Public Accounts

That is very reassuring. On these occasions, it is tempting to recite from our canon of reports a litany of Government failures, sugaring the medicine with the occasional acknowledgement of hard-won success. I want to focus on three themes arising from the reports referred to in the motion—themes that reach the core of not just the Committee's work, but its very purpose. I hope that hon. Members will recognise that the Committee seeks to protect the public's interests in public spending—that is what we are there for—but the public are not just providers of ready money to Her Majesty's Government: their interest goes beyond the question of how efficiently taxes are collected and spent, important though that question is. The Committee seeks to represent the taxpayers' interests in the efficiency and productivity of public services, but we recognise that taxpayers are also patients, parents and pensioners. Many of those ““consumers”” are those with the least voice and yet the greatest vulnerability. Alone, they are small citizens faced with a large state. Obviously, the public—whether as taxpayer or consumer—benefit most from the Committee's activities when we have most impact. There is power in our bark, hard and even horrible though it may be to some witnesses at our hearings. There is power in our bite, too—the power of our recommendations to lead to savings for the taxpayer and better services for the consumer. I want to use this opportunity to highlight several such bites. Recent reports have shown both light and shadow in the way in which vulnerable consumers are treated by public services. There is a clear need for the Government to design services around the needs of citizens, not the convenience of those who deliver them. For instance, our 12th report examined the compensation scheme for former miners suffering from work-related lung disease and hand injuries. The early stages of the implementation of the two schemes were seriously mismanaged. Many of those claiming were elderly and ill, and in no position to wait 10 years or more for compensation, as some did. Some claimants died while they were waiting. I welcome the fact that money has now come through to many claimants, but the scheme's failings offer a clear example of the human suffering that was a consequence of poor planning at the start of a project. The taxpayer, too, has taken a big hit. The cost merely of administering the schemes is expected to total nearly £2.3 billion, not least because the relevant Department's negotiation of solicitors' fees was weak. I do not hesitate to say that some solicitors engaged in what I can only term profiteering. Solicitors also featured not too creditably in our report on legal aid and mediation for people involved in family breakdown. In one third of cases, solicitors did not advise their clients that professional mediation was an option, yet mediation is often a swifter, less acrimonious path—and it is, of course, cheaper. That is not to ignore the wider social problems that family breakdown creates, but we should never forget that it is children who are the most vulnerable party, and they warrant special consideration. Even when the mediation path is taken, children are not routinely consulted. Our work also illuminates neglected or unfashionable issues. To my great pride, we have raised greatly the profile of hospital-acquired infection and stroke care. The Committee has played an important role in bringing those issues way up the political agenda. This year, we want to do the same for dementia, one of the last great taboo subjects. We tackled it in a report this year. It affects more than half a million people in England and costs some £14 billion a year. The number of cases is predicted to soar by more than 30 per cent. in the next 30 years, yet dementia remains relatively neglected by health and social care services. If the NHS is to discharge its duty of care to the vulnerable and those without a voice, awareness is key. Too often both the public and professionals believe that little can be done to help sufferers. Many general practitioners lack the knowledge to make a formal diagnosis of dementia. Often a diagnosis is not early enough and specialist care is not available. As a result, carers—usually family members—bear a heavy burden and play a vital role, saving the taxpayer many millions of pounds by caring for relatives with dementia at home. They need and deserve better support. In my view, dementia must be given the same priority that is accorded to cancer and coronary heart disease. Like those conditions, it should be given a single leader within the Department of Health with the power to drive through improvements in diagnosis, treatment and care. 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 arrived—well, not today, perhaps—but 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." We pointed out that"““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.