This paper explores the development and diffusion of accounting techniques in UK hospitals and finds that attempts to utilise accounting data, for performance measurement and control, predate the introduction of the NHS in 1948. The main focus of the paper is the move from the uniform system of accounts, first introduced in 1893, to departmental accounting information in 1956. After identifying the antecedent accounting conditions the paper explores both why and how change occurred by analysing the roles of dominant individuals, institutions, political and economic forces that led to the introduction of departmental accounting. The process of change, after the nationalisation of the hospitals in 1948, had a significant impact on the accounting technology adopted: with departmental budgeting being dropped. Finally, the role of the medical profession in the departmentalisation debate is explored and possible explanations for the reluctance to adopt new management accounting techniques are discussed.