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Accepted Paper:

Accountabilities in the NHS: coercion, finance, responsibility and democracy  
Piyush Pushkar (University of Manchester)

Paper short abstract:

Where previous scholars documented the eclipsing of other forms of accountability by the calculative rationalities of accounting, in my field, multiple forms of accountability overlapped. The duty to “balance the books” was a key driver, but also had to be enforced by direct coercion.

Paper long abstract:

My paper is based on ethnographic fieldwork in the UK public healthcare system, which is undergoing wide-reaching transformations and fiscal austerity. I undertook participant-observation with political activists who objected to these transformations, as well as interviewing the managers and politicians who were administering the reforms.

Campaigners sought to mobilise the concept of accountability against cuts and privatisation, arguing that managers and politicians were not being honest about the potential consequences. While managers and politicians were often sympathetic to activists’ points of view, they felt constrained by “the reality” of limited funds. However, managers felt unable to speak honestly either regarding the financial rationale for reforms, or the possibility of negative consequences, because they feared losing their jobs. Thus accountability to one’s employer became a means of enforcing reforms that were necessary to balance the books according to budgets set by central government.

Activists had no means of engaging with the Westminster politicians whom they understood as primarily responsible. Thus they “held accountable” the local managers and politicians with whom they had a relationship. This recognition of accountability as a relational technology sheds light on the workings of the contemporary state. The various meanings of accountability end up working in favour of increasing power centralisation, as the people responsible for making decisions driving iniquitous healthcare reforms remain insulated from political accountability.

Panel Pol03a
Beyond 'audit cultures'? New critical approaches to accountability, responsibility, and metrics I
  Session 1 Monday 21 June, 2021, -