce, mashed potato and steamed vegetables are served with the aim of making them look as appetising as possible. Lighter meals include broccoli and pea soup, omelette, salad, fruit and blueberry cheesecake. Any leftovers are sold to staff at a discount. Under the new regime, patient satisfaction has shot up and food waste has been cut by 70%.

“We try to make very simple food,” says cook and dietician Linda Hagdahl, who is head of meal service, during a tour of the kitchen.

They make as much as possible from scratch, including pancakes, bread and meatballs, but avoid anything too fussy. “It should be tasty and nice, but not too much, because then it’s hard for the wards to work with it.”

Patients tell Hagdahl that the arrival of food is the highlight of the day (having recently given birth at Sös, I can attest to this). “There is a lot of worry in the walls here,” she says. “So mealtime is maybe the only thing you can feel is normal.”

Across Sweden, there is a heightened focus on hospital meals and the importance of food to recovery. The Swedish Food Agency’s 2022 guidelines say that a good meal served in an attractive way contributes to wellbeing and should be a “prioritised part of care”.

At Sös, Hagdahl wants to implement a digital ordering system so that patients can take more control over what they eat. “Without energy in the body, it’s hard to recover,” she says. “It’s hard to get up and move around and recover. It’s a part of the medical treatment.” Miranda Bryant

Australia

Photograph: David Kelly/The Guardian

Harry Iles-Mann has spent more than 50 weeks in one of Sydney’s major public hospitals after two liver transplants and various complications. During that time he became used to eating “food served in a puddle”.

The 29-year-old’s experience reflects the generally poor reputation of hospital food in Australia. Many states contract out their food preparation services to private companies to produce meals in bulk and deliver them frozen to hospitals. Many hospital kitchens no longer have the ability or the equipment to cook food, only to reheat it.

The process not only leaves meals swimming in water from condensation as a result of reheating, but also affects the texture and taste. It makes meat and vegetables rubbery, flavourless and difficult to cut. Different menus are offered to patients, depending on their needs, and food has to meet nutritional and safety standards. However, Iles-Mann, whose experiences have led him to become a health consumer advocate, says: “The nutrition is predicated on the patient putting that food in their mouth, and that’s where the problem is. The food is so unappetising, no patient wants to eat it.”

A typical hospital meal could consist of chicken, gravy, mashed potatoes and steamed carrots, but the way it tastes and is presented can vary greatly – in public hospitals it might be tough and rubbery owing to being reheated, and could be served in a single-use plastic dish covered with a plastic dome, with plastic cutlery and even any accompanying fruit placed in its own separate plastic container. However, that meal in a private hospital, and some other public hospitals, could be made fresh and served on china plates with metal cutlery.

There is increasing pressure to improve the quality of meals in public hospitals as malnutrition has been linked to worse patient outcomes, according to Adrienne Young, a dietician at Royal Brisbane and Women’s hospital and a researcher at the University of Queensland.

Queensland does not have a contract outsourcing meal preparation, so public hospitals like Royal Brisbane and Women’s are able to prepare meals in their in-house kitchen that have been designed by hospital dietitians. In future, the hospital plans to introduce a “meals on demand” service, allowing patients to place their order when they feel like eating, similar to hotel room service. This model has already been implemented in some of Australia’s private hospitals.

As “someone who has spent way too much time in hospital, eaten far more of this food than I care to admit, and thrown away even more of it than I am comfortable with”, Iles-Mann warmly welcomes the changes. Natasha May

Italy

Photograph: Rocco Rorandelli/The Guardian

Lunch of the day at San Camillo Forlanini, a government hospital in Rome, is risotto with courgettes and speck, beef and green beans, peaches and plums, chocolate pudding and brown bread. It’s a typical example of Italian hospital food. Dinner is lighter – instead of risotto there is soup.

Patients’ favourite dish of the day tends to be the first course, of pasta or rice. That said, complaints are common: hospital food is not homemade in the way Italians are used to. It is cooked in bulk, and served from 6-7.30pm to make sure meals get round to all the patients. Some struggle to eat so early, as in Italy dinner is usually at 8pm.

Patients are better served over the Christmas and Easter holidays, when there is a festive menu – perhaps lasagne, panettone and a small bottle of spumante, sparkling white wine.

Food is associated with hospitality and conviviality in Italy, and that’s hard to replicate in hospital, where patients are likely to eat from a tray in solitude. For that reason, some are considering introducing communal rooms for patients to eat together. Italians talk about food all the time. But when it comes to hospital food, what they have to say is rarely complimentary. Alessandra Maggiorani

Brazil

Photograph: Leonardo Carrato/The Guardian

There are striking cultural differences across Brazil’s 27 states, but hospital meals have two things in common. First, they’re widely seen as unappetising. Second, whether in the far south or up north in the Amazon, it’s hard to find a healthcare unit where the staple of Brazilian cuisine isn’t served: arroz com feijão (rice with salted beans).

At Rio de Janeiro’s largest public emergency unit, Municipal Hospital Souza Aguiar, about 350 patients are served five daily meals: breakfast, lunch, afternoon snack, dinner, and a night-time snack. Lunch – the country’s main meal of the day – usually features the Brazilian classic. On the day I visited, there was beef, pumpkin and chayote (a squash) – besides rice and beans, of course – served on compartmentalised plastic trays.

Isis Castro da Costa, manager of the hospital kitchen, says this is typical: “Rice, beans, a protein – which could be beef, fish or chicken, but usually it’s chicken – and salad.” Dessert that day was either plum sauce flan or watermelon.

Rice and beans aside, the quality of hospital food varies significantly across the country. Brazil has its own version of the NHS, available to all, which is used by 70% of the population. The other 30% access private healthcare, mainly through insurance plans. There are variations within both systems: some public hospitals serve good food, while others have rotten ingredients, and some private units offer dishes crafted by renowned chefs.

However, the stigma of bland hospital food persists. The food is less well-seasoned and contains fewer fried or fatty elements, which are part of some Brazilian culinary traditions, but professor and nutritionist Patrícia Speridião points to another factor. “It’s all about cost. Healthcare in Brazil is underfunded, whether in the public or private sector … And it’s in the kitchen that costs are cut, either due to limited resources or to maximise profits,” Speridião says.

“It’s a challenge to work like this, so I tell my students that, above all, hospital food should be prepared with care, respecting the dignity of the patients,” she says, adding: “Just because it’s hospital food doesn’t mean it can’t have flavour.” Tiago Rogero

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