Healthy living centres (HLCs) blossomed in the first spring of the New Labour government. They were trumpeted as a way for the poorest people in our divided society to be nurtured to a more wholesome future, an innovation that would link nutrition, physical exercise and medical care into a coherent whole, providing deprived people in forsaken communities with the means to help themselves.

They would also demonstrate the government's commitment to carving out a new direction for national lottery funding, away from establishment projects such as buying Sir Winston Churchill's papers for the nation, and focusing investment on local communities. In 1998, an explicit policy direction was issued to the lottery distributor, the New Opportunities Fund (Nof). It stated that Nof "shall, by September 2002, commit funds to projects that should establish or develop healthy living centres accessible to at least 20% of the population of the UK. The fund shall commit a total of £300m to [healthy living centres] projects."

In explanatory notes, the government set out its far-reaching ambitions for HLCs: "The aim of this initiative is to target areas containing the most deprived sections of the population in order to reduce health inequalities throughout the UK and improve the health of the worst off in society."

Stephen Dunmore, the chief executive of the Big Lottery Fund (BLF), which succeeded Nof, remembers it, not only because HLCs became one of his fund's flagship initiatives, but also because, in only his second day in the job, he attended a public health conference in Scotland at which Tessa Jowell, the minister responsible, held forth on the benefits HLCs would bring, saying of their establishment: "Let a thousand flowers bloom."

A thousand didn't, but 257 did - the £300m delivered rapidly to set up varied initiatives, following consultation with local communities, in HLCs from Tyneside to Devon. The third annual evaluation was concluded last month, with encouraging findings: 70% of regular users considered their physical health had improved; 69% felt their mental health had improved; 63%, movingly, said they had "more hope for their future".

The same, however, cannot be said of the future for the HLCs. In the original policy direction, lottery funding was limited by the government to that £300m over five years. Three years on, the HLCs feel crushed by official silence. The government has no plans whatsoever for them, leaving them to find their own way. The white paper, Choosing Health, setting out the government's strategy for public health, makes no mention of HLCs at all.

So strong is the feeling of abandonment that Dunmore has taken the step of expressing his anger publicly. "This was probably the main public health initiative of Labour's first term," he told me. "It was the biggest single community health initiative ever delivered. There was a real feeling the government were committed, not necessarily to fund it after the five years, but certainly to build on it if the HLCs were successful.

"For the first couple of years, they were on our backs all the time about delivery, but, around 2002-03, the Department of Health's interest disengaged, and we found it difficult to have meaningful conversations.

"Now the government has no strategic approach to HLCs and seems to have airbrushed them out of existence. We have shared our evaluation with them but are struggling for information on theirs. That is tremendously disappointing, not only for us as a lottery distributor but for thousands of people in communities, and the partners, who have worked so hard to establish HLCs and improve public health."

Loss of interest

The DoH told me that Caroline Flint, now the minister for public health, was not available to talk about HLCs. Instead, a spokesperson denied that the government is backing off: "When we launched HLCs we made clear they would need to consider how they would become sustainable. The development and support programme aimed to assist HLCs to network with each other and to build links with organisations in the health sector and beyond. It was never expected that all HLCs would continue in their existing form but that some would integrate into mainstream health services."

Inside BLF, they feel that the Department of Health (DoH) is poor at working in partnership and has simply lost interest, rather than come to a considered conclusion, based on evidence or policy, that for some reason HLCs have not worked. Other observers see a government always looking for the next eye-catching initiative - such as personal trainers, a proposal in Choosing Health - rather than one genuinely prepared to dig in and do the steady, unglamorous, long-term work necessary to make a real difference to people's health in poor communities.

"People feared that this would happen," says Geof Rayner, visiting research fellow at City University's department of health management and food policy. "The crunch was always going to be sustainability. Ministers move on, and every minister has to have a new policy initiative. They're not prepared to get to the root causes of these health problems."

With no government plan in place, the HLCs are left to scramble for whatever funding they can find in two years' time. BLF has put together £4m for a sustainability programme, managed by the consultants Accenture, to help the 257 centres investigate potential lifelines, whether through partnerships with local authorities, primary care trusts (PCTs) or other statutory bodies.

Chris Drinkwater, professor of primary care development at the University of Northumbria, was one of the founders of the West End Health Resource Centre in Benwell - opened by Tony Blair, in one of the poorest areas of Newcastle upon Tyne - and still sits on the board. The centre runs a small gym and fitness suite, a steam room, has space for community activities, and earns some money in rent from a GP surgery based in the building.

"We have 2,000 people a month using the gym, and we know that many of these people did not normally exercise," Drinkwater told me. There were 21,532 visits to the centre's gym last year; 47% of regular users said they rarely exercised before. Of the visits, 37% were by black and ethnic minority users, 56% were by women, 18% were by people over 61. The centre has also trained 18 health link workers to do outreach work.

With no sign of funding on the horizon, Drinkwater and his fellow board members are sinking into a bureaucratic tangle to try to keep the centre alive. He says: "We're used to finding money where we can, and I'm an optimist, but the reality is that, without a strong government voice behind HLCs, we are struggling."

With Accenture's sustainability programme just getting under way, it is too early to say what will happen to the 257 centres. In July, Wirral HLC became the first in the country to be "mainstreamed", by its local PCTs. Begun four years ago with over £1m from Nof and other matched funding, the centre has nine full-time staff who run 35 activities a week, concentrating on encouraging physical activity, better diet and positive mental health, with vulnerable people, young and old, largely in deprived areas of Birkenhead and Tranmere. Food projects have been hosted for young people on the Leasowe Estate, described as a "food desert" by Carol Evans, health improvement projects manager for the Wirral's PCTs and local authorities.

Mainstreaming means the work will continue, and they can plan for the long term. "Our team has no uncertainty," Evans told me. "We're not spending time scrabbling for funding. The healthy living centre is recognised as having made a huge difference to people's lives and diets, and is now an integral part of public health here."

Elsewhere, that is not the case. At the healthy living partnership in the deprived Park ward in Halifax, nine staff run exercise, gym, gardening and healthy eating sessions, particularly targeting local people at risk of heart disease and mental health problems. The future is uncertain. Coordinator Catherine Putz says Calderdale PCT and the local authority are very supportive of the work, and provide office space and resources, but they cannot say whether they will be able to commit revenue to the HLC when the £750,000 lottery funding runs out in two years.

Positive impacts

In a ward of around 11,000 people, 60% of whom are of Indian or Pakistani origin, the centre has had contact with 3,000, and reports positive impacts: healthier eating, more physical exercise, good mental health outcomes, among people who would not otherwise have had access to such activity or expertise.

Initially careful to speak positively and diplomatically about the support she hopes the centre will find to enable it to continue, Putz, finally, releases some of the emotion building up in the painstaking search for a future.

"I'm concerned that because the people using this and other centres are in deprived areas, HLCs are not flavour of the month with the government. We're proving our worth, but if no solution is found, people who already have a poor deal will carry on dying early, having mental and physical health problems - continue to have a poor deal. And this will turn out to have been a tremendous missed opportunity."