The authors completed a survey of the career paths of one-sixth of senior women managers in the National Health Service, UK. The report 'Women managers in the NHS: a celebration of success' was published by the Department of Health in November 1992. All the women in the survey had experienced being dependent on senior males who donated their power to them and who established the conditional nature of masculine support. A pattern emerges of the ways in which women are used in male organizations. There seem to be two distinct kinds of patronage which represent two different stereotyped views of female ability. Women are often matched to posts which are seen as 'women's work' and denied access to other posts defined as male. Alternatively, at times of change, the appointment of a woman to a key post may be made in order to symbolize a committment to change amongst those appointing her. This paper considers the conditional nature of women's promotions and the experience for women at the top of an organization in which class, gender and racial divisions are marked.