'One can understand why anxiety, uncertainty and fear rule'

When health secretary Patricia Hewitt arrived to give the closing speech of last week's Confederation conference, the session chair expressed his confidence that she could be assured of a more courteous reception than the one she had received recently at another event.

As he made the point, rumours were buzzing that Ms Hewitt's treatment at the hands of the Royal College of Nursing annual congress was a key factor behind the departure of its general secretary Dr Beverly Malone; a departure which has since been confirmed, even if speculation about the reasons why has been denied.

Perhaps discretion is the best part of valour: no-one would want to see NHS managers giving the health secretary the kind of barracking to which Ms Hewitt was subjected in April.

During her speech to the confederation, the health secretary was careful and reflective, aware that her audience was feeling anxiety, uncertainty and weariness. But given the opportunity to ask Ms Hewitt about the direction of policy, and to raise concerns being discussed in the conference centre's many corridors and coffee bars, few outside the mental health lobby were prepared to raise their heads above the parapet.

With primary care trust chief executives engaged in a difficult recruitment process, without even knowing their pay rates, and chairs embarked on a yet more opaque process, one can understand why anxiety, uncertainty and fear rule. But the Department of Health could do with honest advice and probing now more than ever and Ms Hewitt cannot afford to mistake her public reception for undiminished support.