The Nurses Registration Act (Ministry of Health, 1919) instigated the beginning of a movement which precipitated nursing on a journey towards professional status. Many changes have taken place in health care since this Act. There has been a steady retraction in the number of large hospitals that for many years were seen as places of "asylum" for people with mental health problems and those with learning disabilities. The increase in the number of older people who require health and social care and people who have chronic illnesses or disabilities, and the ever shortening period that people now stay in general hospitals have led to an increased focus on community care. There has also been a philosophical shift in health care provision from what was previously amelioration of illness to a more preventative health-promoting focus.