Adapting not Adopting: 1958 – 74. Accounting and Managerial ‘Reform’ in the Early NHS

Abstract

This paper examines accounting and managerial reform in the public sector National Health Service (NHS) hospitals in the UK from 1958–74. This period is often regarded as one of ‘consolidation’ (Klein, 1995; Webster, 1998) after the ‘turmoil’ of the early years of the NHS, though there were a number of attempts to improve ‘efficiency’ through initiatives largely rooted in commercial practice. There was a deeply embedded respect for local self governance rather than central ‘command and control’ (Harrison, 1988; Klein, 1995) and more ambitious reforms were avoided. Accounting practitioners and senior civil servants appeared to be content to adjust existing accounting processes rather than embrace major change. The paper concludes with a review of possible factors mitigating against more radical accounting innovation.