Photograph of a report on a table, the report is labeled, "NHS"

The NHS In England: Patient Safety News Roundup

By John Tingle

There is always a lot happening with patient safety in the NHS (National Health Service) in England. Sadly, all too often patient safety crises events occur. The NHS is also no sloth when it comes to the production of patient safety policies, reports, and publications. These generally provide excellent information and are very well researched and produced. Unfortunately, some of these can be seen to falter at the NHS local hospital implementation stage and some reports get parked or forgotten. This is evident from the failure of the NHS to develop an ingrained patient safety culture over the years. Some patient safety progress has been made, but not enough when the history of NHS policy making in the area is analysed.

Lessons going unlearnt from previous patient safety event crises is also an acute problem. Patient safety events seem to repeat themselves with the same attendant issues

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A calculator, a stethoscope, and a stack of money rest on a table.

Why Our Health Care Is Incomplete: Review of “Exposed” (Part II)

By: Daniel Aaron

Just last month, Professor Christopher T. Robertson, at the University of Arizona College of Law, released his new book about health care, entitled Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done About It. Part II of this book review offers an analytical discussion of “cost exposure,” the main subject of his book with a focus on solutions. Read Part I here.

Baby solutions

Prof. Robertson writes two chapters on solutions. In the first, titled “Fixes We Could Try,” he offers reforms, from mild to moderate, that would make cost exposure less harmful. The chapter largely retains the analytical nature of the prior chapters, but it comes across like a chapter he might have rather not written. This is evident in the following chapter’s title, “What We Must Do.” It’s also evident because some of the proposals do not seem fully considered, and in some ways appear more controversial than the more comprehensive solution offered later. Read More

A calculator, a stethoscope, and a stack of money rest on a table.

Why Our Health Care Is Incomplete: Review of “Exposed” (Part I)

By: Daniel Aaron

Just last month, Professor Christopher T. Robertson, at the University of Arizona College of Law, released his new book about health care, entitled Exposed: Why Our Health Insurance Is Incomplete and What Can Be Done About It. This book review will offer an analytical discussion of “cost exposure,” the main subject of his book.

What is cost exposure in health care?

Cost exposure is payments people make related to their medical care. There are many ways patients pay – here are a few common ones.

  • Deductible – Patient is responsible for the first, say, $5,000 of their medical care; after this point, the health insurance kicks in. Resets each year.
  • Copay – Patient pays a specific amount, say $25, when having an episode of care.
  • Coinsurance – Patient pays a specified percentage, say 20%, of care.

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Gavel And Medical Stethoscope

What Should Academics Know About Lobbying Law?

This post was originally published on AM Rounds on January 14, 2020.

By Holly Fernandez Lynch, Alison Bateman-House, and Suzanne M. Rivera

Academics sometimes get a bad rap for being stuck in their ivory towers. But many academics realize that their expertise can be useful to policymakers and aim to make it widely available through a variety of avenues. We write op-eds, publish in policy-oriented journals, send letters to elected officials, write amicus briefs, submit comments on proposed regulations, serve on advisory committees, and offer testimony. At the current political moment, these types of public engagement and advocacy activities are particularly salient for academics doing work relevant to health and science policy, topics at the top of the national agenda.

In a recent article in Academic Medicine, we describe how academics can engage in advocacy without running afoul of legal restrictions on lobbying. Here are the top 10 things you need to know.

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An index finger rests on one yellow star while four other stars are shaded to the right, indicating a one star review.

Improving the Mindset on NHS Complaint Handling

By John Tingle

History has not served the NHS (National Health Service) complaints system well

History has not served the NHS complaints system well. There have been many reports about NHS complaints going back well over two and a half decades, saying the same or similar things about the system. Many have argued and continue to argue that the NHS complaints system needs to be much more responsive, simpler in operation and less defensive. It is fair comment to argue today that the NHS complaints system is still plagued with endemic and systemic problems. The NHS has never been able to gets its health care complaints system right.

Two contemporary reports, one published in 2018 and the other in 2020, give support to the view that the NHS needs to do much more to improve how patient complaints are handled. Read More

Soft-focus photograph of wheelchairs lined up in a hospital hallway

Toward a Safer NHS in 2020

By John Tingle

As the New Year begins its important to reflect on the previous year’s National Health Service (NHS) patient safety milestones in England. We should ask also whether the NHS patient safety agenda will make major advances in 2020.

