Design for life

But each is only a small part of local programmes to bring integrated health, education and training opportunities to communities across the UK.

The New Opportunities Fund, which distributes National Lottery money, launched the healthy living centres programme in January 1999. It is spending£300m on creating a core network of centres and services.

'The aim is for broader wellbeing, bringing together the community, the voluntary sector and health, ' says Ben Jupp, senior policy adviser with the fund.

'Projects must link into mainstream healthcare and make a significant difference to their communities.

'Forty of the 58 projects funded so far are led by the community and voluntary sector.

'The application process has taken longer than we expected and that carried some frustrations. There is something that we and the Department of Health can learn from that, ' says Mr Jupp.

'The majority of projects have a partnership management board.

It is local authority-led with health authority involvement.

The voluntary sector puts in money in kind.'

Grants are for three years only, so what happens when the funding runs out?

'Well, projects must be rooted in local needs and in local authorities. I think that different projects will go in different ways.'The fund will spend£450,000 on evaluation, helping to support projects looking for further funding.

'We will be measuring qualitative and quantitative aspects. We will look at how people feel about the projects and look for reductions in smoking, coronary heart disease and cancer rates, ' says Stephen Dunmore, chief executive of the fund.

He says that healthy living centres and primary care trusts should not be in competition;

the centres should get involved with PCTs. 'Healthy living centres are bottom-up, forging strong partnerships. They must tie in with health improvement plans especially.

'We are redefining community health. If we can change the culture of public health and show these projects are working, then we will have succeeded.'

The first centre to be approved by the fund, the St Augustine's project in King's Lynn, Norfolk, opened officially in May. It is based in a purpose-built centre on an estate in North Lynn, a deprived part of the town.

'Our bid to the fund weighed 6.5lb, so it was the size of a baby, ' says Lin Twell, manager of the St Augustine's centre, which is part of North End and North Lynn Community Trust.

For as long as anyone can remember, local people had travelled across the town to see their GP, with registration spread between five surgeries.

'Health was a big issue because of the lack of GP services locally.

We found some startling statistics:

87 per cent of people questioned said they or a relative had visited their GP in the previous three months. People were going all over King's Lynn. In two years, this population of 5,800 had 4,000 visits to accident and emergency.

The incidence of elective surgery and emergency surgery was high in all but one speciality.

'We started the Medibus scheme with voluntary organisations. But it was a stop-gap. We fell neatly into the New Opportunities Funding.'

The new building houses a wide range of facilities including, for the first time, a purpose-built practice led by two GPs.

'I expected the practice list to build up gradually, by word of mouth.We put out a lot of publicity about how to change doctors. I thought 100 in the first month would be good; we actually have 400. People are joining the classes, and we have been inundated with bookings for meetings.'

The enormous centre is the sort that wins awards. The architect has exploited natural light everywhere, with large windows and glass partition walls. Upstairs, a huge hall running the length of the building can be partitioned into two or three smaller rooms, for hire at low rates.

Downstairs is the health centrestyle surgery, art studio, computer room, crèche and café. West Norfolk Community Transport Scheme rents an office and the Citizen's Advice Bureau comes in two days a week. Classes run in everything from computing to stress management; many will offer free taster sessions and, like other projects, workers and service users will be able to study for qualifications and accreditation.

The centre also works with the primary school, which backs on to the two-acre site. Outside, a large patio overlooks a play area. The grounds will be landscaped with an adventure playground, a garden with raised beds, and a 'secret garden'.

'The idea is that people come in for one thing and see another they would like to do. It is a bit 1960s, I suppose, but I want this place to have that communal, unified feel about it, ' says Ms Twell.

A different kind of local need inspired projects in Redbridge and Waltham Forest, London. 'We have looked at improving services to disadvantaged communities, ' says a spokesperson. 'We have set up footcare clinics for homeless people in the centres and bed and breakfast hostels.

'Another project is helping asylum seekers to get better access to the NHS - the service is provided by two very experienced doctors who are themselves refugees.

They are able to translate and advise on problems specific to some refugees, such as female genital mutilation.'

The idea of services integrated into the communities they serve may remind Ms Twell of the 1960s; you can also see the idea in the 1930s Bauhaus movement.

If the healthy living programmes can secure continuing funding, what was a good idea of the 20th century may finally become a reality in the 21st.