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I was not going to talk about local government finance today; I have bored this House often enough on that subject. However, I must respond to the reference in the Minister’s introduction to yet another social care precept and emphasise how unfair such a system is. If you put 1% or 2% on council tax it sounds even across the country, but the amount of revenue raised by it depends on the value of properties, the banding and so on. Quite frankly, there are more £1 million houses in Richmond than there are in Wigan. A 1% increase in Wigan raises about £1 million; in Richmond it is about £2 million, and our population is bigger. This is a discriminatory move, and I hope that the Government have learned from previous problems.
Sustainable health is an important area which has been mentioned by a number of noble Lords. Just before the Conservative Party conference, the Prime Minister visited north Manchester and announced that a new hospital was going to be built as part of the capital programme. That was welcome in the city, because the old one is a disgrace and ought to have been replaced many years ago. The health outcomes in that part of the city are among the very worst in the country. Manchester has some of the worst anyway, and north Manchester is one of the most deprived parts of the city, with life expectancy between four and five years below average. Even greater is the gap in healthy life expectancy. In north Manchester, people become ill in their mid to late 50s with a series of long-term conditions and become dependent on drugs and so on. In Oxford, people are probably in their 70s before that happens, so they can have a number of years of healthier life.
Welcome as the new hospital is, it is only going to have a marginal impact on those health statistics because we know that the determinants of health are not simply medical facilities but lifestyles and economic and social factors. In that area, 21.7% of people smoke, whereas the national average is 15.5%, which is considerably different; one in four is economically inactive, which we know makes a difference to health; and one in three older people is said to be destitute. As the right reverend Prelate the Bishop of London said, Sir Michael Marmot’s report in 2010 identified all these wider links to health outcomes which we need to think about. We need to rethink how we are going to change health. The long-term plan was a welcome move in the right direction, but it is not far enough. We need to go further.
It was recently said that life expectancy in the UK has risen for about 47 years, but it has now begun to tail off. There are international comparisons, but it is probably worse in the UK than anywhere else. We need to understand this. The gap in healthy lifestyle between the top fifth of the population and the bottom fifth is growing. People have said that this is down to austerity; I do not want to get into that argument. We need to acknowledge that this is happening and try to find ways of dealing with it. The CQC report, which a number of noble Lords have mentioned, highlighted the inexorable rise in demand for the NHS. July levels in A&E were the highest for a number of years. On Friday, we had a conference in Manchester about winter pressures. We need to recognise that, for the NHS, winter now lasts about 10 months of the year.
As your Lordships may know, there was some devolution of health powers to Greater Manchester in 2016. We have a partnership made up of health authorities, local authorities, voluntary and community groups and so on. We want to recognise that our challenge is not simply to deliver a good and effective health service. It is not enough to make sure that there is better integration between different parts of the system. We must address the fundamental issues of health and well-being outcomes. We are not going to do that simply by concentrating on health matters; we want to concentrate on wider social issues. We surprised some people with our early strategy which included school readiness and economic activity. We have achieved some things, but I do not have enough time to go through them.
I want to look to some solutions. Health cannot do this on its own; it has to work in partnership with other people. It is part of public service reform: reshaping services to meet people’s needs; thinking about population health with prevention and early intervention. Above all, it is about keeping it local: identifying local needs and encouraging collaboration and innovation. There are things we can do together to improve and make the health service more than just an ill-health service.