Public Accounts

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 Committee's 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 organisation's 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 Committee's 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 Alzheimer's 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 carer's assessment and the help to which that entitles them. I welcome the Government's response that the NHS will now address that problem through the Prime Minister's 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 NHS—let 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 Government's 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 strategy's 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 Government's approach to health care is not simply about the state providing care for those who need it—a 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. 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.