Costing a Secure NHS Network

Much debate has surrounded the development of computer networks in the National Health Service (NHS), particularly in connection with perceived threats to the confidentiality of patient records. Cryptography has been proposed as a means of protecting such information although significant costs are involved, not simply because modifications have to be made to existing computer equipment and software, but because of new administrative overheads. There is a danger that the complexities of implementation, and the costs which derive from them, will be under-estimated. Lessons should be applied from previous IT projects in the NHS, in which initial vagueness in definitions of scope and cost were identified as one of a number of factors likely to contribute to project failure.     

Why the computer industry is restructuring now

For over 30 years the computer industry has been a growth sector. Recently major players have run into trouble and many smaller ones have fallen under the onslaught of two major forces. Firstly, what is being sold, to whom, and with what margins is changing rapidly as computing moves from being an immature, high technology market for major corporations and specialists to a mass market for every size of firm. Secondly, the industry has by tradition depended on a confused jumble of proprietary standards to defend market share. Today the phenomenon of open systems is destroying those old defences. Long-term survival will mean not only adjusting to the effects of open systems on reducing traditional margins but also playing by the new rules of the resultant commodity market. Success will depend on rapid readjustment, with exploitation of the internal influences of open systems on the company value chain, in order to slim down yet achieve a new scale of productivity.     

Service line reporting in a National Health Service foundation trust: an initial assessment of its relevance and applicability

Financial management and control systems are key components of effective management in NHS organizations. Systems have recently been enhanced by the introduction of service line reporting (SLR) in NHS foundation trusts (NHSFT). This article explores the extent to which SLR has been introduced into one NHSFT and what achievements have been made so far. It also considers the extent to which the SLR approach aligns with modern thinking about budgetary systems.     

Change and Decision-Making in the NHS: The Case of the Care Programme Approach

Using the Care Programme Approach (CPA) as an example, this article examines the difficulties of implementing change within the National Health Service (NHS). A framework is suggested which aims to clarify the nature of change by distinguishing where, when and how decisions are made. It is argued that structural change in the NHS and the related emergence of new institutions, systems, relationships and operational principles, have generated new uncertainties and ambiguities. A fuller appreciation of how the decision-making process operates is necessary to an understanding of how different policy objectives are pursued.     

Loose coupling in asset management systems in the NHS

This paper aims to identify whether the components of a loose-coupled system were present in the asset management systems of the National Health Service (NHS) in Wales and, if so, whether this had a negative impact. By utilising a qualitative analysis of semi-structured interviews with senior officials at two NHS Hospital Trusts together with the findings of a survey of all of the Hospital Trusts in Wales, we conclude that the asset management system of the NHS in Wales exhibits the features of a loosely coupled system with detrimental consequences. Where information on capital assets has been required below board level, lower management relies on local systems, while the information for senior managers and political leaders relies on the management accounting system and ad hoc enquiries. The result has been an impairment of the ability of lower management to reconfigure capital assets which leads to the nation's health service underperforming.     

The Use of Computers in Accountancy Courses: A New Perspective

Bhaskar (1982, 1983) proposed a list of 26 topics, classified under three categories (computer science, computer as a computational tool, computer-aided instruction), for the use of computers in accountancy courses. This scheme is argued to be confusing, as some topics are classified wrongly, and is replaced by a new seven-category scheme. Among other things, computer-aided instruction is found to have doubtful value as judged from the collected experimental evidences. An important question is raised as to the necessity and desirability of the use of computers in accountancy courses. It is argued that not all topics proposed by Bhaskar are absolutely necessary, and that his list contains disturbing omissions and unrealistic expectations of accounting students' time. A new list of necessary computing topics is proposed. Each topic requires 2–3 hours of terminal time during a supervised laboratory session, and can be incorporated easily into existing accounting curricula. It is felt that a postgraduate diploma should be introduced for accounting graduates to cover the ever expanding fields of computer science, artificial intelligence, information systems, and their utilisation in accountancy. Finally, in the light of the Japanese fifth generation project, it is argued that the computer should be viewed as the accountant's intelligent assistant rather than merely as a computational tool.     

