Thick, salty soup that looks like wallpaper paste, clearly made from artificially flavoured powder; a chicken-and-ham pie boasting a crust with all the texture of furniture foam and none of the flavour; inside, a meagre serving of misshapen, mechanically recovered 'meat' and a white sauce that is as claggy as the soup; dry mashed potato; over-cooked cabbage; a brick of cake with custard served cold.

It's enough to make you sick. Or it would have been for Poppy Lloyd, a 26-year-old radio journalist, if she hadn't been so sick already. Confined in the isolation ward of a central London hospital a few months ago, she was at the mercy of the hospital caterers. And they showed her none.

'The nurses at the hospital were brilliant, but I never had any sense that the food I was being given was regarded as a part of helping me to recover,' she says now. 'The best you can say is that it was just fuel to get me through my stay.' Nothing, she says, was fresh. 'It was all tinned or frozen.'

Poppy's is not an isolated case. In the course of numerous interviews - not just with patients, but with nursing and medical staff too - we have been given hair-curling accounts of truly dismal hospital food: of toast prepared five floors below the wards so that it is stone-cold and floppy by the time it reaches the bedside; of the worst kind of cheap sandwiches served up as an evening 'meal'; of mashed potato made from concentrate, plated in domed shapes as if with an ice-cream scoop; of sticky packet gravies; meat as grey as a winter sky; vegetables boiled to extinction.

'Hospital food is foul,' one nurse told us. 'Breakfast is especially bad,' said another. 'The [nursing] night shift want to get home pronto, which means they put the food in front of the patient as quickly as possible so they can get off work on time.'

A couple of weeks ago, the charity Age Concern published a major report into what they called 'the scandal of malnourished older people in hospital', which simply backed up everything we were hearing. Surveyed by the charity, nine out of 10 nurses admitted they did not have time to provide the elderly with the assistance they need at mealtimes. There were descriptions of food trays left at the bedside, only to be removed untouched half an hour later either because the patient couldn't reach it or didn't have the wherewithal to eat. Patients would receive the wrong meal, or food that was completely inappropriate to their needs.

According to Age Concern, six out of 10 older people, who occupy two-thirds of beds, are now at risk of malnutrition while in hospital.

'We were getting regular reports of problems from patients and their families before publication,' says Ray Mitchell, the charity's campaigns manager. 'But since the study was released those reports have gone through the roof.' To complete the picture, in August the Commission for Patient and Public Involvement in Health, the umbrella body for the volunteer-based forums attached to every one of the 570-plus NHS trusts in England, announced that they, too, would be conducting a major survey of hospital catering. They had also been inundated with complaints about truly lousy hospital food. 'There was enough concern about this for us to make it one of our national focuses,' says Sharon Grant, chair of the commission.

So far so familiar: just another depressing story of an atrophied public service, in desperate need of a Jamie Oliver-style campaign to make the government sit up and take notice. But this particular narrative is rather more peculiar than that. Hospital food is already supposed to have had its make-over. There have been initiatives. There have been new guidelines. In 2001, as part of the much-heralded NHS plan, the Department of Health established the Better Hospital Food Panel. It was a truly august body which included some of the biggest names in Britain's chef world who, under the leadership of Loyd Grossman, were invited to completely revolutionise the menus being served in hospitals across the land. Working alongside the chefs were some of the most trusted experts in the fields of nutrition and dietetics this country has to offer.

There is no doubt that the food panel has had an effect. The government can - and does - point to a series of statistics which indicate an increase in patient satisfaction with hospital food. As well as the plethora of catering horror stories we have heard, we have also come across examples of really good practice. But whether you are one of the lucky patients who gets to experience what those particular hospitals have to offer seems still to be a lottery. And it's not even clear whether there is any likelihood of improvement in the future. Very quietly, earlier this year, the Department of Health simply disbanded the Better Hospital Food Panel. 'A lot of people worked really hard on that panel,' says Loyd Grossman now. 'I'm unhappy that such an opportunity was missed.' The NHS buys over 300 million meals a year. And it appears that far too many of them are simply not good enough to eat.

The story of the rise and fall of free hospital food in Britain has much in common with that of universal school meals. Both were part of the new social contract which emerged out of the hunger for a more socially just Britain following the victory in World War II.

'A lot of it was literally a legacy of the war,' says Rick Wilson, director of Dietetics and Nutrition at South London's King's College Hospital and an internationally renowned expert on the subject. 'Many of the recipes used were old army recipes and many of the people who cooked them had also served in the catering corps.'

