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7 - Quality and the NHS: fair-weather friends or a longstanding relationship?
- Edited by Mark Exworthy, University of Birmingham, Russell Mannion, University of Birmingham, Martin Powell, University of Birmingham
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- Book:
- The NHS at 75
- Published by:
- Bristol University Press
- Published online:
- 03 April 2024
- Print publication:
- 30 October 2023, pp 136-156
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Summary
Introduction
The quality and safety of healthcare remains a global health policy priority with the likes of the World Health Organization and major international forums promoting standards and methods for improving care quality (WHO 2022). The English National Health Service (NHS) exemplifies such trends where the significance of quality as an NHS priority has been framed, in a large part, by the many high-profile failings and scandals in care quality dating back to the late 1960s. Scandals around long-term care at Ely, unsafe paediatric heart surgery at Bristol Royal Infirmary, the systematic neglect of patients at Mid-Staffordshire hospital and very recently, the prominent failings at multiple maternity units provide a disturbing backdrop to the NHS and the quality of care (Mannion et al, 2018; Knight and Stafford, 2022). Such events have often been followed by investigations and Public Inquiries and led to extensive recommendations, many of which look similar from one report to the next, arguing for increased transparency, support for speaking up and whistleblowing, culture change, better governance and reforms of professional regulation (Powell, 2019).
The response to quality failings has instigated a range of regulatory responses and the need for greater quality assurance (Waring et al, 2010). National improvement and performance management programmes from the early 2000s onwards have been implemented by a succession of regulatory bodies from the Centre for Healthcare Improvement (CHI) followed by the Healthcare Commission and then the CQC. In responding to such events, the NHS has also been the testbed for many innovations in quality improvement and management, often drawing from the experiences of other safety-critical or high-quality industries (Waring and Bishop, 2010; Millar, 2013). This is exemplified by the growth of specialist agencies and charities committed to promoting care quality such as the Modernisation Agency, the Institute for Innovation and Improvement, NHS Improvement and The Health Foundation (The Health Foundation, 2021).
And yet despite such an emphasis and policy innovation, the commitment to quality and quality improvement has not been constant. The focus on quality and quality improvement has competed for attention among other policy priorities, especially cost and responding to exogenous events such as the COVID-19 pandemic. Such variable traction and success have led to the quality agenda appearing more like fads and fashions rather than a sustained policy approach (Ham, Berwick and Dixon, 2016; Molloy, Martin and Gardner, 2016).
Food insecurity and coping strategies and their association with anxiety and depression: a nationally representative South African survey
- Siphiwe N Dlamini, Ashleigh Craig, Asanda Mtintsilana, Witness Mapanga, Justin Du Toit, Lisa J Ware, Shane A Norris
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- Journal:
- Public Health Nutrition / Volume 26 / Issue 4 / April 2023
- Published online by Cambridge University Press:
- 24 January 2023, pp. 705-715
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- Article
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Objective:
To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression.
Design:Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations of food insecurity and related coping strategies with anxiety and depression.
Setting:South Africa during COVID-19, October 2021.
Participants:Nationally representative sample of 3402 adults, weighted to 39,640,674 South African households.
Results:About 20·4 % of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from ‘food secure’ to ‘at risk’ or from ‘at risk’ to ‘food insecure’ group was associated with 1·7 times greater odds of being in a higher category of anxiety or depression (P < 0·001). All coping strategies were used to some extent in South African households, with 46·0 % relying on less preferred and less expensive foods and 20·9 % sending a household member to beg for food. These coping strategies were mostly used by food-insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all P < 0·001), begging for food was associated with the highest odds (OR = 2·3).
Conclusions:Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.