I have just returned home on a cold November night, glowing a little – in a good way (virtuous glowing) rather than a bad one (angry glowing).

Staying late at work for our nascent patient involvement group, we felt like we made some progress. Small steps towards the holy grail of true patient power but steps none the less.

Patient and public involvement in health is one of those ideas that is pretty easy to say, but much harder to achieve. Successive governments and health authorities talk about ‘no decision without me’, and ‘patient centred healthcare’ but few get close to it. One of the reasons for this is that we are all patients to a greater or lesser extent, and we all remarkably enough have our own opinions, which is most inconvenient.

If you combine this with the problem that the sicker you are, the less you are either inclined or able to ‘participate’, then we have a bit of a problem. It can happen that the ‘usual suspects’ dominate and speak on behalf of others. It is also too easy for the ill and the marginalised to lose their voice and be lost in a crowd.

Of course, this problem is recognised, but it makes it too easy for health managers and professionals to dismiss patient and public opinion.

However fear not, there is a solution.

We live in a society that is increasingly becoming more and more connected together.

It is true that the bonds that connect small communities together are fraying, but with the power of telephones, computers, emails and mobiles, we have more and more ways that people can communicate.

So instead of having to rely solely on the brave soles who freeze their dedicated socks off coming to evening meetings, we can also get opinions and views in other ways.

From those who are too immobile, or are carers, or perhaps are just a little bit lazy watching the latest ‘reality’ hospital documentary (much more exciting than the real thing but less interactive).

That said, we still need the doughty individuals who give up their time simply to try to improve services for others, and at the same time to give those of us who deliver the services a little bit of healthy stick.

But as the wise man said (or was it Bruce Wayne’s butler?), ‘with great power comes great responsibility’.

Health services are precious and resource is limited.

Patient involvement in decisions needs to be responsible. Everyone would like a world-class hospital at the end of their street (and depending on who you ask, some people round here may have one), but the services need to be there to provide the best quality we can manage for the greatest number of people.

This means that decisions need to be made on the basis of who needs them, not who can shout (or tweet) the loudest.