NHS press officers have never been more in demand - and never more maligned. They are increasingly regarded as essential to the running of the modern health service, and yet are distrusted as "spin doctors".
It is the "spin" allegation, with its suggestion of untruths, black propaganda, partisan behind-the-scenes briefings, and intimidation of recalcitrant journalists that rankles with health PRs.
It may happen in Westminster, or even in the Department of Health. But, says Leigh McGowan, head of communications at the Queen's Medical Centre University hospital trust in Nottingham, spin is not in his brief.
"Our job is to present the facts," he says. "We have got to be as open, honest and available as possible. If you are seen as a devious and secretive organisation it will undermine public confidence in you."
The government's determination to make the NHS "more open and accountable" by developing the communications function is sometimes perceived as an attempt to gloss over its imperfections.
As a former journalist, Julie Sheppard, head of communications and PR at University College London Hospitals trust, is well aware of the tensions inherent in the job.
Media scrutiny
"I worked in the media, on the side of the 'angels', generating lots of' bad news for government and companies. I'm now on the receiving end. I'm conscious media scrutiny is the lever that gets change brought about and there are some uncomfortable moments where you think to yourself, as a citizen, I should let this story run and run. But it is part of my role to ensure stories do not get to the stage where the reputation of the trust is tarnished. My mantra is 'let's be transparent about things'. It's not my job to lie, dissimulate or conceal. I can't pretend to you that water is wine.'
The role of the NHS PR is not just about dealing with the press. Communications with the public and with staff - particularly in a large trust spread over several sites - are increasingly important.
Sheppard manages a four-strong team: a press manager, a corporate communications manager responsible for internal communications with 5,500 staff on six sites, a website manager, and a junior communications officer.
It can be an exciting, exacting job. An NHS PR might be editing an internal newsletter one day and dealing with the world's press the next. PRs are often on call 24 hours a day, and while it can be rewarding to work for the NHS, pay lags behind the private sector.
Junior press officers start on £11,000 - £14,000. A middle manager might earn £20,000 - £27,000 while a NHS trust head of PR could earn £30,000-£40,000. At the top pay is improving as communications is recognised as a key job within any NHS management team. Top communications staff at large NHS trusts can earn up to £50,000; those with a seat on the board can earn £60,000 plus.
National institute of clinical excellence media director Anne-Toni Rodgers is on the board. So too is Matt Tee, director of communications at the commission for health improvement.
McGowan believes that the likes of Rodgers and Tee are blazing a trail for the future of NHS communications.
"I think we have got to the point where the head of communications should have trust board director status," he says.
