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I was present at a patient/user representative conference recently and heard and saw Cynthia Bower speak for the first time. Following a life-long career in the NHS I was very underwhelmed by Ms Bower's presentation. For someone in such a senior and key position I was very disappointed and not impressed. Whatever her positive qualities are, communication skills do not appear to me to be one of her strengths. I would have thought that such skills are essential to her role and the lack of such skills and the diminished confidence of stakeholders is likely to be the outcome and is disappointing.