The Rocky Bennett inquiry's finding that the NHS is riddled with institutional racism was hardly a bolt from the blue.

For years, ministers have been aware of the discrimination suffered by patients and staff from black and minority ethnic communities. They said it was intolerable and promised to do something about it. Little changed.

This may explain the sceptical tone adopted yesterday by Sir John Blofeld, the former high court judge who led the inquiry. His report said: "In view of the history, we reserve judgment about whether this time good intentions will be translated into action ... sufficient to cure this festering abscess, which is at present a blot on the good name of the NHS."

Sir John may have had in mind the Department of Health's weak response to a survey it commissioned from consultants Lemos & Crane in 2000. They found that half of frontline NHS staff from ethnic minorities had been victims of racial harassment in the previous 12 months. Racial abuse from patients and the public was common, with little done to protect staff.

The findings lay buried in the department for nine months before they were leaked to the Guardian.

Further evidence came in a report in 2001 from the King's Fund, an independent health thinktank. It found bullying and discrimination were a daily fact of life for black and Asian doctors.

On Monday, the Royal College of Nursing published its 2003 employment survey showing nurses from minority ethnic communities were twice as likely to be underpaid as their white colleagues.

A survey last June by the British Medical Association of the careers of 476 doctors who qualified in 1995 found: "Racism is manifest in access to training and careers, and in norms of acceptable behaviour. The system is sustained by the reluctance of trainees to complain."

Ethnic monitoring by the NHS Confederation, representing managers and trusts, found black and minority ethnic staff make up 8.4% of 1.3 million NHS employees, but only 1% of trust chief executives, whose leadership is crucial if discrimination is to be tackled.

A range of initiatives to improve the ethnic mix of NHS senior managers is now under way, including a programme run by the NHS leadership centre and a black and minority ethnic forum led by Melba Wilson, chairwoman of Wandsworth primary care trust in London.

Ms Wilson said the aim was to spot talent. The first 75 candidates have been identified and the programme will start later this month.