Patricia Hewitt, the health secretary, is experimenting with new channels of democracy that are far removed from the power play of the party conference in Brighton, where today she will defend the government's plans to make NHS hospitals compete for business. The new approach, which seems to excite her a lot, involves listening harder to what ordinary people are saying. By chance, one of the events she is staging to tune the Department of Health into the public mood took place last week, close to her constituency in Leicester - and she invited the Guardian to come along and listen, too.

This was the second of a series of citizens' juries that are being assembled by Hewitt to discover what patients want from the next stage of NHS reform. They are part of a consulation exercise called: "Your health, your care, your say."

These are not mere focus groups tapping into people's gut instincts. They are all-day events structured by consultants Opinion Leader Research to discover a more considered public view. Representative groups of 60-100 local citizens become informed about health and social care by telling each other of their experiences. Once informed, they vote on priorities for change.

Debate by the seaside in Brighton today is likely to focus on policies set by her predecessors, Alan Milburn and John Reid, to energise NHS hospitals in England by making them compete - with each other and the private sector - to attract patients.

Hewitt, a few months into the job, will defend that blueprint for the hospitals, apparently convinced it has the backing of Gordon Brown as well as Tony Blair. But her mind is already on the new frontier of reform, preparing to introduce the same competitive edge to health and social care outside hospitals.

And that is where she thinks the citizens' juries are useful - telling her what ordinary people really want from GPs, practice nurses, therapists, midwives, home helps and all the myriad other skilled people who provide care from the cradle to the grave.

Local meetings

She will decide how to organise these services, but the juries are telling her what those services should be. She says: "This is a new politics, trying to engage people in policy making. It's drawn from the US. A few months ago, I came across America Speaks, a citizens' organisation that is pioneering a different kind of deliberative democracy, engaging citizens in debating public policy issues." Hewitt's version, using structured local meetings, will build up to a national gathering of about 1,000 citizens in Birmingham at which the people's priorities will be established.

She is excited by the potential of citizens' juries to find solutions by using common sense and shared experience. Some years ago, she encouraged the health authority in Leicester to use a similar technique to resolve the future of the city's three hospitals. They gave the NHS managers a hard time about problems of access by public transport and, she thinks, came up with a durable solution.

Then, as now, it was people's enthusiasm that impressed her. "People who begin the day wondering whether they have anything to offer, end it by asking if they could do it again," she says. "When you give them the chance to challenge the professionals, they bring common sense and personal experience to the table that sometimes the policymakers miss."

One message from the citizens' juries in Gateshead and Leicester came as no suprise: people are fed up with GPs who cannot organise their affairs to allow people to book appointments in advance at a convenient time. This, says Hewitt, came up time and again in discussion. "It's very frustrating and it needs fixing."

Other views emerging from the juries were less obvious. The Gateshead panel made it clear that patients are no longer content with traditional GP surgeries offering basic consultations during limited hours on weekdays. It wanted health centres to become one-stop shops, meeting a wide range of health and social care needs, open during evenings and weekends as well as normal working hours.

The citizens argued for annual "health MoTs", providing everyone with a statement of medical problems and the action required to deal with them. There should be a single needs assessment, setting out a complete package of requirements from health and social services. This would avoid having to repeat the same problems at lots of different appointments with different professionals who did not seem to talk to each other, the panel said.

The Leicester jury agreed about the need for a one-stop shop, but its top priority was moving services out of hospital into the community. People wanted hospital specialists to run clinics closer to their homes, offering blood tests, x-rays, scans, minor surgery and physiotherapy.

Hewitt says: "We are trying to find out what patients need, rather than what it suits us to provide. And the people are saying: 'We want services to work together.' They ask: 'Why do I have to tell my story over and over again to different people; why can't I see the same person, or if that's not possible, why can't they pass the information on to other people.'"

She views this as support for the government's plans for an electronic patient record. "But it also points to a need for a much more effective partnership between social care and health services . . . working on behalf of the patient and mobilising the support that person needs across the public service." The Gateshead jury's view is that the health centre's role should extend even further, into providing advice on jobs and skills training.

The panels are providing some insight into what services people want, but they are not being asked to decide who should provide them. Hewitt, the former trade and industry secretary, has plans to run six pilot schemes in under-doctored areas to test out alternatives.

"I very much hope entrepreneurial GPs from neighbouring areas may want to expand," she says. "But we may well have independent providers saying they can do this." It is too early to say who these independents might be because the businesses do not yet exist. There are opportunities for nurse practitioners to take the lead in setting up new types of practice employing salaried GPs, and midwives might want to set up social enterprise companies offering home births to mothers who want them, designing services to the needs of the local community. "GPs don't always have to lead the provision of primary health care," Hewitt says.

Priorities for change

After sitting in one one of the Leicester discussion groups, it was easy to understand Hewitt's enthusiasm for the approach. There was a genuinely good discussion, at the end of which it was clear that people had enough information to vote on their priorities for change. But they were choosing between propositions put to them by the facilitators of Opinion Leader Research. It was no surprise that they meshed well with Hewitt's own reform agenda.

Since many of the proposals that will appear in a white paper on primary care reform - due to be published in December - were conceived by ministers before the consultation began, there is a danger that the citizens' juries may be used to legitimise a recipe prepared earlier.

Hewitt has also announced plans for a quick round of mergers of primary care trusts (PCTs) - the NHS bodies that are charged with organising care outside hospitals. She says they should stop providing services after 2008 and concentrate on commissioning them from others. This is causing consternation among community nurses and family planning staff who are directly employed by the PCTs. They think Hewitt should have first consulted on what services people wanted and then worked out who might provide them, before deciding any reorganisation of PCTs.

In a government interested in promoting a patient-led service, that view may be dismissed as the vested interest of producers. But the opinion of the staff voiced by their unions is at least as well informed as the citizens' juries. Maybe Hewitt thinks she will hear enough from the unions in Brighton this week.

The CV

Age 56

Education Canberra Girls' grammar school; Newnham College, Cambridge.

Career history May 2005-present: health secretary; 2001-05: trade and industry secretary; 1999-2001: trade and industry minister; 1998-99: junior trade and industry minister; 1997: Labour MP, Leicester West; 1994-97: director of research, Andersen Consulting; 1989-94: research director, Institute of Public Policy Research; 1983-89: Neil Kinnock's press and broadcasting secretary/policy coordinator; 1973-83: women's rights officer, then general secretary, National Council for Civil Liberties; 1971-73: public relations office, Age Concern.

Status Married with two children.

Lives London and Leicester.

Hobbies Reading, theatre, gardening.