Last week's LGA conference could just as well been renamed the Local Government and Integrated Care Conference so vital was the latter to the proceedings. 

In fact the event must have confi rmed to most delegates how the future of local government is now inextricably bound up with that of the NHS.

Virtually all speakers, whether left or right, agreed that the ageing society and the cost of care is about the most serious financial challenge facing the NHS and local authorities.

All agreed that on thegrounds of efficiency and service, care and health should be a single entity with acute health separate.  Both health secretary Jeremy Hunt and his shadow, Andy Burnham, said care and health services should integrate.

The LGA's Rewiring Public Services report says they should be run from a single place-based budget.  So if everyone agrees then what stops it from happening?  That of course is the $64,000 question.  The barriers, budgetary, cultural, political, are immense, not least from the NHS and its workforce.

Sceptical council senior executives and leaders regard NHS management as over-paid and feather-bedded, a view based on their experiences of taking on public health this year.  At a round table of North West council chiefs I chaired last week there was general astonishment at the salary levels and perks of NHS directors and at the generous redundancy pay-offs, which were they in local government would be front page news.

The ring-fencing of NHS budgets also locks in inefficiencies, providing little incentive to make the kind of structural changes local government has been compelled to do because of budget cuts.

For too long the NHS, its working practices concealed from public view, has been seen as untouchable, its staff angels, its management grappling nobly with rising demand. The hospital care scandals have dented this image.