The year 2019 was another bumper year for NHS patient safety policy developments and crises. Some major patient safety publications were produced, and stories of NHS patient safety crisis continued to regularly hit the headlines. The NHS is no sloth when it comes to patient safety policy report writing and the number patient safety adverse incidents happening. Read More

U.S.-Mexico border wall in Texas near a dirt road

Targeting Health: How Anti-Immigrant Policies Threaten Our Health & Our Humanity

By Patricia Illingworth and Wendy E. Parmet

On May 19th of last year, Carlos Gregorio Hernandez Vasquez died of the flu while being held in a cell by U.S. Customs and Border Protection (CBP) in south Texas. He was just 16, a migrant from Guatemala. Hours before his death, when his fever spiked to 103, a nurse suggested that he be checked again in a few hours and taken to the emergency room if he got any worse. Instead, Carlos was moved to a cell and isolated. By morning, he was dead.

Sadly, Carlos’s substandard medical treatment was not an isolated case. Between December 2018 and May 20, 2019, five migrant children died while in federal custody. All of them were from Guatemala. Their deaths were not accidental. Rather, they died as a consequence of harsh policies that are designed to deter immigration, in part, by making life itself precarious for migrants.

Since taking office, the Trump administration has instituted a wide-ranging crackdown on immigration. A surprising number of the policies the administration has instituted as part of that crackdown relate directly or indirectly to health. For example, in addition to providing inadequate treatment to sick migrants, CBP has refused to provide flu shots to detainees, despite the fact that influenza, like other infectious diseases, can spread rapidly in overcrowded detention facilities. In dismissing a CDC recommendation to provide the vaccines, CBP cited the complexity of administering vaccines and the fact that most migrants spend less than 72 hours in its custody before being transferred to other agencies, or returned to Mexico. These explanations lack credibility given how easy it is to administer flu vaccines. Read More

Several vaping devices on a table

E-Cigarette Laws that Work for Everyone

By Daniel Aaron

The Trump Administration has retreated from proposed tobacco regulations that experts generally agree would benefit public health. The regulations would have included a ban on flavored e-cigarettes, a favorite of children who use e-cigarettes. Currently millions of youth are estimated to be addicted to e-cigarettes.

The rules also could have reduced nicotine in cigarettes to non-addictive levels. Nicotine is the addicting substance largely responsible for continued smoking. If nicotine were “decoupled” from smoking, smokers might turn to other sources of nicotine, rather than continuing to smoke. Smoking is the leading cause of preventable death in the U.S., killing about 500,000 Americans each year, or just about the number of Americans who died in World War I and World War II combined.

Part of the difficulty in regulating e-cigarettes is that, unlike cigarettes, they offer benefits and harms that differ across generations. This concern is called intergenerational equity. How can a solution be crafted that serves all Americans?

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People taking part in the "Lights4Liberty" protests against President Trump's planned ICE raids against immigrants and the detention centers along the southern border. The protestor is carrying a sign that reads, "Child detention camps destroy children."

Memory, Trauma, and Asylum Law: A Role for Neuroscience?

This post is part of our Eighth Annual Health Law Year in P/Review symposium. You can read all of the posts in the series here. Learn more about the event and stay tuned for video of each session on the Petrie-Flom Center’s website.

By Francis X. Shen and Aldis H. Petriceks

Today hundreds of thousands of asylum seekers await their hearings. Multiple studies conducted in 2019 confirmed that the conditions of detainment are often deplorable. The federal government recently acknowledged a lack of adequate medical and mental health care at the Southern Border, and the U.S. Civil Rights Commission issued a 200-page report documenting the Human Cost of Inhumane Immigration Policies, highlighting the severe damage to child and adult mental health at the border. All the while, despite public outrage and government claims to the contrary, family separation has remained prevalent. Read More

Three hard hats for construction work lined up on a concrete wall

Enhancing Patient Safety Education and Training through Legal Study

By John Tingle

In the new NHS Patient Safety Strategy for England there is a discussion of patient safety education and training. While safety is now better understood there are significant numbers of people who still have a limited understanding of safety science.

A National Patient Safety Syllabus

A commitment is made to have a universal patient safety syllabus and training program for the whole of the NHS. Health Education England (HEE) will have a pivotal role: Read More