Published: 31/10/2002, Volume II2, No. 5829 Page 20 21

The NHS has never done enough to create leaders from black and minority ethnic communities, but it is not only in management that institutional racism affects the health service ('Minority report', news focus, pages 14-15; comment, page 17, 17 October).

In almost every health profession there is clear evidence of discrimination against black and minority ethnic staff.

Many find their working lives blighted by racist behaviour, and their opportunities to progress to the higher ranks of their professions blocked.

Tackling institutional racism requires concerted, active leadership across the NHS and the professional bodies with which it works. Equal opportunities can only be achieved by positive, assertive action to ensure that people from marginalised groups who have the talent to become managers, doctors or nurses have a fair chance of doing so.

The King's Fund has taken the initiative through its black and ethnic leadership programme, which provides targeted training to black people working in the health service, and through its anti-racism workshops for existing NHS leaders. The NHS is also now taking action to promote genuine equality of opportunity for its staff.

But more needs to be done.

Managers in the NHS need increased support to tackle racism effectively. With such a conspicuous absence of black people in the NHS, they need to look outside the service for its future leaders and to be able to look to the communities around them, creating new pathways to NHS employment.

In so doing, they may find the most sustainable means yet of tackling the service's staff shortages and of creating a workforce that more closely reflects the communities it serves.

Rabbi Julia Neuberger Chief executive King's Fund