This Report evaluates current National Health Service procurement arrangements for nutritional supply services in England. The principal focus is on contractual procurement of these services in the secondary care sector, but, since the economic effects of the secondary sector arrangements and their implications for the NHS depend crucially on how they function alongside primary care arrangements, it is necessary also to take account of the latter. Specifically, the assessment takes particular account of the economic linkages between procurement decisions in the two sectors, which give rise to a number of important issues and questions.