'The Audit Commission report makes clear that reconfiguration 'is damaging the potential for more successful joint developments,' creating rifts and instability.'

Although health inequalities are one of the small number of priorities on which all trusts should be concentrating - the so-called Selbie Six - we also know that progress has been disappointing. The relationships between local government and NHS are strained despite the friendly rhetoric. Money is scarce for projects which have very long-term goals.

Greater Manchester has enjoyed a reputation for both high-quality primary care and action on combating health inequalities. And yet even this region is facing huge challenges, according to a report we reveal exclusively (link to news story).

The Audit Commission reveals that despite some progress and a reasonably clear understanding of the problem, there is a lack of vision and a lack of champions. The result is that there is a black hole of leadership at the centre of the strategy. It is particularly worrying that local strategy partnerships seem not to be having the promised effect, bogged down by lack of consistent engagement. Mental health services, in particular, are suffering.

Is Greater Manchester an isolated failure? If anything, the trusts involved are likely to be more aware of their shortcomings than others. The Audit Commission report makes clear that reconfiguration 'is damaging the potential for more successful joint developments', creating rifts and instability. The ripple effect is felt in the performance of boards and the effectiveness of oversight and scrutiny committees. Meanwhile, pressure is increased by spending variations, clumsy ways of managing small amounts of cash and a lack of intelligent information.

All of these issues will be being felt in other parts of the country. For these reasons the report will make sobering reading for many health economies - its findings will have ramifications far beyond the North West.

For more information on the Sustainable Communities Awards go to www.sca2007.com