Health secretary Alan Milburn may think he has achieved something by amalgamating health authorities until they reach the size that regions used to be, and enlarging primary care trusts until they are the same size as HAs once were.

But all this serves little purpose so long as all these bodies are full of nominees who have no relationship to their local communities. The NHS should be accountable to elected regional government. NHS regions should be aligned with other government departments.

Then we can abolish HAs, as has been proposed in Wales. It is time this government became a little braver and embraced the principles of democracy a bit more firmly.

Martin Rathfelder Development director Socialist Health Association London E1