Doctors, Accountants and Accounting before the formation of the UK National Health Service

This paper is the first of two that explore the development of attitudes to accounting amongst hospital doctors in Britain around the time of the formation of the National Health Service. It challenges the commonly argued position that doctors as clinical specialists are against the use of accounting for managerial purposes in the hospital setting, as it interferes with clinical practicalities, and refuse to engage with it on those grounds. The evidence presented here is derived from debates that were occurring in the medical, accounting and national press at that time. It demonstrates that in the pre-NHS period doctors were quite actively adopting accounting information to support managerial rationales and concerns with economy and efficiency. Further, the accounting language used by the doctors concerned was sophisticated in its understanding of the technical aspects of accounting and its behavioural consequences and was probably technically superior to the language used by accountants as they discussed hospital accounting of that time. Thus, it is argued that there is no ‘natural’ functional distinction between the two professions that prevents communication via accounting rationales. Instead it is proposed that the long reluctance, or refusal, of modern medical professionals to engage with accounting stems from changes in the status of medical professionals with respect to hospital administration that arose as a result of the formation of the NHS.