Patient and public involvement is a 'sham' and politicians are 'pretty useless' at explaining NHS reform, key NHS figures have warned.

Speaking to HSJ before taking part in a debate at next week's NHS Confederation annual conference on the 'turbulent times' facing the service, four leading voices issued some blunt criticism.

Picker Institute chief executive Professor Angela Coulter described patient and public involvement as a 'sham', with ministers not providing a 'positive lead' on explaining the government's vision for the NHS.

Dr Barbara Hakin, chief executive designate of East Midlands strategic health authority, agreed that neither NHS managers or politicians were doing a good enough job explaining the reasoning behind service redesign.

And King's Fund chief executive Niall Dickson said politicians had always been 'pretty useless' when it came to delivering messages about NHS reform to patients.

But Monitor chair Bill Moyes questioned how much the public should be able to influence the configuration of services given that they are not healthcare provision experts.

All four were limbering up for a panel conference discussion entitled Interesting Times: preparing for a turbulent future.

Professor Coulter said the government was 'stuck in an old-fashioned paternalistic mode', and had done nothing to create a patient-led health service.

'Unless people are really engaged in decisions about their care and really informed about appropriate and inappropriate treatments, it will just generate demand and dependency rather than getting people to take a greater role in protecting and promoting their own health.'

Professor Coulter acknowledged that there were too many hospitals providing poor-quality care, and that services in the community needed to be boosted.

But she added: 'You cannot achieve that shift unless you are really prepared to explain the arguments to the public and ministers aren't providing a positive lead.'

Mr Moyes said there was a discussion to be had about when to 'legitimately involve the public and give them the right of veto over change'.

'When do we have to say them: 'I'm sorry you are paying us a lot of money to run the health service, you want the best you can get and it looks like this?' The public are not experts at planning healthcare.'

Mr Moyes, however, said asking patients for input on issues like what kind of hospital services they wanted and visiting hours was 'interesting and legitimate'.

Dr Hakin said the public often reacted to proposed change without thinking through the consequences. ?One of the things we haven't done as well as we might is getting the public to understand what we are doing. We sometimes get a reaction to sensible strategic plans without a recognition that the majority of people would rather not be in hospital unless they have to be.'

Mr Dickson said there was a 'lack of clarity' on behalf of government about the 'end goal' of NHS reform. 'In so many areas you can see an outline about what is being proposed, but lots of unanswered questions about how the market will work, how regulation will bite and how far commissioning is going to be devolved down to GPs.

'Politicians are very gung-ho when it comes to the concept of making difficult decisions that affect the local health service, but much less gung-ho when it comes to supporting them.'

NHS Confederation policy director Nigel Edwards will chair the session on 16 June, the final day of the conference. He said: 'We pretty much understand what the challenges are in the NHS: less money, more demanding patients, lots of targets and not long to hit them, and people breathing down trusts' necks for better productivity. The question is what action do we need to take to make the system work?'