The Last RefugeA Survey of Residential Institutions and Homes for the Aged in England and Wales; Peter Townsend: Routledge and Kegan Paul, 60s. 552 pp.

“We have decided to make a great departure in the treatment of old people. The workhouse is to go. Although many people have tried to humanise it, it was in many respects a very evil institution.”

Thus Aneurin Bevan in 1947. There were then some 40,000 old people immured in the old workhouses of England and Wales—over 300 solid reminders of the 19th century Poor Law, founded on the principle of “less eligibility”. Officially they had been renamed “Public Assistance Institutions”. After 1948 this title too was abolished, to be replaced by such euphemisms as “Luxborough Lodge” and “Homelea”. We no longer speak of workhouses, but of “old people’s homes”. Yet, although the workhouses were nominally abolished, the forbidding structures for the most part still remain and so does their forgotten population of the aged, the infirm, and the unfortunate— 35,000 of them in 1960.

In the total picture of old people’s homes in England and Wales described in Peter Townsend’s book, the workhouse occupies a less dominant position than it did in the 1940’s. The increased demand for residential care of the old has been met by the provision of so-called “small” homes. Local authorities now house more old people in these homes than in the former Public Assistance Institutions. But a combination of public parsimony, general housing shortages and growing numbers of old people in the population postponed the realisation of Bevan’s dream for a generation—perhaps longer if this profoundly shocking study fails to arouse the sense of human urgency which the situation demands.

There is no need even to go inside these dreary prison-like blocks to realise how totally inappropriate is the use of the word “home” in describing them. Mr. Townsend’s brilliantly chosen photographs speak more eloquently than words of the sheer dreariness and inhumanity of the buildings—the endless uncarpeted corridor, the barrack-room dormitory, the bare, comfortless day-room (who ever heard of a day-room in a home? Or a dormitory for that matter?) But his book is not about buildings but about people; and the conclusion that emerges from his survey of 173 old people’s homes of all kinds—former workhouses, converted mansions and purpose-built homes—owned by local authorities, voluntary bodies and private proprietors, is that while in most respects the quality of life in the old workhouse is worse than in other types of institution, the criticisms that he makes apply in some degree to all types. He is thus led to challenge the whole policy of institutional care which has until now occupied a key role in the social services of this and other countries.