Brian Abel-Smith

Abel-Smith was born at 24 Kensington Court Gardens, London, the younger son of Brigadier-General Lionel Abel-Smith (1870–1946), and his wife, Genevieve Lilac, née Walsh (1898–1980).

His elder brother, Lionel Abel-Smith (1924–2011), inherited the title and estate of Lord of the Manor of Wendover, in Buckinghamshire.

They were distantly related to the royal family, and friends wickedly introduced him as twenty-seventh in line to the crown.

Brian Abel-Smith (6 November 1926 – 4 April 1996) was a British economist and expert adviser and one of the most influential figures of the twentieth century in shaping health and social welfare.

Abel-Smith was educated at Hordle House Preparatory School (1935–39) and Haileybury College (1940–1945), before entering the army for his National Service.

He was commissioned in the Oxfordshire and Buckinghamshire Light Infantry in 1946 and was ADC (aide-de-camp) to Sir John Winterton, the military governor of the British zone in Austria during 1947–8.

He entered Clare College, Cambridge, in 1948, graduating with an upper second in Economics in 1951.

He was an active member of the Cambridge Union and the University Labour Club.

Abel-Smith remained at Cambridge to study for a PhD under the supervision of the economist Joan Robinson.

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.

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.

From 1953 he aligned his research to fit with his appointment as research assistant at the National Institute of Economic and Social Research (under the supervision of Professor Richard Titmuss of the Department of Social Administration at the London School of Economics) to assist with the Guillebaud Enquiry on the cost of the National Health Service (NHS).

His first publication was for the Fabian Society in 1953: "The Reform of Social Security".

In Britain, his research for the Guillebaud committee in 1956 proved that the NHS provided extremely good value for money and deserved more investment.

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.

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.

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.

From the 1960s he was one of a new breed of special advisers to Labour government ministers – helping Richard Crossman, Barbara Castle and David Ennals to reconfigure the NHS, set up Resource Allocation Working Party, and the Black Inquiry into Health Inequalities.

Internationally, he steered the development of health services in over 50 countries.

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.

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.

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.

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.

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".

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.

His investigation, which demonstrated that the NHS was actually very good value for money and needed further investment, has been described as "a minor classic of modern social analysis" (C. Webster, The Health Services Since the War Vol. 1, London, HMSO, 1988, p. 207]. He was awarded a Cambridge PhD in 1955, and in the same year Titmuss appointed him as an assistant lecturer in his department at the LSE. He was promoted to lecturer in 1957, reader in social administration in 1961, and full professor in 1965. He retired in 1991, but returned to work part-time with Elias Mossialos to establish the LSE Health unit.

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.

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 was a key WHO and EEC adviser, intimately involved in setting the agenda for global campaigns such as Health for All by the year 2000.