Journal of Accounting & Organizational Change

Purpose – The purpose of this paper is to trace the changes in accounting practice in UK hospitals, focussing on costing, funding and budgetary control, and to place more recent accounting changes in their historic context.

Design/methodology/approach – The paper is largely chronological and draws from previous research by the author and other secondary sources, both of which are supplemented by reference to government publications, accounting practitioner journals and public records.

Findings – The paper argues that contrary to many implicit assumptions in academic accounting studies, our accounting ancestors promoted, and sometimes used, accounting data in pursuit of similar objectives to those advocated in the twenty-first century. But, although cost information “evolved”, within its historical context, the process of establishing standard costs was slow and sometimes controversial, and the use of such information for funding hospital activity was avoided. In addition, the history of accounting reform in UK hospitals is one littered with disappointing results.

Originality/value – The paper provides an historical context to more recent accounting reforms in UK hospitals and suggests that the long history of “problems” documented in the paper may provide some cautionary counsel to contemporary accounting reformers.