Health minister Ben Bradshaw has raised the prospect of a shake-up of local governance after he issued a warning that there is a 'problem' with primary care trusts' accountability to their patients.
Mr Bradshaw said patients found it difficult to influence decision-making and 'make their voices heard'.
His comments follow prime minister Gordon Brown's announcement to Parliament in July that the government was to review arrangements for making appointments to NHS boards.
At a debate on the future of the NHS, Mr Bradshaw said: 'One of the things where I think we have a problem is that at local level there is still not very much democratic accountability.
'PCTs that increasingly will be responsible for spending vast sums of money and commissioning services don't have any direct democratic accountability.'
'If people in their local area don't like what their PCT is doing it is quite difficult for them to make their voices heard and to make sure that changes are made.'
The minister also said managers should communicate using simpler language.
Healthcare terminology was 'far too managerial and technical', Mr Bradshaw said, citing commissioning and primary and secondary care as examples.
'Part of the reason that we have this terrible language that is inaccessible to most people is that too much power has been in the hands of the health managers and not patients and staff.'
Mr Bradshaw's warning has re-ignited the debate about how changes, such as the introduction of directly elected or local authority-appointed members, would be put in place.
NHS Alliance chair Dr Michael Dixon said he thought the comments indicated that the introduction of directly elected boards was up for debate.
'It highlights that there is a lot of discussion going on about how we involve the local voice,' he said.
But he warned: 'Such a move would complicate things when we are trying to give the NHS some stability and get on with the job of improving services.'
His comments were echoed by Stockport PCT chief executive Richard Popplewell, who said trusts needed 'a period of stability' to engage with the public after the abolition of community health councils in 2003 and the patient forums next year.
But he conceded that trusts' involvement of the public varied. 'All PCTs try to engage, listen to and reflect their local population but whether we are adequate and competent around that is very varied.'
Tameside and Glossop PCT chief executive Tim Riley said trusts were 'increasingly without the need for formal structures' to represent patients better. 'They are including their public more in the choice and design and how their services are governed,' he said.
NHS Confederation policy director Nigel Edwards said the NHS was 'likely to see this debate hotting up'.
'I think they are looking at various solutions about how you can appoint PCT board members.'
Models could include members being elected through the local authority or by direct public vote, he speculated. Yet he said this could present problems. 'You do run the risk of running into a stasis where nobody is prepared to make any strategic decisions because of the short-term electoral consequences,' Mr Edwards said.
Jim Keegan, national officer at union Managers in Partnership, said it was a fact that PCTs hold no democratic accountability. He welcomed any moves to involve the public more.
However, he remained sceptical that a major shake-up was in the pipeline. He said: 'We have gone from 1948 to now and the government has not relinquished control to locally elected boards. I am not sure they are thinking that way now.'
Mr Bradshaw was speaking at the Healthcare in our Hands event at the Royal Society for the Encouragement of Arts, Manufactures and Commerce in London, organised with social enterprise firm Commotion.
His comments on language were welcomed by the Plain English Campaign, which has worked with NHS trusts to ensure documents are easy to understand.
Spokesman Steve Jenner said: 'There is a fair amount of jargon and unnecessarily wordy descriptions of everyday things in health circles.'
He added: 'If a document is to be consumed by the general public then special thought has to be put into how accessible it is.'