High on a hill in East Brighton stands an imposing building which became a hospital even before the National Health Service started in 1948.

Yet a few older locals still refer to Brighton General Hospital as the workhouse because that is how it began life in the previous century.

Historian Harry Gaston has traced the history of Brighton General and seven other former workhouses in a new book which says the fear of entering them still lingers on after all this time.

Gaston says conditions in workhouses varied greatly and in some cases it was better to be in one than outside.

He puts the lasting bad image of them partly down to Charles Dickens in Oliver Twist, In the 1930s, part of the Brighton building was a municipal hospital and the rest a home called Elm Grove House which catered for destitute people.

Conditions in the home were far worse than in the hospital, with only one inside lavatory. The wards looked grim and patient’s had to be carried up and down narrow staircases.

One hospital secretary, arriving there, said the wards were like cowsheds filled with people.

Even when the National Health Service began, there was little money to make hospitals like Brighton General appear anything but unfriendly.

In the 1960s and 1970s money was gradually spent but all the time there remained the possibility that Brighton General would be closed as improvements and extensions were made to the Royal Sussex County Hospital only a mile away.

In 1970, a report on hospitals was critical of Brighton General, which by then was mainly catering for old people. It made headlines nationally and locally. The Argus called it “the hospital that progress forgot”.

The report said one block had been condemned as long ago as 1938 and urgently needed replacement... Another was putting great strain on staff because of its poor state.

It added: “We can only offer our humble admiration to the staff that has battled with such intolerable conditions for so long.”

But conditions did slowly improve, thanks to pioneering work by specialists in treating elderly patients such as Dr Tony Clark.

In 1990, Jevington Block, which even then had crowded conditions, closed and the 80 patients were transferred to nursing homes where the quality of life was better for them.

Plans were announced soon afterwards to replace the other unsatisfactory wards, but lack of finance repeatedly led to delays, It was not until December 2007 that the remaining elderly patients left and the last of the former workhouses in East Sussex finally closed its wards to the elderly of Brighton.

Harry Gaston, a former hospital manager, says many people thought, until recently, that workhouse history ended with the abolition of Poor Law guardians in 1930.

But it took a long time for geriatric medicine to be developed so that elderly people in former workhouses such as Brighton General could be helped.

The fear of them gradually disappeared as old people who remembered them died, but unacceptable physical conditions in the buildings remained.

Even now, he says, there are concerns all over the country that vulnerable and elderly people are not always receiving appropriate care and basic dignity in hospital.

* A Lingering Fear: East Sussex Hospitals And The Workhouse Legacy by Harry Gaston is published by Southern Editorial Services at £12.50. Proceeds from sales will go to the Friends of Brighton and Hove Hospitals.