Health action zones have begun to set up partnerships in their local communities. Mark Gould finds out who is doing what

Mindful that the eyes of government and local communities are upon them, it is not surprising that the 11 first-wave health action zones are making a cautious start.

With ministers due to announce the second wave of HAZs this week, the first 11 abound with talk of partnership and forging new alliances. But the real test will be whether they can make tangible improvements in the health, housing and employment prospects of local communities.

All the HAZs feel confident that they will meet the October target date for submitting a detailed action plan to the NHS Executive. But there are varying degrees of enthusiasm for concentrating until then on establishing formal partnership arrangements - the priority set by health secretary Frank Dobson.

In Plymouth, which also has education and employment action zones, there is 'a real buzz' around the project according to HAZ team leader Debra Lapthorne.

Ms Lapthorne, a health visitor, has been 'seconded from her day job' to co-ordinate the development of the HAZ and ensure that the 500-odd community groups in the area have a real say. Sections of the business plan are being written by interested voluntary bodies like Age Concern and the local Youth Inquiry Services.

But the Ministry of Defence, which owns much of the derelict former naval dockyard land, and even the Catholic and Anglican bishops of Plymouth want to get involved.

'We are going out to community groups and local authority and health authority meetings with a team of 12 facilitators. It is a proactive approach,' Ms Lapthorne says. The feedback will be used in the Plymouth HAZ plan to be published in April.

Plymouth deliberately avoided creating a formal management structure with a director or chief executive, and there is similar caution elsewhere against setting up hierarchies that could deter involvement.

North Cumbria health authority chief executive Robin MacLeod says a partnership board has been set up, with a small steering group under a senior manager seconded from the county council for a day and a half each week.

'We did not want to go ahead and appoint a HAZ chief executive or director with their own office and secretariat because we were acutely aware of the danger of building another tier of bureaucracy,' he says.

'We want to ensure that we spend the next few months after October making sure we know where the HAZ is going to go before we formally appoint a leader.'

Part of the current work is concentrating on 'the capacity building and partnership side rather than taking forward major issues', he says. 'Part of the job has been to make various pressure groups and voluntary and community agencies aware that the HAZ was not just a source of top-up funding. They have to know that this is a partnership and that there has got to be genuine co-operation.'

The appointment of Edna Robinson, recently the director of healthcare development at Manchester HA, as director of Manchester, Salford and Trafford HAZ is regarded as a 'key milestone' locally.

She says herself that many factors affect the health of local people, including housing, employment, education, the environment and transport. 'We need to make a difference by working in partnership and finding new and different ways of tackling local problems.'

Salford and Trafford HA chief executive Ian Greatorex says that he will be set a series of 'short-term deliverables' and detects 'widespread enthusiasm for the project'.

Manchester HA communications manager Ian Rhodes says a lot of preparatory work has been done, but because this is the 'set-up year' people are not expecting too much. However, people in the voluntary sector are 'raring to go - we don't want to let that dissipate', he says. 'But we also don't want to raise any false expectations in the start-up year.'

Keith Barton, deputy chief executive of East London and the City HA, says he feels guilty about trying to involve too many groups. 'It has taken us longer than I really think it should have, but this sort of partnership work does take time to get going.'

One of the problems has been assessing how much freedom individual HAZs are being allowed by the centre to develop in an organic way that reflects local need.

'Our way of working in the East End is that we don't want to establish anything at all that would disrupt the existing lines of accountability.'

Tyne and Wear HAZ - the biggest in the country - has set up a planning group to ensure the October deadline will be met. Sunderland HA chief executive Clare Dodgson says: 'We are on target. There is still a lot of work to be done, but it is gratifying to see that people are already working together on things like children's and mental health services.'

Five health forums have been set up in Tyne and Wear, and a co-ordinating chief executive will be seconded to oversee the NHS part of the HAZ. 'One of the good things that has already come out is that we are producing a Tyne and Wear framework for a health improvement plan,' Ms Dodgson says.

In Luton, the partnership board met for the first time last week. It agreed terms of reference and membership, and identified key partners and primary areas for implementation.

The HAZ expects to present a draft action plan at a stakeholders' conference on 30 September and to draw up its action plan on the basis of the feedback.