Making hospital food scrumptious, and sustainable
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When a body is discovered 10 miles out to sea, it sparks a mind-blowing police investigation. There's a man living in this address in the name of deceased. He's one of the most wanted men in the world. This isn't really happening. Officers finding large sums of money. It's a tale of murder, skullduggery and international intrigue. So who really is he?

I'm Sam Mullins, and this is Sea of Lies from CBC's Uncover. Available now. This is a CBC Podcast. So my wife Kate was diagnosed with breast cancer in 2018. Kate went through chemo, she went through radiation, then she went and had her surgery, her removal. And thank God the cancer removal was successful.

Happy New Year and welcome to White Coat Black Art. I'm Dr. Brian Goldman. A concerned guy talks about his wife's breast cancer treatment. Our show this week is about what he says next. But when she was in hospital after that surgery, she was fed. And, you know, it left questions in my mind about could we do better?

He says, could we do better? It helps to know about his day job. We love welcoming Chef Ned Bell to the show. Welcome back. Good morning. How are you? Good morning, too. We're doing well, and we're going to dig into some delicious tacos here this morning. You're going to make your famous... The husband happens to be Chef Ned Bell. He's a five-star executive chef, cookbook author, founder of Chefs for Oceans, which raises awareness and advocates for responsible seafood choices.

As husband Ned Bell was saying. Back in 2019, his wife Kate was being treated for breast cancer. And one of the people that saved her life is Dr. Andrea McNeil, who was my wife's surgeon. So my name is Dr. Andrea McNeil, and I am a surgical oncologist, which means I'm a cancer surgeon at Vancouver General Hospital and BC Cancer.

I also founded and run the UBC Planetary Healthcare Lab. And I have a medical leadership role within Vancouver Coastal Health as the medical director of planetary health. We'll hear more from Dr. Andrea McNeil herself in a bit. Chef Ned Bell's passion is sustainability in preparing food. Andrea's is sustainability in hospital systems that include hospital food.

That, plus the fact that Ned's wife Kate happened to be Andrea's patient, is what brought the two together. The catalyst of their collaboration was Kate's first meal after successful breast cancer surgery. Mac and cheese, beige, no flavor. Exactly what you might expect from hospital food. But in this case, Chef Ned Bell pulled Andrea aside. Well, you know, because she saved her life and was a part of our life, I just asked her the question. I said, you know, hey, you know,

Can we not do better? And she said, you know, Ned, actually, we're about to do something pretty significant. What a coincidence. Would you like to join us? And so I don't know if it was the universe or if it was whatever it might have been. And I just said yes blindly, not really knowing what it was going to mean or what it could lead to. And what it's leading to is a sustainable hospital menu that tastes a lot better than your grandmother's hospital food. It's part of a much larger movement.

In 2022, New York health and hospitals did something radical. Eleven New York City public hospitals committed to make plant-based meals the default option for inpatients. In 2023, New York Mayor Eric Adams called for the city to decrease meat consumption for the health of people and the planet. The first year of the program in 2023 saw roughly three-quarters of a million plant-based meals served to New York City hospital patients.

Patient satisfaction was up over 90%. Carbon emissions went down 36%. And it saved money. 59 cents per plate. And now Vancouver General Hospital, part of Vancouver Coastal Health, is trying to do the same thing here. Which is why I've come to the hospital on a Saturday morning to taste some very different hospital food and to meet the chef himself.

Hi Brian, well yes, my name's Ned Bell. I'm the culinary director for the Planetary Health Pilot Project here at VGH. We're here, of course, on this incredible mission to put delicious things in people's belly and help with the idea that real food heals. To create those healing foods, chef Ned Bell teamed up with doctors, registered dietitians and food service employees at Vancouver General.

