Ray Rowden's article 'Focus pocus or change' (Open Space, 2 April) and your coverage of the Greater London Authority and mayor's possible future role in London's NHS (News Focus, pages 12-13, 2 April) misses an opportunity to highlight important issues about the running of London's NHS since the general election.

Ray Rowden's disillusionment since 1 May simply reiterates the tedious management ethos of whingeing that politics has no place in the NHS. Any NHS manager who can't handle the management challenge of working under the direction of elected politicians within an accountable public service (whatever the political complexion of the government) is in the wrong job.

More importantly, Ray confuses the political direction of the NHS by government with its implementation at local level. It is the job of regional chairs, local chairs and non-executives to ensure the implementation of the government's NHS policy in London in practice on the ground, not that of a minister.

The really worrying trend for senior managers in London's NHS who welcomed the election of a Labour government is that policy pronouncements from the government appear to be subverted, particularly in the regional office. Some people appear to have grown dangerously accustomed to unfettered power guided more by the market economy of the previous government and their own agendas than by the current government's vision.

For example, the prevailing mood in North Thames has been to rubbish the proposal to establish a London regional office, as a precursor to joint work with the GLA and mayor. Massive service changes are being quietly stitched together behind closed doors in North Thames in acute services and in mental health services which bear no resemblance to the government's agenda. In the absence of open scrutiny, such fundamental proposals are proceeding unchecked.

Rather than being the 'Department of Health's thought police' as Ray Rowden claims, regional offices have evolved into local baronies which are neither part of the civil service, nor locally accountable. The mayor and GLA should be well placed to bridge the chasm in democratic accountability in decision-making in London's NHS. I fear, however, that Londoners (among others) will continue to see a widening gap between the Labour government's intentions and their practical impact in local NHS services until this is tackled.

Sadly I must ask you not to disclose my name. As a senior manager in London's NHS, I too fear the long arm of the regional office. Sorry, Ray, but it's the bureaucrats - not the politicians - who are the weasels managing the NHS.

Name and address supplied.