I entirely agree; otherwise, confidence in public policy and the machinery of government is very much undermined. Increasingly, people do not give credence to announcements made by Ministers. They believe that there is double accounting, window dressing or double dipping, and that nothing will materialise. When nothing happens, they understandably feel cheated, which is unfair on everyone involved. The hon. Gentleman makes a reasonable proposal: why should there not be a straightforward audit trail of money that is specifically allocated by the Department of Health for a specific purpose, whether it be for dementia or for carers, so that everyone knows where it has gone?

The PAC's next recommendation states:

"The implementation of the Strategy is dependent on achieving"- an eye-watering-

"£1.9 billion of efficiency savings by increasing care in the community and reducing reliance on care provided in care homes and acute hospitals."

Let us take that apart a bit. As I understand it, the dementia strategy that the Government are introducing will require somewhere a saving of nearly £2 billion by reducing the spend on acute hospitals and care homes and by increasing care in the community.

Where does care in the community come from? "Care in the community" is shorthand for people being looked after at home by a mixture of carers and care workers, yet the Government's attempts to give further support to carers at home, by allocating money to help them, have fallen at the first hurdle.

I am sure that when the hon. Member for Sutton and Cheam meets carers at his local carers centres and asks them about their needs, he finds-as I do-that they almost always first articulate the need for a break, or respite care. It varies from person to person: some ask for a weekly break, or a few hours off so that they can do shopping and so on. The all-party carers group, of which I am a member, had a meeting with the Prime Minister last year and all of us-officers and members-articulated that need. In fairness, the Department came forward with a chunk of money for carers. It was intended for carers' breaks, but it is not being used for that by PCTs. What confidence can carers have that the Government will support them if they fail at the first hurdle by not ensuring that PCTs allocate carers the money that was meant to be allocated to them?

Where are the care workers to come from? I have a real concern that nursing homes on my patch seem to be manned almost entirely by good-quality nurses from the Philippines and Bulgaria. I do not mean that facetiously. The nurses are recruited and trained by UK nursing homes, but as soon as they are trained, they are often poached by the local NHS and move into it. Nursing homes are continuously having to train and retrain people. It is an ongoing experience.

I do not see a co-ordinated programme to ensure that jobs in nursing homes are seen as worth while, rewarding and valued in their own right by society. I see no evidence of local further education colleges or universities laying on courses at, for example, national vocational qualification level 4 so that we can have more qualified care workers. [Interruption.] I would be happy if the Minister told me in his summing up that I am wrong. I just do not see evidence of that in Oxfordshire. Whenever I visit nursing homes, I am told that one of their great concerns is recruitment of staff. If we are to have far more people providing care in the community, it will require a considerably larger number of qualified, caring care workers. One can introduce the policy only if such people are available.

The shorthand for that move is "personalisation of care services", which is the jargon that is being used. May I put down a marker? If people are to be looked after more in the community, that should not be shorthand for their being isolated at home; they still need to be able to get to day centres to interact with others and to have a community life. I am concerned that pressures are being put on social services departments and county councils, on one hand to increase the amount of money that they are giving for care in the community, which is shorthand for people being looked after at home, whereas on the other hand, as a consequence, there is less money for day centres and other provision for the elderly.

The PAC states:

"This should include an immediate requirement for acute hospitals to have an older people's mental health liaison team in place to ensure that unnecessary admissions are avoided and that discharge to appropriate care is as swift as possible."

I can only report that I have not yet come across an older people's mental health liaison team in the Oxford Radcliffe Hospitals NHS Trust.

The next recommendation states:

"Early diagnosis of dementia is crucial in providing timely and appropriate care and in preventing more costly hospital or residential care. The Department should work with Primary Care Trusts to ensure they urgently commission good quality and effective memory services."

I have another suggestion that will help. Most general practitioners are stressed for time, but the condition of a large number of people who are suffering from Alzheimer's or dementia in its early stages will have been picked up by their family or their husbands or wives much more quickly than by the GP. If we asked GPs to set up a voluntary register of people who are carers, and if carers were recognised much more in the NHS system, I suspect that there would be greater opportunity for carers to say to GPs, "I think my husband or wife is in the early stages of some difficulties with memory and perhaps dementia." It can often be difficult for an individual to acknowledge or admit that they are in the early stages of dementia or Alzheimer's. We need to encourage more people, as carers, to discuss candidly and frankly with their GPs the suffering of their loved one or the fact that they are in the early stages of dementia.

I am sure that all hon. Members, as friends, relatives and constituency MPs, see people who are finding life slightly difficult and who will, in a couple of months or so, start going downhill fairly fast. It is not that people are insensitive or unthinking, it is just that unless someone says to their GP, "Look, this person needs some help", a diagnosis will not necessarily be picked up early. If we are talking about continuing professional development for GPs, one thing they need to consider much more in their surgeries is how they respond to and work with carers for those who are suffering from dementia, particularly if the Government's policy is that ever more people should be looked after at home and not necessarily in care homes.

The PAC observes:

"There is unacceptable regional variation in access to diagnostic services for dementia and in access to dementia drugs...Local leadership is still lacking in NHS hospitals, in primary care and in the social care and care home sectors."

That is a pretty damning conclusion. The PAC advises that every acute hospital should have a "senior clinical leader" by the end of this month, who should

"work with the new Care Homes Champion to develop dementia 'Champions' across the care home sector."

That takes me back to my original point, which is that everyone wants to be confident that there are people in the system who have a grip and who provide leadership, whether in respect of an acute hospital trust, a social services department or within the care homes sector.

The PAC says:

"Most people with dementia receive their day-to-day care from domiciliary carers or care home staff, who have little understanding of dementia, which therefore puts at risk the quality of care and safety of some of the most vulnerable people in society. After six years of debate and discussion, plans to introduce registration of social care staff, many of whom are without qualifications, appears to have been abandoned. As a result these staff will remain unregulated for some time to come."

It is not just a question of regulation; it is about staff being valued and appreciated, and about who takes the lead and who should be responsible for ensuring that we have enough domiciliary carers or care home staff who are properly and fully trained and who feel valued, just as nurses in a hospital feel valued. The work that domiciliary carers and care home staff do is crucial and invaluable in our society and deserves to be appreciated, valued and recognised. Registration should not be regarded as some sort of indictment. If there is registration, it should be regarded as a qualification that is considered worthwhile.

Lastly, like a number of previous reports, the PAC notes:

"There is inappropriate and excessive prescribing of anti-psychotic drugs for people with dementia, particularly those living in care homes, which has contributed to up to 1,800 additional deaths each year."

That situation often comes about because care homes have to look after people with dementia with too few staff, and the only way they can manage the numbers is by putting patients on those terrible cocktails of anti-psychotic drugs.

An enormous amount of work still has to be done, and if we are to get a grip on it, there needs to be leadership from Ministers downwards. This is a growing issue-a growing challenge to us all, wherever we live in the country-and we need to ensure as a starting point that in future if the Government make pledges on dementia or other issues, those pledges are not broken.