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.     

Complexity and contradiction in NHS computing

The National Health Service (NHS) has entered a new world of managed competition, where the purchasing and provision of services are formally separated. Accompanying the changes are major investments in computer systems, which will continue for at least the first half of the 1990s. However, the performance of the NHS in implementing computer systems has been variable, so that now is an appropriate time to review the current status of NHS computing, and to consider the key issues for computing in the new environment.     

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.     

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.     

Comparing the content of regulatory impact assessments in the UK and the EU

The need for effective leadership in the UK public sector has been a prominent discourse in recent years. One aspect of this is a growing interest in talent management. This article examines the evolution of processes used for managing talent and developing leaders in the UK's National Health Service (NHS) by applying human resource management theory to an empirical case study. Our aim was to provide a constructive, but critical, analysis of the current role of managerial talent management and to comment on the suitability of the adopted approach in the NHS. Over the past three decades the NHS has come to adopt an increasingly ‘hard’ approach to talent management, i.e. rationalistic, managerial and narrowly focused on leadership competencies and senior management roles. This parallels a more general shift in the NHS from its traditional public sector ethos and humanistic values to more business-oriented values and ways of working.     

Annual Reporting Mechanisms of National Health Service Trusts

This article investigates the role of the annual report and the annual general meeting (AGM) in the context of NHS trusts. The authors report the results of a questionnaire survey of every NHS trust in the UK. Significant variation in the approach taken within a common framework of accountability was found. In general, there seems to be little public demand for trusts' annual reports and attendance at their AGMs was low. The research indicates possibilities of extending annual reporting in the public sector beyond the annual report and AGM and discloses innovative ways that trusts have attempted to overcome the limited interest of stakeholders produced by the traditional reporting mechanisms.     

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.     

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.     

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.     

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.     

A survey of factors influencing the choice of product costing systems in UK organizations

This paper reports on the findings of a postal questionnaire that examines the extent to which potential contextual factors influence the characteristics of product costing systems. Prior research has mostly used the adoption or non-adoption of ABC systems to capture the characteristics of product costing systems. This research has generally been inconclusive and has been unable to establish strong links between ABC adoption and those contextual factors that have been identified in the literature that are conducive to the adoption of ABC systems. Instead of using only the adoption or non-adoption of ABC systems as a measure of product cost system design this research uses four different proxy measures of cost system sophistication to capture the characteristics of the product costing systems. This allows for a more robust test of the relations among the predictor variables and cost system sophistication. Results indicate that higher levels of cost system sophistication are positively associated with the importance of cost information, extent of use of other innovative management accounting techniques, intensity of the competitive environment, size, extent of the use of JIT/lean production techniques and the type of business sector. No association was found between the level of cost system sophistication and cost structure, product diversity and quality of information technology.     

New Zealand's Financial Management System: Implications for Democracy

This article examines the continuing debate about, and inter-relationship between, the NHS, decentralization and local participation. The focus of the article is the experience of decentralization and participation over the past 25 years and, drawing on a new conceptualization of decentralization, it identifies the extent to which the NHS supports decentralized approaches to participation.     

Decentralizing Health Services: More Local Accountability or Just More Central Control?

This article examines the continuing debate about, and inter-relationship between, the NHS, decentralization and local participation. The focus of the article is the experience of decentralization and participation over the past 25 years and, drawing on a new conceptualization of decentralization, it identifies the extent to which the NHS supports decentralized approaches to participation.     

Purchaser Provider Relationships and Innovation: A Case Study of GP Purchasing in Glasgow

NHS reforms have been the subject of much debate in recent years. Evidence from the purchaser provider arrangements is fragmented and limited in its conclusions. This paper presents research focusing on the relationship which has developed, demonstrating how GP fundholders and NHS Trusts have been engaged in mutual education, partnerships, purchasing, and designing services. It identifies considerable scope for innovation and learning at the interface between primary and secondary care and concludes that policy developments need to recognize and build on the achievements which have been made during recent years so as to optimize future collaborative potential.     

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.     

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.     

Changing management roles in the Scottish NHS: implications for management learning and development

The UK government's austerity means that public service providers, such as the National Health Service (NHS), are looking for efficiencies from service integration and collaborative working. This paper highlights how NHS (Scotland) management is coping with these changes and how the role of the manager and the nature of management development is being transformed. New forms and processes of management learning and development are needed for collaborative partnership working in multi-agency public service environments.     

Forecasts in IPO Prospectuses: The Effect of Corporate Governance on Earnings Management

Prior research suggests that managers may use earnings management to meet voluntary earnings forecasts. We document the extent of earnings management undertaken within Canadian Initial Public Offerings (IPOs) and study the extent to which companies with better corporate governance systems are less likely to use earnings management to achieve their earnings forecasts. In addition, we test other factors that differentiate forecasting from non‐forecasting firms, and assess the impact of forecasting and corporate governance on future cash flow prediction. We find that firms with better corporate governance are less likely to include a voluntary earnings forecast in their IPO prospectus. In addition, we find that while IPO firms use accruals management to meet forecasts; the informativeness of the discretionary accruals depends on whether or not the firm would have missed its forecast without the use of discretionary accruals.     

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.