Brian Abel-Smith

Abel-Smith's research interests in health and social welfare were underpinned by his commitment to socialism. He focused on the impact of the new post-war British welfare state, publishing regular articles and books in the academic and mainstream press to highlight persistent inequalities in health and social welfare that Beveridge's model had not adequately addressed. His first publication was for the Fabian Society in 1953: "The Reform of Social Security". He collaborated with the sociologist Peter Townsend – who also moved to work with Titmuss at the LSE in 1957 – on projects on poverty, pensions and social security. They conducted a major study using a new method of constructing a poverty line that demonstrated that poverty had increased in Britain in the 1950s. Their 1965 book, The Poor and the Poorest, was used to launch the Child Poverty Action Group, which Abel-Smith remained closely involved with for the rest of his life.

Another of Abel-Smith's key research interests was the financing and development of health services. Following on from his work on the Guillebaud Report on the cost of the NHS, he was invited in 1958 to lead a multi-agency project for the World Health Organization on the costs of health care in six countries. He produced the first comparative classifications, which became the standard for reporting health care expenditure. Although his background was in economics, he was increasingly interested in the finance and management of health services. He gained first-hand experience of the British NHS through his appointment as a governor to a number of regional boards and London hospital management committees in the 1960s, including St Thomas' hospital.

His ideas on health and social welfare financing reflected his engagement with leading international health economists and social policy theorists such as Wilbur Cohen, Ida Merriam, Milton Roemer and Dorothy Rice, and he was frequently invited into expert advisory groups. He collaborated with Archie Cochrane in the early 1970s, resulting in his classic book Value for Money in the Health Services (1976), which explored strategies for cost containment, effectiveness and efficiency. As his experience through advising developing countries increased, he moved away from his ideological commitment to fully state-funded services, and embraced the concept of social insurance and, in the 1990s, the potential offered by user charges.

While at Cambridge, Abel-Smith had been identified by Hugh Dalton as a potential future Labour MP. He began political campaigning, but when he was offered the nomination for Dalton's safe seat in 1957 he turned it down, worried that if his homosexuality were revealed that it would cause embarrassment for his family. Instead he played a key role in modernising the Fabian Society and served it for 31 years as executive committee member, treasurer and vice-president. From the mid-1950s he served on various Labour Party working parties and committees, providing policy ideas on pensions and social security. The Fabian pamphlet he had co-authored with Townsend, "New Pensions for the Old", was used by Richard Crossman as the basis for a radical revision of Labour's social welfare system. When Crossman was appointed as Secretary of State for Social Services in 1968 he invited Abel-Smith to become his part-time adviser, one of the first such posts in British government. Abel-Smith advised issues including the re-structuring of the NHS and helped to set up an enquiry into the Ely Hospital scandal in Cardiff. When Labour lost the 1970 general election Crossman wrote in his diary that Abel-Smith "has been my closest personal friend and without him I could have done very little in the past two years".[1]

When Labour returned to government in 1974 Abel-Smith was re-appointed as a special adviser by the new Secretary of State for Social Services, Barbara Castle. He helped her, and her successor David Ennals, to introduce a new pensions scheme [SERPS]; set up the Resource Allocation Working Party [RAWP] to allocate NHS resources to regions according to health needs, and to set up the Black Report into inequalities in health. When he was working for Barbara Castle she appointed Jack Straw as political adviser. "Let me be clear", she said to Straw, "I have appointed Brian for his brilliance. I have appointed you for your low cunning." At the end of her cabinet career she wrote that "Brian's steady, informed and perceptive help is a tower of strength" (B. Castle, The Castle Diaries 1974–76, London, Weidenfeld & Nicolson, 1980, p. 721). In 1978, frustrated with tensions between the government, NHS and the medical profession, he accepted an offer to work as special adviser to Peter Shore, Secretary of State for the Environment, where he tackled housing and urban planning issues. After the defeat of Labour at the 1979 general election, Abel-Smith was asked by a number of health policy think thanks including the Kings Fund and the Nuffield Trust to advise on reforming aspects of British healthcare.

Abel-Smith's wider command of social policy included legal institutions. His capacity for penetrating, indeed adventurous, analysis led to one of the most original contributions to the role of law of the twentieth century. His book with Robert Stevens, Lawyers and the Courts (1967), was a sociological study of the English legal system from 1750 to 1965 which showed its social origins and mode of control and helped to make an unanswerable case for root-and-branch modernisation. The sequel, In Search of Justice (1968), demonstrated the failings of the legal system as a social service. He served on Citizens Advice Bureau committees and in 1973 he co-wrote with Michael Zander Legal Problems and the Citizen.

Parallel to his academic post at LSE and his appointments as special adviser to Labour governments, Abel-Smith regularly worked as a freelance consultant for international organisations, including the World Health Organization, the International Labour Organization and the World Bank. One of the first of these missions (for the British government in collaboration with Richard Titmuss) was to Mauritius (1959–1961), where their controversial recommendation to introduce a family planning service was adopted. After his death the Mauritius government issued a set of commemorative stamps to mark his contribution to the establishment of the country's health service.

In 1976 he was invited to become a European Economic Community [EEC] adviser to the Directorate of Social Affairs. He worked closely with the Commissioner Henk Vredeling on establishing European standards for healthcare and social welfare, especially on controlling costs of pharmaceuticals. In the early 1980s he was appointed to lead the European response to the WHO global initiative Health for All by the Year 2000, and in 1984 he accepted an invitation from Halfdan Mahler, Director General of WHO, to become his personal adviser. During the 1980s and 1990s, Abel-Smith travelled widely to advise on country-level and regional policies. He continued to advocate policies based on socialist and egalitarian principles, which increasingly brought him into conflict with staff at the World Bank, whose neo-liberal ideology seemed to threaten core values of risk sharing and social capital in health and social welfare systems.