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The most shocking fact the Committee heard on the matter is that between half and two thirds of people with dementia never receive a formal diagnosis at all, let alone an early diagnosis. Absurdly, many dementia sufferers are not diagnosed unless they go into hospital with another illness or an injury. That is a disgrace. Reversing that situation should be a high priority for the NHS.
The main obstacle preventing correct and early diagnosis is GPs’ poor knowledge of dementia and lack of the training necessary to recognise it. Currently, GPs can go through their entire career without learning about dementia at all. At undergraduate level there is no compulsory medical component on dementia or older people’s mental health, and little general coverage of the condition. Once qualified, there is no requirement for GPs to spend any of their continuing professional development on older people’s mental health.
The situation is hardly any better for nurses. The Royal College of Nursing told the NAO that most student nurses receive between only two and five hours of teaching on older people’s mental health. That is completely baffling when we are faced with a problem that is the greatest health care challenge the country will encounter now or in the coming decades. The NHS should insist on dementia training for health care professionals. Let us see that absurdity remedied as soon as possible, with a clear requirement on the NHS that all trainee doctors and nurses learn about dementia. My hon. Friend the Exchequer Secretary has a direct interest in that happening: the saving to the economy of achieving early diagnosis of dementia will benefit the whole country significantly.
The final point from the report that I want to highlight is the lack of dementia awareness in care homes. It is a sad fact that although 62 per cent. of people in care homes are thought to have dementia, only 28 per cent. of care places are registered specialist dementia places. The shortage of specialist dementia care places is a scandal, and it is a matter of which we as a country should be thoroughly ashamed. It is tantamount to neglect of some of the most vulnerable people in our society. It is a wrong that we have to put right, and I look to my Government to take the lead in that just cause.
Furthermore, two in 10 care homes do not meet the medicines management standards required of them. Neuroleptic drugs such as haloperidol and risperidone are over-used to sedate difficult patients in far too many cases, even though those drugs are known to make dementia worse—a point well made by my hon. Friend the Member for North-West Leicestershire (David Taylor) in his ten-minute rule debate only yesterday. Professor Sube Bannerjee, an adviser to the NHS on dementia, told the Committee that those caring for dementia sufferers should resort to neuroleptic drugs only after other methods of managing difficult patients had failed. The guidelines for care homes are clear, yet the Committee found that they were being disregarded in too many cases. It is time for the Government to ensure that such unacceptable and counter-productive abuse of dementia sufferers is brought to an end.
The Committee has brought the massive issue of dementia before Parliament, and I hope that the changes advocated in the report will be introduced as speedily as possible. I cannot over-emphasise the impact of dementia
on our national life. It must become a priority for the national health service, and it is up to Members of the House to ensure that the Government and the NHS make it a priority.
2.43 pm
Dr. John Pugh (Southport) (LD): I rise as a bit-part player in our Treasury team and also as a member of the PAC. In preparing for the debate I thumbed through the whole back catalogue of PAC reports, and was struck by the analogy between the Committee and an ageing pop supergroup. As with many groups that show longevity and staying power, the membership changes although certain key core figures remain—rather like the Drifters. The distinctive sound and character of the group survive despite the departure of some and the arrival of others who are usually destined to play minor, supportive and not so well recognised roles. The PAC even has its own fan base. We invariably fill Committee Room 15 with our groupies, and we feature in Private Eye.
Like any other supergroup, we require extensive back-up staff to put the show on the road, in the shape of the National Audit Office, the clerking team, the press officer and the excellent Mark Etherton, who plays the Brian Epstein impresario role. We have our own front man in the shape of the hon. Member for Gainsborough (Mr. Leigh), known for his forthright, punchy delivery and wild, flowing locks; the incisive tones of the hon. Member for South Norfolk (Mr. Bacon); the accusatory Welsh lilt of the right hon. Member for Islwyn (Mr. Touhig); and the uncompromising sound of working-class Glasgow from the hon. Member for Glasgow, South-West (Mr. Davidson)—plus lyrical inventiveness and flights of fancy from the hon. Member for Great Grimsby (Mr. Mitchell). None of us has yet been destroyed by excess, despite the constant heady infusions of bottled water at every meeting. As a result, a quality product emerges that is genuinely appreciated, although it has to be recognised that our following among senior civil servants and Cabinet Ministers is not what it could be.
It would be ludicrous in a brief review to try to do justice to our entire back catalogue, or even to the 33 reports under review, so I will concentrate on some of my favourite and more impactful reports—our greatest hits, I guess. To be fair, not all our reports are of equal quality. It is dangerous and tedious on occasions such as this to engage in an orgy of mutual back-slapping—such behaviour is more appropriate to their lordships in another place. We have to be self-critical at times and acknowledge that we have not got to the bottom of every issue. Largely for procedural reasons, we have not been able to follow up some fairly critical issues. Our programme of work depends on cherry-picking of the NAO, which genuinely tests the polymath abilities of elected Members and cannot be guaranteed, within the time scales, to leave no stone unturned. Important issues escape scrutiny because of a lack of time or timely information. Vehicle excise duty is a good example of that. Other long-standing issues such as BBC expenses and salaries and Saudi arms deals escape our attention because of indefensible legal inhibitions.
