Health service managers do not have a God-given right to manage - any more than the health secretary has a God-given right to do his job. That was the warning shot from health secretary Alan Milburn, speaking at the launch of the Institute for Public Policy Research report Future Pat ient last week.

Mr Milburn endorsed the think tank's call for patients to become responsible citizens with an interest in the running of the NHS, not just demanding consumers.

But in questions after his speech, he turned his attention to health service managers' role in the reformed NHS.

'Nobody has a God-given right to be an NHS manager, ' he said, responding to a question from Andrew Wall, visiting senior fellow at Birmingham University's health services management centre. 'I do not have a God-given right to be health secretary.'

He brushed aside Mr Wall's concerns that further reorganisation might take its toll on managers.

'Unless you get the structures right you will not get delivery, ' he said.

Mr Milburn emphasised the need to put patients, not staff, first: 'What we must now do is create a new relationship between services and citizens. Not the old hierarchy based on blind faith, deference and doctor knows best.

Not the naked consumersim of the 1980s when there was no such thing as society.

'More power for patients is vital if services are to be centred on patients.'

But Mr Wall was critical of Mr Milburn's approach: 'It is all very populist stuff. Every secretary of state has said we must get the structure right.

'But health care is incredibly complex. You can't get it absolutely right.'

Managers could not be expected to concentrate on patients' interests when they were worrying what would happen about their own jobs being reorganised, he argued.

Angela Coulter, chief executive of the Picker Institute, reported on the preliminary findings of her study into attitudes to healthcare elsewhere in Europe.

There is growing evidence that younger people want to be more involved in their healthcare, she said.

'It is a real cultural change going through Europe. Health services have got to get to grip with it if they want to engage public support, ' she told the conference.

The study covers the UK, Italy, Slovenia, Poland, Germany and Switzerland.

Future Patient by Liz Kendall. IPPR, 32 Southampton Street, London WC2E 7RA.