Discrimination is probably indirect

EDITOR—Esmail et al attribute disparity between white and non-white award holders to discrimination.1 Existence of direct discrimination in some spheres of the NHS does not imply it also affects distinction awards. The regional and central advisory committees on distinction awards are beyond reproach. Rubin's suggestion that several other factors may explain the skewed distributions is more plausible.2 Disparity between groups of consultants is inevitable because of differences in abilities, training, and opportunities.

The Commission for Racial Equality held that the criteria laid down for distinction awards could, however, result in indirect discrimination, not necessarily with discriminatory intent. For example, the weight given to work of national and international significance may make the awards less accessible to those in smaller district general hospitals or specialties, where ethnic minority consultants may be concentrated. The Department of Health has therefore issued criteria placing less emphasis on national and international recognition and making A awards available to consultants delivering “outstanding and sustained service to the NHS in an exceptionally hard pressed post” provided it is not the sole ground for an award. Introduced for the 1998 awards round, the criteria are fairer and more widely applicable, but will they change attitudes?

Consultants work under varied conditions. However, the criteria do not seem to allow for this. The uniform expectations across the board lead to a skewed distribution of awards with a bias towards academics, consultants in teaching hospitals and larger district general hospitals, and those in the high profile specialties.

Esmail et al quite rightly highlight the disparity. Their campaign should, however, be directed towards rectifying the situation which places not only ethnic minority consultants but also many other consultants at a significant disadvantage. Eliminating prejudice in the system, if it exists, is more difficult than establishing a fairer assessment of achievements …