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Such reports have highlighted how Government can better serve the citizen as consumer. We have also championed the needs of the citizen as taxpayer. Spring may finally have arrivedwell, not today, perhapsbut the economic climate has become distinctly chilly since our last debate. In the Budget, the Government said that they had exceeded their target of more than £21 billion in efficiency savings, and announced an even more ambitious savings target of £30 billion by 2010-11. That is all very interesting. The issue is now at the centre of political debate. Undoubtedly, as the major political parties have come closer together in ideology, ever more
focus is put on efficiency savings and how much benefit they can deliver for the taxpayer. In that sense, our Committee is at the heart of political debate.
The Government say that they want to save £30 billion by 2010-11: just think what we could deliver with that amount. But how solid are any of the savings made? Our 48th report cast doubt on the reliability of nearly three quarters of the efficiency savings achieved. Smoke and mirrors are the last things that we need. Efficiency savings are nothing if they do not free up hard cash or improve delivery. We made a number of recommendations on the subject in our 48th report. For instance, we noted that
There is evidence that some efficiency projects may be having an adverse impact on service quality. The Department of Health, for example, claims efficiencies through patients spending less time in hospital despite the rate of readmissions rising.
Improvements in efficiency may not be sustainable. Some projects, such as the Ministry of Defence's early decommissioning of some of its fast jets have achieved one-off financial savings rather than improving efficiency for the long term.
I suppose that that very detailed work might be considered anorak territory, but it is vital that we have well-informed debate in the Chamber about what is going on, and I think that we can illuminate the debate.
Mr. Nigel Evans (Ribble Valley) (Con): Some efficiency savings are hard to calculate. For instance, the closure of some of our embassies or high commissions across the world may, on paper, seem to save us money, but we could lose trade and investment in the United Kingdom as a result.
Mr. Leigh: Yes. We all have a personal view on our embassies and high commissions. I often think that those historical buildings, right in the centre of town, achieve so much more for this country, in terms of trade, prestige and contacts, than would be achieved by closing them. Often, as with the Dublin embassyan issue on which our Committee reportednothing is achieved by getting rid of the building, anyway.
Andrew Mackinlay (Thurrock) (Lab): I hesitate to intervene on the subject of the UK ambassadors residence in Dublin, but as a member of the Foreign Affairs Committee I am frustrated about a monumental screw-up by senior officials who then are preferred in the honours systemone of them made the House of Lords. It seems that the biggest screw-ups get the biggest rewards in this country. Why do we not sack people who are responsible for malfeasance and irresponsibility? I shall answer my own question: it is because there is a cosy carve-up
That was a good intervention. There is a tradition in our civil service. We never interview Ministers. Our witnesses are only senior civil servants, particularly
Permanent Secretaries, and we often make the point that nobody is ever sacked. But things are changing a little. In the case of one or two people whose appearances in front of the Public Accounts Committee were poorwithout going into detail; I do not want to become personal about ittheir careers have been seriously compromised. The culture is changing and we are making progress.
I was saying that the Treasury has made some progress in the measurements of savings, and I give credit to it. All this sounds basic, but savings claims are now required to take account of costs incurred, which they did not originallya fairly obvious point. I also firmly support the proposal for the National Audit Office to review value for money savings Department by Department. I note that the Government intend to look at all major areas of public spending to identify scope to improve value for money. All this is good stuff. A good start would be to examine the back catalogue of the Committee. We spend years looking into such matters, and we have a real contribution to make.
Spending taxpayers money is what Government do, but we know that spending money is the easiest thing in the world: getting something for it is harder. Government spending on the NHS has nearly trebled over the past 10 yearswe want to give them credit for thatand is set to grow still further. Where there has been such an increase in Government spending, it is important to look carefully at productivity.
