'At the very least, ministers should examine whether those whose HAZ bids do not succeed could go ahead with some aspects of their proposals while decisions are made about a second wave'

Half the health service has submitted proposals to set up health action zones, and progress moves on apace - nowhere more so, it would seem, than in Tyne and Wear, where local NHS managers are often credited with dreaming up the initiative and selling it to the politicians. (See News, page 5).

Of course, it helps if your local politicians include the odd influential minister or three, but there is little doubting the enthusiasm and hard work which has already gone into the Tyne and Wear project. If the other 40 bids are anywhere near as wide-ranging, the impact on health could be tremendous.

Those who have signed up to a Tyne and Wear HAZ believe they can deliver an extra 5,000 years' life for local people; they offer to provide pounds80m worth of additional services a year from existing resources in return for a trivial investment; and they promise to put health on everyone's agenda.

They talk, too, of going beyond what is envisaged in The New NHS, to extend the primary care group model beyond level four to include some hospital and community health services for children, mentally ill and older people, transferring accountability back from trusts to the health authority.

Even at this early stage it seems highly likely that the health and local authorities, trusts and voluntary groups which have put their names to the proposals will get the chance to show they can deliver what they have promised.

Tyne and Wear's is thought to be among the most highly favoured bids for the first wave. Though clearly no final decisions have been reached, the names of a small, select group are mentioned time and again, and it may be that in practice some 30 bidders are chasing a handful of remaining places.

The big challenge, however, will exist not in the areas fast-tracked for HAZ status, but elsewhere. It looks as though there will be only two waves of HAZs, and it is apparent that there will be many disappointed bidders when the successful projects are named in March.

Unlike the all-or-nothing world of trust bids in the early 1990s, however, there is room for compromise. At the very least, ministers should examine whether those whose HAZ bids do not succeed could go ahead with some aspects of their proposals while decisions are made about a second wave.