ACCOUNTING FOR (A) PUBLIC GOOD: PUBLIC HEALTHCARE IN ENGLAND

This paper reviews accounting technologies used over recent decades in the National Health Service: a public service (good) and the accounting for public interest (good) therein. The trends in NHS accounting are considered in the context of the defining characteristics of a modern public service. The accounting technologies, collectively known as New Public Financial Management (NPFM), are integral to wider public service reform. The overview of accounting technologies in context attempts to draw out some of the deficiencies or apparent mismatches in accounting technologies and public service reform.     

From Sickness to Health? Public Health in England

Public health is currently high on the political agenda, perhaps at its most prominent for a generation. Yet various policy initiatives to improve public health have been regarded as unsuccessful, while the National Health Service is still seen as a 'sickness service'. This article explores the development of public health policy in England and asks whether it is likely to become a key driver of policy and service provision in the future.     

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label ‘care pathways’, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.     

Changes in Public Service Delivery in the EU Countries

In the 1990s, a number of EU countries adopted New Public Management (NPM) techniques to restructure their public sectors. Countries have been widely 'deconcentrating' (moving delivery away from the centre) and 'externalizing' (using the private sector, either totally or in part) their public services. The authors chart the extent of this change and highlight some of the problems—for example the difficulty countries are experiencing in developing value for money audits. The article questions whether current methods of delivery and audit are appropriate for 21st–century public services.     

Comparability in IPSASs: Lessons to be Learned for the European Standards

Abstract

In 2013 the European Commission started addressing issues concerning public sector accounting harmonization across EU Member States, embarking on a project to develop European Public Sector Accounting Standards (EPSASs). Although acknowledging the indisputable reference of the existing International Public Sector Accounting Standards (IPSASs), it highlighted that IPSASs, as they were, could not be suitably applied in the EU context (European Commission, 2013a). IPSASs were considered as not covering specific important matters of public sector accounting, not showing enough stability due to the need of constant convergence with IFRSs, and offering several options that compromised comparability.

Comparability of public sector accounts across Member States is one of the main objectives of EPSASs (EUROSTAT, 2016, 2019), clearly established as a qualitative characteristic in the draft EPSAS Conceptual Framework (EUROSTAT, 2018). It is critical for EU economic and fiscal convergence that countries’ accounts allow for substantial comparison and standardized transition to the National Accounts (Jorge et al., 2014).

The IPSAS Conceptual Framework (IPSASB, 2014), meanwhile issued, sustains that adopting these standards would improve comparability of General Purpose Financial Reporting (GPFR), in this way strengthening transparency and accountability of public sector finance.

Given that, despite the above concerns, EPSASs are to be developed on the basis of IPSASs (European Commission, 2019), the purpose of this paper is to show that IPSASs are not an adequate reference for EPSASs in terms of allowing the desired comparability of countries’ accounts in the EU. It relies on evidence gathered from IPSAS-based financial reports prepared by some Agencies of the United Nations System and from audit reports of the UN Board of Auditors.

The research illustrates that IPSASs only allow for de jure comparability of financial reports at a very broad level. Their implementation and interpretation in practice (due to the options permitted and the judgement required) does not allow for de facto comparable GPFR. European standard-setters need to be aware that the comparability EPSASs need to address across EU Member States’ accounts must go beyond the one that is permitted by IPSASs – EPSASs need to stretch IPSASs harmonization to a higher level of standardization.     

The first steps towards harmonizing public sector accounting for European Union member states: strategies and perspectives

This paper analyses the process that led the European Commission to the decision to develop European Public Sector Accounting Standards (EPSAS) for harmonizing public sector accounting practices within the European Union. The paper finds that there was limited scope in terms of stakeholder participation in the public consultation that served as a basis for the decision. In addition, the decision to adopt EPSAS for EU member states raises questions on the relationship between regional and global governance in the area of public sector accounting.     

论人人享有基本卫生保健之改革

本文通过分析"看病贵、看病难"原因而导致的阻碍人人享有初级卫生保健的主要因素,提出必须深化卫生体制改革,发展基层社区卫生服务、建立覆盖全民的基本医疗保障制度以及实行均等化的公共卫生服务和基本药物制度,以实现人人享有初级卫生保健的目标。     

Megaw and the public sector: A union response

One Civil Service union ‐ the Institute of Professional Civil Servants ‐ welcomed the Megaw Report on the grounds that it would help restore internal relativities. Unions representing the great majority of civil servants, however, came out strongly against it. The general secretaries of the Civil and Public Servants Association and the Society of Civil and Public Servants prepared a note for the TUC's public service committee on the implications of Megaw for the public sector as a whole. The following is based on that note.     