It is not for me to question the level of spending, but I am entitled to voice my suspicion, based on several of our reports, that we are not getting enough bangs for that barrage of bucks. It is lazy thinking to increase spending rapidly on a service, point to more doctors, nurses and operationsI agree that there are more doctors, nurses and operationsand not to insist at the same time on maintaining improvements in productivity and efficiency, so that we pay back to the taxpayer who has contributed so much more to the service real, identifiable improvements in productivity on the front line.
Let us take one examplethe pay deal for NHS consultants. The aims of the consultants deal were commendable, but so far generous pay settlements have been awarded without any increases in productivity being achieved. Consultants pay has, on average, increased by 27 per cent., working hours have actually decreased and, as yet, measurable improvements in productivity have been notable by their absence. With GP contracts, on which we will report shortly, we found a similar picture. Pay increases of up to 56 per cent. have been accompanied by a 2.5 per cent. decrease in productivity, plus £1.7 billion-worth of extra costs. We all agree that those who work in the NHS deserve to be paid a decent wage, but those one-sided deals have produced little in return for an enormous amount of investment by the taxpayer.
Is there enough focus on making economies? In our second report on prescription drugs, we found that the NHS could save more than £200 million a year, without affecting patient care, by GPs prescribing lower cost but equally effective medicines. A further £100 million a year could be saved by reducing the amount of unused and wasted drugs. To give the NHS due credit, these are paths that it has already begun to tread, but there is still a long walk ahead.
It is not just in the NHS that money could be saved. Our examination of sustainable employment showed that some £520 million a year could be saved if the Department could only break the debilitating cycle of insecurity faced by too many unskilled jobseekers bouncing back and forth between short-term jobs and welfare.
I regret to say that our most recent look at the sorry saga of tax credits shows little sign of improvement for recipients or for taxpayers. The amount of tax credit being lost to fraud and error is still running at some £1 billion each year. The Department has accepted our recommendations on the need to set targets to reduce this, yet still no targets are in place. The system has also generated massive overpayment to claimants, £6 billion in three years, and £2.3 billion has been written off or is unlikely to be returned.
I make no criticism of the concept of tax credits, and it may indeed be the right thing to do, but we are entitled to look at how efficiently the scheme is being carried out. About 2 million families a year have been placed in debt to the Government as HMRC seeks to recover overpayments. The vulnerable ones face a future of trying to repay the money they owe, with all the hardship that that involves. The taxpayer, in all guises, has been let down.
The Governments response on tax credits is the one glaring omission from the Treasury minutes before us. I understand that the response will appear in June, which is more than four months since our report appeared. I am sure that the Minister, twice a member of our Committee, will recognise that that is not good enough, and I ask her to see that the delay grows no longer. If the Treasury cannot provide its own responses on time, it is hardly setting an example for the rest of Whitehall to follow. I trust that the eight-week deadline will be adhered to from now on. I thought we had an agreement with the Treasury that in order to make our reports and its response reasonably topical, there would be an eight-week deadline for the Government to reply.
Let us turn aside from that sorry tale. I am proud to be able to say that our previous recommendations are now bearing fruit. In 2007, we identified potential annual savings of £500 million from better use across the public sector of external consultants. The Office of Government Commerce has launched a new programme to improve the value for money of spending on consultants. Several Committee and NAO reports on HMRC issues such as fraud, self-assessment and debt management led to savings last year of £200 million. Already, our report on prescription drugs is having an impact. I welcome the recent announcement by the Department of Health, in response to our recommendation, that it will commission research into the scale of medicines wastage and why people do not take their medicines.
Our criticism is intended to be constructive. Government action is always necessary to deliver our recommendations. We rely completely on the Government. In that respect, as in others, our Committee is truly non-partisan. Change could be accelerated and spread more swiftly across Government, but what we have already achieved is testament to the positive value of public accountability. Money is saved and services are improved by our activities, and by our working in tandem with the Treasury, which we view not as our enemies but as our allies.
