Managers need to be ready to cope with more 'active citizenry' of the sort which led to the election of 11 'save-our-hospital' campaigners in Kidderminster, NHS chief executive Sir Alan Langlands told the conference.
'The NHS lags behind other public services - the tradition is of people being grateful for access to care and overawed by professional knowledge and skill,' he said.
That was not sustainable. A stronger, more transparent dialogue was needed at national and local level to give people a real say in the choices facing society in relation to health.
Sir Alan told HSJ there was a growing sense of issue-based politics.
He pointed to the Kidderminster case - where candidates fought and won council seats in May - as an example of an effective lobby based on a defined community.
'In the future we are going to see more of that, and health service managers at every level are going to have to cope with it. It is a consequence of giving people more information.
'Ultimately, I believe that is healthy - the emphasis is on giving patients and patient groups more information.'
Sir Alan said the changes taking place in the NHS were creating 'huge international interest'.
Urging managers to 'get on' with the task of implementation, he said: 'If we make the whole thing add up, we will continue to lead the world on some aspects of change.'
He acknowledged that there was some irritation among managers because investment was linked to reform, with a tight central hold on the purse strings.
'I don't think that is going to change,' he said. 'But there is the potential, as we grow in confidence and show what we are made of, that there will be some greater flexibilities in the future.
'Despite the understanding from our political masters that we are embarked on long-term change, we have to show that we are getting there piece by piece and need to show year-on-year improvements.'
Sir Alan told the conference that ultimately staff skills, knowledge and attitudes determined people's experience of public services, and there was still a 'huge amount of work to do to hit the human resources bottom lines'.
Sir Alan urged managers who had not already done so to read the report on the murder of black teenager Stephen Lawrence, because there was a need to ensure diversity so that 'the workforce reflects the communities it serves'.