A Healthcare Commission survey has revealed scandalously poor compliance with race equality legislation (for more on the survey, click here).

Fewer than one in 10 trusts have honoured their legal duties under the Race Relations Act 1976 to publish workforce data, race equality schemes and race equality impact assessments.

Just one in three trusts appears to be monitoring the ethnic make-up of their workforce, while fewer than one in six has bothered to publish equality impact assessments.

Almost a quarter have not even published a race equality scheme.

These figures betray a systemic failure by the NHS to embed race issues in its behaviour, either as the country's largest employer or as a service provider.

It is difficult to understand how trusts can even contemplate concepts such as 'patient-led services', 'choice' or 'world class commissioning' when they do not even assess the impact of their policies on different ethnic groups.

The tools they are required to use are well established, straightforward and supported by countless examples of excellent practice - local government puts the health service to shame on race issues. There is no excuse for such negligence.

Trusts that have not got to grips with these basic standards cannot hope to provide services sensitive to the needs of different groups. They should be eliminating barriers to access and involving ethnic minority patients in service design and delivery. Bereft of such policies, trusts will be unable to make the strides needed in tackling health inequalities. As HSJ reveals in next week's Good Management section, failure to monitor the ethnicity of diabetes sufferers is impeding primary care trusts' efforts to tackle the disease, the incidence of which fluctuates wildly between different ethnic groups.

And with 1.4 million employees, NHS trusts should be leaders in promoting equality among their own staff.

The commission is running out of patience. It has warned that non-compliant organisations risk being marked down in their annual performance ratings, and within a month it is commencing detailed investigations into race equality at 40 trusts.

The performance rating stick is a good one to beat trusts with, but it is depressing to think that commitment to equality in what is supposed to be a caring service is so low that a regulator has to resort to threats to address such a fundamental issue.