At the time this made a lot of sense: the demands of both an army and patients in a hospital for food of a certain nutritional level served at a reasonable speed, were similar. Eventually, though, they would become an anachronism. Prior to the creation of the Better Hospital Food Panel, the last time the NHS recipe book had been rewritten was in 1975. 'And much of that was still old army recipes,' says Wilson.

It wasn't only the recipes that were old-fashioned. It was the facilities, too. Although the post- war Labour government of Clement Atlee had spent serious money on the newfangled NHS, it didn't always go on the fabric of the hospitals themselves. Many, being of sturdy Victorian vintage, were regarded as robust enough to carry on. And carry on they did, though by the 1980s many of the kitchens were in a shocking state, a fact that became all too obvious when 19 people died at Stanley Road Hospital in Wakefield as a result of food poisoning. Shortly afterwards, Granada TV's World in Action screened an undercover report on the state of Britain's hospital kitchens. It included the unforgettable image of a pallet full of rubbish in the middle of a kitchen, topped off with a soiled wound dressing. 'The fridges here at King's were so old they were made of wood,' says Wilson.

Until the Stanley Road tragedy, hospitals had been immune from prosecution. In 1987 Crown immunity was lifted. That meant hospitals now had to improve their catering facilities, or risk being taken to court. But they were given no extra money with which to do so. Cash that should have gone on food thus went on new equipment instead. The result, unsurprisingly, was a sudden drop in standards. As with school meals, this was only compounded in the late 1980s when the Thatcher government introduced Compulsory Competitive Tendering. Hospitals now had to give the contract to the lowest bidder, regardless of quality and many big catering companies announced they could do it cheaper. 'As a result, 25 per cent came out of the budget for hospital food and it never went back in again,' Wilson says. The disastrous decline had begun.

It wasn't long before research began to show disturbing levels of malnutrition among hospital patients, not merely in those arriving - that had always been the case - but also, worryingly, in those leaving. Report after report backed up the growing evidence that feeding patients badly did nothing but increase the cost of their treatment, not least because they took longer to recover and therefore blocked hospital beds. Bizarrely it is an argument which still has to be made today. Dr Karen Jochelson is a research fellow at the King's Fund, and has published a number of papers on the subject. 'We have been trying to argue that food and nutrition is part of a hospital's healing mission,' she says. 'Instead it's seen merely as a cost and therefore there is a tendency to look at ways to reduce that cost.' Professor Alison Kitson of the Royal College of Nursing has campaigned long and hard for a 'holistic' approach to the matter. 'The biggest thing that is wrong with hospital food at the minute is that food is no longer seen as one of the first interventions in the recovery plan for patients.'

Rick Wilson agrees. 'We actually only got modern medicines very recently,' he says. 'Penicillin appeared just after World War II. And I think what happened was that the medical profession got very excited, said to themselves we can cure diseases now and we don't need all that old-fashioned food stuff any more. We threw the baby out with the bath water.' Proper nutrition stopped being a part of nursing. It became part of facilities, like power in a hospital or the waterworks. He points to the numbers at his hospitals. The amount spent on catering at King's each year is £3 million with virtually no increase for the past five or six years: £26 million is spent on drugs each year and prices are rising at a rate of 10 per cent to 15 per cent a year. (What's more, he says, 'a fair chunk' of that £26m goes on laxatives.)

The announcement of the Better Hospital Food Panel in 2001 was designed to redress the balance. To chair it they chose Loyd Grossman, who had made his name as the presenter of Masterchef, and his fortune through a collection of high-quality pasta and cooking sauces. 'Because I knew there was a problem I was happy to help,' he says. Initially he committed himself to three years, which eventually became five. He, in turn, recruited a panel of 'leading chefs' to help write recipes and menus, including Anton Edelman, Michael Caines, Shaun Hill and Mark Hix. Quickly the media went to town, mocking what they saw as a bunch of celebrity chefs jumping on a bandwagon, who had come up with a menu of poncey dishes that only metropolitan sophisticates would enjoy: things like navarin of lamb with couscous, and beef and horseradish risotto. 'We all did it for free,' says Mark Hix, executive chef of the Ivy and Le Caprice among others. 'And all that happened was that we got slagged off.'

