By Nick Triggle BBC News, health reporter

Two years on, the dream is far from being realised.

Health trainers try to encourage people to change their lifestyles

One of the key initiatives of the Choosing Health White Paper was the creation of health trainers.

These personal mentors were aimed at helping people address all their lifestyle issues - whether it was smoking, eating or exercise.

Derbyshire has been helping pilot the roles.

Ten health trainers are working in the county receiving referrals from GPs and working alongside sexual health services and Sure Start, a scheme which helps deprived young families.

Health bosses said it was too early to collate evidence of their effectiveness, but feedback from the hundreds of people who have used them convinced them to expand the service.

The six local NHS trusts were hoping to increase the network to over 40 trainers in the next couple of years and were aiming to use some of the �3m earmarked under the white paper to expand the service.

Trainers

But like many parts of the NHS, the area has found the public health pot is not so full with under a quarter of the expected money actually being available.

Maureen Murfin, Derbyshire's health trainer project manager, said: "Hundreds of people have benefited form the scheme and we were hoping to expand it further.

"I am sure we will get there in the end, but at the moment we don't know where the money is coming from."

But it is not just health trainers that have been hit.

Another two or three school nurses were expected to be taken on, while plans had been drawn up to employ an extra health psychologist and occupational therapist to tackle obesity.

This will have a direct impact in whether we can ensure health problems don't escalate Dr Carol Singleton, public health director Public health plans 'disarray'

The promotion of safe sex in schools and youth clubs is also likely to be curtailed.

Dr Carol Singleton, public health director at Derbyshire County Council and three of the local PCTs, said: "It is unfortunate, but we have not been able to do all we would have liked.

"There is a problem with finances - the local area has a �12m deficit - and that has to be covered first.

"We originally agreed to halve our allocation to help with these problems, but we have got half that again.

"We are hoping to get the full amount next year, but after what happened this year, we can't be sure.

"This will have a direct impact in whether we can ensure health problems don't escalate."

Raid

Derbyshire is far from unique. The Association of Directors of Public Health believes trusts across England are facing similar problems.

The trusts have said they are being forced into prioritising finances because of directives from central government to balance the books by the end of the year.

One public health director, who wished to remain anonymous, said: "When money is tight, it is all too easy to raid public health budgets.

"You can't blame the trusts because they are being leant on by government, equally the government does not want to control everything from the centre so does not want to tell trusts what to do.

"You can understand both sides, but in the end public health loses out, storing up problems for the future. It is depressing."

Whatever happens, the NHS cannot say it was not warned.

Four years ago former NatWest chief Derek Wanless was asked to look into the rising health problems.

His study claimed unless the nation became healthier spending on the NHS would increase by �30bn over the following 20 years.

However, the government remains confident such a scenario will not happen.

Despite the problems in some trusts, the Department of Health is still on target to have 1,200 health trainers in place by 2008 - albeit with some employed by the army and voluntary sector.

A Department of Health spokeswoman added public health was a "key priority" and the government was fully committed to achieving what was set out in the white paper.