“Unless you’re Adam Curtis, the pictures have to fit the words”: talking to NHS England’s in-house filmmaker, Thomas Randall

Our series of articles celebrating the NHS’s 75th anniversary has been a mix of looking back at 75 years of archived filmmaking, looking around us at the relationship between health and filmmaking today, and looking forward to how film and our National Health Service might evolve together in years to come, populating the archive of the future. In this interview we encompass all three, as Thomas Randall, employed as in-house filmmaker for NHS England, explains his role, shares his favourites from the BFI National Archive, and speculates on the future of film in our public health services. He offers a fascinating behind-the-scenes glimpse of NHS filmmaking, and the NHS itself.

Tom, you started in TV. What’s your back-story?

At university in Manchester, I did a two-day journalism course, from which I got BBC work experience and an invitation to apply for a broadcast journalism PGDip. Then I moved to Northern Ireland to report for Derry’s C9TV. Back in Manchester, for BBC North West Tonight, I took Public Enemy to where teenager Jessie James was murdered, to meet local Moss Side boys; and for Granada, I flew round the world in three weeks, stopping off in 10 locations to meet North West expats. Moving to network TV, I travelled in 165mph police cars, went undercover as a debt collector for Dispatches and slept on the sofa of a victim of antisocial behaviour for News at Ten.

Graduating to producer-director, I filmed undercover at bogus colleges in Pakistan (culminating in shouting questions at one college boss as I chased him through Walthamstow); moving into a hotel temporarily housing homeless people; captured the far right doing Nazi salutes while drinking mead from horns (while pretending to be from a charity); and spent five months travelling with an antique funfair.

Finally, I stepped up to exec producer, creating a BBC One series about an attempt to use food waste to solve food poverty, uncovering police sexual misconduct for ITV Exposure, then for BBC Panorama breaking the news that the DWP were the UK’s worst employer for disability discrimination.

So quite a ride in broadcast. Then – during Covid – I joined the NHS.

What’s your role as filmmaker-in-residence at NHS England?

I’m attached to the communications department to make films about interesting, impressive new things that the NHS is up to. The key is finding the human angle, how new schemes affect the public, patients and staff. I travel England with access to clinics, hospitals and outreach teams, as a fly-on-the-wall. I make around 20 films a year, shooting and cutting everything myself. They end up on our YouTube channel and across social media.

How do you turn NHS briefs into effective audience-facing films?

With my journalistic background, where editorial control is sacrosanct, I was worried my films might get cut to shreds in the corporate world. But they haven’t been. Most sail through without any changes and where there are notes they’re minimal, sensible and have strong arguments attached. In TV I was perturbed by how many changes were subjective. It’s not like that here.

In corporate communications, the central goal is conveying ‘key messages’, which can be done with storyboards and scripting answers to questions but often leaves films feeling stilted. My opening argument is: if the people we’re filming aren’t actors, why are we giving them lines? I then explain that if we get the right people, in the right place, at the right time, while the right things are happening – not only will we hit your key messages, we’ll capture important points you haven’t even thought of. This, I say, is the beauty of observational documentary.

Talk us through some examples.

Our vaccination/kidney transplant film was great because it was unplanned. I was travelling around documenting the vaccination rollout, looking for unusual locations and came across Blackburn Cathedral. By sheer luck I ran into our contributors, with a fantastic story they told really well. I shot and edited it fast. Everyone loved it: no changes.

The best single moment I’ve captured here is in a long-running series with the health inequalities team. Their communications head, Leicia Feare, gets access and Professor Bola Owolabi plays the Louis Theroux role. It’s the moment when Bola asks the contributor what life was like before the team helped her that really demonstrates my belief that documentary can surpass drama as an art form. You can catch a moment that, because it’s actually happening, outclasses anything scripted. Bola has an amazing ability to connect with contributors (she’s a GP, so perhaps that’s not surprising). Then we just shoot what unfolds. These films are usually shot in a couple of days but take much longer to edit.

The film we did on virtual wards exemplifies how Reithian principles (inform, educate, entertain) are applied to my NHS pieces. On paper, the name and concept of ‘virtual wards’ are abstract. But the film gives viewers insight into what it means in practice: what will happen if they, family or friends are admitted onto a virtual ward. So ‘inform’ and ‘educate’ are covered. Then I’d like to think the film also ‘entertains’, because of the patients’ contributions. Their struggles and the relief they get being on the ward are easy to empathise with, speaking to the human condition.

We did a piece on sickle cell disease that I hope shows that my films, and the NHS, can tackle uncomfortable issues, requiring self-criticism:

But I think my best one is on long Covid and would like it to speak for itself:

You made England’s official NHS75 anniversary film, which uses the BFI National Archive holdings.

That was great – a challenge going through the collection, but I loved it. There’s so much there and I relished the opportunity to combine it with material I’d shot. Very different from my usual style. I suppose the previous experience I brought were the fundamentals of storytelling. Unless you’re Adam Curtis, the pictures have to fit the words, but shouldn’t be on the nose. Don’t try to find a picture for every word.

As a contemporary filmmaker exploring the BFI collections, what were your reactions?

Overall, what struck me – perhaps I shouldn’t have been surprised – was the quality. The films were so well-produced: the sound, especially, was perfect. So many good up-sounds to choose from. I can only hope my films aspire to such quality.

I agree with you about the brilliance of the mental health training film Understanding Aggression (1960). It’s not just a good NHS film, it’s a great film in its own right. An extraordinary piece that really affects the viewer, showing the value of drama as well as documentary to inform people:

More specifically, Doctor’s Dilemma (1948) provided a perfect start for my film. Watching it in full you realise it still sums up how the NHS works, 75 years on:

The animation Your Very Good Health shows how you can get messages across using different media:

In my film I used two beautiful moments from Polio – Diagnosis and Management (1948). The first clip encapsulates the sentiment at the heart of the NHS. The second has the same authoritative but warm voiceover. But the real value comes from the change of expression on the patient’s face. She goes from looking very serious and quite worried, to looking reinvigorated when she realises the device she’s testing will really help her. That second smile is a perfect documentary moment. I could give you a shot-by-shot description to be honest – I wonder if people outside the industry are aware that if asked we could explain the significance of every frame we use.

Hospital Team in Action (1960) provided the perfect close. I can’t overstate how the voiceover and visuals of these films cut through, grabbing the modern audience’s attention as effectively as any modern material:

What’s the future for internal NHS filmmaking?

NHS England is going through a reorganisation. I’m moving from strategic communications to a new ‘creative team’. It’s really exciting. From speaking to the deputy director in charge, my new role will involve making a wider variety of films – a challenge I’m looking forward to.

With thanks to John Carino, BFI National Archive footage team, for facilitating NHS England’s access to BFI National Archive holdings, and to Gillian Scothern for essential work in coordinating and supporting the BFI’s contributions to #NHS75.

Explore the NHS on Film collection on BFI Player.