Putting the enterprise into the enterprise system

Enterprise systems present a new model of corporate computing. They allow companies to replace their existing information systems, which are often incompatible with one another, with a single, integrated system. By streamlining data flows throughout an organization, these commercial software packages, offered by vendors like SAP, promise dramatic gains in a company's efficiency and bottom line. It's no wonder that businesses are rushing to jump on the ES bandwagon. But while these systems offer tremendous rewards, the risks they carry are equally great. Not only are the systems expensive and difficult to implement, they can also tie the hands of managers. Unlike computer systems of the past, which were typically developed in-house with a company's specific requirements in mind, enterprise systems are off-the-shelf solutions. They impose their own logic on a company's strategy, culture, and organization, often forcing companies to change the way they do business. Managers would do well to heed the horror stories of failed implementations. FoxMeyer Drug, for example, claims that its system helped drive it into bankruptcy. Drawing on examples of both successful and unsuccessful ES projects, the author discusses the pros and cons of implementing an enterprise system, showing how a system can produce unintended and highly disruptive consequences. Because of an ES's profound business implications, he cautions against shifting responsibility for its adoption to technologists. Only a general manager will be able to mediate between the imperatives of the system and the imperatives of the business.     

Pharmaceutical Policy in the UK

For many years drug price regulation posed few public management problems. However, the overall NHS drugs budget has been increasing by almost 9% per annum over the past decade. Governments in the 1990s tried to control this growth by introducing new pharmaceutical policy instruments. This has led to an element of instability in the regulation of the pharmaceutical industry, which is affecting NHS financial programming, as well as R&D investment decisions by companies. This article recommends the creation of an office for drug regulation (an 'OFDRUG') to reintroduce stability into pharmaceutical policy.     

Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts

The authors investigated how the formal national provisions for pricing in the National Health Service (which are a form of prospective payment, known as ‘Payment by Results’) are operationalized at local level. Transactions costs theory and existing evidence predict that actual practice often does not comply with contractual rules. A national study of pricing between 2011 and 2015 confirms this and indicates that such payment systems may not be appropriate to address the current financial and organizational challenges facing the NHS. As the NHS struggles radically to reconfigure services, it is necessary to reconsider the appropriateness of a wider range of pricing mechanisms to facilitate moving care out of hospitals.     

The NHS Plan: Accounting for investment and reform in twenty acute hospital trusts in England (1998–2003)

The National Health Service (NHS) Plan published in 2000 summarised Labour's commitment to modernising the NHS in England. The NHS would receive substantial additional funding bringing expenditure on health, as a share in national income, to levels comparable with a European average. The promise of secure financing from government promised to reduce uncertainty and facilitate medium term resource planning in the NHS. Extra funding, as outlined in the NHS Plan, would also be tied into capital and labour process reform(s) to ensure that investment translated into the much needed additional capacity to treat patients. During the period 1998–2003 funding for an average acute hospital has increased 50% in cash terms satisfying expectations set out in the NHS Plan. It is now an appropriate time to review progress. Using information collected for 20 acute hospitals, selected on the basis that they had started and completed PFI projects in the period 1998–2003. This paper constructs a physical and financial audit which is then used to reveal the degree to which acute hospital finances are now secure and the extent to which physical capacity to treat patients has been robustly transformed.     

Global catastrophic risk and security implications of quantum computers

With advancements in quantum computing happening almost weekly it is time to examine the effects this new technology will have on society and current computational systems. Specifically, cryptographic systems need to be carefully analyzed since the introduction of quantum computational resources would render discrete logarithm and factoring based cryptographic systems like those based on Rivest, Shamir, Adleman (RSA) and Elliptic Curve Cryptography (ECC) algorithms woefully obsolete. These algorithms are widely used in the form of digital certificates, message encryption, and even physical authentication devices like Radio Frequency Identification (RFID) badges. With this technology compromised by quantum computing, governments and other organizations would be able to eavesdrop on private citizens with relative ease. This has the potential to cause a slew of rights violations and atrocities leading to catastrophe. With compromised digital certificates 3rd parties could masquerade as trusted organizations. This would call many types of digital transactions like into question, including those related to stock exchanges, personal banking, and software verification. By eroding this previously solid foundation of trust global scale economic catastrophes are not out of the question. This paper introduces quantum computing to the study of catastrophic threats since the use of quantum technology while existing vulnerable encryption schemes are still in place raises severe safety issues. These issues are addressed here along with a proposed two-fold solution involving the development and maturation of post-quantum cryptographic algorithms coupled with government and international regulation. This regulation would promote the containment and responsible use of quantum computers in order to help alleviate some of the security issues posed by outdated cryptographic systems in a post-quantum environment.     

