Accounting for healthcare in the Newcastle Infirmary during the 19th century

Abstract

Accounting played a critical role in the management of the Newcastle Infirmary during the 19th century. In a class-based society, the poor relied upon the generosity of the wealthy for their healthcare at a time when poverty itself was seen as a sin, an act against God. These wealthy donors established and maintained hospitals, such as the Newcastle Infirmary, and were responsible for the governance, management and admission of patients. Their aim was to be seen to use resources efficiently and to treat the “deserving poor” to restore them to productive members of society. Throughout the century new buildings, medical advances and increasingly highly specialised staff had to be financed to cope with increasing demand. In the last quarter of the century, paid administrators were employed to manage the Infirmary as finance came less from the wealthy few and more from individual workers and separate charitable bodies. This thesis demonstrates how the management of the Newcastle Infirmary used accounting as a moral practice to allow treatment for patients who were outside the rules, which were a guide to the admission and treatment of patients, and to justify expenditure on large capital projects on nothing more than acts of faith. In turn, accounting was used as a tool to hold managers accountable for their actions and as a vehicle for communicating that accountability to the changing providers of finance. This thesis adds to the literature on accounting within early voluntary hospitals by identifying the balance of contributions of costing systems to planning and decision making and the impact of finance on governance and holding managers accountable for their performance and the successful treatment of patients.