IT'S tough at the top.Every day Carole Taylor-Brown has to make difficult and complex decisions that she knows may well leave her unpopular and even vilified.

IT'S tough at the top.

Every day Carole Taylor-Brown has to make difficult and complex decisions that she knows may well leave her unpopular and even vilified.

But as the chief executive of Suffolk Primary Care Trust (PCT) she certainly isn't paid to be popular.

“It is quite an isolated personal position to be in,” said Mrs Taylor-Brown, who commands a salary of £133,584. I'm the one that is held to account in the public eye.

“I've been chased down the street when someone spotted me and said 'That's Carole Taylor-Brown'. Then I had an army of people after me! I spoke to them for a bit but really I just wanted to get away.

“Times like that are very tough. I just have to focus on what I'm trying to do. Because I have to balance competing demands so publicly people know who I am and have firm opinions about me.”

And the 50-year-old admitted her detractors were often quite right in labelling her out-spoken and direct, qualities she said she tries to use to fight for the people of Suffolk.

Because a large part of her job involves working together with other NHS organisations and outside bodies to make sure the health service in the county is run the way the PCT wants it run.

“I'm a quite forthright person and in a woman that can be quite challenging for people,” she said.

“It is a political job with both a big and small 'p' and there are positions I take on behalf of Suffolk that might not be consistent with the corporate NHS line. In fact I have a reputation at the SHA for standing up for Suffolk.

“Some policies may work in an urban setting but don't make sense in a rural county like Suffolk, so I do kick up a fuss sometimes.

“I get on very well with partner organisation here in Suffolk, though we have fairly robust discussions with them. We have differences of opinions and I'm clear about what I expect from them - but then afterwards I can sit down and have a cup of tea!”

Mrs Taylor-Brown began her career in HR before getting “bored” and moving to local government where she worked for 20 years in Essex and Hampshire before becoming director of Ipswich Hospital in 1996 where she stayed for four years.

She also worked for the Department of Health and the Strategic Health Authority before taking the reigns at Suffolk East PCT and continuing in the top job when the Suffolk PCTs combined.

Being the chief executive is a role she loves but finds demanding in equal measure, a job where great power brings with it even greater responsibility.

And when the public have been put to the test they too have discovered the post is something of a poisoned chalice because you can not make all the people happy all of the time.

For an experiment the PCT put ordinary people in the hot seat and asked what decisions they would make about deciding what services should be paid for out of the PCT's budget of around £720m. Most people admitted they would struggle to balance all the conflicting demands.

Mrs Taylor Brown added: “At the end of the day you have to make hard decisions.

“I thought very deeply about the consultation process we went through around community hospitals. It is not good to see people so upset and distraught.

“What you have to do is look at the health need and ask will the NHS pound be spent effectively? Not everyone can have everything they want.

“It is terrible sometimes and there are times that you wish you could do more.”

However, despite acknowledging many decisions were very difficult, Mrs Taylor-Brown, who lives near Bury St Edmunds, insisted that even with hindsight there were no choices she thought the PCT had got wrong.

She added: “We do our best and there are good times. The best part of the job is actually when you see some of the changes come through and you get patients who tell you how pleased they are about it.

“I heard from a man after his wife died and we had been able to support his wife dying at home. Even in his moment of grief he had found the rime to write to thank me for that. That really did move me.

“The worst part of the job is when I can't get things to go quickly enough. I'm always rushing because I want things to happen and want things to be better and I want it as soon as possible.”

Have you got a message for Carole Taylor-Brown? Write to Your Letters, Evening Star, 30 Lower Brook Street, Ipswich IP4 1AN or e-mail eveningstarletters@eveningstar.co.uk.