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Gordon Brown may be struggling to convince voters that he has a vision, but during the early months of 2008 the Prime Minister set out a challenging and progressive agenda for the NHS in its 60th anniversary year. The headlines have mostly been about health checks and screenings, but a series of thoughtful speeches has seen him reaffirm the government's longstanding commitment to tackling the deep health inequalities that the NHS was brought in to eradicate.
In his speech to Welsh Labour conference, for example, Gordon Brown included the NHS for the first time in his new narrative about his mission in government:
now we must move to the next stage of the Opportunity Revolution and start to offer access to all of us what 10 per cent can already obtain by paying privately - the offer of regular check ups, early screening for cancer and other diseases, weekend and evening access to your GP when you need it, and the personalised care and support reshaped to your needs that will not only cure illness but prevent illness in the first place (Brown, 2008b).
Gordon Brown also made health inequalities central to what he described as the 'third stage' of Labour's NHS reforms. Stage one, he argued, was to set minimum standards, while stage two was to create incentives for better local performance and more choice for patients. Stage three will be to deliver for patients, by increasing preventative care, 'tackling the underlying causes of health inequalities' and acting on failing services (Brown, 2008a).
The challenge of inequality
Labour is not acting before time. Looking back, the policy landscape is littered with major reports that have resonated loudly before being implemented in part, or in pieces, if at all: Black in 1981 ; Acheson in 1998 (Townsend and Davidson, 1990; Acheson, 1998). There has been plenty of analysis but precious little action. The need for a new commitment from Labour is best demonstrated by the famous tube journey along London's District Line. Life expectancy declines by a year for every six stops you travel eastwards from the City to the East End. Although closely linked, health inequality has been deeper and more persistent than poverty defined in the narrow sense of low incomes. As Professor...