Co-designing healthy and sustainable hospital food for children
Collaborative work to reformulate children’s hospital menus and evaluate how changes impact meal sustainability, nutritional value and cost
Overview
The Mandala Consortium aims to identify and test strategies to address food system challenges, evaluating their health, environmental, economic and societal impacts. The research focuses on the city of Birmingham and the West Midlands region.
One of the activities of the food system being studied by Mandala is public sector food procurement (i.e., food provided by institutions such as schools and hospitals). Institutional food has been identified as a potentially powerful way to address food system challenges. Hospitals, for example, are facing growing pressure to make their catering more sustainable. A shift toward plant-based meal options is considered part of the broader strategy to achieve a NetZero National Health Service.
This case study focuses on ongoing collaborative work to reformulate inpatient children's hospital menus with the goal of improving sustainability while maintaining nutritional value and cost effectiveness.
People involved
The Mandala Consortium brings together interdisciplinary expertise in population health, systems thinking, food policy, environmental sustainability, and health economics, working alongside Birmingham Children's Hospital (including hospital dietitians and operations team), Sodexo (the contract catering team at Birmingham Children's Hospital), The Food Foundation and Birmingham City Council's Food System team, as part of the wider Birmingham Food Revolution initiative.
Project activities
Initial meetings
To identify an intervention relevant to the hospital that aligned with their interests and commitment to NetZero.
To identify an intervention relevant to the hospital that aligned with their interests and commitment to NetZero.
Knowledge exchange workshop
Mandala co-designed a workshop with Sodexo to explore good practice from other sectors (e.g., schools, early years settings) where menu changes have been successfully implemented. The workshop included school chefs, and organisations such as Chefs In Schools and ProVeg International.
Mandala co-designed a workshop with Sodexo to explore good practice from other sectors (e.g., schools, early years settings) where menu changes have been successfully implemented. The workshop included school chefs, and organisations such as Chefs In Schools and ProVeg International.
Input from a range of organisations
Plant Based Health Professionals, Menus of Change, and the Soil Association’s Food for Life, University of Reading’s catering department, and two early years nurseries that have improved the sustainability of their menus.
Plant Based Health Professionals, Menus of Change, and the Soil Association’s Food for Life, University of Reading’s catering department, and two early years nurseries that have improved the sustainability of their menus.
Meal reformulation
Mandala had regular meetings with the catering team, providing evidence on the environmental sustainability of ingredients and example dishes that are appealing to children. The catering team have incrementally made changes to dishes, keeping familiar foods enjoyed by children, while increasing the proportion of sustainable ingredients in favour of unsustainable ones, in particular red meats.
Mandala had regular meetings with the catering team, providing evidence on the environmental sustainability of ingredients and example dishes that are appealing to children. The catering team have incrementally made changes to dishes, keeping familiar foods enjoyed by children, while increasing the proportion of sustainable ingredients in favour of unsustainable ones, in particular red meats.
Taste testing
Reformulated meals were taste-tested with young people as part of the hospital's ongoing approach engaging with a Young People's Advisory Group.
Reformulated meals were taste-tested with young people as part of the hospital's ongoing approach engaging with a Young People's Advisory Group.
Evaluation of the impact of menu changes
On carbon footprint, biodiversity, nutrition, and costs. Outcome measures were jointly identified by the research team, hospital staff and the catering team. Evaluation of these menu changes is now being conducted.
On carbon footprint, biodiversity, nutrition, and costs. Outcome measures were jointly identified by the research team, hospital staff and the catering team. Evaluation of these menu changes is now being conducted.
Co-production principles
Knowledge
The research team highlighted the value of bringing together expertise and experience from different sectors (hospitals, nurseries, schools) to share good practice, alongside knowledge of nutritional needs for paediatric inpatients from hospital dietitians, with existing evidence regarding the environmental sustainability of ingredients.
"We're connecting the hospital into existing networks of knowledge around school, nursery… and children's food." (Researcher, Mandala)
The team made a film together to promote the project, and plan to co-create a practical toolkit of learning from the project to share with other institutions.
Relationships
The collaboration evolved from existing connections between the Food Foundation, Birmingham City Council and the Children's Hospital. Project collaborators have highlighted the mutual benefits from their involvement.
The collaboration "brings a whole load of credibility through academic rigour which we just wouldn’t have without the Mandala Consortium behind us." (Project collaborator, Birmingham City Hospital)
Power
Birmingham Children's Hospital staff were involved from the start of the project, engaging in initial meetings to identify an intervention relevant to the hospital that aligned with their interests:
"They were involved right from the outset in terms of determining what was going to be done." (Researcher, Mandala)
A dietitian (representing both the hospital Trust and Sodexo) led the menu redesign, working in collaboration with the catering team and following a cautious approach. This was strongly supported by the research team, given the complexity of children's nutritional needs in a hospital setting.
Inclusivity
To ensure practical challenges were fully understood, the research team stressed the need to engage not only with those who redesigned the menu, but also with the catering staff responsible for cooking the reformulated meals.
Find out more about this project
Related references
Food Foundation (2025). 'Pod Bites: Pod Bites: Revolutionising hospital food'. https://shows.acast.com/right2food/episodes/pod-bites-the-mandala-project
Mandala Consortium (2025). 'More environmentally sustainable hospital food'. Retrieved 18 June 2025. https://www.mandala-consortium.org/about/interventions-evaluations/healthy-sustainable-hospital-menus/
MRC Epidemiology Unit (2025). 'Designing more environmentally sustainable hospital menus'. Accessed 19 June 2025. https://www.youtube.com/watch?v=6HGHYReY1Nw
Sawyer, A., Parsons, K., Adams, J., Soujanya, M., Cummins, S. and White, M. (2025). Towards a collaborative interdisciplinary systems approach to urban food system transformation: a case study from the Mandala research consortium. Philosophical Transactions of the Royal Society B. https://doi.org/10.1098/rstb.2024.0155
Mandala Consortium
Food for Life
Plant-Based Health Professionals UK
Chefs in Schools
ProVeg International