A survey of the food service departments in 93 hospitals throughout NSW Australia (covering 51% of hospital beds in the state) was conducted using a mailed questionnaire and the results compared with those from similar surveys conducted in 1986 and 1993. Over the past eight years there has been a significant increase in the proportion of hospitals using cook-chill food service production systems, from 18% in 1993 to 42% in 2001 (p<0.001). Hospitals with cook-chill systems had lower staff ratios than those with cook-fresh systems (8.3 vs 6.4 beds/full time equivalent staff; p<0.05), but there was no significant difference in the ratio of meals served per FTE. There was no difference between public and private hospitals in terms of ratios of beds or meals to food service staff. Managers using cook-chill systems reported significantly lower levels of satisfaction with the food service system compared to those using cook-fresh. Two aspects of the services have not changed since the last survey: approximately a quarter of food service departments are still managed by staff without formal qualifications and meal times remain the same, with more than 90% of hospitals serving the evening meal before 5.30pm and a median of 14.25 hours gap between the evening meal and breakfast.