Nearly twenty years after the ground-breaking report by Brent Community Health Council (CHC) (1981) into the standard of health care provided to minority ethnic communities, there is continuing evidence of failure on the part of the National Health Service (NHS). One of the ways in which the New Labour government has sought to address such inadequacies in public services has been to increase the numbers of minority ethnic people in the workforce. The central argument of this thesis is that the notion of 'ethnic diversity' has not been adequately defined, and that the practical implications of diversity may be the creation of new'ethnic specialisms' and the consequent marginalisation of minority ethnic individuals. The means by which the government are seeking to achieve ethnic diversity, i. e. mainstreaming 'race' equality issues and using strong positive action (PA), have no tradition in the NHS and are likely to be resisted. Even those who might be considered natural allies of the government, personnel and human resources professionals, undermined to some extent by new public management, may prove obstructive. They appear to have developed a fairly new equality practice, managing diversity (and in particular the model promoted by Kandola eta! 1995; Kandola & Fullerton 1998) to overcome their relative loss of influence. This is an individualistic tool wholly antithetical to the use of PA, which works on the basis of group identities. The research findings presented here are drawn from a national mail survey of NHS trusts, and a semistructured interview survey carried out with various actors involved in minority ethnic health issues in a major city in the south west of England. Its primary contribution is to conceptualise explicitly the notion of ethnic diversity, establishing its practical implications, and testing empirically the possibility of redefining the merit principle to include group identities.

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