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Perhaps that silence was particularly hard to bear for that crossbreed of people who are civil servants but also in the communications business. Official lines of communication may be down, but media and communications players across the NHS have been having their own fun and games.

Last month, it emerged that Department of Health director of communications Helen McCallum - highly rated in the service for her commitment to genuine consultation and communication with staff and the public - is to leave the post and move to the Environment Agency.

Well-placed sources have been quick to defend her. They say 48-year-old Ms McCallum's wellknown ideals clashed with the power-crazy values of ministers determined to make their political mark. Exercises such as the NHS plan - which Ms McCallum was assured would ensure genuine public involvement in the creation of a new patient-led service - became tick-box exercises within minimal timescales.

Weeks before her departure was announced, Ms McCallum betrayed some frustration at the way her game plan was being thwarted. At a presentation to the Ambulance Service Association she expressed dismay at the way regional offices learned of their demise, which was through the pages of a daily newspaper.

Ms McCallum probably knew then that her days were numbered. Colleagues in the field are unsurprised that, in the final analysis, her efforts to improve relations with staff and the public came second to column inches.

One source spoke of a 'frightening level of ministerial control' over the running of the media centre, another of an administration that paid only 'lip service' to the idea of open government. Few would speak on the record.

Some say the timing of the announcement was significant, coming after the health secretary announced plans to abolish regional offices and before the general election.

One source says: 'More and more, the co-ordinating role is being taken on by the Cabinet Office. If you are supposed to be head of a communications department, that level of interference might upset you. Prescott will be made Cabinet Office minister. He has already made remarks about kicking arse when he gets there.'

Although no-one has knocked the 'almost idealistic' stance Ms McCallum has taken in rating staff involvement over media headlines, some suggest that staying close to the service meant she was left out of the political loop.

Jonathan Street, of Jonathan Street Public Relations, who worked in parallel with Ms McCallum earlier in their careers, says: 'I think Helen was right to think the internal communication was vital. Out in the regions and field, we felt there was a lot of joined-up work going on, which was down to Helen. The danger is that, otherwise, you get a gap between the DoH and the field.'

Nick Samuels, former head of corporate communications for Kings Healthcare trust, says: 'It would be fair to say that Helen, given her place at the top table of communications, would have a great deal of close contact with ministers. Most people would only want to do that kind of job for a certain period of time'.