In the third in our series on the government's modernisation plans for the NHS, we look at prevention and inequalities.
This is one of the toughest agendas for any political party. Few politicians will want to back a policy which encourages people to eat less fish and chips (remember the furore when Edwina Currie slated northerners' diets? ).They are even less likely to do so when any positive effects may not be felt for another decade.
But with the mid-June deadline for final reports almost upon them, there is an air of excited anticipation among members of the prevention and inequalities modernisation action team.
Ideas under discussion range from the broad - just what is the NHS's role? - to the narrow - should people be encouraged to turn their balconies into miniature allotments?
The mood of optimism is almost infectious, but the real test will be whether the ideas manage to win over the electorate. At the moment, there is a danger, certainly on the prevention team, not only of preaching to the converted, but becoming so enthusiastic that members lose sight of how the public will react to all their ideas.
Lynn Eaton reports Tackling health inequalities and improving health through good prevention policies don't attract the sexy headlines that cutting waiting lists or introducing new health treatments do.
But long term, both could have a major impact on healthcare in this country, reducing lung cancer and heart disease and saving the NHS money.
For prime minister Tony Blair, struggling to come up with a pre-election blueprint for the NHS, developing prevention policies and tackling health inequalities might not be the first thing on his mind as he thinks of ways to woo voters.
Yet Mr Blair has made it clear he wants long-term solutions to these problems, and health secretary Alan Milburn is talking about a national plan for the 21st century.
The prevention and inequalities modernisation team is thinking big. It is looking at how health crosses all boundaries - how transport, environment and housing impact on health.
Provision of bus services discourages car use; parks and green spaces encourage people to take exercise and impact on depression; good housing improves safety and so on.
Sir Alexander Macara, former chief executive of the British Medical Association, says: 'There is a recognition that healthcare and policies for healthcare have to be within a context of care for health.'
In this team partnership is the key word, according to John Ransford, head of social affairs, health and housing for the Local Government Association and a former social services director.
'If you are going to improve health, that can only be delivered in partnership with the local community. That is not a key health agenda, although they have got to have a stake in the process.'
Rabbi Julia Neuberger, chief executive of the King's Fund, says one of the most exciting proposals is for a separate community development fund for local health improvement initiatives.
'These would be small sums of money that enable community development for health initiatives, ' she says.
'How it is held is up for grabs, but it could be used by new organisations, or on the back of existing tenant organisations.
'It could be for anything from helping set up a fruit and vegetable co-op to a special cafe. It could even be encouraging people to grow vegetables on their balcony.'
That's just the sort of soundbite Mr Blair would love, so this one looks set to be a winner.
Hazel Stutley, a health visitor in Falmouth and team member, is an enthusiastic advocate of community initiatives. She has been involved in a beacon project on a rundown council estate in Falmouth, working with local people, police and the council to improve general health.
Houses on the estate now have central heating, there are safe play areas and an empty shop has been converted into a centre providing contraceptive advice, physiotherapy, Relate counselling and other services.
Crime is down by 50 per cent, the number of patients treated for postnatal depression has dropped from 18 in 1995 to four in 1999 and the number of children on the child protection register has fallen from 23 in January 1995 to eight in January 1999.
'I think it is the way to go, 'Ms Stutley says. 'The community has these powers within it. It is a question of how you tap into it.'
While the team is coming up with 'big-picture' ideas like this, it is also grappling with the problems of obesity and smoking.
Nick Young, chief executive of Macmillan Cancer Relief, says the team is likely to recommend that free nicotine patches be made more widely available. But he acknowledges that it is not easy just to persuade people to give up.
'When you are in an area of deprivation, it affects everything. It is not easy saying to people, stop smoking, as it may be one of the few pleasures they have.'
He says the team is also looking into the possibility of having a health promotion 'czar', who could co-ordinate initiatives. It also wants an earmarked budget for health promotion.
'I think there is a sense in which nobody quite knows who is in charge of all this, ' he says.
Jo Williams, president of the Association of Directors of Social Services, has argued elsewhere that, if the government is serious about improving health, it should put local government in charge of public health.
But the LGA's John Ransford is reluctant to push that idea at the moment.
'I am not going to argue on the one hand that it is an irrelevance to combine health and social care but also say we want to take public health back into local government, 'he says.
If anything, the main task is to clarify what the NHS can and cannot do, says team member Jan Hull, health promotion manager in Somerset.
'The NHS can't solve everything.
We're working out what is the NHS role in this agenda. We can't start putting everybody's benefits up with NHS funding.'
Dream team: who's who The prevention and inequalities team is chaired by chief medical officer Professor Liam Donaldson. Members include:
Jan Hull, health promotion manager, Somerset health authority;
Dr Ruth Hussey, director of public health, Liverpool HA;
Neil Lockwood, chief executive, Sandwell HA;
Sir Alexander (Sandy) Macara, National Heart Forum chair;
Andrew Mawson, Community Action Network, Bromley-by-Bow;
Rabbi Julia Neuberger, chief executive, the King's Fund;
John Nicholson, head of the UK Public Health Association;
John Ransford, head of social affairs, health and housing for the Local Government Association.
What's to be done
. . . about obesity
Tackling obesity is about more than just educating the public, argues Dr Nick Finer, consultant physician at Luton and Dunstable Hospital and past chair of the UK Association for the Study of Obesity.
'I want to see the government establish a clinical service framework for the management of obesity, in the same way we have done recently for HIV and for infectious diseases a hundred years ago.
'Prevention is going to require courage for the government to recognise obesity is a serious problem: one that needs intervention.
'I don't think there is any real interest from the government or health authorities to get involved at the moment. The leaked National Audit Office report on the cost to the NHS of obesity is probably still sitting on some minister's desk at the moment.'
. . . about cancer
Jude Cohen, chief executive of Cancer Aware, formerly the Women's Nationwide Cancer Control Campaign, says her biggest concern is why certain women are failing to turn up for screening.
'Women from minority ethnic groups and deprived areas are not attending. But no-one has gone out and done any research into why that is. Until we know who is not attending, we can't target them. All we know is something is going wrong.'
. . . about smoking
Action for Smoking on Health wants wider availability of free nicotine patches to help people give up cigarettes. At present, some people can get a free supply for a week.
'We would like to see that extended to everyone, ' says a spokesperson. 'We want more intensive support for heavily dependent smokers who want to give up.'