A lot of people still need convincing that the arranged marriage between local government and the health service will be mutually rewarding. Maura Thompson sat in on their joint conference

As the government embarked on day 1,001 in power (and was it any more or less significant than any other? ) there was yet more preaching to the converted in the region of Millbank.

Junior health minister Lord Hunt, fully on-message, was even taking on the mannerisms and intonation of his boss - lips pursed, hands folded, then outstretched - as he praised the sterling work of staff who dealt with 'winter pressures' and reviewed the successes of government initiatives such as health improvement programmes, health action zones, Sure Start and the New Deal.

The occasion was the first joint conference of the Local Government Association and the UK Public Health Association to explore the process of 'joined-up working' that is supposed to come into being with the implementation of the Health Act in April.

More LGA than health service, it was still clear that all the delegates 'sang from the same hymn sheet', as one speaker put it.

More pedestrian than inspiring, Lord Hunt out - lined how the brave new partnership world, postHealth Act, could create flexibility and open up new opportunities, making it possible, for example, for a local authority to pay for a temporary residential facility in hospital grounds that could take the pressure off acute wards in times of 'crisis'.

He outlined some of the 50 examples of joint working he'd brought with him - mysteriously dominated by transport initiatives such as signposted cycle routes, subsidised buses and village walks. Perhaps the glazed expressions indicated delegates' thoughts that signpost money could pay for a couple more trolleys for accident and emergency.

Only the shadow health secretary, poor Dr Liam Fox, struck a note of discord, and that was because he seemed to have turned up at the wrong conference. He breezed in after coffee, oozing charm to outline his vision of the future of healthcare.

It was time to put behind us the petty posturing and sloganeering over the NHS, said Dr Fox, and to dispel the myth about the NHS being the best in the world.

Goodness, no, it was not even the best in Europe. A bit of travel made you jealous about decent health - care - look at the Germans.

What we needed was real partnership, because joint working was the only way to take the health system forward.

It was ludicrous, he insisted repeatedly, that the NHS wasn't working hand in hand with the private health sector to improve standards materially. If only employers were to enter into a partnership to offer private healthcare to employees - with the appropriate corporate incentives - all that pressure would be lifted off the NHS.

Fortunately, a lastminute programme change (to allow for the politicians) brought Tony Elson, chief executive of Kirklees borough council, to follow Dr Fox so that the palpable indignation of delegates was dissipated by a taste of optimism.

A simple summary from Mr Elson of one project run locally was enough to sum up the day. The local authority asthma project aimed to provide support to families with a child with chronic asthma.

Their houses were cleaned with steam cleaners, they were provided with mattress covers to combat dust mites and given advice on restricting smoking in the house. Six months later there was a significant reduction in GP prescribing and call-outs, in emergency hospital admissions and length of stay, as well as improvement in the children's lung capacity.

Then a local authority delegate hit back: 'That's health. That's them, not us.

Why are we paying for this?'

When it was pointed out that these children underperformed at school, didn't participate in leisure, and had parents who didn't work, lived in poverty and were so worn down they couldn't participate in the local community, then it made sense. It was clear that everybody was working for the same goal and - surprisingly - could find a way of achieving it to make everybody happy.

While every part of the country can produce examples of local initiatives in joint working that would never have been possible a couple of years ago, the barriers exist - not least the performance culture of both health and local government.

It was a case of 'chins on the floor', said Mr Elson - people who had to be so focused on their performance targets, on best value and 'doing the day job', that innovation wasn't easy.

And the leadership that's crucial wasn't always there - there was a dearth of council leaders, chief executives from health or local authorities, or people from the Department of Trade and Industry at the conference - because the public health agenda was still for the minority of health groupies.

This conference was for that evangelical health lot with a mission. For, as Professor Sian Griffiths, director of public health and policy for Oxfordshire health authority pointed out, health wasn't even something a lot of NHS chief execs had much time for.

Bogged down with the acute hospital agenda, they hadn't the time or energy.

Yet Oxfordshire, like other areas, can list a raft of initiatives to help the homeless, pregnant teenage girls and elderly people in rural communities to live healthier lives - real dayto-day examples of people from the NHS, local government and voluntary organisations working together to improve people's wellbeing and reduce their chances of getting sick.

Public health is being kept on the agenda by such initiatives to reverse the growing inequalities in mortality, morbidity and access to services.

Dr Debbie Freake, chair of Newcastle West primary care group, also listed a host of examples of crossagency working and joint advisory groups.

But, she reminded everyone, PCGs were GP-led, and GPs worked from a disease model like the acute trust people - it was not about coterminosity, different cultures, the pooling of budgets or staff, it was about a different mindset.

Health, not sickness. Longterm, not short-term.

Proactive, not reactive.

It was about the NHS working with all of local government - housing, environment, transport, leisure - not just social services, she said.

Social services' role as local government's representative on PCGs was lamented by one speaker after another, because social services were such a small part of the public health picture. But also because the biggest barriers were not between health and local government. They were between people in the same organisation, between the departments in local government.

New duties for local government under the Health Act

Promoting economic, social and environmental well-being.

Putting health policy higher on the agenda.

Co-ordinating actions within the local authority.

Raising awareness of public health.

Better joint working.