The work, which began in 2023 and ended in 2024, took eight months. They call it the Planetary Health Menu. 24 new dishes made the cut. In a hospital elevator en route to the test kitchen,

Ned lays out the nitty-gritty of the project. Well, I call my food globally inspired and locally created. So the focus has really been around dishes that were inspired by flavors from around the world. We have a real mix of protein-forward recipes, but the focus has been plant-based dishes. Because, of course, we have cultures from all over the world.

based here in Vancouver, very culturally diverse community. But we've also wanted to make sure that the dishes are going to be enjoyed and consumed. And so we want them to be approachable. This is it. Here's the kitchen. We are walking into the retail kitchen. So this is where anybody that comes to VGH...

that is a family member, of course a patient as well might be looking for something additional to what they're offered or have been offered day of or during their stay. Obviously from my perspective as a chef, I've been a chef for three decades, I know how to cook, but I don't know how to cook in this environment. And so that has been...

the challenge but also the opportunity for me has been okay Ned so you think you can do delicious here let's see what you've got and so that's been what we've been working on and then we had to cook them and tweak them and cook them and tweak them because we had to do it at scale breakfast lunch and dinner for

500 to 1,000 people, you know, three meals a day is a lot. And then make sure that my great friend Anne actually enjoyed eating the food. And I did. And you did. I loved it, yeah. My name is Anne Mackey, and I'm here today to talk about the wonderful new form of food that's happening. It's just the best.

and I'm a former family therapist and retired now. She may be retired, but Anne Mackey is not the retiring type. She's a patient advocate and an official taste tester of the fledgling hospital menu. What motivates Anne is her own experience with hospital food that was very much like Ned Bell's wife, Kate. Anne had a stroke and was admitted to Vancouver General Hospital. So I had to have...

Holes drilled in my brain. Oh, you had it like a subdural. Yeah, right here. You can feel them if you want. There's three holes in my head. So it was a long pull in the hospital. So you recovered. You must have had confusion and then you started to wake up and then you're hungry. Yeah. And the food you had was... Not satisfying at all. Food was not my highlight of the day. What did they serve you? Watery eggs.

Cold and dried out toast. Beige. Yeah. They call it like it's an ocean of beige. Yeah, absolutely. With no flavor, no color, no texture, nothing. The beef is beige. The gravy is beige. The toast is beige. The oatmeal is beige. Yeah, exactly. The vegetables are beige. Did you finish it?

Did you finish your plate? Not usually. And that's the other thing that hopefully this new way of cooking will stop as much food being brought into the hospital by patients' family and friends because they don't want the hospital food. So hopefully this new, better-tasting, better-looking food will prevent that and also the huge amount of wastage that

You know, I mean, if it doesn't taste very good, you're not going to eat it. And the health care system the way it is, we can't afford to be wasting any health money. Hospital food has long been the butt of jokes. The reality isn't funny at all.

Dr. Andrea McNeil. We know that it's a huge problem. It's about 50% of food that's served in Canadian hospitals that just ends up in the garbage bin. I've never cooked on the radio before, Brian, so this is a first for me. I've cooked on TV a lot, but never cooked on the radio. All right, so the noodles are refreshed. In the hospital kitchen, me and Anne Mackey sit together at a metal table to the sound of Ned cooking noodles.

While we wait to be fed, I get to learn more from Anne about being a guinea pig for the new menu. How much of it have you tasted? Oh, quite a lot. I'd say 12 meals.

That's a lot. And good. What makes them good? The texture, the taste, and it's in part a different kind of cooking than I used to do for myself. I'm using less meat and many more legumes and nuts and seeds. I used to have a lot of ground beef and that kind of stuff, but I'm cutting back on the beef now and the red meat in order to get the protein from other sources. Yeah.

Less greenhouse gases? No, it's more sustainable. Absolutely. It's better for the planet and it's better for Anne Mackey. Me. The taste of the food. So you haven't been able to taste any of his? No, I'm about to. Oh, good. Well, I'll look forward to a great taste. Not soft and mushy? No, no, not the watery old stuff. Beige stuff. So, you know, well, I wouldn't like to be back in hospital for a month, but if I have to...

I'll be happy this time with the food. While Ned cooks in the test kitchen, let's bring back Dr. Andrea McNeil. She's a cancer surgeon at Vancouver General Hospital and the Regional Medical Director for Planetary Health for Vancouver Coastal Health. Her dual roles as surgeon and environmental advocate make her the ideal collaborator on Ned's hospital food pilot.

