Some 14 years ago at a social care conference I listened to the then new Conservative health secretary Andrew Lansley expound his view on the future of the NHS. He, like most health ministers, accepted that care and health were inextricably entwined, that addressing the social determinants of health like housing or pollution and poverty were local government responsibilities but in practice the two sectors were far apart. 

He even admitted that in opposition his party had even considered whether to give responsibility for the NHS to local government. 

The argument against it was that the NHS would soon soak up every item of local government spending, that councillors faced with whether to allocate cash to mending potholes or cancer treatment would have no alternative but to opt for the latter.

Lansley's subsequent much slated NHS reforms in 2012 described as ‘so big you could see them from space' attempted to modestly address the wider social determinants of health by transferring public health responsibilities from the NHS back to local government, in effect trying to recreate the old council-run medical officer of health function. 

We all know what happened there. Once public health was taken out of the NHS its grant funding was steadily cut. 

This did not augur well for any future attempts to move health and care closer together. 

Remember the health and wellbeing boards? 

They were a good idea when launched in 2013 but their impact was hardly far-reaching.

And that is the core weakness at the heart of health and care integration. 

When it comes to the crunch funding will always head to the NHS because that is where the most immediate pressures occur. Some of the ICBs have also found that the focus is on the NHS rather than on care and on local government's role in affecting social determinants of health. 

This does not in any way mean integration should be off the agenda, far from it, but it does require a concerted focus on addressing these often competing funding demands.

So here we are again, a new government with a huge majority, and a pragmatic health and care secretary in Wes Streeting who makes it clear he is not dazzled by what is often described as the UK's religion, the NHS. He has a great opportunity to grasp the nettle of care and health integration knowing that if Labour really is in for two terms then reforms now should see results within the next eight to ten years. 

He has already made two salient points that look wider than the traditional role of the NHS as simply a medical service. One is that the NHS has an economic role in improving the nation's health. We already have a record number of working age people who have dropped out of the workforce, largely for health reasons with an escalating rise in sickness benefits. The priority is cutting waiting times to get people back to work while creating training and job opportunities to help deliver the growth agenda.

Streeting also recognises the wider role of local government in improving health just as Lansley did back in 2010. On X, formerly Twitter, he wrote earlier this year that ‘so much of what determines our health and our healthy life expectancy sits outside the NHS - but the NHS will be overwhelmed unless we deal with the social determinants of ill-health'. In its own submission to ministers the NHS Confederation said that there should be ‘a cross-government national mission for health improvement to shift the focus from simply treating illness to promoting health and wellbeing, reducing inequalities and tackling the wider determinants of health, and supporting the public to be active partners in their own health'.

Streeting has brought back some previous big hitters to take a hard look at the NHS. Former minister Lord Darzi led his review while Paul Corrigan, a former health advisor under Tony Blair, is back as an adviser.

The challenges of both integrating health and care and focusing on upstream prevention are enormous, as we know having been here before and – yes - more funding cannot be avoided. But this is an exciting time for both the NHS and local government, an opportunity for the latter to take a key role in helping the former, not just in integrated social care but in really delivering better health and wellbeing. 

This article was originally published in our sister title, The MJ.