The foundations of health action zones are set. It's now time to build local policies and structures. Lyn Whitfield reports

A gentle snow of faxes descended on the Journal 's offices as health secretary Frank Dobson gave the go-ahead for the first wave of health action zones.

Each of the favoured 11 sent a press release, most carrying comments from 'delighted' managers, councillors, business people and voluntary groups. It was a good guide to the range of bodies involved.

The government is making£5.3m available this year. A further£30m will follow. HAZs will also have access to money from the New Opportunities Fund for healthy living centres, 'priority' for further development funds and a range of 'freedoms and flexibilities' to improve services.

In the Commons, Mr Dobson highlighted East London HAZ's plans to cut unemployment among under 25-yearolds from ethnic minorities. Its first target is to work with the New Deal to create 100 work placements, mostly with HAZ partners, in its first year.

But East London HAZ has other objectives, including many familiar from Our Healthier Nation . And it wants better access to healthcare and action on the two-thirds of primary care premises that fail to meet basic standards.

To do all this, it is prepared to consider some radical solutions - such as transferring premises to an outside agency, like a housing association, in return for refurbishments and repairs.

Kevin Barton, deputy chief executive of East London and the City HA, said: 'We need to get this right. Otherwise there is a danger that this initiative will remain at the level of good intentions, instead of leading to real change.'

From the different perspective of rural Northumberland, HA chief executive Jackie Axelby agrees.

Mr Dobson used his Commons statement to praise Northumberland HAZ's plans to create a network of healthy living centres, including 'virtual' centres in isolated areas. These will use facilities such as libraries and touring buses for scattered populations.

Northumberland HAZ also wants to cut deaths from heart disease, to create 'integrated, person-centred and social care', and to 'ensure equitable funding for all health, social care and related services'.

To do this, Ms Axelby says it will 'explore' whether some social services functions could be done by health organisations - and vice versa - and whether there will be 'flexibilities' about who can fund what.

She believes the centre knows what needs to be done 'at a philosophical level'. But she thinks HAZs will be left to work out the details.

'Learning from what we achieve here will be useful to other HAZs and to other areas which may never be HAZs, ' she says. 'Equally, if we get things wrong we need people to know about it.'

The first year of HAZs is being regarded as a preparatory year. Successful areas have been asked to develop a detailed action plan by October, including specific targets and ways of achieving them.

Meanwhile, Mr Dobson's announcement has disappointed 30 bidders for HAZ status out of the 41 which applied.

Those contacted by the Journal last week were putting on a remarkably united front. All were 'naturally disappointed' but still supporters of the concept of HAZs.

This may have been because all expressed an interest in being one of the '10 or a dozen' second-wave HAZs Mr Dobson said he would create next year.

One chief executive said candidly: 'We will be going ahead with as much as possible of what we planned.

'We will have plenty to keep us busy and in the meantime we will go through the whole blinking business of drawing up a bid and smiling at people in meetings again. But don't say anything that would spoil our chances.'

HAZ priorities

Frank Dobson gave the Commons one example of local priorities from each of the health action zones:

Bradford - to establish a community-based diabetes service.

South Yorkshire Coalfield Communities - to set up a heart health programme and redevelop rehabilitation services for 'the casualties of the coal and steel industries'.

East London - to improve job opportunities for young people, particularly those from ethnic minority backgrounds.

Lambeth, Southwark and Lewisham - to develop an integrated approach to child health and family support services.

Luton - to focus on the health needs of Asian women.

Manchester, Salford and Trafford - to take a 'holistic' approach to mental health.

North Cumbria - to improve transport and access to services in rural areas.

Northumberland - to develop a network of healthy living centres.

Plymouth - to focus on dental health, particularly that of children.

Sandwell - to develop community-focused health services, building on previous work.

Tyne and Wear - to improve the health of elderly people, for example, by improving transport and housing.