chapter  5
21 Pages

Managerialism avant la lettre?: The debate on accounting in the NHS Hospitals in the 1950s

This paper seeks to examine a relatively neglected area, the early history of attempts to apply management techniques to the British National Health Service (NHS) and the role of research both in structuring proposals for changes in management practice and in assessing the impact of such changes. In particular it focuses on debates on accounting methods in NHS hospitals in the first decade of the Service. The issues raised by this debate are significant because, as will be argued below, this period has frequently been perceived as 'pre-managerial'. In social scientific accounts, the emergence of a salient role for management in the public sector has been seen as a feature of the last quarter of the century. Such accounts are, in part, reasonable. Commentators on contemporary public sector management are right to point to the sustained and systematic character of the application of management techniques in public sector services over the last twenty-five years1. However, it will be argued that the debate on accounting in NHS hospitals represents variants of a public sector managerialist project 'avant Ia lettre'. As such it has potential lessons for the evaluation of the more recent systematic attempts to apply managerial techniques in public sector services.