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

I was somewhat amused to read the article 'Minority report' and your editorial.

The situation of black and ethnic minority managers in the NHS has remained the same for the last 25 years.

At any one time there are a handful of senior managers from minority groups. They tend not to move into top management, and invariably leave the NHS entirely. I am sure they could provide some interesting answers to the questions you have posed.

A few studies have looked at the texture of race relations and equal opportunity practices in health authorities and provider units. They make grim reading.

Neither is it much fun talking to minority staff about their experience of working in the NHS.

Recent articles and features in HSJ have revealed aspects of NHS management culture that might provide clues as to why minorities have particular difficulties in surviving in that senior management environment. 'Pain into gain' (news focus, pages 10-12, 10 October) showed the manner in which senior managers have been displaced by recent major organisational change.

Previous changes have also left many well-regarded top and senior managers being displaced and totally lost to the NHS.

Alongside this we have cases of chief executive officers and senior managers who have found themselves or their organisations being perceived as failures. Some are forced to resign, while others are hustled out of a side door, into jobs created specifically for them.

Having been outside the NHS and the UK for the past 10 years, I note that remarkably little progress has been made on equal opportunities in NHS employment.

Minority users, too, continue to enjoy a poorer service than their fellow citizens. National and local attempts at equal opportunity policies and addressing racial inequality consist largely of exhortations, with minimal effort even to monitor patterns of employment and service use.

The mechanisms for creating change on both fronts are no more difficult than other forms of process improvement being undertaken in the NHS.

Finally, it has to be acknowledged that racism remains a persistent part of the working and management culture of the NHS. The fact that, at certain places and times, minorities predominate in particular staff groups is not an example of 'equal opportunities', but the result of the workings of labour market forces, and the interaction of race and social class.

If you join these various dots together, it will be clear why the texture and contents of the race equality schemes to be drawn up by NHS managers will be impoverished.

Even if these schemes were more substantial, their priority for NHS managers and policy makers remains questionable, as the recent history of race in the NHS has indicated. I wish it were otherwise.

Dr Allan McNaught Senior lecturer in management and health policy School of Health and Social Care Greenwich University