The NHS may have good intentions on race relations, but it has a long way to go before it achieves equality. Thelma Agnew reports on an HSJ survey

The devil is in the detail. Anyone looking at the headline figures to come out of HSJ's first survey of ethnic minority managers in the health service would think that the NHS is doing rather well.

More than 11 per cent of NHS employees are drawn from ethnic minorities, who make up only 6.48 per cent of the general population.

But the further up the ladder you go the whiter it gets: just 3 per cent of senior managers are from ethnic minorities.

More surprising are the basic gaps in trusts' and health authorities' commitment to equal opportunities. Two per cent of trusts still don't have an equal recruitment policy or written equal opportunities document. It is worse at HA level: 6 per cent of HAs have no formal equal opportunities recruitment policy - a further 2 per cent of respondents weren't sure whether they had one or not. Fewer than half of trusts (45 per cent) and 27 per cent of HAs actively recruit from ethnic minority communities.

The NHS may not be deliberately excluding non-white personnel, but nor is it going out of its way to welcome them.

The comments from respondents ranged from the rallying call: 'We all need to review our own philosophy, ideals and prejudices to make any real difference to the workforce', to the couldn't care less: 'This area has NO ethnic minorities'. Organisations which appeared to be doing the most were among the most self-critical.

Gary Theobald, head of personnel at Basildon and Thurrock General Hospitals trust, says: 'We have five senior managers from ethnic minorities, so in that sense we are OK. And our staff is much more diverse than our local population - but that's probably been a source of false comfort in the past. I couldn't say diversity issues are well managed in the whole of the organisation.'

The trust is about to sign a pledge to eliminate racial discrimination from the workplace - the Commission for Racial Equality's 'racial equality challenge' - and its equal opportunities group meets once a month.

But there are no projects targeted specifically at ethnic minorities - a deliberate omission. Mr Theobald is enthusiastically behind the Department of Health's policy of 'mainstreaming' action on race equality into the fabric of the health service. 'Diversity issues are part of our staff charter. I'm even trying to avoid using the word 'race'.

Diversity is about everybody.

'The problem with the NHS is we pick on single issues and make a big deal of them and then, when the next one comes along, the last one falls off the end.'

Amanda Oates, human resources manager at Liverpool's Cardiothoracic Centre trust, is also keen to avoid making race this month's issue. The trust has only 'one or two' ethnic minority senior managers out of a staff of 740; improving on that is a long-term aim: 'We need to find a way of getting into communities and encouraging people in future generations to get into the service.'

Keith Kerr, on the other hand, is a trust chair in a hurry. Since joining the Royal Berkshire Ambulance trust in November, his approach has been 'no delays, no excuses'.

'Two or three employees out of 400 here are from ethnic minorities.

When I asked questions about this, initially people said they were 'trying to find community leaders'. That's bunkum.

'You don't need to go to the mullahs.

What we need is to get a recruitment stand in the middle of Slough telling people what the work is - then they will join in droves.' Mr Kerr approached one of the ethnic minority staff members himself (who had languished in a junior grade for 16 years) and encouraged him to apply for promotion: 'When I asked [other managers] about him I was told: 'We never thought he would want to take on a managerial role'.'

The strong direction on race equality from the Department of Health, particularly since the Macpherson report into the Stephen Lawrence murder, has given Mr Kerr confidence: 'Being black, it has empowered me. I'm reflecting the aspirations of the government.'

Walter Brinzer, director of Binley's - the health database company that compiled the results - says NHS organisations which are content to have no ethnic minority managers, on the grounds that they have hardly any ethnic minority patients, are missing the point: 'The NHS is a national employer - you should be able to move comfortably from inner London to Yorkshire. There is an obligation to ensure an overt programme of equal opportunities in recruitment.'

It worries him that HAs seem less committed than trusts to equal opportunities: 'A large number of the primary care groups said, 'We adopt the HA's policy' - so if HAs are lacking, it doesn't augur well for PCGs.'

What no NHS organisation can afford to do is assume that progress, over time, is inevitable. Chris Myant of the Commission for Racial Equality points out that the health service's (ageing) ethnic minority workforce may be about to shrink, as young black and Asian people decide not to follow in their parents' footsteps.

Naaz Coker, director of race and diversity at the King's Fund, says the NHS has to move from good intentions to action. And white managers need to relax about race: 'I know managers who are afraid to appraise black people in case, if they're critical, they are viewed as racists.

That's a nonsense. We need to move beyond this if we are going to see anything change.' l