'Spy' committee calls for reforms

13 July 2011 Last updated at 12:56 GMT Sir Malcolm Rifkind says the reforms would increase the transparency of the intelligence community A committee of MPs and Peers wants to be able to order intelligence officers to provide it with information as part of a proposed overhaul of its powers.

In its annual report, the Intelligence and Security Committee (ISC) also called on the prime minister to give up his right to see its reports first.

The committee oversees the work of MI5, MI6 and the Government Communications Headquarters (GCHQ).

It says its structure has become "significantly out of date".

The 2010/11 annual report covers issues including cyber-security, the London Olympics and the government's cost-cutting.

In it, the Intelligence and Security Committee asks that its remit be extended from covering the security agencies' policies, administration and finances to their operations as well.

Chairman Sir Malcolm Rifkind said the committee's remit and structure needed to be reformed.

Continue reading the main story It be made a parliamentary committeeIt be given the power to order informationThe secretary of state - not agency heads - be able to decide when information should be withheldIt be allowed to take evidence from the broader intelligence communityIts remit cover all agencies' work, including operationsIt be given more research resourcesSixteen years after it was created by former Prime Minister John Major, the committee's arrangements are "significantly out of date", he says.

"Public expectation in terms of transparency and openness has increased significantly during this time, and we must ensure that the committee now has the powers and remit that are necessary to provide reassurance to the public and to Parliament," he said.

"It is essential that we are able to provide credible reassurance that, consistent with necessary secrecy and security, the agencies operate in the public interest."

The ISC report says that it is no longer appropriate that the committee be hosted by the Cabinet Office.

"As a matter of principle, no matter what the circumstances, it clearly is not right to be hosted by an organisation that you have some role in overseeing and there is a danger that boundaries might not be respected."

Sir Malcolm says the ISC should become a parliamentary committee, delivering its reports to Westminster as well as Prime Minister David Cameron.

He says the proposed reforms will "increase accountability, transparency and capacity for oversight of the intelligence community".

The changes could be introduced in the government's Green Paper on the protection of intelligence material in the courts, he says.

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Call for end-of-life care reforms

1 July 2011 Last updated at 00:16 GMT By Adam Brimelow Health Correspondent, BBC News Too many people end their days in hospital against their wishes, the report suggests An independent review is calling for a set of universal standards for care of the dying after uncovering "stunning inequities" in provision in England.

The inquiry, requested last year by the government, says the current system is confusing and inconsistent.

Its report proposes a set of guarantees on what the state will provide, and a new payment system to help more people die at home rather than in hospital.

It estimates that thousands of people miss out on palliative care each year.

Health charities have welcomed the findings.

The review, led by the the chief executive of Marie Curie Cancer Care, Thomas Hughes-Hallett, describes huge variations in the quality of end-of-life services.

It praises the "many highly committed professionals" who are doing their best, but concludes that thousands of people who need help do not benefit from their expertise.

Unmet needs

The report estimates that of just over 470,000 people who die in England each year, some 355,000 require palliative care - to prevent and relieve suffering and help them to live as well as possible.

However, only 171,000 receive specialist palliative care.

It says some at the end of life may get the help they need from other health workers, but it estimates that more than 90,000 people do not even discuss their end-of-life care.

It warns that this figure is growing and that too many end their days in hospital against their wishes.

Citing figures from the Department of Health, it reports that in the last financial year one primary care trust spent approximately ?186 per death while another spent ?6,213.

And it says the system faces increasing pressures from people living longer, with more complex needs as they approach the end of life.

The report proposes a statement from the government setting out the support and services patients, carers and families can expect to receive from the NHS.

It also calls for a new system of tariffs to incentivise high-quality care.

This should reflect the complexity of patients' needs and the type of care required.

It would also be designed to encourage community-based services, enabling more people to end their lives at home if they wish to.

Mr Hughes-Hallett says there is an urgent need for change.

"You get better clinical and economic outcomes when patients receive palliative care. But there is no tariff for this in hospitals or the community so it is no surprise that good outcomes are not achieved. We are left with stunning inequities."

The tariff would cover all patients' clinically assessed needs, regardless of setting, just as with other types of NHS care.

Each patient would have an appointed co-ordinator to help guide them through the different services. They would also have their social-care needs covered at the end of life.

The report says a similar system has been tried and tested in Australia and is working well.

'One chance'

It estimates that providing more community-based services could reduce the number of hospital deaths by 60,000 a year by 2011. The authors calculate that the annual saving to hospitals would be ?180 million.

Simon Chapman, from the National Council for Palliative Care, says it is vital that the government acts on the review's recommendations.

