News that London's powerful new executive mayor will have a considerably stronger role in health matters than was first planned has its down side (see news, pages 2-3). Of course the mayor should be required to consider the health impact of their policies. So should all local authorities. But there is a danger that, without responsibilities for the way the health service works, a populist politician may exploit their position to attack those who have difficult decisions to make about the running of the NHS.

The answer is not to give the mayor a role in this, too, but it does raise once again the issue of NHS board accountability - and in particular the anomolous role of regions answerable only to the NHS Executive and ministers and yet exercising a very real influence over health authority and trust managers who also have to account locally. It is time for another rethink of the regional offices.