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.     

Diffusion of an Accounting Innovation: Fixed Asset Accounting in the NHS in Wales

As part of ‘New Public Management’ in the UK, changes have been made to the accounting regime. These changes typically involve the adoption of private sector accounting and budgeting approaches using accruals accounting. The process by which new ideas are spread is known as diffusion; this paper deals with the aspect of diffusion relating to the imposition of a new idea, accruals accounting, and how it is absorbed by the organisation, in this case the NHS in Wales. In particular, the paper questions whether the lack of secondary diffusion is limiting the influence of the new accounting approach. To analyse the level of diffusion we have focused on one aspect, namely, information on capital assets. The paper uses a mixture of qualitative and quantitative research methods including in-depth interviews with senior managers at two NHS Trusts and a questionnaire survey with responses from senior finance staff in all NHS Trusts in Wales. We conclude that the diffusion of accruals accounting for fixed assets has been restricted to the primary level at the top layer of management and has not penetrated below that level. There is evidence of continuing managerial indifference to the accruals accounting consequences of owning fixed assets.     

DEVOLUTION, ACCRUALS ACCOUNTING AND ASSET MANAGEMENT IN NHS WALES

This paper describes how a strategy for health services has been developed for NHS Wales and examines the role of accruals accounting in asset management and development. It uses archival investigation as well as interviews and a questionnaire. The role of accruals accounting in the operation of the service, particularly as it relates to the capital asset base of the Trusts and how these are managed, is discussed in the context that Trusts are autonomous units that develop services, and hence their capital asset base, through their own internal planning structure. It is found that, on devolution, there was a lack of consistent information about the stock of capital assets and that capital charges, based on accruals accounting, were not penetrating asset management within individual Trusts. Although strategies were being developed centrally, their implementation at a Trust level can be impeded as a consequence of accruals accounting.     

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.