Trusts believe in the principle of equal opportunities - the policies are there to prove it - but only a minority know how to put them into practice. Thelma Agnew reports

The NHS Executive's progress report on equal opportunities policies in trusts amounts to a 'could do better' reprimand.

Almost every trust, according to the Executive's survey, has a written policy, and more than 90 per cent are monitoring their recruitment procedures. But that is it.

The essential next step - putting policies into practice, and evaluating their effects - has only been taken by a minority.

Elisabeth Al-Khalifa, head of the NHS equal opportunities unit, says candidly that many trusts are just 'going through the motions'.

However, she is confident that managers believe in the principle of equal opportunities; they just don't know what to do about it.

'The most important thing for trusts is to use the data they already have, because there is an awful lot of it. They have to use it in order to ask questions about what's going on in their organisations and then take action. That's what's missing.'

Many trusts are collecting information on gender, race and disability because it is 'therapeutic'. 'It's a physical token that policy is being put into practice. But often it's not even being presented to the board.'

Ms Al-Khalifa says the NHS human resources framework will ease trusts into equal opportunities, by making it a fact of daily business for trust managers.

'There will be equal opportunities objectives which trusts have to deliver. We will also be setting standards.'

A benchmarking group has been formed as a result of the survey to enable trusts to chart progress.

Those in need of immediate inspiration can turn to the 25 best practice examples in the report.

Staff's reluctance to reveal information about their gender, race or health status in monitoring forms (a problem for 42 per cent of trusts) has been overcome by linking the information to payroll systems (no information, no pay cheque).

These best practice trusts have a commitment to equal opportunities at senior management and board level.

At Walsall Hospitals trust, chief executive John Rostill applies a hands- on approach. 'To make things happen you have to have top-level commitment and strong leadership. That's what I've tried to instill into the organisation.'

At the beginning of the 1990s, the trust lost an industrial tribunal case, primarily because it did not have a written procedure for equal opportunities. Since then it has, as Mr Rostill says, moved 'ahead of the game'.

The action team is the personnel director and an education development officer, employed because of her background in equal opportunities work.

They attend a weekly trust management team meeting, chaired by the chief executive, which reports to the board once a month. There is also input from a cultural awareness group, Opportunity 2000 group and local ethnic minority representatives.

The trust (which won an Investors in People award in 1996) easily meets its target of having 10 per cent of staff drawn from ethnic minority communities, and has set a target increase of 1 per cent in departments in which they are still under-represented.

It monitors gender within workforce data to prevent the formation of a glass ceiling, encourages female employment in 'male' jobs, and vice versa.

Initiatives have been implemented in response to the Disability Discrimination Act, and any disabled person applying for a job and meeting the criteria will be shortlisted.

But there is no room for complacency at Walsall, Mr Rostill admits. According to the report, staff view some of the cultural awareness courses as a 'management exercise'. The staff side also claims that selection of job applicants for lower management is still about finding a face that fits.

Bradford Hospitals trust was one of the first to develop an anti-discriminatory job application form. Every new employee completes an induction course on cultural awareness, and all senior managers attend regular briefings to keep equal opportunities the 'dominant focus' within the trust.

Unusually, Bradford has a full-time post dedicated to equal opportunities and is about to appoint a full-time trainer for ethnic minority issues.

John Murgatroyd, director of personnel, says: 'Equal opportunities often revolves around one person, who is not senior. But it's a major task. The focus of our attention has now been broadened - the trust's efforts are supported by two working parties with ethnic minority representatives from the local communities - and that's one of the reasons for our success in affecting change.'

Trusts wanting to make a difference need to do three things: make better use of data; make action a management and board priority; and spread the workload. Equal Opportunities and Monitoring in NHS Trusts. NHS Executive Equal Opportunities Unit. www.open.gov.uk/doh/ coinh.htm