Their joint venture began in earnest back in 2019, shortly after Andrea operated successfully on Ned's wife, Kate. Yes, it was quite a remarkable reunion for both of us. He did speak about how, for lack of a better word, appalling he found the food and how just incongruent it was with the idea of healing and recovery and bringing his unique experience

And chefs lens to the situation thought, surely we can do better than this when people are at their most vulnerable and most in need of nutrition. Surely we can we can do better. It sounds like it was all meant to be, but there had to be a leap of faith here. You know, what made you think that a five star restaurant chef would be able to design and execute a hospital menu?

I am an eternal optimist. And I think Ned shares that trait. And we saw an opportunity. And we really didn't have to sell this idea to anyone. We discovered that our food services team had been thinking about these things for years and simply hadn't been able to enact that vision. And we were able to make it happen. Ned cautioned us that there would be

a learning curve between developing successful menu items, say in a focus group, small group setting and producing them at scale for an entire hospital. And I think maybe we didn't quite believe him or didn't appreciate the scale of that challenge, but our team just completely rallied and shifted our approach and focused on the production piece and how we translate Ned's stellar recipes into 900 plates.

Now, I want to take you back to the before time. I'm thinking about the regular hospital menu before Chef Bell arrived on the scene. How often do you think your patients left their food trays untouched?

Yeah, very frequently. I think every, I can only speak for surgeons, every surgeon has a similar experience whereby we spend much more time than we would hope focusing on optimizing our patient's nutrition via workarounds to the hospital food rather than other elements of their recovery that we would hope to be discussing. And so we counsel them about

family members bringing food from the outside world or how they might source things that are more palatable to them. That is a universal experience, I think, to physicians who work in an inpatient setting. And I mean, the whole system has historically undervalued food and relegated it to a support service rather than recognizing it as part of the therapeutic paradigm.

We, you know, easily spend thousands and thousands of dollars on surgical robots or pharmaceuticals or advanced kind of interventional techniques. And yet, on average, in Canadian hospitals, the per day expenditure on patient food is $10 to $15 per patient per day. Yeah, it shows you a value system that's maybe a little bit out of whack. Yeah. Or maybe a lot out of whack. Yeah.

Um, what's the global financial cost of patients not eating well? Have you, have you spent some time trying to calculate that?

Well, the Canadian Malnutrition Task Force estimated this in a Canadian context. We know that malnutrition is associated with worse outcomes. So that includes things like increased complication rates after surgery because people have a hard time healing when they're malnourished. They tend to stay in hospital longer. And honestly, there's even an association with increased mortality. And it's been estimated that malnutrition-related adverse events cost the Canadian health care system $2 billion a year.

Wow. That, that is, that's incredible. Um, chef bell didn't just make the food tastier. He made it largely plant based. And,

And I wanted to ask you, what was that shift? What's that shift about? We used the so-called planetary health diet that was defined by the EAT-Lancet Commission as our model. At this point, it's kind of the global standard, global gold standard for a diet that best meets the needs of human and environmental health.

And it's not entirely plant-based, to be clear. The Planetary Health Diet certainly allows for some animal proteins, but it recognizes that poultry, for example, and sustainable seafood are much preferable from an environmental perspective than red meats such as beef and pork.

And so we adapted the planetary health diet to an inpatient setting in a way that met all of the nutritional guidelines for hospital inpatients and all of the operational constraints of a hospital setting to show that it was possible to apply those principles even within the fairly constrained environment of a hospital. I know from other hospitals that have implemented similar strategies that

that because plant-based proteins tend to be cheaper than animal proteins, it tends to be a cost-neutral, at least a cost-neutral transition, if not cost savings. We'll be right back.

I'm Katie Boland. And I'm Emily Hampshire, who didn't want to be here. On our new podcast, The Whisper Network, we want to speak out loud about all the stuff that we usually just whisper about, like our bodies, our cycles, our sex lives. Basically everything I text to you, Katie. So this is like your intimate group chat with your friends. And we can't wait to bring you into The Whisper Network. This journey is a nightmare for me. I'm doing it for all of us. So you're welcome.

You're listening to White Coat Blackheart. This week, a look at Vancouver General Hospital's Planetary Health Menu Pilot, which is revolutionizing what and how they feed patients. Dr. Andrea McNeil has teamed up with Ned Bell, a five-star chef and husband, to one of Dr. McNeil's cancer patients to create a fresh menu based on fresh ingredients, seasoning with sustainability, less carbon-heavy red meat, and much more plant-based proteins.

