At first I thought Steve Ainsworth's piece on equal opportunities ('Opportunities knock', 29 October) was a spoof. I suspect instead that he gives us a perfect illustration of why the NHS and so many other employers still have significant work to do on equal opportunities.

After 15 years' work with the NHS, I have yet to meet a black senior manager. Black senior clinicians are a rarity. This suggests that institutionalised racism is alive and unwell in the NHS.

A large proportion of women will become mothers, and men fathers, during the course of their careers. It is telling that Mr Ainsworth refers only to the former. A woman who has children after establishing a successful career is still commonly faced with continuing to 'make the necessary sacrifices' or giving up the job - according to Mr Ainsworth, 'without any pressure whatsoever' - trusting that, when she is ready to return, she will find an employer sympathetic to the reasons for the gap in her CV.

Men who become fathers will be expected to pursue, with all the 'obsessive behaviour' they can muster, the traditional linear career model, which assumes someone else is looking after the children. Naturally there are exceptions.

Job sharing, flexible working hours, carer's leave, paternity leave, workplace creches - all could be implemented by an employer serious about equal opportunities, but they remain the exception in the NHS as elsewhere.

Equal opportunities policies have to recognise and address the fact that people have unequal experiences and live with unequal constraints. In our society these are still influenced profoundly by an individual's gender and race. Of course, things have improved in the past 50 years, and there is recourse to law for individual cases of discrimination. But there is a long way still to go. Mr Ainsworth's it-never-happened-to-me-so-it-can't-be-a-problem attitude displays exactly the kind of subjectivity that good recruitment and retention practices should be endeavouring to overcome.

Heather Hurford

St Albans, Herts