A hospital boss said his staff had to deal with "racist and homophobic" abuse from patients, with some refusing to be treated by black nurses.
Nick Hulme, chief executive of East Suffolk and North Essex Foundation Trust, made the remarks during a Health Service Journal (HSJ) discussion.
Mr Hulme told the BBC he stood by the comments, saying there needed to be a zero tolerance approach to racism.
Unison said his comments were a "step forward" in raising the issue.
Speaking as part of the HSJ round-table discussion, Mr Hulme said: "We have some of the most right-wing, bigoted, racist and homophobic remarks and behaviours, certainly in north-east Essex.
"How do you deal with a patient who says they refuse to be treated by a black nurse, which is not uncommon?
"Do we reflect the community we serve or do we challenge the community we serve? I think we have a responsibility to challenge some of that."
The panel of hospital trust chief executives were involved in a debate about their roles and diversity and inclusion.
Mr Hulme, who is in charge of Ipswich and Colchester Hospitals, said he stood by the issues he raised.
"We have a zero tolerance approach to racist abuse and homophobia in our trust. This is all about protecting our patients and staff," he said.
"One important point that I made is that only a tiny minority of the communities we serve who display these behaviours.
"If anyone is offended by my comments, I apologise".
Cheryl Godber, Unison's eastern regional organiser, said: "While Nick's terminology was rather hard-hitting, I do believe it's what is needed to give this issue with the NHS the profile it needs."