NATIONALLY, Birmingham was relatively slow to construct its first voluntary hospital. Of England's provincial centres, Winchester and Bristol were the first towns to found such institutions, both of these communities having been served by hospitals from 1737. By the end of the eighteenth century, another two dozen towns, of which Birmingham was one of the last, established similar medical charities. Although situated in an industrial region with its numerous associated hazards, Birmingham established a general hospital only in 1779, approximately thirty years after similar institutions had appeared in Liverpool, Manchester and Newcastle. Largely following a pattern that had almost become routine, the Birmingham project still managed to stand out as unusual, given that it was originally championed in 1765 by Dr John Ash, who was both an outsider and a doctor, most other institutions having been founded by local clergymen and funded by wealthy merchants, as well as ordinary shopkeepers and tradesmen. As was common to many of such early charitable initiatives, meetings concerning the establishment of a 100-bed hospital in Birmingham were held at a public house, in this case the Swan Inn. William Small, a local physician, was the only other local medical man to join Ash on the organising committee. Thereafter, as had occurred in nearly every community where voluntary hospitals appeared, a group of trusted and energetic supporters commenced to canvas the homes and businesses of the region's inhabitants in order to fund the venture.

Not surprisingly, given the time it initially took for such a project to emerge in Birmingham, matters continued to proceed at a very slow rate, despite Ash having acquired a suitable plot of land and assembled a thirty-one-member building committee. While this rate of progress was not unusually slow, there were several reasons for the dilatory manner in which matters subsequently progressed. To begin with, it was not the first medical institution in the town, a workhouse having existed in Birmingham since 1733. Several of its rooms, as at 500 other workhouses in existence throughout the nation in 1750, would have been occupied by ill and infirm paupers. In response to criticisms that the parish's suffering poor were already sufficiently served by the workhouse, Ash claimed that half the town's sick came from outside Birmingham and, because they were not legally settled in the parish, were not entitled to local Poor Law services.