Former Health Secretary Alan Milburn has called for people with long term conditions to be given control of their own NHS budget in a radical move to extend patient choice.
Mr Milburn, a staunch Blairite often regarded as an "outrider" for the Prime Minister's personal agenda, also urged the introduction of elections to primary care trusts.
In his first major intervention on health since quitting the Government in 2003, Mr Milburn said "tinkering" with healthcare would not do.
"Structural change might help but it cannot guarantee services that are built around patients," he said.
"Only patients can do that. In the end it is their health not ours. It is time to fundamentally change the distribution of power in healthcare - to put the patient in control."
Setting out where the next phase of reform should lead, Mr Milburn said moves to introduce choice had to go further.
"The next stop is where budgets are not just devolved to institutions but instead put into the hands of individuals," he said. A similar scheme has already been introduced in social care to allow disabled and older people to buy their own support rather than relying on the council.
"The Department of Health is currently piloting individual budgets for a wider range of services," he said.
"Health care is not yet included. I believe it should be for patients whose care needs already entitle them to receive a direct payment for social care.
"Otherwise we miss the opportunity of genuinely integrating care into the patient's point of view."
Personal budgets could not be used to cover episodic or emergency treatment, he acknowledged.
In a bid to give communities more say over the NHS, he also said primary care trusts could be opened up to direct elections alongside local councils.
"Such a reform would be genuinely devolutionary.
"It would get local services focussed more sharply on the needs of communities.
"It would fundamentally change the accountability of the NHS from one that is top down to one that is bottom up.
"And it would make this great public service open, for the first time, to the voices of the public."