The NHS on the box: in praise of the great British hospital soap

While the first NHS hospital was opened by Aneurin Bevan in Greater Manchester in 1948, it wasn’t until 1957 that audiences were first admitted on to the fictional wards of the hospital soap. But from that inaugural episode of Emergency – Ward 10 on through to Angels (1975 to 1983) and Casualty (1986-), TV dramas set in hospital environments have been a mainstay of our screens ever since. Even children’s television hasn’t escaped the siren call of ambulances and heart monitors, with the groundbreaking drama Children’s Ward (1989 to 2000) launching the careers of countless familiar faces in front of and behind the camera.

Thinking of hospital soaps might surface visions of the much-parodied ‘injury of the week’ opening scenes of Casualty. Such scenes are often watched through fingers while we wait for that inevitable, potentially bone-crunching misfortune to occur before the victim is hurriedly brought through the doors of the local accident and emergency ward. Perhaps what springs to mind is impossibly glamorous medics wafting around the wards, saving lives without a hair out of place as their patients swoon. Maybe it’s fast-paced shaky camerawork reflecting the high-pressure, high-stakes world of the emergency ward, full of characters talking in unintelligible jargon.

Whatever your view, it’s not surprising why these soaps are enduringly popular. The hospital setting is the ideal dramatic arena for presenting the highs and lows of human experience. It’s a space where anyone could find themselves and so has the potential to include a wide range of characters – a society in microcosm. What’s more, they can also play a vital role in raising viewers’ awareness of important health issues, while also presenting the challenges of the NHS through the perspectives of those on the front line. These programmes have to walk a dramatic tightrope, finding balance between high drama and portraying realistic medical practice with all of its potential gore and viscera.

Just as the NHS has had to adapt to changing pressures and keep up to date with new discoveries and medical technology, hospital soaps have had to do the same. Below, we take a selected trip through some of the lesser-known examples on British television. So grab your stethoscope and let’s go on our rounds, as we look at some of the ways that hospital soaps have reflected not only changes in British society but also the NHS as a whole.

One of the earliest hospital serials, Emergency – Ward 10 set the standard. Created by Tessa Diamond and produced by ATV (Associated Television), it was initially broadcast twice a week and ran from 1957 to 1967. Following the lives of patients and staff at a busy hospital in the fictional Oxbridge, the soap began with 1 million viewers in 1957 but at its peak reportedly commanded 24 million. Its popularity was such that a feature-length film, Life in Emergency Ward 10, was released in 1959. Luckily, many episodes of the show still survive.

Focusing on the staff and the patients that they care for, episodes typically centred on the arrival of new patients to the wards and their treatment. It offered viewers a look behind the ward curtain, with staff balancing their professional and personal lives. The show drew attention to the stresses of the medical profession, depicting staff as fallible human beings rather than god-like healers. With stories ranging from the dangers of stripping lead paint from old houses to the graphic nature of skin-graft operations, the programme was praised by press and politicians at the time for raising awareness about the latest and most pertinent medical issues. These included immunisation, prevention of accidents in the home and encouraging blood donation to what was then the National Blood Transfusion Service.

While efforts were made to demystify some of the medical jargon frequently spouted by the staff, medical authenticity was at the heart of Emergency – Ward 10, and its set were based on real hospitals visited by producers. Audiences were reportedly so convinced that the actors received letters from viewers asking for medical advice.

The show also took small steps to represent the diversity of British society at the time. In 1959 Gloria Simpson became one of the first Black actors to be cast in a British soap, while 1961 saw the soap’s first Black doctor, Dr Jeremiah Sanders (played by Clifton Jones). Malaysian-British actor Pik-Sen Lim played Nurse Kwei-Kim Yen from 1964 to 1967, and the much commented-on interracial kiss between Dr Giles Farmer (John White) and surgeon Louise Mahler (Joan Hooley) in 1964 was once cited as the earliest example on British television, courting controversy with the supposed explicitness of their romance.

In an episode from 1964 about the collapse and treatment of an Australian sports reporter, we witness the reporter’s personal life unravel. He is found by a long-lost (possibly unwanted) love and his job is hanging in the balance as a nurse has restricted access to a shared telephone on a trolley. He becomes equally frustrated with the lack of private rooms on the NHS as a fellow patient tells him it’ll cost extra. What’s really jarring is seeing visitors smoking on the wards – all very strange to modern eyes.

