Metropolitan Poor Act

Growing concern about workhouses

Those in the workhouses were increasingly elderly and often chronically sick. So infirmary wings developed with scandalous standards of nursing and medical supervision. 

Florence Nightingale had campaigned for people to be treated in appropriate institutions, for medical relief in London to be managed by a single body, and for funding of medical treatment through general rates rather than parish rates.

Almost in parallel, from July 1865, the Lancet published a set of damning articles exposing the poor, unsanitary and overcrowded London workhouses, which suggested that the workhouse system was a 'disgrace to our civilisation'.

Against growing criticism of the conditions faced by the poor (and in particular those who were sick) in workhouses, the Metropolitan Poor Act 1867 was introduced in March 1867.

The establishment of asylums

The 1867 Act provided for the establishment of asylums for the sick and other classes of the poor in London.

Though restricted to London, the Act began to influence services nationally. The Act gave the Poor Law Board powers to bring unions or parishes together into districts. Each district was to have an asylum or asylums as directed by the board.

The Act allowed the board to raise contributions to the Common Poor Fund, which would fund the maintenance of patients with specified conditions, the cost of specified medical appliances and the salaries of Poor Law officers. The fund could also be used to invest in new hospitals.

The Act gave the central Poor Law Board the power of regulation, direction and control over detailed matters. For example, the Cubic Space Working Party laid down space standards for the chronically sick and lying-in women. Other standards were that nursing and general management should be under the charge of a matron with some previous hospital experience and the medical officer should be in control of the infirmary.

The Metropolitan Asylums Board

The 1867 Act led to the establishment of the Metropolitan Asylums Board (MAB), a Poor Law institution. The MAB consisted of 45 elected guardians and 15 appointed members.

Its role was to manage the Metropolitan Asylum District, which brought together the unions and parishes of the Metropolitan area to manage smallpox or fevers such as smallpox, typhoid and cholera in a coordinated way, since these presented too big a problem for individual Boards of Guardians.

The MAB also established its own Metropolitan Board hospitals, which were effectively the first state hospitals.