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.     

Managing Health and Finance: Conflict or Congruence?

National Health Service trusts are required to report publicly on two distinct aspects of their activities: finance and patient care. Financial information is included in an annual report and accounts, while patient care performance is released in league tables as part of the Patient's Charter. This article discusses the background to the different measures and reports managerial reactions to them. It reports on a comparison of the results of a sample of NHS trusts in these two separate fields, which found no correspondence between financial and patient care performance. This finding is used to illuminate the role of such information in the process of accountability, drawing comparisons with the private sector.     

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.     

The U.K. private finance initiative: An accounting retrospective

The Private Finance Initiative (PFI) in the U.K. has been the subject of considerable interest in government, professional and academic literature. This reflects its importance as one of the classic forms of Public Private Partnership, its adoption in other jurisdictions, the scale of infrastructure investment under PFI legislation and the extent of controversy that has accompanied its development and application. The financial reporting of PFI schemes has been one element of this controversy in view of its potential to limit public sector financial accountability by off-balance sheet financing and the potential for alternative interpretations of its accounting treatment. It is now an appropriate time to review the turbulent history of accounting for the PFI as U.K. public sector accounting is now based upon International Financial Reporting Standards. This has resulted in the redundancy of previous accounting guidance issued by the UK ASB and the Treasury which, at the time of being abandoned, contained unresolved inconsistencies.This paper uses a triangulation method of investigation linking the input to, and output from, the regulatory process to an analysis of public domain evidence of press coverage and letters submitted to the standard setter and interviews with key participants to the standard-setting process. This approach shows that hidden pressures were influential in the process of developing PFI accounting regulation. Different interpretations of the ASB's principles-based Application Note and the Treasury's more rules-based Technical Note created de-facto alternative accounting treatments. The pressure, from organisations such as the Financial Reporting Advisory Board, for reform of PFI accounting was only released by the government's decision to switch the U.K. public sector to IFRS-based accounting.     

External Audit Fee Levels in NHS Trusts

This article discusses the external auditing regime of NHS trusts and analyses the fees charged by their auditors. It adapts approaches developed in the private sector to investigate audit fees paid by NHS trusts and finds that, while similar factors are associated with the audit fees of trusts, there is no evidence of a 'Big 6' premium and trust audit fees are significantly lower than those of similar private sector organizations. Explanations for this are sought in the different natures of public and private sector audits, which indicate that differences in fees might be anticipated in the public sector, especially with the presence of a quasi-regulator in the form of the Audit Commission.     

The Market for External Audit Services in the Public Sector: An Empirical Analysis of NHS Trusts

This study investigates the market for audit services in the UK National Health Service (NHS). The market has a number of interesting features, including the presence of the Audit Commission as a regulator, appointer and provider of audit services. Following a theoretical overview of audit pricing in the NHS, evidence is provided on the behaviour of private sector auditors in an environment where audit risk characteristics differ from the private sector. The research also investigates, for the first time in the public sector, the relationship between audit fees and non–audit (consultancy) fees. Comparisons are also drawn between audit fees in the public and private sectors in an analysis of audit fees by industry. Despite some key similarities, the study shows that a number of differences exist between private and public sector audit fee models. In particular, we find no evidence of Big 6 (or mid–tier) auditor premiums, but we do find a significant negative relationship between audit and consultancy fees providing support for the 'knowledge spill–over' hypothesis. In addition, the fees charged to trusts appear significantly lower than their private sector counterparts, despite trust auditors having additional duties to perform. Possible explanations for this finding are offered in the paper.     

Introducing spreadsheets into an intermediate financial accounting course: the results of a quasi-experiment

Previous research has revealed a measurable decrease in student attitude towards the use of computers when they are integrated into teaching. This fall in attitude is thought to reflect the initial diffculties encountered when attempting to use computers and learn acounting techniques at the same time. However, it is postulated that once the students' computer ability has achieved an adequate level, then attitude will recover. This paper reports the results of a continuing investigation into the attitude of second-year undergraduate accounting students towords the use of computers in their studies. The method used was to ask students to complete a questionnaire about their attitudes and self-assessed ability and to undergo a written test of their computer/spreadsheet Knowledge. These data were merged with those from earlier testing to give a two-year data set. The results indicate that the attitude of students to using computers generally continued to fall significantly. However, their ability to use computers and spreadsheets rose. In the case of spreadsheets, this rise in ability was significant. It was found that students who took, as options, additional courses which integrated computers had more positive attiudes and achieved higher scores in the computer Knowledge test than those who did not. This implies that the initial fall in attitude experienced in previous studies was not an isolated temporary phenomenon. The imporvement in ability is observed, but this did not have the expected effect.