Public health in English local authorities: accounting, performativity, & practice

Brackley, James (2022). Public health in English local authorities: accounting, performativity, & practice. University of Birmingham. Ph.D.

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Abstract

By following Public Health activities through a historic transfer from the UK National Health Service into local government in the aftermath of the Health and Social Care Act 2012, this project draws together several crucial discussions in the critical accounting literature. Namely, the growing STS inspired accounting literature on the role of accounting representations in making accounting objects both knowable and valuable, together with the public sector accounting literature exploring the role of accounting in constructing value, identity, and ethically informed alternative accounts in times of austerity.

In following the transfer of Public Health activities the project focuses on two case localities, both of which had lost over half of their managed expenditure, together with the newly created statutory body Public Health England, through a series of interviews, observations and document analysis between 2015 and 2018. The project explores how professionals in this new organisational environment construct their ‘evidence base’ in making the case for Public Health, re-establish their professional legitimacy and identity, and work towards ‘intelligent accountabilities’ in the most difficult of times. Data was collected across a range of settings involving senior Public Health consultants, health economists, finance professionals, and Directors of Public Health, together with observations of workshops, group meetings, and the newly established Health and Wellbeing Boards. To date accounting practices of naming, measuring and reporting have been largely absent from initial studies of the transfer of Public Health activities into local government, but are found to play a crucial role. The study follows the successes and challenges as these strategies are put into practice, but also reflects on the reconstruction of ‘Public health’ itself, as a discipline, as professionals navigate new and conflicting accountability arrangements, budgetary structures, and funding cuts.

In following these practices, the study applies a science and technology studies (STS) inspired methodology, and Karen Barad’s agential realism, in its exploration of the active, iterative, and ethical knowledge construction processes applied by Public Health professionals. In so doing, it demonstrates that such processes are far from politically or ethically neutral, arguing that organisational activities that seek to construct the ‘facts’ in establishing what is made valuable are by their nature dynamic, iterative, and networked. Public Health professionals are found to be rigorously trained in scientific and mixed methods, but increasingly needed to learn how to make use of this evidence in mobilising change in a highly politicised austerity context. This in turn drove new calculative and discursive practices, constructed to better suit the new organisational context. It was in this sense that giving ‘account’ of the ‘facts’ became an active, political, and entangled affair.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):