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Founded in 1868 as the Poplar and Stepney Sick Asylum, as a result of the Metropolitan Poor Act of 1867 (30 and 31 Vic.c6), which gave authority to the Poor Law Board to order the combination of Unions and Parishes to provide asylums for the Sick Poor. Poplar and Stepney Unions formed one of six such Asylum Districts and administered the Asylum, built at Bromley-by-Bow along architectural lines favoured by Florence Nightingale, and opened in 1873. The Poplar and Stepney Sick Asylum District, whose minutes (1868 - 1925) are held at London Metropolitan Archives (ref: PSSA), administered the Asylum until the District was abolished in 1925.
The Asylum was renamed St. Andrew's Hospital in 1921 and was administered by the Metropolitan Asylums board from 1925 until 1933, at which time responsibility transferred to the London County Council. St. Andrew's became an N.H.S. Hospital in 1948 and was administered by the No. 8 Group, Bow Hospital Management Committee, until 1963, when the Group merged with the West Ham Group to form the Thames Group of Hospitals. From 1974 to 1982 the Hospital formed part of Newham Health District (though positioned in Tower Hamlets) under the City and East London Area Health Authority (Teaching) and since 1982 it was been administered by the Newham Health Authority.
The Hospital grew through 19th century extensions to over 650 beds. A School of Nursing was established in 1875 and nurses followed a three-year course for a certificate of training and sick cookery. By 1930 an optional maternity training course had been established and the nursing staff had expanded to over 200. The headquarters of Newham District School of Nursing transferred to St. Andrew's following the closure of Newham Maternity Hospital, Forest Gate, c.1985, and the School merged with in 1991 with the Princess Alexandra College of Nursing and Midwifery.
In 1990 the Hospital had 283 beds, but a systematic reduction of services had begun. Eighty-five percent of the Hospital buildings were considered to be in poor condition and below acceptable standards for clinical use. The Out-Patients Department closed, as well as some wards. Patients were transferred to Newham General Hospital. The Devons Road entrance to the Hospital was closed. The Intensive Treatment Unit closed in 1995, as well as the Accident & Emergency Department (but a Receiving Room was retained so that GPs could refer patients with medical or surgical problems; this closed in 1999).
The remaining services concentrated on rehabilitation and geriatric care.
The Pathology Laboratories closed in 2001. It had been intended that the site would be vacated by 2004, but St Andrew's remained open for patients until it closed in 2006.