How does a new chief executive go about turning round a health authority facing seemingly intractable problems?

When Jenny Griffiths stepped down after three years as chief executive of West Surrey health authority, she had one motivation: 'Basically, It is about getting a life.'

Ms Griffiths was fed up working 60 or 70 hours a week. Yet when she left in January, she insisted the particular pressures of West Surrey were not to blame.

Those pressures are pretty overwhelming.The HA is still wrestling with almost intractable problems:

how to pay off its£14.5m debt, bring an end to its history of bedblocking and attract staff to one of Britain's most expensive areas.

High land values also mean that some of the solutions to delayed discharge used in other parts of the country - the use of private sector care homes and intermediate care - are less of an option, as care homes are sold off for tempting sums.

So who would want to take on the running of West Surrey?

Maggie MacIsaac did. She took up her first post as chief executive in June, from a background as project director for Southampton and South West Hampshire health authority. And Ms MacIsaac, aged 36, is determined to hang on to her 'work-life balance'.

'I think the first thing is that any senior job in the NHS is tough. It doesn't matter what the particular issues are. But yes, I came into this job with my eyes wide open.

'I think it is important for me and for everyone in the NHS that we have got a balance in our lives.

You know what they say about all work. . .' she laughs.

'I try to make a bit of space in my life - I think it makes you more productive and more creative anyway.Of course, there are times when I fail miserably to get the balance right.'

Ms MacIsaac insists there are positive elements to counter the pressures at West Surrey: 'It is a challenge, and I think my colleagues would acknowledge it is a challenge because it is a complex health system.

'It is got big financial, operational and performance issues, but what it has got is a tremendous health community perspective, so people do work together across health and social care.We have got good signup to improving things.'

Softly spoken, Ms MacIsaac's optimism nonetheless shines through: 'I think I have got the energy and enthusiasm and a cando approach. I tend to work in an open way.'

She began her career as a graduate nurse, before joining the 1988 intake of the NHS management trainee scheme.Why that move? 'I always enjoyed nursing, I loved it - but I was always drawn to the bigger picture and having a chance to make a difference in a bigger way.'

Since then, she has been inspired by managers who have shown good people skills - and those who are not afraid to speak out.

'I think I've been very fortunate in terms of who I've worked with in my career, people who I have aspired to be like. . . people who call a spade a spade and people who can take a calculated risk.'

It looks like that approach has rubbed off on her.

Not many HAs announce their struggles. But Ms MacIsaac's first board meeting in July was followed by the issue of a press release with the bold heading: 'Delayed discharges a continuing problem'.

It went on to detail a report which showed West Surrey's position was the second-worst in the country, with 181 people staying in beds longer than they needed to.

Asked about her priorities, Ms MacIsaac says: 'I think the first thing that is an issue for us is definitely the delayed discharge. It is an issue for the whole of the South East.We are a hotspot.'

The HA has appointed a dedicated delayed-discharges manager and is planning a three-pronged attack to improve performance.

This involves getting the basics right on how patients flow through the system; implementing a joint protocol with social services on arrangements for leaving hospital and health needs assessments; and talking to Surrey social services about improving the market in residential care. Meanwhile, the HA wants more investment from the centre and is considering more work with the private sector.

Under current proposals, West Surrey will become part of a strategic health authority spanning Surrey and Sussex.How does Ms MacIsaac feel about leading a HA when such organisations are nearing their end?

'I applied for the job knowing it was going to be about bringing about change. I guess since the appointment the pace has accelerated so, in a sense, that has been a shock. That is a challenge. These changes are going to touch a lot of people's working lives.'