The NHS is undermanaged.

The evidence demonstrates this. Sadly, however, this is an argument that is lost for the time being. In a time of austerity few are brave enough to argue for the importance of management capacity in terms of both improved efficiency and patient outcomes.

But the savage reduction in management numbers is having other unintended consequences. It is, for example, in danger of making the leadership of the NHS whiter.

NHS Commissioning Board transformation director Jim Easton has warned that black and minority ethnic staff are “at risk of being significantly disadvantaged” as the system downsizes to fit within its new economic constraints.

The board is to be commended for raising this issue and attempting to ensure a staffing mix with a representative spread of ethnic backgrounds.

This is especially important because, as board commissioning development director Dame Barbara Hakin had to effectively admit last week, there is no guarantee the leadership of clinical commissioning groups will be representative of the communities they serve.

What former NHS chief executive Lord Crisp called the “snowy peaks” of NHS leadership have long been a stain on the service’s impressive record of offering equal opportunities. The fact there was just one non-white face in the latest HSJ100 list of the most influential people in health shows the situation is not improving.

Tokenism is not the answer. But an NHS leadership cadre whose ethnic mix would not look out of place in the 1970s will struggle to develop services which are responsive to a 21st century population. A greater role for the more representative third sector would help tackle this problem while the NHS gets its act together.

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