Former health secretary Alan Milburn broke a three-year conference silence on health by calling for the election of primary care trust boards and the setting down in law of patient entitlements to healthcare.
At a Health Hotel fringe session at the Labour Party conference in Manchester, Mr Milburn was asked what he would do if he was ever health secretary in the future.
He said: 'I would make sure that PCTs were directly elected and make it clear where the accountability lies. We should bring the idea of democracy slap-bang into the heart of the NHS. If we elect people to have charge over leisure centres, then elected people should play a role in locally run NHS services.'
Commenting on plans for an NHS constitution, floated by health minister Andy Burnham over the weekend, Mr Milburn went on to say: 'I would also enshrine in law a patient's rights and entitlements. There's been a lot of talk about an NHS constitution [see news, pages 5-7], but I would take it a stage further. What the protection of law does is sharpen the elbows of those who are most weak.'
He said: 'What the health service does not need is a whole lot of structural reform. Far more fundamental will be a relocation of power in the system. Patients still feel disempowered.'
Mr Milburn also defended his legacy as health secretary in moving the NHS from a sickness service to a well-being service. However he said the health service had also gone through huge changes since he stepped down as health secretary in 2003. 'It has been six years since we created the cancer plan and I fully support plans for a second plan that takes reforms such as choice into account.'
He said the debate over access to drugs and treatment and the role of the National Institute for Health and Clinical Excellence 'posed huge dangers' for the government 'but also had huge opportunities'.
'It was a debate we had six or seven years ago and now we need to have it again. We know that we have reached the limits of acceptability in terms of taxation so we have to accept limits [on what drugs and treatment can be funded], but we also have to get more out from what we are putting in.
'We now have a rational system. Our critics said NICE would be a rationer but now we know it's actually been a spreader of care. There will be more hard choices to make in the future and the public want us to make them.'