Laura Donnelly interviews the new chief executive of West Midlands SHA

'I have gone into this job assuming it's my job. I know it's an interim job, but I am behaving as though the job will go on indefinitely. I don't think you can do it any other way.'

Cynthia Bower spent 16 years working in social care in Birmingham, rising to become assistant director of social services. In 1996, a single city-wide health authority was established and its then chair, Bryan Stoten, wanted someone with a local government background to take a policy role.

She went on to become director of primary care. The new health authority had inherited 'a real financial mess' and she was part of the team which created a 'very robust economy' based on the notion that achieving income and expenditure balance was 'basically your licence to operate'.

From here she took a role running Birmingham's specialist community health trust in the two years before its abolition, when she became chief executive of South Birmingham primary care trust, which continued to provide all the city's specialist services.

One of the most 'exciting things' that came next, she says, was working in partnership with the first wave of foundation trusts.

They began work on demand management, improving community emergency care, 'understanding the tariff as well as the foundations did'. 'It was absolutely the best thing that happened to us.'

She was keen to share the learning: 'I felt very strongly that we had to find our own feet in that process and reinvent ourselves. I must have bored the pants of everyone endlessly saying we've got to get the commissioning side right.'

When David Nicholson was given a role running three SHAs, she was made managing director of Birmingham and Black Country SHA; working on getting PCTs fit for purpose, ahead of the creation of a national process.

How would she describe her management style? 'I'm an enthusiast. I have a lot of energy. I'm clear and I'm rigorous. I talk too much probably.' By which time the tape has run out.