The Association of Directors of Adult Social Services has stressed.that joint working should be the first, not the last, option considered by local authorities and primary care trusts.

The editorial on 31 May ('Partnership working needs financial conviction').drew attention to the Association of Directors of Adult Social Services' plea that joint working be the first, not the last, option considered by local authorities and primary care trusts. Elsewhere, articles drew attention to the lack of patient choice, control and responsibility within NHS services.

The first has the potential to be the solution to the latter. Health has much to learn from models of self-directed care and individual budgets in adult social care, which reinforce the basic principle that everyone is in control of their own body and life and our job is to give them the support they need to do so, not take the job over.

If we want transformational change in the NHS, surely integration, not just of services and commissioning, but also of concepts of self-managed care, are the way forward.

Ailsa Claireis chief executive of Barnsley primary care trust.