Published: 15/07/2004, Volume II4, No. 5914 Page 20

The 1 July issue of HSJ contained three seemingly contradictory items on race equality in the NHS.

Firstly, a survey of mental health trust chief executives finds that 57 per cent are 'very confident' their organisations are not institutionally racist (news, page 9).

Then Ben Page's Ideas article on patient perceptions notes that 'trusts serving patients drawn from relatively diverse populations attract lower ratings from patients than those operating in relatively ethnically homogeneous areas' (Ideas, pages 16-18).

Lastly, Lord Adebowale reflects on how black and minority ethnic service users view current services: 'If we are judged on it at the moment then I would say it [the NHS] would be viewed as a failure' (news, page 8).

It is undoubtedly the case that providing services to diverse populations is challenging. One problem is ensuring clinical practice and service delivery are culturally appropriate and reflect the available evidence on effectiveness of treatment interventions and medication in different ethnic groups.

In much of the NHS we do not have the framework, processes or commitment to ensure that this happens in a systematic way.

The Blofeld inquiry into the death of David 'Rocky' Bennett illustrated this problem in relation to mental health services.

The same is true across much of the health service.

In addition, universities, practice educators and training institutions are failing to prepare the current and future generation of health professional to practise in a culturally and linguistically competent fashion.

The 57 per cent of mental health trust chief executives who are 'very confident' their organisations are not institutionally racist are at best dangerously complacent or, at worst, bumbling incompetents.

I would challenge this group to produce the evidence to show that they are providing culturally competent and appropriate services to their patients to support their own rating of their institutions' performance.

Dr Allan McNaught Senior lecturer in management and health policy Greenwich University