After a patient complained about a sandwich, three Cornish hospitals found a way to serve fresh, locally sourced food – all within the NHS budget. Why can't other health trusts follow suit?

Ten years ago I ate a sandwich I still remember to this day. I was filming in a hospital in Sydney and needed to grab something quickly for lunch. I expected the canteen food to be as abysmal as it was back home. The sandwich turned out to be a toasted ciabatta with sunblush tomatoes, char-grilled artichokes, roast peppers and rocket and was nicer than anything you can get in Pret a Manger today. Unfortunately, a decade on, most hospitals in the UK have not caught up with the bush tucker from down under.

Patients describe cold meals that should be hot, crumbles that are far from crisp, soggy chips, stale bread, limp salad, watery fish, eggs boiled as hard as cricket balls and casseroles, stews and soups that all taste alike no matter what they're meant to contain. In the last patient survey carried out in 2007 by the Healthcare Commission, it claimed that more people thought the food was very good. Indeed they did: 19 per cent thought the food was very good, a whole percentage more than the previous year. Which still leaves 81 per cent thinking that the food was good, fair or poor. A study published in 2007 by the University of Newcastle on meals provided at the University Hospital of Hartlepool found that children were being given chips six days a week with processed meat: chicken nuggets, hot dogs and burgers. There was a paucity of fruit and vegetables.

Amid the powdered soup and reconstituted mash, the grey fish and gristly stews, there are of course exceptional hospitals providing exceptional meals. Just when the government set up the Better Hospital Food project in 2000, which was led by Lloyd Grossman and ran for five years, two hospital trusts opted for quite a different approach. They were partly funded by Defra and supported by the charities Sustain and the Soil Association. The Good Food on the Public Plate project (now at an end) worked with four London hospitals, Ealing General, Royal Bethlem, Royal Brompton and St George's. And one continuing success story is the Cornwall Food Programme, which is run at the Royal Cornwall, St Michael's and West of Cornwall hospitals. Both projects aimed to make food local, sustainable and organic, as well as edible.

The Cornwall Food Programme began when a patient at the West Cornwall Hospital in Penzance complained that the sandwiches came from Oxford. Head of hotel services, Mike Pearson, wondered why they were transporting food more than 250 miles when a local supplier could make the sandwiches using local ingredients, which would also help boost the local economy. At the time the NHS sourced food centrally to save money so, in spite of Cornwall being a coastal region, fish was sent from the NHS's contractor in Grimsby, Lincolnshire. It arrived as frozen fish cakes containing only 30 per cent of fish and which one patient described as being, "as hard and as tasty as hockey balls", or 10kg blocks of frozen white fish from the North Sea. Pearson switched to using fish caught by the local business Matthew Stevens and Son, who supplies Rick Stein. Stevens developed fish cakes using local potatoes and locally caught ling fish as ingredients. It is, he says, "a good firm fish, which is caught in abundance and is not a threatened species." Although the new contract is not a particularly large one, Stevens says: "It's important that our community has access to fresh, local fish. Patients in hospital should be eating the best quality food to speed up their recovery."

As the NHS food budget is only £2.50 per patient a day, at times making the menu local has been hard. Pearson says: "Our long-life yoghurt was of questionable nutritional value – but it was cheap. The challenge was to find a local supplier." A delicious local yoghurt made by Gwavas Farm on the Lizard Peninsula was too expensive. However, the farmer, Will Bowman, agreed to use smaller pots for his yoghurt, which retails at the same price as the long-life one; it might not seem a good deal – getting a shorter shelf life for the same price – but according to the patients, the yoghurt is much tastier and is rarely wasted.

It took time to iron out the details, but seven years later Pearson has met the Soil Association's Food for Life targets of 75 per cent of food that is fresh and unprocessed and 50 per cent locally produced, although none is organic. Pearson says: "Having local food is more relevant to our patients and to farmers. Organic food can often be in short supply and cost up to 70 per cent more." The number of food miles has also been cut by 67 per cent from a whopping 936 deliveries by vehicles travelling 164,042 miles per year. Patient satisfaction has increased dramatically, with 90 per cent of patients claiming the food is good to excellent. The Cornwall Food Programme has in part been successful because there was funding for the Eden Project's Roy Heath to come on board as sustainable food development manager. He set up a farm shop staffed by residents from care homes that will sell local produce at the hospital in summer. He's hoping to organise a box scheme using existing NHS couriers to deliver organic food throughout Cornwall. A Central Food Production unit has also been created, which fast freezes meals made from 80 per cent local produce. "Another major advancement is that we're preparing our own vegetables," says Pearson: "We're now buying dirty veg from local suppliers, which means it's considerably fresher, we can keep an eye on the quality and it's great for local farmers."

Those involved in the Cornwall Food Programme are clearly proud of their work, but there seems to be a lack of government will to use it as a blue-print for the rest of the country. Part of the problem, as seen by the Soil Association and Sustain, is that many hospitals do not even have their own kitchens but outsource their meals.

"The majority, 80-90 per cent, of hospitals outsource their food," says Rosie Blackburn, Sustain's project officer. "Some hospitals get their food from suppliers who make it elsewhere and it's not uncommon for them to bring it in from hundreds of miles away, which is unsustainable and leads to not entirely wonderful food." The meals are then reheated (regenerated in hospital catering speak) on site.

"I don't personally think oursourcing is a problem," says Rick Wilson, who is the director of nutrition and diet at King's College Hospital. "At Kings we used to cook our own food. We have a thousand beds and if your ward was close to the kitchen, the food was warm and good, but if it was three-quarters of a mile away, it was no longer hot or appetising. We now prepare frozen food and finish it off near the ward, serving 30 people at a time. Cooking meals from fresh is logistically challenging." The problem, as Wilson sees it, is where the NHS outsources its food from. "You get what you pay for," he says. "You can buy really good food or buy rubbish – you can faff around with it but it'll still be rubbish."

In 2007, the Department of Health held a nutrition summit and the result was the Nutrition Action Plan Delivery Board. The board is winding down now but has come up with five action plans to be implemented. These do not include sourced locally produced food. Instead, Wilson, who is on the board, says that the most crucial action plan deals with food service. He says: "When you go to a restaurant, the quality of the food is half of the story, the other half is the service. We may well be delivering better food but it might arrive cold, at the wrong time or was not what the patient chose. If people don't get their food and chew and swallow it, it's worthless. That's the real problem."

The NHS is divided into trusts, each of which runs more or less autonomously and can differ widely from each other in terms of service. According to the results of the last survey carried out by the Healthcare Commission, at the lowest scoring trust 42 per cent of patients said they did not receive the help they needed eating meals, while in the highest scoring trust the figure was only three percent.

If patients are unable to eat, this clearly has serious implications for malnutrition. According to the British Association for Parenteral and Enteral Nutrition, 60 per cent of hospital patients are clinically malnourished (out of a sample of around 11,000) on arrival. Yet so far no one has monitored how patients fare once they're in hospital. Malnutrition can impair the immune response so the risk of infection increases and recovery from illness is slowed. Disease-related malnutrition is thought to cost Britain more than the £2 billion associated with obesity. Wilson says: "There are 150,000 beds in hospitals so that's 150,000 people we could malnourish."