Old wine in new bottles: IFRS adoption in NHS foundation trusts

UK public sector organizations, including NHS foundation trusts, have changed to International Financial Reporting Standards (IFRS). Treasury aims were ‘to bring benefits in consistency and comparability between financial reports in the global economy and to follow private sector best practice’. This comparative analysis of foundation trusts' financial statements under IFRS shows worse financial results and lower surpluses for the year, higher values of fixed (non-current) assets and more indebtedness than under UK GAAP. Implications of the new accounting regime on comparability and transparency of NHS organizations are discussed—some wine shows improvement, while other wine looks worse in the new bottles.     

Shaping strategic change ‐ The case of the NHS in the 1980s

This article explores the question of why the management of change has become an issue in the National Health Service (NHS). It reports the results of a study which explored reasons for variability in the observed rate and pace of strategic service change in the NHS. The metaphor of ‘receptive’ and ‘non‐receptive’ contexts for change is introduced and eight ‘signs and symptoms’ of receptivity outlined. Some examples are presented. These results give us a logic and language which may enable us to understand processes of change in the NHS.     

Austerity and Hospitals in Deficit: Is PPP Termination the Answer?

While austerity is commonly presented as a necessary, although undesirable, reduction in public expenditure, this framing may disguise a re-imagining of the state whereby governments seize the opportunity of economic difficulties to shrink the state. This paper offers a critical examination of the nature of austerity by exploring the case of the UK's National Health Service (NHS), which according to political rhetoric is protected from austerity cuts. However, in the context of eight years of historically low funding growth coupled with increasing demand pressures from a growing and ageing population, the NHS has for several consecutive years faced substantial overspending by NHS provider organizations. With the Government intent on continuing its deficit and debt reduction path within a framework of ‘austerity’ focused almost exclusively on the expenditure side, NHS organizations have begun to explore radical solutions for reducing their costs. Following reported savings obtained by the early termination of a PPP contract at the Hexham General Hospital, politicians and some NHS managers have considered whether this experience might be repeated elsewhere. Our aims in this paper are to examine the financial feasibility of responding to the pressures created by austerity in this particular way, and to challenge the notion that the NHS has been protected from austerity. We extend the evidence base on PPP contract termination and analyze statistical information and financial statements in the public domain to highlight the legal and financial realities of early PPP termination.     

Public sector borrowing requirement: A plain man's guide

With the implementation of an internal market in the UK National Health Service (NHS), interest in marketing NHS services is growing. Yet marketing practice in other sectors of the economy, and the experience of other markets in health care, raise doubts and objections as to whether marketing should be introduced in the NHS at all. Some of these objections have force, and there are important structural differences between the NHS internal market and conventional markets. Simply copying conventional marketing methods is therefore unlikely to be an effective, or even a desirable, approach to marketing in the NHS. Specific forms of marketing are required for the NHS and these forms differ for purchasing organizations, for commercialized health care providers (including NHS trusts), and for directly‐managed NHS services. Differences between these variants can be illustrated by considering the different ways in which a generic model of marketing would have to be amended for each case. The differences also suggest some policy and managerial parameters for the future development of NHS marketing.     

Bank computing in a changing economic environment: the IBIS project in New Zealand

This paper examines a major bank computing redevelopment attempted in New Zealand in the 1980s - the IBIS project. After the expenditure of some hundreds of millions of dollars this project was not proceeded with and this paper looks at the factors that led to its eventual failure. We find that dreams of banking technology can be as costly as other failures experienced by banks, and that banks must have regard to the competitive environment in building their computer systems.     

New development: Commercialization of the English National Health Service: a necessity in times of financial austerity?

ABSTRACT

This article examines income received by National Health Service (NHS) providers from non-NHS sources. In 2015–2016, it amounted to 9.1% of their revenue. In the English NHS, there is an increasing reliance on non-NHS income to provide revenue for NHS organizations, due in part to government’s austere financial plans. This article is the first comprehensive analysis of these financial data for all English organizations. It provides new evidence in the ongoing debate about the nature and values of public service organisations and the role of commercial imperatives.     

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.     

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.