The first step towards the establishment of an independent body to supervise standards of care for psychiatric patients was taken with the appointment in 1774 of Commissioners in Lunacy with the responsibility of licensing and inspecting private madhouses in London. It consisted of five physicians elected annually by the Royal College of Physicians. They were replaced in 1828 by a body of Metropolitan Commissions, consisting of fifteen members appointed by the Home Secretary, of whom only five were physicians and most of the rest were Members of Parliament. Their powers included (with respect to London) the supervision of 'subscription hospitals for the insane’ in addition to private madhouses (but with the exception of Bethlem). For a short period from 1842 their jurisdiction widened further to include provincial hospitals as well as those in the Metropolis.