"Although the majority of us would prefer to be cared for and die at home, in a care home or in a hospice, more than half of us die in hospital.

"We only get one chance to get it right for dying people, which is why it must be a priority to ensure everyone who needs it can access palliative care round the clock."

Ciaran Devane, chief executive at Macmillan Cancer Support, said: "Twenty-four hour community nursing services are crucial to the delivery of choice and to the realisation of these ambitious recommendations.

"It will be up to the government to ensure that these services are standard across the country. We need to see a massive improvement on the 56% of PCTs who currently provide 24-hour community nursing."

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Ministers 'losing way' on reforms

16 June 2011 Last updated at 19:35 GMT The threat of strike action is weighing heavily on ministers, the CBI believes The coalition is "losing its way" over its promised public sector reforms in the face of union pressure and fears of a public backlash, the CBI has said.

The business group's deputy director general said the planned NHS shake-up had turned into a "debacle".

And Neil Bentley urged ministers to ignore the "forces of inertia" and push on with public sector pension changes.

The PM's spokesman has said the delayed public services reform white paper will be published before the summer recess.

But the criticism from Mr Bentley comes amid reports that the government's blueprint for public sector reform will not be published until the early autumn.

In a speech in Surrey, Mr Bentley praised the government's progress in some areas, saying it had hit targets for efficiency savings, improved government procurement and given a greater role to private firms in its welfare-to-work programmes.

'Losing momentum'

But he said ministers promised a white paper setting out their vision for greater productivity in the public sector in February and - four months on - it was no clearer when this would be delivered.

"After all this time, this ongoing uncertainty - combined with the debacle over NHS reform - clearly calls into question the coalition's commitment to reform," he said.

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The coalition gives the impression of having lost its way, uneasy about reforms and unsure how to present them”

End Quote Neil Bentley Deputy director general, CBI The government's rethink on its proposed shake-up of the NHS in England was a "missed opportunity" and would have serious consequences for the health service, he argued.

"We have seen the forces of inertia in the NHS triumph on health reform. Patient services will only be improved if the NHS is opened up to far greater competition and dependence on hospital care is reduced."

Mr Bentley claimed proposed changes to services in local government, policing, probation and other areas were "losing momentum".

Failure to secure greater competition and diversity of provision could hamper the coalition's deficit-cutting strategy, he said, arguing that competitive tendering for public sector contracts could cut costs by up to 30%.

"In most areas we are seeing public services cling onto existing ways of doing things, with vested interests fighting modernisation at every turn and campaigning against change."

"Today, the coalition gives the impression of having lost its way, uneasy about reforms and unsure how to present them."

Pension battle

The government is locked in a fight with public sector unions over changes to pensions.

More than 750,000 workers are set to strike later this month, unhappy about plans to require them to contribute more and work longer before they can collect their pension.

Unions say the retirement income of many low-paid workers will be reduced, contrasting this with what they claim is continuing excess in the banking sector.

But the CBI is challenging ministers - who have warned of the danger of strikes and said they are committed to affordable pension provision - to press ahead with the recommendations in the Hutton report earlier this year.

"The government has to hold its nerve," Mr Bentley said.

"Otherwise the public sector pensions deficit will get even more unaffordable. The private sector has bitten the bullet on this. Now the government as an employer needs to do the same."

The Times reported on Thursday that ministers had delayed the publication of plans to get private and voluntary groups to take over the running of more services - due out next month - amid internal friction over their speed.

This followed leaked documents last month which suggested ministers had decided the "wholesale outsourcing" of public services to the private sector would be politically "unpalatable".

Cabinet Office minister Francis Maude has said the blueprint would be made public "within months".

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Call made for reforms at Holyrood

11 June 2011 Last updated at 23:15 GMT The Scottish Parliament Business secretary has called for reforms of the parliament Reforms are needed to ensure Holyrood is more open, responsive and in tune with the public, the parliamentary business secretary has said.

Bruce Crawford has called for a review to raise standards at the Scottish Parliament.

He also said that there should be greater scrutiny of legislation and engagement with the public.

Labour welcomed the moves, but criticised the SNP's dominance of committees.

Mr Crawford said that while structural and procedural changes were needed, any reforms needed to go further.

He highlighted several potential areas for improvement, including:

Ensuring quicker responses to public concernsGreater pre- and post-legislative scrutinyMore focussed committee inquiriesEncouraging committees to bring forward their own billsChanging the chamber sitting timesMore flexible rules on contributions from backbenchers

Mr Crawford said: "Scotland's legislature is founded on a distinctive and progressive vision - one in which the government, the parliament and the people work in partnership to shape our nation's destiny and deliver the policies Scotland needs.

