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Its report, presented in 1864, recommended only one change to medical relief in the workhouse.

Nursing in workhouses was usually done by elderly and illiterate inmates.In 1866, a total of 21,000 sick and aged inmates in London workhouses were being cared for by a nursing staff that included only 142 paid non-pauper nurses, very few of whom had received any hospital training.Their report, which contained statistical studies of the diseases and accommodation of the non-able-bodied poor, recommended the creation of separate hospitals for the sick poor, and dispensaries for the outdoor poor.Gathorne Hardy also consulted the President of the Royal College of Physicians, Sir Thomas Watson, who convened a committee to examine workhouse medical provision in the capital.Meanwhile, Florence Nightingale had approached the Prime Minister and old family friend, Lord Palmerston, who encouraged her to draft a bill encapsulating her recommendations.

Unfortunately, Palmerston died in October 1865, and in December she went back to Charles Villiers with her proposals.

In December 1864, much publicity was given to the death of an Irish navvy, named Timothy Daly, from gross neglect in Holborn workhouse.

As a result of this, Florence Nightingale began a campaign for nursing reform in workhouse infirmaries.

However, Villiers felt that the weak state of the Whig Government in the spring of 1866 made it an inopportune time for proposing new legislation upon such a controversial subject.

In June 1866, the Whig government fell and was succeeded by a Tory administration with Lord Derby as Prime Minister.

Between 18, the Metropolitan Asylums Board (MAB) played a substantial and increasing role in the care of London's sick poor.