Alison Hyde has had enough. After 20 years reporting or working for the NHS, she's moving out of health altogether and, she insists, she has no regrets

In May this year, I made up my mind to leave Wiltshire health authority and, indeed, the NHS. The reasons are many and varied. Ironically, what motivated me to move was a programme of executive coaching Wiltshire HA sent me on two years ago. I thank the HA for that. The process was invaluable. It made me think very clearly about where I wanted to go next, what I wanted from my job and when I wanted to move on.

The personal development plan that I drew up with my coach's help said that I would expect to be moving on in about two years. It is almost exactly two years. The plan also said that I would need two years to learn as much as I possibly could from my current position as corporate communications manager and make as much of a contribution to the communications function as possible.

I think I have done that.

But, as with all major career change decisions, there were other factors at work. I was looking for a job that dealt with national issues and had a wider remit than just a county. I wanted a job that was not health-related, one which would enable me to learn about something different. I have found all this at the Intervention Board which is to fund, account for and operate the Common Agricultural Policy in the UK.

At my job as public affairs adviser to Swindon HA and later in my post at Witshire and Bath health commission, I came to realise that I do not like working and living in the same place. It creates in me a feeling of claustrophobia. I love bigger towns and am looking forward to returning to the town of my birth, Reading.

I think I was probably a very bad reporter on local newspapers because I feel no real sympathy with the issues that concern people living in small and, in some cases, isolated areas. Not for me the fury that is created by new double yellow lines, uncut verges, changes to what happens in local hospitals or battles between parish councils.

But I have been sent into a rage in recent months by some of the narrow-minded, insular attitudes that people display towards any potential changes in health services, even when they are for the greater good.

For example, a local paper ran a campaign against some planned changes to services for elderly people with dementia. This was always likely to have been a difficult plan to implement - it is a highly emotive issue. But I don't think I have ever witnessed such a dishonest bit of campaigning.

The paper used pictures of older people that were guaranteed to wind everyone up. The staff at the units affected went on marches and demos without linking the potential job losses to their tireless campaign. The editor said the paper was just reflecting community opinion.

Balderdash. The headlines on the stories gave the lie to that. The editor's real interest was to promote the story to increase sales. The paper might have won more respect if it had been more honest about it.

I am still perplexed by the conundrum that people in Wiltshire thought it was fine to be abusive to those working for the HA, but it was not acceptable for them to be challenged. If I had spoken to people the way they have spoken to me and members of my department in the past five years, I would have been sacked. However, I just had to take whatever ill-informed, biased, ignorant nonsense they felt like throwing at the time.

We encountered what seemed to me to be a very petty problem with one parish council towards the end of my period of notice. This was at the time of the Omagh bomb and the days upon days of funerals. I did wonder then about people's sense of priorities.

I had no hesitation in accepting my new post, even if I was bound to feel some pangs about leaving behind something that has occupied such a major part of my life.

As well as a certain amount of bitterness, there is a measure of sadness too. I have always taken it as read that, warts and all, the NHS is a good thing.

Through all the muck and bullets of the past five years, I have remained proud of the NHS and committed to it. I know that people get sick of constant change. It is wearying, worrying and irritating when you never seem to have time to get used to one thing before it changes . But we are living in cloud-cuckoo land if we think things aren't like that in other parts of the public sector and the private sector too. In the end, though, I think that if you are so at odds with an organisation it is time to leave .

This sense of reflection has not been brought on solely by my decision to leave. Working on the celebrations of the 50th anniversary has led me to think about the changes I have seen in 20 years of writing about, and working with and for the NHS.

When I joined what was then the Health and Social Service Journal in 1978, it was a very different NHS. I had a year of the last Labour administration before Mrs Thatcher swept all that was good about it away.

I can remember, with some fondness I must admit, the days of industrial unrest in the NHS - when NUPE would strike over things like bikes left in operating theatres;

when we were all sporting our 'Save the Elizabeth Garrett Anderson Hospital' badges.

Meanwhile, most hospitals worked on as normal. I can remember being furious with the TUC when it came to trying to attend any of the national rallies and events about the issues. We, the journalists who covered NHS affairs day in, day out and who were broadly sympathetic to the workers' cause, were not invited - we were shoved aside for TV and radio reporters who did not know one end of a stethoscope from the other. They still don't.

I remember my shifts with the London Ambulance Service, junior doctors in Winchester and visits to the special hospitals and the Prison Medical Service on the Isle of Wight.

During my brief and ill-fated spell with one of the weekly papers for GPs, I learned some hard lessons about doctors.

It needs to be remembered at all times that GPs are running a business. And like all other self-employed business people, they need to make a profit.

I would not admit this to everyone, but my vote for the best health secretary (so far) goes to Kenneth Clarke. As a journalist, I enjoyed dealing with him, but most of all I admired him for his honesty and moments of supreme tactlessness, such as his comments about GPs reaching for their wallets.

I have real concerns about how primary care groups can be expected to work. The idea seems to show a complete misunderstanding about the psyche of GPs. You have only to ask anyone who has worked in primary care to know that GPs often don't get on with each other in their own practices: so how are bigger groups going to work?

Indeed, I really wonder how they will tackle communications both between themselves and with the wider public. There is a real task there for the communications professionals who stay with the NHS, and those who come to it fresh.

I have two abiding memories of the past 20 years. When I first joined HSJ , I was sent to visit what was then the Epsom cluster of hospitals. I could not believe that in 1978, people with mental health problems were cared for in those conditions.

The other was sitting in the basement of the old HSJ offices in Furnival Street, reading the report of the inquiry into what went on at Normansfield Hospital. I sobbed.

Crying was not my reaction when I heard health secretary Frank Dobson make his recent remarks about care in the community. Nobody thinks it is a perfect system. It isn't.

But I do hope we are not going to start indulging in that British passion for nostalgia.

I would urge everyone to go back and read some of the major inquiry reports again. No system will prevent people with mental health problems killing either themselves or others. However, we have a duty to look at the human rights of all concerned and of making sure that people with mental health problems are cared for with dignity and are able to have some self respect.

We mustn't lose the good things about the changes in the way people with mental health problems are treated.

So, I move on now. I wish all those who continue to work for the NHS nothing but good. It is a difficult thing to say without sounding trite, but I do owe the NHS an awful lot - as a consumer and as a former employee. Thanks for the good times, and the bad.