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It is time those working in local authorities took on the health service and challenged the NHS to take them seriously, conference delegates were told.

Rita Stringfellow, chairperson of social affairs, health and housing at the Local Government Association called for wider recognition by the health service that those involved in social care had valuable expertise and experience to bring to the table.

But she added: "My real challenge to health, to the Department of Health and to ministers, is that we have a dialogue, an honest dialogue, about what integrated services mean."

Stringfellow questioned the role of the new four regional directors of health and social care and asked why people had been appointed to the posts before the role had been properly defined. "Do they anticipate drawing powers from local government or the Social Services Inspectorate? Otherwise why should this layer exist?"

She said she "struggled with" the fact that there are now eight government office regions, seven SSI regions, the new strategic health authorities and the four health and social care regions. "What is the added value of the latter?" she asked.

"It might be tempting for some directors of social services to see themselves as part of the health establishment - but it is more complicated than that," she declared, adding that perhaps it should be chief executives who sit on health bodies as they had more clout than social services directors.

The LGA social affairs and health executive has so far focused on the setting up of the new care trusts. But what was clear was that the key to future improvements to services was maintaining a dialogue with those in health. "Now is the time to draw a line in the sand and say to the NHS at the centre 'talk with us not at us'," she said.