Last weekend was open house at the wonderful Royal Hospital for Neuro-disability (RHN) - it's a fantastic charity which supports people who've suffered severe brain injuries, strokes or been struck down by neurological conditions. I got the chance to explore the hospital buildings and grounds as well as a look at the hospital archives that date back to the 1850s.

What astonished me (but perhaps shouldn't have done) was that in the nineteenth century the hospital, because of its limited resources, held a selective ballot to decide which patients were allowed in the hospital - often for the rest of their lives. Each patient was nominated by friends, families or their doctor as deserving of a place. These sponsors then lobbied the members and donors of the charity to get their candidate selected in the ballot. 

The notion of medical need as the over-riding criterion hardly featured and inevitably, in the Victorian age, the sponsors built their case on the moral and social rectitude of the patient. This meant that middle class women made up a disproportionate amount of the intake because they demonstrated the values that the members appreciated and were 'deserving' of charity. The poor, or those without an active sponsor, were unlikely to get the revolutionary care the Hospital could provide. 

It struck me that the RHN's move from Victorian establishment to semi-state provider (most of its funds now come from the NHS) echoes a path taken by the charity sector more widely. While this has clear benefits of limiting the idea of the 'undeserving', and we shouldn't be ashamed of that, it seems that legacy attitudes in the wider public concerning what charity is have their parallel in who should receive it.