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Richard Younger-Ross (Teignbridge): The hon. Gentleman refers to care in the home. The Griffiths report, suppressed initially by the Conservative Government, suggested that there should be more such care. Care in the home was introduced in the 1990s—the Conservatives eventually adopted the recommendation—but it is restricted by cash. Social services departments throughout the country would like to establish more care in the home but they cannot afford to do so. Does the hon. Gentleman think that the Government should give more money to enable that to happen?

Dr. Stoate: Yes. Of course more money should be going into the health service in general. Of course more money is needed for social services. That is why my hon. Friend the Minister of State, Department of Health told us that there would a real-terms cash increase of 6 per cent. next year and, hopefully, in subsequent years. Of course it is important that we put more money into the sector. Of course there must be more money for social services. Of course we need more money for hospitals. There is no question about that. We are suggesting more money, but we do not hear anything from the Conservatives about more money—and we hear very little from the Liberal Democrats, who are long on ideas but short on delivery. Of course more money is needed. Labour is finding more money, but it is important to spend it wisely and carefully.

In our society, people are living longer, and that is right. Thanks in small part to people like me, people are living longer than they used to. Medical care is improving,

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as it should be. Many people will have a long and—I hope—reasonably fruitful old age, but they will need increasing levels of care.

Mrs. Cheryl Gillan (Chesham and Amersham): The hon. Gentleman referred to the 6 per cent. increase promised by the Minister. Does he agree that the money will be swallowed up almost immediately. First, the increase in staff wages is approximately 3 per cent. Many local authorities have been offering care homes only half the inflation figure. Secondly, the regulations require more and more staff, reducing staff-patient ratios, so the money will be completely eaten up and there will be no improvement in care standards.

Dr. Stoate: The hon. Lady makes a fair point and I would be much more sympathetic if she were able to explain how her party could deliver more than 6 per cent. At least the Government are putting in 6 per cent., although I agree that it will probably not be enough and that we will need to put in even more. The Conservatives do not plan to put any money into the sector, so how will they achieve improved standards?

During the 1990s, the Conservative Government awarded the social services real-terms increases, year on year, of about 0.1 per cent. At least we have put in considerably more than that. I entirely agree with the hon. Lady that the increase will be swallowed up by increased staffing, higher care standards and improvements to the homes, but it is much more than we are being promised by the Opposition.

Kali Mountford: Does my hon. Friend agree that one way of making the best of the available money would be to pool resources between social services, the health service and other partners in local health trusts, as in the pilot schemes initiated by the Government? Is that not a better way forward? We are finding imaginative and innovative ways of spending money wisely on behalf of our constituents.

Dr. Stoate: My hon. Friend makes an extremely good point—as always. When I was a member of the Select Committee on Health, we examined the relationship between health and social services to try to break down what we described as the Berlin wall between social and health care. We considered how health and social services could pool budgets and work collaboratively in the community to deliver care packages. We made some sensible suggestions that the Government were pleased to address and to adopt. My hon. Friend is right: we need more of that collaborative working because that is one of the ways that we can deliver better packages of care in the community.

People are living longer and they will need longer periods of care. Local authority funds are stretched; their money will always be tight and we have to ensure that they can live within their budgets.

The costs of providing decent care will always be high, however. The main thrust of my argument is to explore what we can do to reduce dependency on the care home sector. As a GP, when someone goes into hospital, I do not think it is a success—to a large extent I consider that

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a failure. When I see an elderly person who is not coping in their own home, I do everything that I can to institute a care package in that person's home. If the nursing and social care facilities are available we can set up that package in the majority of cases. That work is unsung; it is not heroic or recognised. It is not even necessarily counted statistically. However, a vast amount of work is undertaken in people's homes—small amounts of nursing or social care, help from relatives and friends and so on—which can make a massive difference to people and can prevent them from having to go into a care home.

Mr. Burstow: Perhaps the hon. Gentleman could develop that point. Does he agree that we need to make progress on preventive strategies? One of the main problems is that the cuts that local authorities have made in those low-level home help services have devastated the moves towards preventive care. People have to do more for themselves and are putting themselves at risk of falls; a person has mucky nets and falls off a ladder trying to change them. Every year, the NHS spends £1.7 billion on hip fractures. Surely, we could recycle some of that money to provide low-level preventive measures.

Dr. Stoate: That is an excellent suggestion. The hon. Gentleman has made some sensible proposals during the debate. He is right. A person aged over-75 who suffers a hip fracture has only a 25 per cent. chance of regaining independent life. The majority of people of that age who go into hospital with a fractured hip will end up in institutional care, which is a great tragedy. With proper rehabilitation, intermediate care beds, step-down facilities and care packages in the home, many of them could be rehabilitated to their own homes, but often they are not.

Often, an elderly person may be coping nicely—although perhaps on the verge of early dementia—but if they are taken away from their home and put into hospital, they become institutionalised in almost no time at all. It is completely impossible for them to go back to their own home because they have lost the ability to cling on to their home circumstances and their little networks. When that goes, it is the end of their chance to be rehabilitated.

Mr. Drew: My hon. Friend is making a very carefully constructed speech, but no one has so far mentioned the other part of the tripod, which is, of course, housing itself. One of the major reasons why people return to hospital is not necessarily their mental condition, but the fact that they live in inadequate or inappropriate housing. The unsung heroes are often the home improvement agencies, which do very minor alterations, such as fitting handrails or handles on baths. That is where we need to invest. It is not rocket science and it does not involve huge sums, but steady investment in such work could make an enormous difference. Does my hon. Friend agree?

Dr. Stoate: I entirely agree with my hon. Friend. That is exactly the sort of thing that we need to do; it is cheap, easy and quick. It does not involve huge waiting lists or create huge problems. It can often be done in a matter of days or weeks, and it can make the difference. As I have said, when vulnerable people lose contact with their surroundings, many of them can never live independently again.

Mrs. Browning: As the hon. Gentleman is collecting good ideas, I hope that he thinks that it would be a good

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idea to return to a policy that was in place across the country when the Conservatives were in office: instead of delivering a month's block of frozen food to elderly people in their homes, more hot, cooked meals should be delivered daily. I have just had the experience of having no alternative but to place an elderly relative in a residential home simply because she could no longer cope with cooking a meal at home on her own. That is exactly the sort of thing that the hon. Gentleman is talking about in referring to the small things that make all the difference between life being sustainable independently and having to go into residential care.

Dr. Stoate: I thank the hon. Lady for that very thoughtful contribution. I have a great deal of sympathy with what she says. I entirely agree that even a short daily visit from the meals-on-wheels service, providing a hot meal, can keep people more cheerful and gives them much more to look forward to each day than taking something out of the freezer and putting it into the microwave. Often the daily meal delivery is the only source of contact that an elderly person might get, tragic though that may sound. The daily visit from the meals-on-wheels service can make all the difference to the contact with the outside world.

A two-minute chat about something of interest can make the difference. Small, simple things such as that save money. Although it may seem as though money is saved by giving elderly people a month's frozen food, the overall cost can often be much greater if they have to go into a residential home instead of looking after themselves at home.

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