"Holding the government to account may seem more relevant now that there is a majority government but this is not the first time such a majority has held sway across parliament - the first eight years were dominated by a coalition which also held a majority of committee conveners and members.

"I have already taken steps to ensure the smaller parties have committee places and that the Liberal Democrats are represented on the Parliamentary Bureau. But we need to go further."

Labour Business Manager Paul Martin said the parliament was never designed for majority rule, so attempts to introduce more checks and balances were welcome.

He added: "But these suggested reforms don't change the fact that by dominating every committee and then electing one of their own as presiding officer the SNP are already acting as judge, jury and executioner.

"Labour will engage positively with this process to ensure the parliament lives up to the expectations of the people of Scotland and will bring forward its own proposals to make the parliament more accountable."

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NHS reforms may change - Lansley

2 June 2011 Last updated at 06:59 GMT Health Secretary Andrew Lansley promised he would "never privatise our NHS" Health Secretary Andrew Lansley has said he is ready to accept "substantial and significant" alterations to plans for changes in the NHS in England.

He told the Daily Telegraph there could be changes to the health bill "if they help us improve care for patients".

But Mr Lansley warned the NHS would face "financial crisis within a matter of years" unless it was reformed.

Labour, as well as Lib Dem leader Nick Clegg, have called for the bill to be sent back to MPs for reconsideration.

'Threaten values'

With the government's "listening exercise" on its proposed changes drawing to a close, Mr Lansley said: "We have always been clear that we are ready to accept any changes - substantial and significant - if they help us improve care for patients.

"When the Health and Social Care Bill comes back to Parliament, people should have every confidence that we will make the changes necessary to ensure the NHS is protected for our future generations.

"We will never privatise our NHS.

"But if we choose to ignore the pressures on it, the health service will face a financial crisis within a matter of years that will threaten the very values we hold so dear - of a comprehensive health service, available to all, free at the point of use and based on need and not the ability to pay.

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Our health service is facing huge challenges that, if not dealt with today, will almost certainly mean a crisis tomorrow”

End Quote Andrew Lansley Health Secretary "I will not allow that to happen."

Mr Lansley said reform was necessary in the face of "enormous financial pressures" caused by an ageing population and the rising cost of treatment.

He said the number of people in the UK aged above 85 had almost trebled over the past 25 years and was set to double again over the next 20 years. By 2034, one in 20 of the population would be aged over 85.

As a result the NHS would have to perform two million more operations a year and health spending would double to ?230bn, he said.

Mr Lansley said this was a figure the UK "simply cannot afford".

'Disgracefully unethical'

Prime Minister David Cameron has "paused" the legislative progress of the reforms, which aim to hand control of budgets to GPs and increase competition in the NHS.

The move was to allow further consultation on the proposals, a process which came to an end on Tuesday, with the NHS Future Forum, which is overseeing the exercise, expected to report later this month.

The forum brings together doctors, nurses and other health professionals.

Health officials said they had received about 15,000 website responses and 720 letters.

Mr Clegg has said he would oppose the idea of a regulator promoting competition in the health service, a key part of the planned changes.

Confidence vote

The deputy prime minister has indicated that Lib Dem MPs could vote against the bill unless changes are made.

The British Medical Association (BMA) has described a system of incentive payments for GPs known as "Quality Premium", another important part of the reform programme, as "disgracefully unethical".

Dr Laurence Buckman, chairman of the BMA's General Practitioners Committee, said: "We don't understand what the Quality Premium means. We don't understand where it will come from. We rather fear it will come out of our pay and be paid back to us if we do certain things."

In April, delegates at the Royal College of Nursing conference in Liverpool passed a vote of no confidence in the health secretary.

Nurses said they were angry about the changes and the way the government was running the consultation.

'Care passionately'

Mr Lansley said the vision set out by the government would deliver "a truly world-class NHS, with doctors and nurses leading the design of health services, patients taking more control and budgets controlled by locally-accountable people".

"Our health service is facing huge challenges that, if not dealt with today, will almost certainly mean a crisis tomorrow," he said.

"I care passionately about protecting the NHS for the future. This is why doing nothing is not an option. I will not leave the NHS to neglect."

However, for Labour, shadow health secretary John Healey said Mr Lansley was "just adding to confusion and uncertainty in the health service".

"He makes a case for change but not the Tory-led government's top down re-organisation of the NHS," he said.

"As Labour has argued from the outset and as the chorus of criticism during the 'pause' has underlined, these are the wrong reforms for the NHS.

"They are being forced through for reasons of political ideology not improved patient care.

"The huge upheaval of re-organisation is making it harder not easier for the NHS to deal with the financial and efficiency squeeze."

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