I will concentrate my remarks on areas that I understand reasonably well, leaving Icelandic trawlermen for other Members to fulminate on. The first of those areas is health. We have reported on clinical governance of
primary care trusts, the consultants contract and prescribing costs in primary care—all areas that have been victims of the Government’s reform programme. Unsurprisingly, we found that the Maoist permanent revolution in NHS structures fomented by the cultural revolutionaries in the Department of Health left PCTs ill equipped to commission effectively, to manage the private sector—although they are encouraged to take it on—or properly to understand what was expected of them. It is no wonder that we have problems with the delivery of out-of-hours services. We identified the prevalence of a “commission and go” philosophy—not an unexpected finding. Nor was it surprising to find that consultants negotiating a new contract had successfully outwitted hospital trusts and got more money without increasing productivity.
Vested interests were in play when we examined the prescription drugs market, where useful potential savings were identified and there were clear disparities between one PCT and another as regards how capable they were of getting at those savings, which could be engineered only if the driver was the interests of patients, not those of the pharmacy industry. The report contained remarkable evidence of sheer waste and over-prescription. That was not particularly to do with the behaviour of PCTs but more with the fact that people retained drugs that they no longer needed or got them when they did not need them. The crude moral that one might draw from this is that vested interests must be challenged—in one respect, the Government are endeavouring to do so—but that Maoist permanent revolution might not be the best way of doing so. Interestingly, that conclusion was arrived at in China some time ago.
On education, I shall deal with the academies programme. The NAO report slightly sold the pass on that, because it did not examine the effects on surrounding schools of the arrival of a bright, shiny, well financed academy. The evaluation was therefore skewed from the start in favour of the academy programme. None the less, it found that academies indisputably delivered no better results than the previous excellence in cities programme. Given the obvious point that children always work better in shiny, new, well financed schools, the report genuinely calls into question whether the structural upheaval that academies represent is justified by any gains in performance. It is clear that they are not the answer to every educational ill.
Expanding our scientific base might be a smarter move, and that brings me to our report on big science. It is genuinely difficult to establish value for money in science. We concluded:
“There is a risk of leaving decisions to a small group of scientists without input from the wider community.”
As a north-west Member of Parliament, I want to underline that vigorously. At Daresbury, the diamond synchrotron eluded our grasp for reasons that appeared to have more to do with the interests of the Wellcome Foundation than those of anyone else, unless it was due to the anxiety of key members of the Oxbridge and London research community about a possible dangerous move to the badlands of the Cheshire tundra.
Daresbury was offered the fourth generation light source, which, to be fair, was a reasonable consolation prize because it kept cutting-edge science at Daresbury
and has strong relevance to commercial applications in the area. It has the potential to generate the highly skilled jobs that we need in the north-west. However, we now find that that is in doubt, and I should like us to return to the topic in future.
We identified no fit between science policy, regional policy and industrial policy. I hope that future PAC work will examine in depth regional disparities and the huge amount of money inexpertly spent on urban regeneration.
This happy band of interrogators has recently unearthed so much that it is worth reflecting on several conclusions. Some universities clearly do not know why their students drop out. We overspend on roads as much, if not more, than on rail. The lottery, post-Olympics, is in a fix, and that will have an adverse effect on lottery funding in the regions.
We discovered, from an extraordinarily interesting and oddly positive report, that the costs to society of dementia can be allayed by the distribution of good practice and early diagnosis. I agree with hon. Members who have already spoken that that report was one of the most important and useful that we considered.
I want to conclude with two big ticket issues. As the hon. Member for Gainsborough said, the jury is out on the Government’s efficiency programme because all and sundry are unsure about the distinction between front-line and back-office staff. Everybody wants to get rid of the back-office staff; nobody wants to get rid of the front-line staff, but nobody knows the exact difference between them. There is also confusion about the difference between sustainable and unsustainable savings. There is some debate about what might constitute a sustainable saving. There is also uncertainty about the distinction between an efficiency and a service reduction. We must agree with the Treasury’s somewhat philosophical conclusion:
“This can present a complex and difficult measurement challenge”.
We also discovered that the Government’s preferred capital investment vehicle—the private finance initiative—is in as much trouble as ever. It is the second major subject on which we should dwell at least a little more. We found inadequate benchmarking, sloppy contracts and rising unit costs. To be fair, we found evidence of a learning curve, but little evidence for elevating the PFI above traditional models of procurement and capital finance. All that simply whets our appetite for future sessions.
Although our relationship with witnesses can often appear adversarial—and, at times, confrontational, even bordering on the unnecessarily macho—our relationship with Government is not necessarily adversarial. No one in any party or position wants one pound of taxpayers’ money to be ill spent. I hope that our Committee has made a small contribution to that.
On a personal note, since becoming a Member of Parliament, I have found working on the Committee one of the most useful things that I do. I am proud to be a member of the band.
