Buy our book here.

The NHS in the UK has long been subject to ‘new public management’, which effectively aims to make the health sector more cost-efficient. Often, though not always, such an approach drives cost-cutting measures, something which is obviously quite an emotive issue.


We’re all aware of the hard financial times that are being experienced right now, globally; and ‘austerity’ is a commonplace description of how economies are being governed, including health provision.


Recently, in an effort to make savings, the NHS in Devon has announced that smokers and the morbidly obese will be declined routine surgery unless they stop their smoking habit or lose significant weight.


More specifically, prospective patients who smoke must quit their habit at least eight weeks before the planned surgery. While those patients deemed as obese must either reach below the threshold body mass index of 35, or at least shed 5% of their body weight before the planned surgery.


NHS Devon has been clear that due to significant deficits, they must cut costs in order to help meet waiting list targets.


This raises several key questions about accounting for important public services such as health provision. First, it highlights the difficulty of accounting for ‘true’ price (e.g., of good health), or ‘real’ cost (e.g., the opportunity cost of undertaking mostly expensive surgery as opposed to routine surgery), and the continuous trade-off or contest between these and more alternative choices.


Second, this seems a situation where, via accounting measures, personal agendas are being forced upon patients. This may in the long term have some benefits, but should the patients be forced to do this for their (expectation to have) surgery? Moreover, it appears that the NHS Devon’s approach was significantly underpinned by their key objective to improve waiting list (i.e., accounting) performance targets. This is yet another example of just how powerful (and maybe morally questionable in this case) management accounting can be.


(Source: ‘Devon smokers and the morbidly obese denied routine surgery unless they quit smoking or lose weight’, Exeter Express and Echo website, posted 4.12.14)