From trans health to children’s palliative care: how three new short films tell untold stories of the NHS

To mark the 75th anniversary of the NHS in 2023, the BFI joined forces with the Arts and Humanities Research Council (AHRC) to create three films that used archive footage as inspiration to tell the untold stories of our National Health Service. 

Now available to stream on BFI Player, the finished films tackle various kinds of intersection with the NHS, including patient access, care and the life experience of employees. As Patrick Russell, our senior curator of non-fiction, described the films, “They respond creatively to archival material, creating new films which are potent mediums for sharing information and emotion; and capturing experiences and interactions throughout the health service.”  

The filmmaking teams were mentored by Professor Shane O’Sullivan from Kingston University who said that what he found most impressive about their work was the extent of “rigorous research and experimentation and great care shown by the filmmakers to accurately represent the communities involved”. 

This is borne out when you watch the films, as their perspectives cover a wide range of stories, including the personal histories of staff who have migrated to Britain from India; trans patients whose interactions with the health service are fraught with difficulty; and children’s experience of palliative care. All of these speak to a deep form of emotional intimacy, a bond that we may all experience with the NHS during our various life stages.

I spoke to the different directors of these films about their choices, processes and how archive films informed them throughout the filmmaking process.

Xavier Pillai: Your film deals with the really difficult subject of children’s palliative care (CPC). How did you approach the process, and how did the different perspectives contribute to the film? 

Oisin Power: When developing Every Moment Counts, we wanted to make a film that acts as a counterpoint to common portrayals of children’s palliative care, which often focus on the tragic and the medical. The problem with these portrayals is that they skew people’s perceptions about what palliative care actually entails. These skewed perceptions isolate families, as other people don’t know how to interact with them appropriately. They also create barriers between families and children’s palliative care services, by deterring people from accessing them. 

During our research, we heard how many families, upon finally visiting a children’s hospice, expressed regret: “I just wish we’d come earlier, but we were scared of what it meant.” This statement reflects a deep-seated fear and misunderstanding about palliative care, and Every Moment Counts aims to be a tool to help challenge these fears and misconceptions. 

Put briefly, Heard [the charity] facilitated a series of workshops with their network of people with lived experience of CPC: both accessing and delivering those services. These workshops directly informed our plot, art style and characters, and one powerful insight, that stayed with me, was: “What a non-disabled person might see as ‘heartbreaking’, is often, in fact, just a disabled person living their life.” This quote inspired us to develop our non-verbal main character – Sarah – a young girl with a rich inner world, and who interacts with her environment in her own unique way. 

One of my favourite aspects of the film is the touching way that sound animates her world. Can you talk about how you chose to animate that sequence?  

We also worked with St Oswald’s Hospice in Newcastle. They allowed us to speak directly with their staff and children; they allowed us to complete drawings on site, lending their architecture to this film, and they allowed me to shadow various members of staff. 

It was when I was shadowing a music therapist that I realised music therapy had to be a central part of Every Moment Counts. This is because music therapy is such a good representation of the personalised nature of good palliative care. Of course, this meant that we would need a good soundtrack. And we have one, thanks to the efforts of our composer Matthew Dwivedi – who works as an NHS pharmacist during the day – and thanks to our partner Spitfire Audio, who granted us access to their musical sample libraries, massively improving Matt’s capabilities. 

The Central Office of Information (COI) has a rich history of animation. Were there any characters in the NHS on Film collection that inspired the animation style or any other aspect of the film? 

There weren’t particular characters that inspired this film, but throughout the archive there are many examples of personalised care provided by the NHS. This resonated with my story. I care so much about palliative care because of personal experience, in an adult context. In 2016, my mum was diagnosed with inflammatory breast cancer. Her name was Mary Power. Mary died in 2019. And during those three years, Mary taught me how palliative care involves many non-medical dimensions. Good palliative care involves trips to the beach, it involves birthday parties, and in Mary’s case it involved a last meal of honeycomb ice cream.   

I believe Every Moment Counts captures this essence and shows how, in reality, children’s palliative care is all about people working together and the relationships that form between them.  

Xavier Pillai: I had family who came to work in nursing from the Caribbean, so I really appreciated the universality of the story of sacrifice in the nurses’ experiences as it comes across in your film. They become breadwinners for siblings or families, care for patients continuously, and, of course, they share a willingness to leave home. Did you encounter any stories like this within the NHS on Film collection? What role did the nursing films in the collection play in your creation of this film? 

