1 9 8 6 – current (UK)
Since it was launched on 6 September 1986 as a 15-part series, the hospital drama Casualty has grown into one of the BBC’s most successful programmes.
Eventually running to 24 episodes a year (plus a repeat season), and with ratings second only to those for soap operas EastEnders and Neighbours, it was to become a linchpin of the schedule and crucial to the corporation’s confidence in the run-up to the renewal of its charter in 1996.
The series began as the brainchild of Jeremy Brock, a young BBC script editor, and Paul Unwin, a director at the Bristol Old Vic Theatre.
A visit to a Bristol A&E (Accident and Emergency) ward, and conversation with one of the charge nurses, prompted the idea of a series which would deal with the working lives of casualty staff but which would also have a campaigning edge at a time when the National Health Service in Britain was under increasing financial and political pressure.
The proposal was taken up by the Head of BBC Drama, Jonathan Powell, who was convinced that a medical series was essential to a healthy schedule.
The Bristol hospital became Holby General and the nurse, Peter Salt, one of the programme’s medical advisors and a model for the longest-serving central character, charge nurse (later nursing manager) Charlie Fairhead.
The foregrounding of a male nurse was one of the several ways in which Casualty set out to contest the traditional values of hospital drama.
The gender stereotyping associated with sluice room romances of popular medical fiction was inverted in storylines such as Charlie’s passionate involvement with a female house officer, and the protracted consequences of nursing officer Duffin’s pregnancy by a feckless doctor.
The series also attempted to address racial under-representation by placing black characters at the centre of the drama and has carried storylines on racial prejudice and abuse.
What Casualty sought to achieve in its first series was a gritty realism bordering on documentary authenticity, capable of dealing with the day-to-day stresses of front line emergency care and the further difficulties of working in a system coming apart at the seams.
Brock claimed to have been influenced by the high-octane style of MTM shows, especially Hill Street Blues, with their overlapping narratives and dialogue, their rapid cutting and their wry humour, though the series never went for the sort of élan found in its US counterparts.
It began on a modest budget and was shot exclusively on video, with lightweight cameras to give it pace and fluidity: the technique of following dialogue down corridors and picking up on several overlapping conversations within the same take was to become a hallmark of the emerging production style.
The central storyline for the first two series was the campaign to keep the night shift open at Holby in the teeth of funding cuts.
The shift also provided the setting and time frame for each episode and, improbably, a justification for focusing on the same eight members of staff. By the end of the first series, although another was in production, there was talk of Casualty being axed.
There had been criticism of the show’s stress-laden relentlessness and press coverage of protests from the medical professions about the disreputable image of staff conduct, though there was considerable support for the series’ representation of health service conditions.
The programme also came under attack from the ruling Conservative Party for its stand against such key Thatcherite policies as funding cuts and the contracting out of services. Along with news coverage of the bombing of Tripoli and the drama The Monocled Mutineer, Casualty was held up as an example of alleged left-wing bias at the BBC.
However, as audience figures for the second series began to climb to eight million, the BBC started to invest more in it. New characters were brought in and a sharper style began to emerge, particularly in the cross-weaving of storylines and the more honed gallows humour.
By 1991, Casualty had an audience of 12-13 million and the formula was securely established; a basic structure created by the ten main characters’ continuing stories, a major accident interwoven with six to eight further parallel storylines and up to 80 short scenes per episode, a real-time feel based on the single shift setting, sharp cutting, mobile single-camera work, no background music, realist lighting, an army of trauma-specific extras and models, and a range of 30-40 guest actors per series.
The casting of familiar, high-calibre performers in cameo roles was for some time one of the series’ main attractions, along with its growing reputation for graphic authenticity in the depiction of injuries and their treatment.
The series also shed its regional identity: although still shot in and around Bristol, this was no longer its ostensible setting and the characters came to reflect a more general population mix.
A proposal by Powell, by now Controller of BBC1, to go to a twice-weekly, early evening slot was rejected but by this time, many would argue, the show had already softened into standardised predictability.
By 1993, audiences were peaking at 15.47 million and the unsuitability of a storyline about ‘rent boys’ and male rape and further controversy over an episode showing teenagers rioting and burning down the ward forced the new BBC1 Controller, Alan Yentob, into a promise of greater “responsibility” in the handling of topical material. A year later, audiences stood at 17.2 million.
Against the claim that Casualty has lost its earlier political abrasiveness, the producers would argue that public opinion had caught up with the programme, that the once-controversial claims had become fact and the issues were more subtly woven into the fabric of the stories. By 1995, however, the series seemed to reach a final transformation into soap opera.
It was the human interest vignettes imported with each casualty case which now dominated, along with the lives and loves of the regular medical staff. Yet the storylines have never fully lost contact with the fabric of contemporary life, one of the series’ recurring concerns being the social cohesion of the world beyond the hospital doors.
Casualty is a classic example of the development of formula based television fiction. All the attractions of hospital drama are there: life, death, and human vulnerability; institutional hierarchy; the personal and professional tension.
Beneath the surface, however, the fictional structure rests on foundations tried and tested in the traditional police drama, and it is no coincidence that the background of founding producer Geraint Morris lay with series such as Softly Softly and Juliet Bravo.
The Accident and Emergency ward, in particular the waiting area that provides the focal point of the production set, operates here as a classic front line – a site of friction between the hospital community and life on the street, and a space into which hundreds of individual cases are drawn, to be returned, in varying states of social and psychological repair, to the world beyond.
Dr Mike Barratt
Dr David Rowe