In the first of an occasional series on a health action zone in the making, Laura Donnelly looks at the challenges of linking up with other agencies

One lucky city is soon to be the proud owner of three action zones - for health, education and employment. For five years it has successfully bid for urban regeneration cash, and is part of a nationwide scheme to build private-public partnerships. It even has a freshly created unitary local authority to keep the synergy alive.

So is Plymouth a 'trailblazing' flagship of joined-up thinking and seamless service, where innovation cannot help but break new ground? Or is it an administrative nightmare in which consultation via a web of taskforces and design teams blocks effective action?

A bit of both, says Debra Lapthorne, team leader of Plymouth's city- wide HAZ. Action teams share an enthusiasm for flexible working, less hierarchical structures and inter-agency partnership, she says. 'We already have good networks in the city. We don't have to wait for formal processes to engage - if we have a good idea, it's a question of picking up the phone and getting on with it.'

But she admits the number of partners involved can 'create complications' with 'large amounts of paperwork', and central government guidance to respond to.

Consultation with local community groups and private and public partners meant 500 extra copies of the Plymouth HAZ draft implementation plans rolled off the printer. This may not be what health secretary Frank Dobson had in mind when he called the first wave of HAZs 'partnership in action - not partnership on paper'.

'Ground-breaking developmental work doesn't fit into the existing psyche very comfortably,' says Ms Lapthorne. Nor does the need to meet specific targets and deliver detailed plans sit easily with moves towards innovation.

Plans were sent to South West regional office last month. Plymouth's plans were described as 'detailed, cohesive and viable'. But performance manager Peter Mankin has asked Plymouth HAZ to 'demonstrate more clearly' the connections between it and other agencies.

Ms Lapthorne says: 'We presumed South West region would already know that we were closely linked with the other teams, so we hadn't actually spelled it out.'

Fellow HAZ staffer Neil Boot admits inter-agency co-ordination is not yet what it should be. 'We need to develop links with other agencies. At the moment we are a group that stands alone - and we know it's wrong.'

But Plymouth HAZ believes it is working towards it. The teams will share implementation plans to 'map out common areas', and are considering joint evaluation arrangements, says Ms Lapthorne.

Local authority special projects officer Paul Maber-Gill, co-ordinating the city's education zone, cites the three zones' differing timescales as one 'obstacle'.

Plymouth HAZ has seven years to run, while the education zone - due to start in January - has three to five years. The employment zone is almost half way through its two years. And while the HAZ is city-wide, the education zone covers a fifth of the population, and employment just 1,000 people.

Mr Boot believes the creation of 'an overarching co-ordinating structure to ensure there are no gaps or duplications' is likely in the long term. Meanwhile, he is optimistic that goodwill will overcome difficulties.

Last week, the HAZ steering group, consisting of members of 'design teams' from 12 programme areas (see box), endorsed a three-member sub-group.

Ms Lapthorne says the HAZ's first year aims to create the infrastructure to support the scheme over seven years. 'It would be easy to fall into concentrating on the early gains, but if we are going to tackle health inequalities, we need a longer-term approach.'