Some practical hints for newcomers to health futures

The three authors of this article are all relative newcomers to the health futures field. One is based within an academic Institute of Public Health, another at the regional tier of the UK National Health Service (NHS), and the third within the NHS Executive Headquarters. The common bond between them is a desire to contribute to the development of new ways of planning for health and a wish to see health futures actively engaged with health services to bring about effective change. With the aim of providing practical advice for others who are beginning to take an interest in health futures work, they look back on their own personal experiences and summarize the lessons they have learned.     

Performing 'Performance'—A Comedy in Five Acts

The public service in the United Kingdom is awash with performance data. From the ubiquitous league tables for schools, local authorities and police services, through key performance indicators for civil service agencies right up to Government-level Public Service Agreements, the number of published performance data sets probably now reaches five figures annually. The author discusses some of the aspects of being what are probably the most 'performance-reported' public services in the world.     

Accounting for Public Hospitals: A Case Study of Modified GAAP

Public hospitals in the U.K. apply GAAP as modified by the Treasury, the Financial Reporting Advisory Board (FRAB) and the Department of Health. Individual National Health Service (NHS) Trusts apply their interpretation of the accounting manuals with further guidance and scrutiny from oversight bodies such as the Audit Commission. This article uses a case study approach to investigate how GAAP is modified and to outline the consequences of the constructed reality. The modifications are layered and often opaque. The accounts are constructed according to accounting requirements stipulated by Government and the account preparers adapt the requirements at Trust level. The accounting statements play a part in constructing a reality ( Hines, 1988 ) that has consequences through the NHS control regime and in how the financial position is portrayed to the public. It appears that GAAP is used to legitimate the NHS as a modern organization applying commercial accounting practice, but the accounting statements provide a distorted view of GAAP compliant statements. The accounting, while not itself real, is real in its consequences and can lead to biased decision‐making, service closures and job losses. The planned compliance of NHS Trusts with international GAAP may provide further scope for modification and manipulation in constructing NHS accounting reality.     

Making sense of New Zealand’s ‘spirit of service’: social identity and the civil service

ABSTRACT

This paper explores the creation a more unified civil service in New Zealand with the Public Service Act 2020, which promotes the most profound changes to the public service since New Zealand’s New Public Management heyday in the late 1980s. Among its many reforms is an explicit attempt to foster a unified culture around a ‘spirit of service to the community’—a construct without fixed definition that appears to incorporate ideas of motivations and ethics. This paper shows that this unified culture can be traced through a series of key collaborative discussions that have taken place among New Zealand’s public sector chief executives. The authors present a case study to show how these collaborations contributed to a new social identity, and provided a foundation for a civil service unified by its spirit of service to the community. The paper contributes to this PMM theme by providing empirical evidence from the latest New Zealand experience; and also contributes to theory of social identity and sensemaking in creating civil service values.     

Divergent Identities? Professions, Management and Gender

This article critically examines issues of gender in relation to the 'professionalization' of management, with particular reference to the National Health Service (NHS). It focuses on the Master of Business Administration (MBA) qualification and the role this plays in professional development of managers and clinicians. One MBA course, which has included a number of participants from the NHS and has attempted to include some recognition of gender issues, is used for illustrative purposes. The article raises important concerns about the implications of gender for NHS and other public sector professionals, and draws some conclusions about the ways in which management education might incorporate gender into the curriculum.     

Implementation of EU initiatives on gender diversity and executive directors’ pay in municipally-owned enterprises in Germany and The Netherlands

A popular topic in the assessment of the functioning of municipally-owned enterprises is the corporate governance (CG) of such organizations. The results of the comparative study presented in this paper indicate that European Union initiatives on gender diversity and executive directors’ pay are often not implemented in public CG codes and in practice in municipally-owned enterprises in Germany and The Netherlands. The paper proposes that EU initiatives should specifically target municipally-owned enterprises and shows concrete hard and soft regulation options for national and international policy-makers and future research perspectives.     

Dealing with Clinical Risk: Implications of the Rise of Evidence-Based Health Care

This article considers the nature of risk in health care and the use the National Health Service (NHS) makes of risk management. It explores how the concept of risk has been challenged by the rise of 'evidence-based' health care, accompanied and accelerated by a decline in professional prestige, status and mystique and much greater use of external measurement and controls as part of the New Public Management. The nature of evidence-based health care is outlined and the implications of the use of guidelines and other practice aids are explored. Finally, the article discusses how evidence-based health care is affecting our views of clinical risk.     

