The NHS plan pledges to join up health and social services by "removing the outdated institutional barriers between health and social care which have got in the way of people getting the care they need when they need it".

The Health Act 1999 removed legal obstacles to joint working and thus underpins much of the plan. For the first time, social services and the NHS are expected to have pooled budgets for a variety of services. Schemes covering budgets of more than £200m are already up and running but these benefit only a small minority of patients.

The plan requires that joint budget powers are applied across the country. Social care will be delivered in new settings such as GP surgeries. "Local care networks" of social service staff, GPs and other primary and community health teams will jointly assess patients' needs. An extra £900m has been allocated in 2003-04 for personal care plans, espcially for older people.

The plan also picks up recommendations in the act to merge the commissioning services of local and health authorities. Either authority can now take the lead to provide "one-stop care packages" on behalf of both services.

The commission for health improvement, the audit commission and the social services inspectorate will monitor health and social care organisations, charting the progress of joint working. The targets include reducing delays in discharging older patients from hospital, reducing preventable emergency hospital admissions, readmitting older people and people with mental health problems and assessing older people's needs more rapidly.

Authorities which work together successfuly are given incentives to keep up progress. In social services, £50m a year will be available from April 2002 to reward improved joint working in 2001. From April 2003 this will rise to £100m. Grants will initially focus on intermediate care performance: those services which promote independence and improve quality of care for the elderly.

What are care trusts?
The plan expects all primary care groups to become trusts by Aprl 2004. Care trusts will be set up in areas where health and social services want to forge close partnerships. Single, multi-purpose legal bodies would be formed to commission care, and councils would be authorised to oversee the care trusts and decide where they are needed. The model for this idea is being enacted in Somerset, where the joint service provides a single care plan, a single key worker and a unified multi-disciplinary team to address the needs of each client.