We have the advantage of hindsight, of course, but hindsight also brings the foresight to do things better in the future. To paraphrase Confucius, a man who has
committed a mistake and does not correct it is committing another mistake. Like Arnold Schwarzenegger in The Terminator, Departments should know that we will be back, and not just on tax credits. We have looked on a number of occasions at the dome and at the 2012 Olympics. We are about to revisit the perplexing project that is the NHS programme for IT. That is the strength of the Committee. When the Government, through the Treasury, accept our recommendations, we increasingly ask, as the Committee for the National Audit Office, to look at that acceptance and see what has happened 12 and 24 months later.
Furthermore, we are trying to get involved and have a genuine look at fashionable projects such as the academy programme. We have issued hard-hitting reports based not on ideology or whether we like academiesI know that the issue is controversialbut on what is happening on the ground. For instance, we found that literacy and numeracy levels are still too low among academy pupils and that the Department should ask successful academies to identify and disseminate good practice. We looked at cost overruns, which have been common because cost control is not robust enough and found that the Department should disseminate the lessons learned about project management and so on.
We operate from the sound base provided by the staff and skills of the National Audit Office. Everybody knows that the Committee could not do its work alone and that it works so well because 400 civil servants work for it. We do not claim much of the credit; we are simply the voice of the National Audit Office, although it also relies on us to give our own parliamentary experience of what goes on.
In that context, I must express our gratitude to Sir John Bourn, who retired as Comptroller and Auditor General in January after nearly 20 years of unstinting support for the Committee. Every member of the Committee shares that view. I also thank Sir Johns successor, Tim Burr, under whose stewardship the NAOs independence and authority continue to be secure.
I am also a member of the Public Accounts Commission, the body that oversees the National Audit Office. We have welcomed John Tyners review of the NAOs corporate governance arrangements and have set out our own proposals for strengthening them. We agree with John Tyner and I think that the Government agree with us; there is no controversy about that. I thank the Government for promising to incorporate the necessary legislative changes into the draft Constitutional Renewal Bill.
However, Mr. Burrs appointment is an interim arrangement; a permanent successor still needs to be found. Progress is not being made at the pace that I would want. I urge the Government to make a bit more haste; surely it is not good to have an acting Comptroller and Auditor General. The process of appointing a new CAG should not be unduly delayed.
In conclusion, I should say that we are not only one of the busiest Committees of the House; I also like to think that we are one of the most effective. I pay tribute to the Committees members, who continue to work hard to hold the Government to account. I thank the hon. Member for Mid-Dorset and North Poole (Annette Brooke), who has left the Committee. I welcome the galaxy of stars who have joined: the right hon. Member for Streatham (Keith Hill) and the hon. Members for Sutton and Cheam (Mr. Burstow), for Edinburgh, South
(Nigel Griffiths), for Sedgefield (Phil Wilson) and for Morecambe and Lunesdale (Geraldine Smith). As ever, we thank our Clerk, Mark Etherton, and his team for their support and help.
Finally, I should say that the Public Accounts Committee helps to give a voice to Parliamentand, through us, to the citizenon the delivery of public services. When services fail those in greatest need, we provide a voice for the vulnerable. When inefficient spending fails those who contribute most in taxes, we provide a voice for the taxpayer. Furthermore, we serve the citizen in all guises by putting our bark and our bite into the pursuit of real change. I commend the motion to the House.
Mr. Don Touhig (Islwyn) (Lab/Co-op): I welcome this debate because it is right that the House should have the opportunity to consider the reports of the Public Accounts Committee, although very few colleagues have availed themselves of that privilege today; there are probably more Members of Parliament in Crewe and Nantwich at the moment than there are in the House of Commons.
In the previous debate on a PAC report, my hon. Friend the Member for Great Grimsby (Mr. Mitchell) referred to the Committees work as a blood sport in which members chase civil servants and attack them, spurred on by a sort of lust to kill. He is certainly right that when Departments are found to have made significant mistakes or to have misspent taxpayers money, we are not known for our gentleness or docility. My hon. Friend has discovered the one blood sport of which I am an enthusiastic devotee.