It's feeding a big idea. But back at the hospital test kitchen, me and Anne Mackey, the patient food tester, are about to get a taste. So that's our Thai noodle bowl with tofu, peanut lime dressing, edamame beans, fresh bok choy. If I got that as a patient, or if my wife got that, or if Anne got that, I think they'd be quite happy. It doesn't look like a hospital dish. It doesn't. Except that we're in a hospital. I hope you enjoy it. Thank you.

First of all, it looks special. It looks like something that you wouldn't normally get in a hospital. But it crunches, it's fresh. And Mackie, the former patient, likes it. And there are other big payoffs to this new and scaled-up hospital menu. For instance, a reduced environmental footprint and some huge benefits for patients, including the ones Dr. Andrea McNeil treats in her cancer surgery practice.

Those are the big ideas. I wanted to ask Andrea about the patients who might not be used to this new way of eating. Of course, an important factor, as we've already begun to discuss, is what patients think of it. And the patient tester, Anne Mackey, who I spoke to, pretty much gave the new menu a five-star review when she spoke to me. Was her opinion in line with other patients? It was so exciting to see the patients try these dishes. It

In many cases, and I think Anne was one of these, these people hadn't had a lot of exposure to plant-based proteins, things like tofu or tempeh, and wouldn't naturally have, say, chosen that off a restaurant menu or even off a hospital menu if given a choice.

And they, so many of them expressed this pleasant surprise at how delicious the dishes were and even expressed a willingness or a desire to try incorporating them into their own personal eating habits. Even patients who said things, I mean, this sounds a bit hyperbolic, but I forgot I was in pain for a while because the fish was so good, you know, um,

really superlative reviews. And I, one of the pleasant side effects for me of being the PI on this study is that I got to eat all the leftovers. These dishes were on par with what I would hope to get in a restaurant setting.

What other data have you gotten so far on this initiative or things that have stuck out for you? We partnered with a nonprofit called Greener by Default, who had been part of a similar transition at some American hospitals. And they did some calculations for us based on procurement data, looking at what sorts of proteins we were buying during the study period compared to before.

And they estimated that we reduced our greenhouse gas emissions by 40% with the introduction of these new proteins. Wow.

And on a dish by dish basis, we found that the new dishes tended to outperform the old ones in terms of patient satisfaction, the amount of food waste that was generated, which is kind of a surrogate marker for satisfaction. If patients are eating more and wasting less, presumably it's better. And from a greenhouse gas emission standpoint. So where previously 50% of all food is thrown out, do you have any idea of what the figure might be now with this new diet?

I don't think we saw the reduction in waste that we were hoping for, but what that told us is that substituting animal-based protein for a lower carbon or plant-forward one is not a silver bullet in terms of addressing food waste. We recognize it is a complex and multifactorial problem relating to how we serve food to patients at what times and how it aligns with their preferences at that moment.

And there are a lot of elements to our food services model that could be tweaked to further reduce our food waste rates. In fact, the literature shows that the single most impactful intervention for reducing food waste is adopting what's called an on-demand system, which is essentially room service.

When patients can just say at any given moment, this is what I feel like eating and I feel like eating it now and have access to that. That is the biggest, the most impactful way of reducing food waste. Is that something that the hospital is considering? It's certainly been successfully implemented at other hospitals. There's a children's hospital in Montreal, Saint-Justine, that reduced their food waste by 95% when they did this.

And BC Children's Hospital has this model. And a number of the newer hospital builds in BC are certainly planning to incorporate that model.

So you've completed this trial. People love the food. What's next? Well, we're taking our best performing star dishes from this trial and planning to roll them out across the rest of Vancouver Coastal Health. So we only trialed the dishes at Vancouver General Hospital, but we'd like to see these available to the rest of our patients.

So that's our next challenge with Chef Ned is to learn from the successes at VGH and be able to provide these winning dishes to all of our patients across the health authority.

From an academic perspective, we're working on publishing our results to make these globally available because while there are nuances in food services models between institutions and systems, there is so much that is universally applicable from what we've learned. So hopefully we can present a prototype for the rest of the world for how a planetary health diet can be successfully adapted and implemented within an inpatient setting.

