A brief history of healthcare provision in London

Until 1889 local government in London had been undertaken by the City of London and the Home Counties, as well as many small vestries and parishes.

Following the Local Government Act, 1888, the County of London came into being in 1889, formed from a large part of Middlesex and parts of Surrey and Kent into which London had expanded.

Replacing the traditional system of local management by church parishes, the newly established London County Council (LCC) became the principal administrative body for an area corresponding to the modern-day London Boroughs of Camden, Greenwich, Hackney, Hammersmith and Fulham, Islington, Kensington and Chelsea, Lambeth, Lewisham, Southwark, Tower Hamlets, Wandsworth and Westminster (the City of London was excluded).

The initial responsibilities of the LCC lay in the provision of transport (road building, bridges, etc) and housing (and later, in 1904, education).  The Lunacy Act of 1890 also required it to provide and maintain mental hospitals for rate-aided patients, and it took over responsibility for thousands of pauper lunatics from the magistrates of Middlesex, Surrey and Kent.  

Poor Law Guardians could save 60% of their costs by referring patients to lunatic asylums rather than keeping them in the workhouse.  Doctors received a fee for certifying patients; those with mild depression could find themselves in an asylum.  For women, having an illegitimate child was regarded as aberrant behaviour that was certifiable (women made up a greater proportion of inmates than men).

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Rivett G 1986 The Development of the London Hospital System 1832-1982.  London, King Edward's Hospital Fund for London.

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