Not to be confused with its American predecessor (on the air since 1963), General Hospital was ATV’s attempt to claw back audiences after it abruptly axed Emergency – Ward 10 in 1967. Introducing viewers to the goings-on of a large modern hospital situated close to a busy motorway in the Midlands, it featured a number of familiar faces, including Lynda Bellingham and Crossroads regular Tony Adams.

Following the hospital soap’s now well-established dramatic set-up, ATV promised viewers “insight into the developing world of medicine, whilst retaining the human interest of both patients and staff”. However, early episodes presented General Hospital as a world of arrogant doctors, belligerent surgeons, stern ward sisters, and junior student nurses giggling together in corners like schoolchildren. Even so, press reports at the time reflected producers’ pride in presenting medical procedures with accuracy and detailed (but not graphic) scenes of surgery became a common occurrence. In 1973 one of the show’s biggest storylines involved filming a kidney transplant operation with loans of equipment from a real hospital.

In 1975 the programme graduated to an early-evening broadcast slot and longer running time. The storylines in these episodes were more self-contained. In the 1976 episode ‘A Stitch in Time’, the focus is on the internal politics involved with running the hospital, where the rules and regulations are seemingly at odds with the nuances of individual patient care – a theme that runs through many hospital soaps. Cantankerous senior surgeon Mr William Parker-Brown (Lewis Jones) has now become a patient, much to the aggravation of the ward sister who later threatens resignation. The consequences of losing a patient on the operating table and the procedures that follow are shown to have an effect on junior surgeon Dr Bywaters (Tony Adams) and his chances of becoming a junior surgical consultant.

General Hospital took representing the then-contemporary NHS a step further with storylines about the challenges of providing patient care with the resources available. Staff shortages, redundancies, strikes and the tragic consequences of overworked surgeons all featured. Despite this, it was never as gritty as contemporary TV dramas such as The Sweeney, and dealt with current issues in a more sanitised way. As it turned out, this wasn’t what audiences wanted, and the show was cancelled in 1979.

The very last episode of General Hospital – ominously titled ‘Killer at Large’ – was broadcast on 26 January 1979. Sadly, the episode is currently missing, although ATV’s press release from the time provides a summary of the plot about the spread of a mysterious virus, which culminates with the decision to put the hospital into isolation – a storyline that feels less like fiction to us now than it might have done to 1970s audiences.

Selected episodes of General Hospital are available to watch on BFI Replay at your local library.

Following powerfully in the same strides as its predecessors, Casualty (and spin-off Holby City) is our best known hospital soap – a fixture on our screens since 1986. Created by Jeremy Brock and Paul Unwin, Casualty has always opted for a more hard-hitting look at the NHS through a busy accident and emergency ward at the fictional Holby City Hospital. Never shying away from the harsh realities of its setting, the show has also incorporated dramatic stunts, celebrity guest stars and long-standing characters such as Lisa ‘Duffy’ Duffin and Charlie Fairhead. As well as serving as a training ground for numerous future stars, Casualty has continued to be innovative in its approach to the genre, with one episode in 2017 being filmed in a single take.

The genre was perhaps never more relevant in its relationship with modern society than during the Covid-19 pandemic in 2020, when – with TV production at an enforced standstill – Casualty and Holby City producers offered PPE and other medical equipment to the NHS.

When Casualty finally returned to our screens, a special episode centred on the pandemic, with sensitively handled stories acknowledging the human cost of the pandemic in both lives lost and those striving to save them. There was no need for an elaborate narrative setup, as audiences were already tragically familiar with the situation. Human experience was central to the narrative as the staff at Holby City Hospital not only struggled with the pressures of the situation but also movingly came to terms with the loss of one of their own.

One of my personal favourites, The Royal was a spin-off from the hugely popular 1960s-set police drama Heartbeat (1992 to 2010). Produced by ITV, it was set in the fictional St Aidan’s Royal Free Hospital in Yorkshire and attempted to recreate (though not accurately reproduce) the world of Emergency – Ward 10 and General Hospital.

The Royal offered audiences a cosy, rose-tinted look back at NHS hospitals in the era of starched bedding, stern matrons and pipe-smoking surgeons. It unashamedly borrowed storylines and character types from those earlier soaps, underpinning it with a 60s pop soundtrack. In many ways, The Royal demonstrated that the hospital soap had come full circle, but it also showed that the form established in the 1950s and 60s could still hold audience attention decades later. Behind the scenes, however, the show faced an uncertain future, which led to an unforgivable cliff-hanger ending the programme in 2011. We never did find out if Dr Gordon Ormerod made it out of the operating theatre alive.