It's clear that, initially, some of the chefs' ideas were a little off the agenda. Early on many of the food and nutrition experts who had been drafted on to the panel were invited to meet the chefs at Westminster Catering College where each one would give a short demonstration. 'One of the chefs was obsessed with juicing,' recalls Rick Wilson, who sat on the panel. 'He told us this was the way to cure all cancers.' After him came Anton Edelman, then head chef at the Savoy, who said he was going to do a sea bass and scallop dish. There was a sigh of disbelief from the audience. The NHS caterers couldn't cook something like that, let alone afford it.

Edelman silenced them. 'He told us that we were having a day out of the office and we should just enjoy it,' Wilson recalls. 'And he was right, you know. We had forgotten how to take any joy in food, in the sight of it and the smell of it.' Shortly after that, the chefs really went to work and though there were a few dishes that even Grossman accepts were 'a bit outré', the vast majority were just modernised versions of familiar and classic dishes.

'It was simple nursery food,' Mark Hix says now. 'It was shepherd's pie. It was fishcakes.' Anybody wanting proof of this need only go and look at the 'National Dish Selector' page of the Better Hospital Food Panel website, which still exists, even though the panel itself does not. Here are literally hundreds of new recipes for everything from lasagne to real Cornish pasties, chicken casserole to fish pie, Black Forest trifle to lemon posset. No one looking at that, with its 100 serving recipes and the complete nutritional analysis for every dish, could doubt the commitment of the chefs involved.

There was a problem though: some caterers executed these dishes far better than others. Something from the National Dish Selector like a good old-fashioned Lancashire Hot Pot might read wonderfully on the menu when it was offered in the morning, but prove decidedly unappetising - gristly meat, grey potatoes, insipid broth - when it turned up in the evening. Other caterers might get it exactly right.

Some in the field put this down to the modern methods now used to produce this food. Many hospital trusts have outsourced their catering to companies who provide cook-chill dishes that can be heated up on the wards, in trolleys or their own individual containers, or regenerated using self-contained steaming technology. (Indeed a number of new hospitals built under Private Finance Initiatives have no kitchens at all.) Caroline Waldegrave, head of Leith's Cookery School, was a pioneer of hospital food who, alongside Claudia Roden, attempted a makeover of the menus at London's Guy's and St Thomas' hospital in the 1980s. She has just been appointed President of the Hospital Caterers' Association and makes no attempt to disguise her disdain for these sorts of methods.

'All hospital catering is going in the direction of food prepared elsewhere and reheated,' she says. 'And I think that's terribly sad. I even heard one caterer talking excitedly about how he could "regenerate" toast. I mean really, what's the point?' Others, though, think that concentrating on the method used to create the food is wrong. 'Is cook-chill necessarily evil?' asks Loyd Grossman. 'No, I've tasted good and bad. What matters isn't method, but quality.'

In any case, Grossman quickly realised that better hospital food wasn't just about recipes. 'There were much bigger issues surrounding hospital food,' he says. Namely, making sure that people actually eat it, for uneaten food is of no use to anybody, however well prepared it may be. Sitting through long hot meetings at the Department of Health, attended by upwards of three dozen people, the panel came up with initiative after initiative. They wanted to introduce protected mealtimes. Too often patients would miss their lunch or dinner, because clinical departments in the hospital insisted on x-rays or blood tests or physio sessions over lunch (or consultants wanted to see patients at lunchtime so they could nip back to lucrative private practice in the afternoon). The panel wanted everything to stop so that nurses and other staff could attend solely to meals.

They suggested introducing a 'red tray' scheme so that vulnerable patients who needed help could be identified. They proposed making available snacks so that ill people who need to eat little and often could do so. A good number of enlightened hospital trusts have indeed introduced many of these programmes. But, as the Age Concern report proved, there are still many who have not.

'We always agreed on a robust common-sense approach to everything we did,' Loyd Grossman says. 'But what we discovered was that nothing could be accepted until it had been tested, tested, tested. For example we said there should be nutritional screening, that patients should be weighed when they come in and at regular intervals. It made sense. We were told there was no evidence to support its use.' Mostly, though, Grossman says he found a simple lack of political and professional will within the Department of Health to get things done, not least because the Blair government has insisted upon a rolling policy of growing independence for hospital trusts.

