Want to hone your management skills in a high-powered but caring place of work? Think NHS, says Nick Jackson

How the NHS is run has become one of the definitive political debates of the last 20 years. While most of us have been happy to sit on the sidelines discussing pros and cons, each year a couple of hundred graduates have been rolling their sleeves up and getting down to the business of doing it.

Working for this British institution is one of the few opportunities any graduate will have to get involved in running a multi-billion-pound business that saves thousands of lives each year.

Unlike many jobs, in the NHS every little really does help, not in turning a profit but in saving lives. Getting the cleaning rota right can prevent the spread of superbugs. Saving money means more to spend on essential services.

The competition is pretty stiff. Of just over 7,500 applicants each year, just 220 win places on the NHS management training scheme, which last month was awarded "Best of the Best" by the Association of Graduate Recruiters.

Those who get through are given every opportunity for a great career. Three of the four last chief executives of the NHS have come from the scheme. Others leave the NHS to take plum jobs in management consultancy, the City, and academia.

"They're seen as the talent of tomorrow," says Nicola Fair, corporate lead for the NHS graduate training scheme. "From the first day they're doing cutting-edge work to support fresh changes in the service."

Any graduate with a 2:2 or over can apply. After filling out an application form you do a series of online tests that assess your verbal and numerical reasoning, how you respond to work situations, and what motivates you.

If you succeed in these, you go for an interview and to an assessment centre, where your analytical, interpersonal and team-work skills are put to the test. Successful applicants join one of three streams: finance, human resources, or general management. "None of our processes test a knowledge of the NHS," says Fair. "We're looking for the person, not the CV they've got."

Alex Baldwin joined the scheme in September 2006. After leaving Manchester with a 2:1 in history, Baldwin joined the NHS in clinical audit for 18 months before joining the training scheme. "That gave me the bug," says Baldwin. "I wanted to take it further."

The application process was straightforward, he says, but not easy. Preparing for numerical and verbal-reasoning tests is a simple matter of buying one of the many practice books available and getting your head down. Baldwin went further, reading the 2000 NHS White Paper and talking to trainees about what the job involved.

Baldwin is now based in Gillingham, doing his first year of operational management before moving on to strategy in September. He is responsible for managing a team of 50 porters who work in the district hospital. "Most of it is on-the-spot problem solving," he says. It has also involved working out how to change the culture of the department, and giving the porters a sense of the importance of what they do.

"I've had a fantastic placement," says Baldwin. "They always found me the opportunities to get the experience I need and hopefully I've made a difference. That's all you can ask for."

Graduates of the scheme often go on to run the NHS. James Rimmer is only 27, but as associate finance director of Southampton City Primary Care Trust he is already responsible for a £70m budget.

Rimmer applied for the scheme at the end of his second year at Liverpool John Moores. "It stood out as a bit different from the other graduate schemes, from BP, Shell or Mars," says Rimmer. "Working for a service that nearly everyone uses excited me."

He joined the finance stream and during his training in Southampton learnt about the different services within the NHS and about what patients needed. "You get a real flavour of everything the NHS provides," he says.

It can be a challenge, says Rimmer, but it is well worth it. "Every day is different. Managing a team, problem solving, it's a fantastic challenge and a great place to work. You only get that buzz from the NHS."