The Committee examined a number of case studies during its inquiry including the Mersey Gateway Project, the Tyne Tunnels and proposals for new crossings in East London and the Lower Thames. The Transport Committee says a short-term approach to planning key infrastructure projects has left many estuary areas in the UK with inadequate transport capacity and poor connectivity: "A lack of cross-river capacity limits local and national economic growth so we call upon the Government to take a far more long-term approach when planning new bridges and tunnels. The Government must rectify that weakness as soon as possible. Important infrastructure projects, such as the Mersey Gateway Bridge, have the potential to generate economic growth by linking workers to jobs and consumers to retailers." The Committee welcomes proposals to build a package of new river crossings in east London and believes these developments are "long overdue."

Flight time limitations regulate the number of hours that pilots and crew work in order to prevent fatigue. Fatigue contributes 15-20% of fatal aviation incidents caused by human error. In July 2013, Member States of the European Union voted strongly in support of a draft proposal on flight time limitations by the European Commission. Overall, the Commission's draft regulation represents an improvement but concerns remain. Particularly about the apparent reluctance of the Commission when developing these regulations to set a lower limit for the flight duty period at night in accordance with the scientific evidence on this matter. It is disappointing that the UK Government has not pressed for a lower limit. It is also disappointing that a consensus has not been reached on the draft regulations with crew and pilot representatives. It is recommended that the European Scrutiny Committee requests the UK Government to press the Commission to ensure an effective monitoring regime is put in place to examine whether the 11 hour limit is at least as safe as the current regime and that they request the European Commission provide an assessment of the regulation two years after its implementation. The Committee also concluded that: the potential under-reporting of pilot fatigue must be properly recognised if it is to be effectively tackled; information should be regularly published on the use of Commander's discretion to extend their crew's flight duty period if unforeseen circumstances arise; and scientists must have a more central role in the development and assessment of flight time limitation proposals

Far better contingency planning and preparedness must be put in place by UK airports, and by the airlines that use them, to prevent the kind of chaos that unfolded at Gatwick Airport on Christmas Eve 2013. The problems that unfolded were not new and the whole event should be a wake-up call for airports across the UK to improve their operational resilience. Airports must ensure that their contingency planning is good enough to ensure that future disruption will be met with well-drilled arrangements that are familiar to airport operators, airlines, and other contractors, and which put passenger interests first. If our largest airports cannot demonstrate they can do this then the Civil Aviation Authority must act. Passengers must also be promptly reimbursed for the extra costs they face as a consequence of disruption. The Committee welcomed a key conclusion from Gatwick's own review of the events on Christmas Eve that the airport should appoint passenger champions at each of its terminals. Similar arrangements should also be put in place at other major UK airports. Further recommendations include that airports should: develop (in consultation with airlines) much clearer operational protocols and guidance on the threshold conditions that will trigger the cancellation or postponement of flights; negotiate robust agreements with airlines (which carry formal responsibility for passenger welfare) for reclaiming the costs of looking after passengers during periods of disruption. Government should also push for amendments to a proposed new EU regulation on passenger compensation to include electronic means of alert and information dissemination

In the UK some 11.5m people already live with a recognised disability and more than a fifth of them experience some difficulty when using transport networks. So it's essential that the Department for Transport delivers an ambitious Accessibility Action Plan. Changes made ahead of the 2012 Paralympic Games delivered access for disabled people to significantly more parts of the public transport network for the first time and highlighted the immense value of such improvements for all. Yet a year later, there is a risk that some of the momentum from London 2012 is being lost because further key accessibility improvements planned have been watered-down or abandoned. The Committee's recommendations include: imposing penalties on bus operators who claim to offer accessible routes but then fail to provide accessible buses; the phased introduction of audio-visual information systems on all buses over the next ten years; phasing out the need for disabled travellers having to book organised assistance in advance; financial incentives to encourage investment in fully accessible vehicles by taxi and private care hire vehicle operators; and a change to EU rules so that in future airlines are required to allow carers to travel free of charge when the airline judges a disabled person incapable of travelling independently. The Cabinet Office should convene a working group of ministers and officials to improve cross-government working on accessibility in order to secure the full benefits to be gained from widening disabled people's access to employment and training, healthcare and wider participation in all parts of society