Sara David: Yes, the idea of sacrifice and dedication to their roles as nurses foregrounds the film. There’s a sense of resilience in how they’ve approached their personal lives and work, and this made the conversations around caregiving and workload shared by the aunties particularly nuanced. Initially, while researching the NHS on Film collection I was surprised by the lack of representation for stories that illustrated the migratory experience or its impact on the healthcare system in Britain. This gap presented me with a great deal of responsibility while making Khichdi.

However, I found Life in Her Hands (1951) from the NHS on Film collection very interesting. Although it was commissioned and functions as a recruitment aid, it also sensitively portrays this single woman’s journey into nursing and the trials faced within that career, the realisation she comes to terms with about what it takes to become a nurse at a young age feels in parallel with Khichdi. There’s a certain intimacy by which we can connect with characters when they’re vulnerable in this way or share their stories with such honesty, which this style of first-person narrative filmmaking allows for. 

There was a real trust between myself, the smaller crew I had with me and, of course, the aunties. I was keen to make the set small and intimate so they were at their most comfortable during this first meeting, which was unfolding in real-time between us.   

The editing and visual language of the film were important to me from the onset and while putting together my pitch decks. Visually, I was intrigued by the style of editing in Day 359 (1971) in the NHS on Film collection; the film’s edit and lyrical aspect resonated with my interest in experimental moving-image. It’s anti-narrative in structure, and the technique is almost messy in style to replicate something homemade and like a vintage home video your parents would make. I want to use these lo-fi aesthetics to develop a filmmaking style that feels warm and inviting, enabling the audience to engage in the conversations among these women rather than merely observe them. This intention is another reason I kept the crew small; it allowed the aunties to directly address both the crew and me, who was also operating the camera and prompting questions. 

There’s a very clever way in which you feature footage from New Delhi at the beginning and end of the film. There’s a circularity related to that desire to return and the interpersonal histories deeply embedded within this film in the form of recipes, poems and pictures. How much of a role did the personal archives of these women come into the film? 

I was incredibly eager to have the film begin and end on the photo archive, to emphasise the significance of this vast collection of personal photo albums that each of the women had kept all of these years. They were reuniting after 35 years, and their memories of one another are captured in these images. 

Coming from a fine-art background, I was adamant that texturally the film should feel like we are moving between something nostalgic and painterly. From the outset, I had envisioned animated collages from the aunties’ archives reading as diaries or scrapbook-like on screen with scans of handwritten notes and text overlapping them. It was important for me to include these animated pauses between the interviews to reiterate the context in which these women have known one another, as their friendship has evolved from girlhood to womanhood. Maryam Adam, our animator, managed to capture this vision of mine beautifully, with a mix of digital and handmade collaged animations for each film chapter.  

The visuals intertwine with spoken word and the singing of hymns throughout the film, which was essential to convey the shared oral histories between the women. Our sound designer, Sarah-Louise Davila, did an unbelievable job at crafting the soundscape for Khichdi by blending kitchen and atmospheric sounds collected in Delhi with the interviews and singing in Manchester. I was so thrilled that these elements enhanced the warmth of the aunties’ layered friendship. 

Was it a family recipe for khichdi, the rice and lentil dish featured in the film?

Yes, it’s my mum’s. Every desi household will have their own version of this dish. 

Xavier Pillai: Of all the commissioned films yours is most clearly influenced by the archival material, yet it playfully subverts the traditional power relationship in historic COI films. One of the most striking ways you achieve this is through the voice of Dr Mess and their use of the traditional RP voice. Were there any particular films in the collection that inspired that choice? How did you record this new voiceover?

We were inspired by the power dynamics that exist in healthcare, which were re-emphasised to us through the healthcare accounts we recorded with our local trans+ community in Birmingham re accessing gender affirming care through GPs. Dr Mess became a caricatured amalgamation of some of the poor healthcare experiences people had had with their GPs, which we included as verbatim dialogue. We initially used AI to generate an RP COI voice by combining some of the character voices in the archive from Understanding Aggression (1960), Computer Doctor (1974) and Word of Mouth (1989). However, we couldn’t get the clearances on these to use in the end. We then hired a very talented voice actor, Oliver Marriage, to mimic these AI voices for both the narrator and Dr Mess. 

Community is a big theme in the film, and you do a powerful job of highlighting community care initiatives, such as Black Beetle, and signposting resources. How much of a role did community play in creating this film?

We think of the film as a community collaboration project, and it’s been very much grounded in engagement with Birmingham’s trans+ community. The project was built from community interviews about experiences trying to access gender affirming care that became our archive. Combined with our own medical research, we used these interviews directly to build the script. We then invited interested participants to a script development session where we collaborated on how to best weave their stories into the film. It was at this session that the participants told us they wanted to act in the film to connect face and voice.