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The message from this really must be "Follow my patient leader". It’s the patients and carers and active citizens who have to be the leaders to achieve real change on the scale post-Francis and in the face of "Nicholson 2" stringency. It’s the “professionals” who should follow the well-informed “customers”, not the other way around.

That’s the point, perhaps uncomfortable for many or arguments for patient leadership and for lay leadership generally. The laity has to be in control. It is simply not enough to expect the “professionals” and policy makers and institutions – however well meaning – to achieve what is needed. It is fundamentally against their interests. It can only come up from the patients.

One thing is sure looking into the near future of the NHS: when the ground stops shaking beneath it, the NHS will need its patients more than ever to be powerful in order to help lead it. They don’t need permission. They have the power if they will but use it.

We have to start facing up to the patient leadership challenge now and investing where leadership matters to people most – “closer to home”.