NHS Comrade In Chief Sir David Nicholson outed himself as a one-man Salt 'n' Pepa of NHS management, when he told the audience of the National Voices conference today "let's talk about sex".

OK, almost true. What he apparently said, according to Twitter reportage (which is usually pretty accurate) was "I really want to make patient leadership sexy".

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In fact, you can argue that the Comrade In Chief is in fact the new Justin Timberlake, because Mark Britnell (now KPMG, then DH DG of World-Class Commissioning) told the 2007 NHS Alliance conference that Comrade Sir David had asked him to "make commissioning sexy".

In other words, he's bringing "sexy" back.

Mmmmm.

Views will diverge about Mark's success in making commissioning sexy (and given David-Colin Thome's views about GP practice-based commissioning as a "corpse not for resuscitation", perhaps this is not an area we should dwell on unduly for legal reasons, as much as ones of decorum).

The concept of 'erotic capital' was proposed by author Catherine Hakim in recent articles. It basically says that life is easier for pretty people: a staggering philosophical insight, up there alongside water being wet.

Now, patient leadership - in terms of the statutory organisations - has been more or less ineffective since the abolition of Community Health Councils by New Labour in 2003. Their successors - patients forums and LINks - were almost all dentally-challenged.

Research by the Labour opposition released to The Guardian shows that over a quarter of local authorities are unclear whether their local HealthWatch units will be ready by the required 1 April start date and nearly 2/3 of LAs have still not signed their HealthWatch contract.

This suggests that, despite warm words about making patient leadership "sexy", its actual priority is low.

(Oh yes, Comrade Sir David also filled his Communist imagery quota by referring to greater patient involvement as "a revolution".)

There were other interesting words from Health Secretary Jeremy 'Bellflinger' Hunt: he acknowledged that the NHS's funding is indeed "effectively flat in real-terms" (which will probably make the Kings Fund's iridescent chief economist Professor John Appleby smile quietly).

Hunt added, on the subject of Mid-Staffs, "we need to look at the role of DH and regulators ... part of the problem has been confusion over roles and responsibilities ... there's too much regulatory complexity, and we don't want another upheaval but we must streamline lines of accountability".

This sends an interesting message about the Monitor-CQC split in the new world.

It also means Hunt is smarter than some may have thought, because he's spotted the significant political risk of a disconnect about NHS accountability under the Health Act post-April 1.

What he can and will do about that problem is another matter.