"We were told that some people can no longer enjoy simple pleasures such as sitting in their garden in the sun, " he added.

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There is no silver bullet and no magic wand, but some simple steps, such as asking every hospital to carry out a friends and family test, asking the patients and the staff whether they would be happy for their family or friends to be treated in that hospital, can make a real difference.

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Such requests normally get a simple yes or no, he said.

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While a future Congress could, theoretically, bring the Accountable Care Act to an end, and while the Supreme Court may yet destroy part or all of the law before Perry needs to make good on a promise that he cannot possibly keep, the simple fact is that there is really no impact on the law that might result from such an executive order.

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