As an institution, the NHS has always been characterised by diversity. A Welshman launched it in the 1940s; its buildings were built by Irish labour in every decade before and since; and it could not have been sustained throughout its life without nurses and doctors from the Caribbean, the Indian subcontinent, the Philippines and elsewhere, all working with English colleagues of many races.
Unlike some, we do not believe modern Britain's diversity to be a threat to social harmony. Our own experiences have shown us that the potential for anger and conflict between different cultures is considerable - whether it is Trevor Phillips's childhood in a Guyana historically riven by ethnic division, or John Reid's two years as secretary of state for Northern Ireland. We know what happens when the politics of difference goes badly wrong.
But what the NHS as a living and giving organisation tells us is that all this apparent foreignness, all these different others living and working in our midst, are not others. In fact, they are melded together by this British institution into "us". We wonder how a member of the British National party accepts the care from the NHS for their bodies and minds that comes from foreigners they want to throw out.
Yet despite the diverse makeup of the institution, the NHS still fails to serve the diverse population of this country. If it did, it would not have allowed consistent experiences of discrimination to exist within its mental health services. It would recognise the need for those services both to help create safety and to understand cultural differences. The moment a diverse NHS realised that a much higher proportion of Afro Caribbean men were being sectioned than their population proportion merited, it would have automatically begun correcting activity. Yet it did not. The NHS has diversity inside it, but has not found a way of responding to the diversity in the population its serves.
The Labour party has failed to address this issue adequately. Successive Labour governments believed in their soul that uniformity of provision was in itself enough to generate equity. Transfixed by the outstanding creation of the Attlee government, and the subsequent mythologising of the NHS, they were unable to recognise that uniformity did not at a stroke remove all existing health inequalities.
This Labour government is concerned about such inequalities; what is more, it is determined to tackle them. This has led to a sharp debate within the party about the role of centralised service delivery vis-a-vis the development of localised services committed to promoting personal choice. The old left regards itself as the guardian of the post war settlement. It views any attempt to tackle inequalities by way of decentralisation, and devolution of power to the frontline, as in some way rightwing.
Our argument is that we now have a diverse society. This cannot be provided with a health service that is delivered through a belief in uniformity. To obtain equity, a diverse population needs diverse services. Uniformity cannot - and does not - provide that.
The belief that the pursuit of equality is furthered by uniform treatment has had particular currency within the politics of race over the last few decades. Indeed, it has often been argued that if we were to argue for difference, there will be greater opportunities for the development of racist politics. It is this argument, both from the standpoint of the NHS and the standpoint of black and minority ethnic politics, that we challenge.
All the evidence shows that black and minority ethnic people want the opportunity to choose. Their experi ences of bureaucracies making decisions for them, of telling them what is best for them, has not delivered equity. They want the right to play a role, and direct, through their preferences, the way in which services are delivered.
Even a moment's thought tells us that if treatment were always uniform, the health of individuals would be deleteriously affected. Each one of us has a different body. It is not medically sensible to treat men the same as women. It is not sensible to treat old people in the same way as the young. In making initial observations and taking the most rudimentary of medical histories, health service professionals base their understanding and interventions on these differences. And they provide a different service to different people. The same must be true for black and minority ethnic people.
An organisation that fails to recognise these differences in body and environment will not find it easy to improve people's health. Diversity and difference is the key to success here. Our argument is that the structure of the NHS has not assisted doctors and nurses in making that differentiation. That is why the NHS needs to provide more power for patients to allow them to develop their health and their health service within the basic principle of equity of access.
It is clear that the NHS as an institution does more than distribute healthcare to the public. It also functions as an exemplar of the degree to which diversity can co-exist with equality and fairness in the Britain of the 21st century. To put things boldly, if the NHS is not seen as fair by black and minority ethnic people, then not only will their faith in the broader fairness of the NHS be eroded but so will their faith in the fairness of British society. And we are in very grave danger of that happening.
So apart from the evidence of the NHS failing to recognise the differences that exist between peoples, there is a wider problem of the different parts of the public's allegiance to society as a whole. People will go on paying for their NHS if it gives them a good service. If it does not, then they will withdraw allegiance. This is true of all groups of the population, however we categorise them - whether they are middle class people or specific minority ethnic groups.
In other areas of policy this withdrawal of allegiance by black and minority ethnic people has potentially severe consequences. Some 25% of parents of black and minority ethnic pupils in London send their children to private schools. Given the income of black people in London this would represent a much higher proportion of their disposable income than for white people. The government's emphasis on the importance of raising standards, and the differentiation through faith schools and specialist schools, is aimed at demonstrating that schools funded by the public can achieve high standards for different black and minority ethnic groups. But the truth is, once that allegiance is lost it is difficult to regain.
We are in a position with the NHS where that allegiance is still maintained. But we must never take that for granted. What we suggest to secure that strong allegiance is a recognition that NHS policy and practice must better acknowledge these differences.
The NHS has a strong and enduring set of core values. It now needs to recognise that these values can only be realised by recognising difference between people, rather than pretending our health and our minds and bodies are all the same.
· John Reid is secretary of state for health. Trevor Phillips is chair of the Commission for Racial Equality. This is an extract from their pamphlet, The Best Intentions? Race, Equity and Delivering Today's NHS, published today by the Fabian Society, price £6.95. Details: www.fabian-society.org.uk