The aim of this research was to investigate the discrepancies between in-patients and service providers (hospital caterers and ward staff) on perceptions of the quality of meal services in NHS Acute Trusts. This aim was achieved through comprehensive secondary research into the implications of the NHS’s continued reforms of hospital catering services, the complexity of patients’ food consumption and the nutritional implications of consumption, and the importance of patients satisfaction linked with the models of service quality. After analysing the literature, a framework structured around service gap theory was adopted. Primary research using multimethods and a modified SERVQUAL instrument was carried out on-site at four NHS Acute Trusts in three phases: Phase I- in-patients questionnaire (43.72% response rate, 662 valid returns); Phase II- hospital staff questionnaire (78.24% response rate, 283 valid returns); and Phase III- face-to-face interviews with catering managers (4 participants). The results found that: Patients’ expectations were higher than their perceptions on 17 meal service attributes; Through a path analysis, the best predictor of patient satisfaction was found to be the food properties dimension (of three meal service dimensions from factor analysis), and the regularity of finishing food was found to have a reciprocal interaction with patient satisfaction; The three gaps between the competing interests proposed in the theoretical framework were confirmed: the service gap between patients and service personnel, the quality assurance gap between patients and catering managers, and the managerial gap between service personnel and catering managers. The study has evaluated and provided a greater understanding of meal service in a group of NHS hospitals. Hospital meal services need to review their policies on the provision of food to patients, which should be made more appropriate to the needs of the sick. Eight managerial implications are offered to aid future hospital caterers in understanding some of the underlying complexities of patient satisfaction toward the meal services. Through the development of industry-specific models, a platform has been constructed that can be used for further research into the gaps between the expectations and perceptions of patients, service staff and catering management. This study synthesises concepts from three distinct academic fields (Healthcare Management, Food Choice, and Service Quality) into a coherent instrument, and applies it to the acute hospital meal service field