You're a cancer surgeon and a researcher. Did you ever think that you'd be involved in bringing a hospital menu into the 21st century? Well, I certainly hoped so. We actually know that global food systems are changing.

some of the biggest contributors to greenhouse gas emissions that from a pure global climate change perspective, one of the most impactful things we can do is overhaul global food systems. So I always had it in the back of my mind that this was a strategic target, but I'm so grateful to have been part of it. Dr. Andrea McNeil, thank you so much for speaking with me. Thank you, Brian.

Back in the test kitchen, me and Anne Mackey get ready for a second course. Take yourself back to that time when you had the subdural and you had the seizure and you were recovering from it. What would this have meant to you? This is going to be a good part of my day. And there aren't a lot of good parts, but having the delicious food is something to really perk you up. From the noodle bowl, I turn to the coconut chickpea curry with mango chutney.

which is when I really start to get it. Fresh veggies and nuts that crunch and a memorably delicious taste. Oh yeah. Oh yeah. It's good. This is amazing. Isn't it good? This is really amazing. So tell me what's in it. Tell me.

The beginning of the dish is onions and garlic and ginger. For a few moments, I completely forget that I'm inside a hospital. Cook that down a little bit, then we add coconut milk. As Ned describes the layers of flavor he's tweaked and tested time and again to get to this really good plate of food, I have doubts that the health care system can or even wants to pull this off. I take Ned aside after the dishes are cleared.

I've worked in a hospital for more than 40 years, and the experience I'm having trying this food is that it feels luxurious. What would you say to people who may go, look, we're in a healthcare crisis? And we are. I mean, the signs of it are everywhere. This food is a luxury we can't afford.

I don't think the food's luxurious. I think the food is just well-made. It's basic ingredients. There's nothing fancy, like really nothing fancy at all. We have used the ingredients that they were already using. We've just rewrote the recipe. But I didn't want to come in here and fail. I wanted to come in here and succeed. Healthcare does have a lot of answers. My grandfather's a surgeon. Like I know the importance of what's being done here at VGH. He was a surgeon here at this hospital before.

And when I told him I wanted to be a chef, he looked at me like I had a hole in my head because being a surgeon and being a chef is not, you know, the same kind of thing, at least in his eyes back then from a generation point of view. Even he would know about the importance of eating post-operatively to recover because surgery is like an injury. I mean, obviously that's why they know and their peers know. I mean, changing food in healthcare is Mount Everest. This is not going to be a simple or easy path. Yeah.

Food can be easy and simple, but to get it through the bureaucracy of healthcare definitely will take some real support from the people that work within it. And I've seen that here. I want to take it back finally to your wife, Kate, who was served a form of mac and cheese that she didn't prefer compared to yours. If she had been served the kind of food you served to me and to Anne when she was recovering...

What difference do you think that could have made to her immediate outcome, immediate recovery from surgery and from cancer treatment? It would have given Kate a feeling of, I'm okay. And, you know, it reminds me of a patient we had here, a gentleman who actually had one of our dishes, and he was in a lot of pain. And he said, you know...

I felt like I should be wearing a bow tie to come for dinner. You know, to this point, from a pilot point of view, we've succeeded. And thank you for sharing part of the journey with me. Thank you, Brian. Thanks for being here today. Since my visit to Vancouver General Hospital, a spokesperson for Vancouver Coastal Health said at least five of the planetary health dishes have made their way onto the menu at 15 sites, including hospitals and long-term care homes.

Eight have been introduced at Richmond Hospital. And they're preparing to launch additional planetary health menu items at sites throughout the region. With Chef Ned Bell and Dr. Andrea McNeil at the helm, they're making a strong case for an enlightened and environmentally responsible menu. But I also know how easy it is for hospitals elsewhere to carry on as usual. And if patients and families don't like it, to tell them to bring their own food. I hope I'm wrong.

That's our show this week. If you'd like to comment, our email address is whitecoat at cbc.ca. White Coat Black Art was produced this week by Jennifer Warren with help from Stephanie Dubois and Samir Chhabra. Our digital producer is Ruby Buiza. Our senior producer is Colleen Ross. That's medicine from my side of the gurney. I'm Brian Goldman. See you next week. For more CBC Podcasts, go to cbc.ca slash podcasts.