Accounting as a mechanism of governmentality in the creation of a British hospital system

Abstract

This thesis is historical in nature. It adopts a methodology that has recently taken the study of accounting history into the arena of the social; leaving behind tradi- tional notions of accounting as being only what accountants do. The focus of the study is on the annual reporting of activity, in terms of both its nancial and phys- ical dimensions, in the history of the British voluntary hospital movement. The study is highly contextualised. By adopting this approach it has been possible to show how accounting reports initially enabled the managers of medical institutions to reverse the focus of accountability onto those charitable individuals that were providing the funding for the hospitals. This greatly strengthened the fundrais- ing capacity of the hospital, while simultaneously de ecting attention away from the e cacy of the institution itself. Later, however, it is shown that after various abortive or only partially successful attempts, it was possible, through the medium of a uniform accounting system, to return the focus of accountability back onto the management of the hospitals. It is important to note that the success of this movement was contingent less on the quality or viability of the accounting system than the legitimacy of the organisation that published its results. Until this legit- imacy was established in the minds of the users of the accounts the e ects of the accounting was severely limited. Once it was rmly established the accounts be- came a powerful knowledge technology that enabled a substantial degree of control to be exercised over hospitals, such that a `quasi-system' of hospitals was created.