Health action zones: 'creating alliances to achieve change'

New Labour has placed partnership across sectors, and with users and communities, at the core of its approach to achieving change. Health Action Zones (HAZs), as one of the earliest and most ambitious of New Labour's initiatives, reflect this focus and their experience offers useful insights for developing such ways of working in future. Research by the national HAZ evaluation team suggests that the ability and willingness of partner agencies to engage with the HAZ has been constrained by factors such as the speed of change in the health economy and the limited capacities of voluntary and community agencies, which sometimes need a lengthy period of support and development if they are to engage as 'equal' partners in such enterprises. Communities also need support in developing skills and confidence before they can become active partners, and again this takes time and resources. HAZs have piloted successful local strategies for engaging partners and involving communities; however, without the extra funding provided by HAZs, these 'bespoke' and resource-intensive approaches may lose out to mainstream and national agendas seeking quick results. Organizational development is also critically important to achieving change. Capacity building is needed within organizations with professionals and practitioners to ensure that genuine partnerships can be entered into. This has proved one of the most challenging tasks for HAZ partnerships, though evidence suggests a key element of success is early establishment of a coherent vision across all levels of partner organizations. Over the long term, the new ways of working piloted in HAZs may produce more streamlined services, greater local control and healthier, more empowered communities, but those long-term benefits cannot be achieved without sufficient outlay on the groundwork. Efficient new systems actually require more resources in the short to medium term, not fewer.