Published: 16/06/2005, Volume II5, No. 5960 Page 35

I am going to take you on a journey, through the next 36 months to the summer of 2008. In our little NHS world the era of double-digit percentage growth rates in funding is becoming a distant memory.

Contestability has started to bite, and the independent sector is emerging as the real pacesetter in choice and flexible use of capacity.

The summer sees the first meeting of the new National Association of NHS Foundation Trust Members.

There are nearly 2.5 million foundation trust members, now that we have 200 foundation trusts.

Attempts by the NHS Confederation to have them throw in their lot with the Confed as a new membership arm have not been well received.

These people are, after all, the new owners of our NHS hospitals and clinics. They are the shareholders, and in keeping with the new spirit of democracy and public accountability that is sweeping the land, they demand their voice be heard as of right, not as a branch of an establishment organisation.

They are knowledgeable, active and committed. They are led by a firebrand of an amateur politician, a woman who lost her husband to MRSA at the very hospital where she was a governor, despite her many attempts to have standards improved. She is notorious for organising the ousting of the trust chair and subsequently the entire executive team.

NAFTM has 100,000 members signed up to various special interest groups and other active strands of membership. An unusual blend of discontent with the slow pace of change in the NHS combined with antipathy to the oppressively robust tactics of regional NHS commissioners, who have been learning at the feet of Tesco advisers, has led to calls for radical reaction.

Already, effective campaigns have been targeted at Westminster, preying on labour MPs with narrow majorities through letters and lobby meetings and conspiring with an eager media.

Even this is not enough for some.

The mental health grouping within NAFTM, many of them people who use the service themselves, have had enough of marginalisation and the continuing failure of their services to get the priority in funding they are supposed to have had all these past years. A march on the House of Commons is organised and 10,000 people turn up, emboldened by their numbers and the passion of their cause. The media is entranced by this flowering of active democracy and give the agitators every opportunity to exploit government weakness. Steeled by years of living at society's margins and joined by diverse and opportunistic political extremists some resort to direct action. A demonstration outside a Midlands BBC studio turns ugly and some service-user protestors manage to get into a broadcasting studio.

Remarkably this has the happy effect that, for the first time ever, BBC Radio Nottingham is heard to play seriously good rock music.

All of this will come to pass. Well, maybe the last paragraph is a bit farfetched, I admit. But you get the message. You can see where we are heading with this. Thousands upon thousands of citizens who have become well informed are committed - indeed passionate - for their health interest and are fed up with the way representative democracy has gone in the country over the past two decades.

Surely it will not be long before we see an increasingly significant number of these new politicians standing on the 'NHS ticket' at local and national elections.

Bring on the revolution. .

Jeremy Taylor is chief executive of Nottinghamshire Healthcare trust, one of the country's largest providers of mental health services.