QUESTIONNAIRE: 'The NHS can be infuriating but it's still a bloody good service'

Abigail Raynor talks to Ray Rowden, 43, director of the High Security Psychiatric Services Commissioning Board

Where did you study and what qualifications do you have?

I started as a nurse aged 17. I took my RMN and SRN examinations in Kent and then trained as a cancer nurse at the Royal Marsden Hospital. I also took a management training course at the Institute of Health Services Management and I've been on countless training courses.

What does your current job entail?

I oversee the purchasing of psychiatric care for high-security hospitals, namely Broadmoor, Ashworth and Rampton. I also advise government ministers on the future of long-term medium provision of psychiatric care and offer advice for the training and development of staff.

What other positions have you held in the NHS?

In the 26 years I've worked for the NHS I've held a number of posts: I was director of the Institute of Health Services Management and was the first person with a clinical background to ever hold that position. I was also chief executive of the NHS Trust in Lambeth, director of nursing at the Royal Marsden and I was a "bread and bitter" trade union officer for the RCN in Wales.

What changes have you witnessed in the NHS during that time and how have they affected you?

First came the overhaul in general management, in 1985. Until then, management had been run by consensus of teams, with no one person taking ultimate responsibility. The Government decided that someone should be accountable. The move was met with defence from the NHS but the then Secretary of State, Kenneth Clarke, said: "Stop whingeing and get on and manage." There were seven of us with nursing backgrounds who decided to do just that. Next came the NHS reforms, in 1990, which clarified the roll of the health authority and allowed the NHS Trust to provide the right services. We implemented huge changes in 18 months flat. It was the best thing that could have ever happened to the NHS.

What do you think of the NHS today?

I travel around a lot and see what other countries offer in terms of health care. I really believe that the NHS is the best system in the developed world. It serves the entire population for 6 per cent of gross domestic product and the state of British health is no worse than that of any other developed country. The NHS can be complex and infuriating, but it's still a bloody good service.

Do you think the NHS would benefit from a change of government at the next election?

Whichever government is in power, NHS pressures will be the same. We face a number of challenges in the next 10 years: new findings about cell behaviour, genetics, an ageing population - all of this against a background of resource constraint. Although it seems naive, I think the bulk of NHS staff wish the politics would just go away.

How do you see the future of the NHS?

I'm an eternal optimist. The one thing that never ceases to amaze me is the complete commitment of the staff. No corporate company could buy it, but we have it. It is their energy that will carry the NHS through.

How high are the standards of health care offered to the seriously mentally ill? Are patients treated fairly?

High-security hospitals have a very chequered history, but I have come across some brilliant examples of clinical practice. Even so, I think we have a lot to learn from other areas of health care. My challenge is to employ these patterns of success within mental health.

What time and money pressures are you under?

Sometimes I wish there were 48 hours in a day. Financially, however, forensic medicine is relatively well funded.

Would you ever consider a profession in private health?

No. I'm in no way anti private health, but I think if you look for richness and a creative buzz from health care, the NHS is the place to find it.