A mayor for London

In May last year Londoners elected a mayor by direct vote for the first time. The mayor and the London Assembly, together forming the Greater London Authority (GLA), have an electorate of seven million people and command resources of almost 6 billion euros. Four appointed committees—the police authority, the fire and emergency planning authority, Traffic for London and the London Development Agency—oversee major services for the capital. But the Greater London Authority also has a “duty to promote the health of Londoners and to take into account the effect of its policies on health.”1

The United Kingdom has decentralisation of power more in theory than in practice. While cities, and their rural counterparts, counties, have been responsible for local taxes and services since the 19th century, in recent years central government has increased pressure to achieve national “standards” for education, housing and welfare services across the country. The National Health Service, created in 1948 and funded from central taxes, has decentralised management authorities (regularly changing in structure), but these are appointed by central government and never controlled by locally elected politicians.

New parliaments for Scotland and Wales, elected in 1999, have changed the balance of power. To match these, the government developed eight regional offices in England—still directly controlled by Westminster—for several of the main ministries, including health. However, this year, as a …