Transport infrastructure in some parts of the UK may get left behind under the new system to be used from next year (2015) to share out central government money for local major transport schemes. The Government has again changed the system for distributing money to local areas for major transport projects, with much more emphasis now on competition for funding. This will not necessarily help regions get a fairer share of transport funding and could make the situation worse. The Government's focus on using competition to bring in private sector funding for projects could disadvantage the regions, where there tends to be less private sector money available compared with London. Those Local Enterprise Partnerships (LEPs) which are well organised and resourced will have an advantage in bidding for funds. Other areas may lose out as a result. In addition, with greater reliance on competitive bidding for funds, there will see more money wasted on failed bids. Strategically significant schemes such as access to ports must not get overlooked. The changes are set against a backdrop where far less money is spent on transport projects outside London than in the capital. Transport infrastructure spending is £2,500 per head in London compared with £5 per head in the north east. This inequality must change. The Committee calls for the new funding arrangements to be reviewed by the end of the next Parliament to ensure that they are efficient and effective in providing funding for the most urgent transport priorities.

The National Policy Statement on National Networks, published in draft for consultation (ISBN 9780108560071), sets out the policy against which decisions will be made on applications for development consent for nationally significant infrastructure projects on the strategic road and rail networks. The Committee has a number of detailed recommendations to improve the draft. The NPS should specify more types of transport scheme which the Government thinks are needed, such as enhancements to the rail network to promote east-west connectivity; better road and rail connections to ports and airports and to parts of the country which are currently not well served by those networks; and schemes to promote regional economic development. Criticisms of the DfT's road and rail demand forecasts should be addressed. Estimates of the impact on UK carbon emissions of building more road infrastructure are needed. Adverse impacts of major transport schemes on localities should be set out. The NPS should make explicit reference to the desirability of connecting HS2 to the classic rail network. Promoters of roads schemes must look to improve road safety (including for cyclists and pedestrians). The Government is seeking to accommodate increasing demand for roads by building more infrastructure rather than seeking to manage demand. Investment in the road network will require new funding streams, a challenge that must be addressed. However, a consensus would be required to introduce any road user charging scheme across the strategic road network as an alternative to road taxation.

This year's inquiry into the work of Monitor concludes that the model of care provided by the health and care system is not changing quickly enough with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided The pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015. Continuing this theme, the Committee argues that as the NHS financial situation tightens, the challenge for Monitor in supporting trusts in financial difficulty is likely to increase. The MPs emphasise the importance of addressing pressures within individual providers in the context of the local health economy. The requirement for major change in the care model can only be delivered if individual providers, and Monitor as their regulator, look beyond preserving existing structures and address the need to develop different structures to meet changing needs. The Committee also expresses concern that Monitor has not done enough to reform the system of tariff payments for providers, arguing that the current tariff arrangements often create perverse incentives for providers and inhibit necessary service change. It recommends that Monitor and NHS England should initiate a formal joint process for a prioritised review of the NHS tariff arrangements with the objective of identifying and eliminating perverse incentives and introducing new tariff structures which incentivise necessary service change

GMC's fitness to practise successfully produces outcomes that protect patients from sub-standard doctors but failures to communicate the reasons for decisions and poor investigative practices have undermined a small number on investigations. The GMC should review its fitness to practice procedures to prevent such mistake. The Committee also found that while it is still too early to judge whether revalidation has been effective there is a worrying approach to the oversight of revalidation. Each designated body has a responsible officer for revalidating their medical staff, but the degree to which the responsible officer will be held to account is unclear. It is imperative that the GMC clarifies the personal responsibility and accountability of responsible officers. There is also concern over the number of responsible officers available to oversee the revalidation of doctors working in primary care. GPs are revalidated not by their own employers but by one of the 27 NHS England local area teams that oversees Clinical Commissioning Groups in England. Just 27 responsible officers will be tasked with overseeing revalidation for approximately 45,0000 GPs in England. The Government's intention had been to give the GMC the power to allow it to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) in 2014 by using a mechanism in secondary legislation called a section 60 order. The Government now plans to introduce the reform in primary legislation as part of a proposed Law Commission Bill thus meeting with even further delay