Local Government Act 1929
The main purpose of the Local Government Act 1929 was to consolidate local government structures.
It also sought to reform the administration of poor relief by transferring the responsibility to care for the poor to local authority public assistance committees (PACs). Poor relief was renamed 'public assistance' but the Poor Law continued.
The origins of local authorities can be traced back to the Local Government Act 1888, which established county councils and borough councils to be governed by elected councillors. Later, the Local Government Act 1894 provided for the creation of parish councils, urban district councils and rural district councils.
A move towards free treatment?
The 1929 Act made local authorities responsible for Poor Law hospitals (workhouse infirmaries). Those who were able to pay for treatment could be charged, but those who were not able to pay could access medical treatment for free as ratepayers. It was hoped that this move would mean that people could receive treatment free from the stigma of Poor Law treatment.
Poor Law infirmaries, once taken over by local authorities, were subject to their detailed regulation and management. The London county councils took over hospitals that were managed by the Metropolitan Asylums Board (MAB), which was highly detailed in the standards and systems it imposed.
The council's management style was centralist and was based on a desire to see rapid improvement in its hospitals and enforce efficiency.
However, local authorities varied widely in the quality of services provided. The pace at which they took over Poor Law hospitals also varied considerably.
A Poor Law institution had to be formally stated or declared to be operating under Public Health Acts. To be 'declared', hospitals had to reach standards stated by the Ministry of Health. Meeting the standards required significant investment by local government.
For some councils, a period of economic depression prevented them from investing in local hospitals.
A key driver in the establishment of the NHS
The disparity between services provided by local government and the voluntary hospitals was to be a key driver in the establishment of the NHS.
Bringing hospitals under the control of local authorities was seen by the voluntary hospitals as a threat. They had far more beds and stable funding from the rates. Neither did the guardians want to lose their powers.
Neville Chamberlain, Minister of Health, made great efforts to bring the various factions together. The Act's provision requiring local authorities to consult a local joint committee representing the governing bodies and medical staff of voluntary hospitals 'as to the accommodation to be provided and the purpose for which it was to be used' was a way of improving coordination between local government and voluntary hospitals. However, such committees were seldom set up.
House of Commons Health Committee.
The House of Commons; 2009.
Pickstone John V.
Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946.
Manchester University Press; 1985.
From workhouse to NHS hospital in Britain, 1929-1948. In: Hillam C, Bon JM (eds.)
The Poor Law and After: Workhouse Hospitals and Public Welfare.
Liverpool Medical History Society: Liverpool; 1999.