Transition from Workhouse to Hospital

The transition from workhouse to hospital nationally was a long and complex one. Although the Local Government Act 1929 abolished the workhouse system, the Poor Law did not disappear entirely until the birth of the NHS in 1948. On the way, the healthcare aspects of the Poor Law gradually came to the

fore.  A very informative article by M.A. Crowther sets out this transition. It also highlights the perplexing relationship between voluntary aided and private hospitals and local authority provision, with funding, as ever, being a driving force.

At the time of writing (2016) St Luke’s Hospital is part of the Leicestershire Partnership NHS Trust, a healthcare trust which provides care for a broad range of clients, in community hospitals and mental
health and learning disability services. St Luke’s fits into the picture as a community hospital offering rehabilitation, palliative and end of life care, usually after a stay in an acute hospital. Many of its
patients are in the older age group, though the hospital is now developing and growing and will soon offer a much wider range of services.

Nevertheless, care of older people can be seen as a link back to the hospital’s origins, with this age group making up the largest proportionof workhouse inmates nationally. St Luke’s, in common with other
workhouses, had an infirmary and, as Crowther highlights, there was often no clear distinction between these two aspects of the institution.

The term ‘workhouse’ always had a pejorative ring to it and was feared by many who needed care, especially in old age. Therefore, the term ‘workhouse’ was replaced, in 1913, under the Poor Law Institution Order,
by the term ‘Institution’. Some local authorities moved away from these terms all together but it is not clear when the name “St Luke’s” was adopted. However, it was certainly in place by the Second World War.
However, the workhouse name still lingered and I recall older people in Market Harborough still using it in the 1960s and 70s.

With the advent of the NHS, hospital care moved to the NHS. In some areas local authorities kept the buildings (and staff) and some former workhouses became homes for older people. Others joined the NHS, some becoming hospitals for people with mental illness or learning disability, others community hospitals such as St Luke’s. As Crowther points out, the relatively low status of ‘geriatric’ care and, indeed, care of people with mental health and learning disability often meant that these hospitals were the poor relation still.

In my nursing career, I have visited several former workhouses, most, like St Luke’s, on the edge of town with some of the old buildings intact. The older buildings at St Luke’s date back to the 19th century
and there are photos in reception showing the rest of the workhouse buildings fronting Leicester Road.

It is unclear whether St Luke’s became part of the NHS immediately. However, it certainly cared for many older patients, particularly at the end of their lives. My own great grandmother was one, in the late
1950s. My father recalled visiting there where she was being looked after in a large ward with other older ladies.

My mother worked there as a nursing auxiliary in the 1970s and I still have her training notes. These indicate that St Luke’s was affiliated with Leicester hospitals, the Infirmary and the General. The old buildings were still in use then and had the capacity to house a large number of patients. In those days, and up until the 1980s, the NHS did care for older patients in long stay setting, the old style ‘geriatric
ward’. This was particularly so for older people with dementia and some people would have had a bed for life.

All this changed in the 1990s, with a drive to care for people in their own homes or in local authority or private care homes, bringing about tensions between the NHS and local authorities- echoing those between
the voluntary services and local authorities in the early 20th century.

Now, with the new developments on site, there is a proposal to change the name from St Luke’s, as this is still associated with the workhouse,showing that it still casts a shadow.

For those who want to read more, Crowther’s article can be found here

And the full reference is:
Crowther, M.A. (1999) From workhouse to NHS hospital in Britain, 1929-1948. In: Hillam, C. and Bon, J.M. (eds.) The Poor Law and After: Workhouse Hospitals and Public Welfare. Liverpool Medical History Society: Liverpool, pp. 38-49.



Crowther M.A. “From workhouse to NHS Hospital in Britain 1929-1948”