Recalling the Public Oversight Board (1977–2002) and winners of the John J. McCloy Award

The Public Oversight Board (POB) was an independent, private sector body that, between 1977 and 2002, monitored and reported on the self-regulatory activities of the SEC Practice Section of the Division for CPA Firms of the AICPA. In retrospect, the POB served an important developmental purpose prior to legislation that established the Public Company Accounting Oversight Board (PCAOB) in 2002. As a part of its activities, the POB began in 1989 to honor individuals who had made major contributions to auditing practice. This paper features profiles of individuals who contributed to the development of financial auditing in the United States and who were nationally recognized when the POB selected them as recipients of the John J. McCloy Award. The McCloy Award, given to recognize individual contributions to the achievement of audit excellence by the POB between 1989 and 2001, honored those who advanced the activities of the external auditing profession. McCloy, for whom the award was named, served as the POB's chairman from its inception in 1977 to 1984. As a diplomat and public servant, this non-accountant accumulated a distinguished record of service over his career. The McCloy Award winners were the exemplars of public accountability. Winners had a mix of backgrounds; some had been president or chairman of the AICPA or had won the AICPA Gold Medal for Distinguished Service. Still other McCloy winners were not involved with publicly-held clients on a regular basis, or were not practicing accountants, but whose recognition was merited because of their insistence on the public accountability of the auditing profession. Regardless, the McCloy Award recipients represent those who contributed to the effectiveness of the public auditing process in the United States. To date the PCAOB has not elected to continue the McCloy Award or to establish a similar recognition.     

理解现代财政:公共风险的视角

理解财政,需要转换思维.表面看,财政行为是利益的分配和转移,而从实质看,财政行为是风险的分配和转移.财政通过分配和平衡风险,避免风险在某处聚集并在风险链上放大,避免了危机的产生,这实质是化解公共风险,所以财政的本质功能是通过平衡风险化解公共风险,以维护社会共同体的生存和发展.财政的基础性作用在于,只有财政有这种平衡风险的内在功能.与社会共同体面临的公共风险治理要求相匹配,是现代财政的判断标准.如果财政能够很好地平衡风险、化解公共风险,那就是现代财政;通过改革与公共风险治理要求相匹配,就是现代财政改革.新时代的现代财政改革,要立足于以下几个方面:构建大国财政体系,应对面临的全球风险挑战;织密预算的制度笼子,完善权力的财政治理体系;建立公平与效率融合的财政制度;为形成经济双循环格局"架桥铺路".     

Financial and Economic Management in Autonomized Dutch Public Organizations

Alongside with the introduction of New Public Management, many governmental organizations in the Netherlands were autonomized. The aim of this paper is to analyze the changes in financial and economic management that accompanied these autonomizations. Case research was carried out in six public organizations. The financial management of these organizations improved somewhat after the autonomization. However, there were hardly any real changes in the economic management. The paper gives an overview of the changes in financial and economic management. It also discusses what factors might have prevented the realization of the planned changes in the (financial and) economic management.     

Audit Adjustments and Public Sector Audit Quality

In the context of austerity-inspired reforms to public audit in England we investigate the extent to which audit firms mitigate management bias in public sector financial reports. A substantial body of literature finds that both public and not-for-profit managers manage ‘earnings’ to report small surpluses close to zero by managing deficits upwards and surpluses downwards. Under agency theory, auditors acting in the interests of their principal(s) would tend to reverse this bias. We exploit privileged access to pre-audit financial statements in the setting of the English National Health Service (NHS) to investigate the impact of audit adjustments on the pre-audit financial statements of English NHS Foundation Trusts over the period 2010–2011 to 2014–2015. We find evidence that auditors act to reverse management bias in the case of Trusts with a pre-audit deficit, but find no evidence that this is the case for Trusts with a pre-audit surplus. In the case of Trusts in surplus, these findings are consistent with auditors’ interests being aligned with management, rather than principals.     

A comment on the role of prices for excludable public goods

Blomquist and Christensen [(2005). The role of prices for excludable public goods, International Tax and Public Finance, 12 ,61–79] argue that welfare is initially decreasing in the price of an excludable public good and that the case for a positive price for an excludable public good price is weak. We argue that this result follows from their particular characterization of the public good and that an alternative and equally reasonable characterization overturns their result. Hence, the policy case for a positive price on the public good is stronger than Blomquist and Christiansen suggest. JEL Classification H21 · H41