EYE-WATERING budgets, enough staff to populate a small country, and the largest property portfolio in Europe. Welcome to the NHS, where horizons are wide, birth and death are near-neighbours and the size of the challenges is matched by the reward that comes from meeting them.

NHS management is not for the faint hearted. The health service is a political hot potato that never seems to cool and is rarely far from its next media mauling.

But for Robert Creighton, the chief executive of Ealing Primary Care Trust, being in the thick of things is part of the attraction. “It is very, very complex,” he says. “Nothing is straightforward and you have to work with a great deal of skill and sophistication. But that’s what stirs my brain. It is endlessly fascinating and you can never grow tired of it.”

Creighton came to the NHS via teaching and Whitehall but more direct routes are available to aspiring leaders. The NHS general management scheme, for example, is an intensive two-year programme that combines study with practical placements. Expect diversity: it’s not just recent graduates who choose to train as NHS managers; others will be career-changers or may already be working in the health service. Placements can be equally diverse: from mental health to midwifery; from community to communications.

Julian Hartley joined the scheme in 1991 and says that it gave him broad experience of the NHS, working alongside everyone from cleaners to consultants. “You get such an immersion in every area, you quickly build up a sense of what the NHS is about.” Now, aged 38, he is chief executive of Tameside and Glossop Primary Care Trust.

If fact, NHS management is so diverse that it’s probably easiest to think first about what you excel at and then consider where in the health service you could apply your skills. The things that need managing are endless: people, obviously, contracts, buildings, information, waiting lists, media relations; not to mention clean sheets, dirty corridors, food, finance and phlebotomy.

When the new University College Hospital in London opens for business this month, its director, Neil Griffiths, will have overall responsibility for 669 beds, 1,200 washbasins, 18 acres of floorspace and 100km of ductwork — plus thousands of patients and staff. But he feels ready for the challenge, having held management posts in various hospital trusts in London and the South East since he joined the NHS 11 years ago as a politics graduate. What is the secret of NHS management success?

“Very good communication skills and the ability to work with all sorts of people,” he says. “Sometimes you are saying things that people don’t want to hear and you have to try to find common ground.” Political awareness helps, too. “Know what the NHS is about and be committed to what it is trying to do.”

Cheryl Warwick came to the NHS from the private sector and is now director of organisational development at the Queen’s Medical Centre, Nottingham, where part of her job is to make 6,500 staff feel that they each have an important role to play. “You have to be interested in people and what they do,” she says. “You must be approachable and be a team player, and value those around you.”

The importance of teamwork is stressed by Steve Barnett, the chief executive of NHS Employers, which represents employers throughout the health service. But aspiring managers need plenty of other qualities, too. “They need a very strong sense of professionalism, and a real commitment to the principles of the NHS,” he says, as well as an understanding of health in a wider context and how it is affected by other issues, such as poor education.

And what do you get in return for all that commitment? “I can’t think of any other organisation that provides such a feeling that you are doing something worthwhile.”

DANIEL ALLEN

DATA FILE

There are seven main areas of management within the NHS:

Rates of pay vary from £45,000 for general managers to £100,000 upwards for chief executives

www.nhscareers.nhs.uk

www.nhsemployers.org

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