Nevertheless, we on the Committee had an enjoyable sitting on 30 April when, much to our astonishment, we found ourselves praising the chief executive of Jobcentre Plus, Lesley Strathie, for achieving the roll-out of the organisations office network successfully, largely on time and under budget. Such success should be seen as an example of best practice across Government, and I hope that other Departments will learn from it.
This afternoon I am going to focus my comments on one particular report among those under consideration: the sixth report of this Session. It addresses the issue of services and support for people with dementia, a matter to which our Chairman has already referred.
When health care is debated in the House, in the media and in the public arena at large, dementia services are often the elephant in the room. It is an astonishing fact that as a nation we spend more on dementia care than we do on cancer, heart disease and strokes combined, yet the national consciousness of problems associated with dementia can appear worryingly low when compared with the scale of the problem. In our Committees sixth report, we state that dementia affects 560,000 people in England, a figure that is set to rise to 728,000 in the next 15 years. In Wales, the Alzheimers Society estimates that the figure is 36,500, which is expected to rise to 50,000 over the same period. Faced with that problem, it is time that we as a country woke up to the urgent need to improve our dementia services.
The Committee has also raised the immensely difficult situation faced by carers. The National Audit Office, in its report on dementia services, said that some 476,000 people act as unpaid carers for people with dementia. It
costs each one about £25,000 a year to provide that care. The Government have accepted that nowhere near enough of those carers receive their carers assessment and the help to which that entitles them. I welcome the Governments response that the NHS will now address that problem through the Prime Ministers carers strategy.
The NHS has also promised a carers helpline and specific guidelines to support carers. I hope that those measures will be in place as soon as possible. When our report was published in January, our Chairman expressed the hope that the Committee would move dementia up the NHS agenda. I join him wholeheartedly in that aspiration.
The challenge must be thrown down to the NHSlet us see it respond promptly and effectively. I am encouraged by the news that the development of the national dementia strategy is under way, with public consultation beginning in June, and that it will be published in October. There must be no delays and no slippage, and a full consultation must be completed within the given time frame.
We need to keep the National Dementia Strategy firmly in our minds over the coming months, maintaining a watchful eye to ensure that it remains a priority. It must not be allowed to disappear into the long grass, as many well-intentioned strategies are wont to do if we in the House take our eye off the ball.
In the meantime, it is imperative that, as the Committee has recommended, a single individual should be appointed to lead dementia services in the NHS as soon as possible. That has been done for cancer and coronary heart disease, and I welcome the Governments response that they are considering appointing a national clinical director to that role based on the model used for cancer services. That appointment should be made now, so that the national dementia strategy can be driven forward by the same team who led its development. It is a constant frustration to those of us who serve on the Committee that a strategy that is begun by one civil servant frequently has to be dropped and picked up by another, who has a vast job to do to learn the ropes before they can implement what their predecessor developed. Consistency of leadership enabled Jobcentre Plus to be successful and that is, again, a lesson that can be learned across government.
Clear leadership and accumulation of experience from the strategys inception will ensure that this vital but long-neglected area of health care is rapidly improved. Obviously our first priority must be the care of those affected by dementia, but the speedy improvement of dementia services should also be a matter of great economic interest to the Treasury. Dementia already costs the economy more than £14 billion each year, and the figure is set to rise as the number of dementia sufferers also increases.
Making dementia a high priority in the Governments approach to health care is not simply about the state providing care for those who need ita principle to which I am passionately committed. It is also an economic necessity. If dementia is diagnosed early, more can be done for the patient and the cost of the services is much lower. If time is wasted, it becomes much harder to help the patient and the cost of treatment soars. I hope that my hon. Friends on the Treasury Bench will keep up pressure on the national health service to deliver early diagnosis of dementia, both for the sake of the patient and because of the money it will save.
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