'Better hospital food requires both national focus and leadership, but it is hard to deliver that, when power is devolved to the trusts and they can decide for themselves to what degree they are going to do things.' Yes, hospitals received instructions on what they were supposed to do - how many of the leading chefs' dishes they were supposed to put on the menu, for example - but, as we've seen, the skill with which they did so differed terribly from place to place. It also didn't help that there was a high turnover of ministers in the department. 'I was on the panel for five years during which I reported to five different ministers. All of them were able people but how do you get consistency with that level of turnover?'

The current minister in the Department of Health with responsibility for hospital food is Andy Burnham, MP for Leigh. He agreed that not everything was as it should be but pointed to the latest statistics released by his department this month which apparently show that just over 90 per cent of patients think hospital food is either good or very good, up from just 17 per cent giving food a good rating in 2002. The Better Hospital Food Panel, he said, had been disbanded simply because it had done its job. 'It was never meant to be forever,' he says. 'I would acknowledge that catering had low status and was a focus for cuts but I think they reversed that.' Now responsibility for hospital food has gone to the National Patients Safety Executive, whose job is to monitor catering to see it does no harm. But Burnham was clear that implementation of all the new initiatives was now a matter for hospital trusts. 'I would be uncomfortable to be seen to intervene from on high where food was not meeting standards.'

Was he not at all concerned about the Age Concern report? One of the key findings was that, among the hospitals failing to meet basic guidelines on care of the elderly during mealtimes, were a significant number who had already assessed themselves as having complied with all the new regulations. 'Yes, but I think the findings of the Age

Concern report says more about standards of care for elderly people than it does about hospital food.' Oh dear. When the minister with responsibility for the issue fails to understand that the success of hospital catering is as much dependent on how the food is served as what food is served, then the grounds for optimism are limited. After all, that is exactly what the Better

Hospital Food Panel had been banging on about for five years. And now even that is no longer around to make the argument.

It is easy, when looking at what is wrong with hospital food, to miss the good-news stories, and those need to be acknowledged, not least to prove that there is another way. For example there's the Cornwall Food Programme, a collaboration between the county's five NHS trusts to buy all their supplies locally and in a sustainable manner. There's the London Hospital Project involving, among others, the Royal Brompton, which is working to increase the amount of organic and local produce being served to their patients. And then there is Great Ormond Street Hospital. No cook-chill, regeneration or steaming packs here. Just a conventional kitchen with chefs cutting up fresh vegetables and fruit, making hamburgers and baking cakes and puddings.

'The thing about children's eating is that if you don't have a way of being flexible it's not going to work,' says catering manager Anna Cornish. Although at 350 beds the hospital is relatively compact, Great Ormond Street deals with some of the most acute paediatric cases in the country and that in itself creates challenges.

'For example we're dealing with a lot of emotion, and that may means they need a bit of comfort food.' So chips are not banned here. And neither are pizzas. But they are a small part of a robust menu which includes everything from pork cassoulet and cauliflower cheese to Thai curries and a mild chicken korma, made from ingredients that, increasingly, are purchased as locally as possible. All of it is assessed by the clinicians in the hospital's nutrition department before being put on the menu. 'We start from the simple basis that all our food will begin life as fresh ingredients wherever possible,' Cornish says.

I take the lift from the large basement kitchens to the light and airy Sky ward on the sixth floor. Eight-year-old Anthony is too busy watching TV to have anything to do with me but his mother, Jackie Cowan, simply describes herself as 'chuffed' with the food. 'He eats everything here. I think they're very good. To be honest I'm quite surprised.' She shows me that day's fruit salad, full of freshly cut slices of pear, apple and orange.

On the other side of the ward, nine-year-old Douglas Moss is working his way through a Junior Suduko, and grinning about the extension to his summer holiday while he gets over an operation to his leg. Asked for his top tips he recommends the roast lamb, the sausages and mash and the stews.

'He even said the stew was better than mine!' says his mum, Amanda, feigning outrage. 'We actually brought money with us from home expecting that we would have to buy meals outside and bring them in for him because of all the stories about hospital food.' Has she had to do that? 'No. He had a pizza brought in once, but that was as a treat. Everything here is home-made and it's really good.' How does she know? 'I taste it all before he does,' she says, with a wink at her son.

It seems so simple up here, on this bright cheerful ward with its fabulous views out across London. You cook good food and then you serve it. And yet, for many hospitals in Britain getting it right still seems to pose too great a challenge. Can they be relied upon to rise to that challenge? Let's hope so. Our health depends upon it.

· Additional research and reporting by Nicole Jackson