2.54 pm
Mr. Austin Mitchell (Great Grimsby) (Lab):
I was very keen to participate in this debate, particularly as our friend the Chairman of the Committee, the hon. Member for Gainsborough (Mr. Leigh), was so heavy in persuading us to take part. The debate is a useful and
interesting opportunity to get some sort of summation of the work we have done during the year. Reports come to us so quickly that it is often difficult to fit them into a framework or to keep pace with them. The schedule of reports up for debate today makes fascinating reading.
We have had a very successful year with some big subjects and some small, but all of them gave an insight into Government procedures that is not available to any other Committee. This has certainly been the most fascinating Select Committee that I have ever been on. If I may transfer my useful sycophancy from the leader of our party to the Chairman of the Committee, I must say that the Committee has been extremely well led. I very much admire the staccato series of bullets that he fires at officials, which gives us headings under which we do our own rifle work later in the debate. That gives an important lead to the Committee, and he has been an effective Chairman. He is effective in giving a lot of diverse characters—we are a high-powered Committee, and the Committee members here today, including former members, are particularly high powered—our heads and allowing us to do our own thing. I deprecate the kind of wry expression that he sometimes assumes as I launch into another insane attack on some institution—he should keep his feelings to himself—but he has the important skill of leadership.
The interesting thing about the Committee is that it is the one I have served on that is most relevant to the needs and interests of ordinary people. After all, it is their money that we are talking about. We produce reports on things that affect their lives, such as the cost of medicine, which hits home to many people, or the state of accommodation for servicemen, and who is responsible for the myriad failures in that area. As part of our inquiries, we have looked at whether people’s doctors provide a good service, and we have helped in that area. We have considered the cost and state of our roads as we examined the Highways Agency and the effectiveness of the vehicle licensing agency in Wales.
Highlighting the failures to report and deal accurately with evasion by motorcyclists was quite an achievement. I did not realise that it is impossible to photograph on an electronic device the registration plates of motorcyclists. Having seen how easily motorcyclists can evade the speed cameras, I am considering the purchase of a high-powered motorbike for my wife, who is accumulating points in a dangerous fashion. A motorbike might be the only way out.
We had an insight into the sort of problems that ordinary people face and we have had a direct impact. People pay taxes and tax will become an increasingly important issue as the election approaches and it becomes a battleground for the parties, and more so, as the economy moves into recession. It will then be essential to see that money is well spent. Tax will become a more important issue, and we are the main agency for seeing that taxes are well and effectively spent, and that people get value for money.
The infuriating thing is that our work is, to an extent, post-mortem work. The people we get to grill are usually not the perpetrators—they are not, as the US Securities and Exchange Commission would say, in its examinations of financial fraud in the United States, the people responsible for the decisions and the deficiencies being examined, but their successors. The people who made
the mistakes have usually moved on and been rewarded with some kind of honour, as my hon. Friend the Member for Thurrock (Andrew Mackinlay) has pointed out. We deal with the accounting officers and it is appropriate that we should do so. However, it would be nice occasionally to be able to call the perpetrators of the failures and problems that we deal with.
We did just that in the case of the Rural Payments Agency and the failure of the European payments, when we examined, after some delay and with some difficulty, the role of the agency’s chief executive. We were able to show, essentially, that the failure was not only his, but a failure all round. It was a failure by the civil service—by departmental officials, and those right at the top, too—to stand up to Ministers when asked to do the impossible and say, “This can’t be done, especially not with the staff resources that we have available.” It is the responsibility of the civil service not only to be a “can do” service, but to be a “can’t do” service when it sees that its work is impossible and when it sees the damage that will be done to the Department and itself. The civil service must have more confidence and speak out.
We should call the perpetrators. As my hon. Friend has said, all too often they are rewarded with an honour, just as people in business who fail are rewarded with high monetary compensation—the case of Adam Applegarth at Northern Rock comes to mind. Unfortunately, the civil service has its equivalents. There should be penalties for failure and they should be made clear.
I fear that we are occasionally bamboozled. I instance a recent inquiry into Postcomm, which seems to be dedicated to ruining the Royal Mail as a service. The other regulators seem to be concerned to give special concessions and advantages to those with power and money, who can get better prices, the costs of which are then imposed on the vulnerable, who pay more for the services that they receive. Postcomm says that it is protecting a universal service, but that service is deteriorating. We do not get Sunday deliveries now and Saturday deliveries are under threat, and there is only one delivery a day, when there used to be two.
However, after Postcomm had appeared before us and defended its procedures, it made an announcement saying not only that it continued to be dedicated to promoting competition and liberalisation, because they were providing a
“far better customer focus and strong incentives for all mail operators”
to serve larger companies, but that it wanted a part-privatisation, which was not mentioned at our hearing. Quite out of the blue, Postcomm admitted a major financial problem, with the pension funds in particular, which it had denied at the hearing. Having admitted that it had reduced the profitability of the Royal Mail, Postcomm went on to advocate making Royal Mail’s activities subject to the same rate of VAT as the private operators.
None of that was mentioned at our hearing, but it all appeared subsequently. We should have known that that would happen, because it is unreasonable to take one position at a hearing and then announce something totally different the next day. That makes me think.
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