Paul Unwin

I had a bad car crash in 1976. I was in a coma and woke up in a hospital in Accrington — the Royal Victoria hospital. The male surgical ward became my home for five months, I was pretty badly mashed up. Thinking about it, my emotions return. The staff were stunning. They helped me through physical and mental trauma. It was quite a transformational experience being in a hospital like that, seeing it all going on, seeing nobody, at any point, say you need to pay for this. I was pulled out of a terrible wreck.

Jeremy and I were old friends from university. We studied at Bristol and then worked together when I directed Jeremy in a play and then directed some of his own work. We were naive about television and were watching things like Hill Street Blues. We both thought we could do something like a medical drama. But we knew very little. We had spent time in hospital, and I think that gave us some sensitivity around nursing, the NHS, and what medicine was about. When Jeremy and I became good friends, I don’t think we immediately started talking about hospitals. But once we got very close, we started talking about how life is held by a thread.

We were quite politically interested. At that time, we felt that television and theatre were forums in which you could express political ideas, if you could find the story. Casualty was driven more by our emotional experience than our politics, though our politics informed everything as we went on.

We wrote a manifesto which began with the line, ‘In 1948, a dream was born. In 1985, that dream is in tatters.’ We were certain that the NHS was in deep trouble under Thatcher. The Bevanite idea of care at the point of need was under pressure: you could see the pressure on the staff. Hospital staff were a family against the world. When the worst happened they took you in and metaphorically held you in their arms. But they were also defending the family against cuts, against unfair working practices, against excessive shifts. What we came up with was a bold idea: that the best way to make this work was that the shift, that unit, those characters would be like a battalion or a regiment all working together. They were the night-shift — six hours, six nights on.

The episode began with the doors banging open. It brought in the story — both how did this person get into this mess and what does that mean — which was often social and political. Injury and sickness are often a result of what is going on in the society. Bad working practices, domestic abuse, malnutrition, disease. Politics explains disease and disease explains politics. That was the important heart of what we were up to.

Peter Salt, an NHS nurse who inspired the character of Charlie Fairhead, became one of the main advisers to the show. He has read and noted every episode of Casualty. I’ve been working back through recently, and I had forgotten his diligence and stubbornness to ensure that the show is authentic about medicine and how the structures of the NHS work. I was talking to him some weeks ago about staff shortages and he was describing how bad they have got post-Brexit, how problematic that was in terms of managing staff. It was quite an alarming conversation, but it also opened something up — which is that the NHS as part of the structure of being British is buffeted by what is changing socially and politically.

There was a classic right-wing attack on us, the NHS, and the BBC. Towards the end of the first season, there was a question asked in the House of Commons about the portrayal of the NHS in Casualty and how we were showing staff drinking on duty out of stress. They thought they’d got us in one, but no. There was a very strong counterattack to that, letters to The Times saying that it was a real experience. People leapt to the show’s defence. The BBC could see that we were going up in the ratings. It became, with this, a real hit. Suddenly something that could have been an eight-episode experiment just caught fire in the public imagination. The show developed a style and a truthfulness. It became popular and went from being a medical drama to something slightly more social-realist. That suited us. We were learning as we went.

Jeremy Brock

I was diagnosed with ulcerative colitis when I was eighteen. I had a very bad attack just at the end of my first year at Bristol. I was the year below Paul but we knew each other. I was in Mile End hospital for two and a half months. I celebrated my twenty-first birthday there. I dropped down to about seven stone; I was in bad shape.

For Paul and me these experiences were very vivid. We were both made acutely aware of what ‘but for the grace of God’ we may have found ourselves facing. It gave us profound respect for what the NHS means, why it exists from cradle to grave, the concept behind it. It was only after university when beginning our careers that we suddenly stumbled on this collective experience that we had. I was working at the BBC as a junior script editor.

Casualty’s success ultimately derives not from any dialectic that we may or may not have wanted to use as a Trojan horse. It derives from its sometimes accidental, sometimes intentional emotional power. The accidental element has a little to do with the milieu we chose, the casualty department, never chosen by anyone in television before. Nobody had stumbled on that idea: when the doors of an A&E department open, a story comes with it. That was a happy accident. Our lack of experience meant we did not really know what we had found. But our political determination was important and we wore it on our sleeves at that age. We were young.

Paul and I started talking about how we could offer something up. We linked up with the Bristol Royal Infirmary and asked to be shown around the A&E department. The young head nurse, Peter Salt, guided us. He became the template for Charlie Fairhead, the central character that runs through the series. I can remember going into the crash room, the resus room, and having to walk out again. I was not ready for anything like what I saw. We were naive, but we were lucky in many ways because we were open-minded and open-hearted. In Peter Salt, we discovered the most fantastic guide.

Our producer guided us through popular television while we were doing our manifesto, folded it into a drama that we believed in and into a set of characters that were familial: mother, father, children. We had that family, we created the drama, it went out. Initially, some of the nursing unions and staff were pretty dismayed at what they saw.

Medical professionals felt that they were the victims of our lack of experience. They felt they were being disrespected. When we went to a nurses’ conference and started speaking to a large room of professional A&E nurses we won them round. Because we told them the truth about what we were trying to do. They could see that our intention wasn’t to disrespect them; that’s what the Tory press was telling them. They actually realised it was the very opposite. NHS staff aren’t angels; they may have drink or drug problems like everyone else, but they have these intentions that are good. That’s the key: fighting against cuts and crazy work practices. From that moment on, we never had any problems.

When drama sings, when all the pieces are really working, your relationship with the audience is unpredictable. You can’t tell when the zeitgeist will catch fire. Season one brought a level of experience, energy, and commitment. It was excitement, along with our audience’s realisation that there was something to celebrate and enjoy. By the end of season two we were roaring up the ratings. The rise was exponential for many years. The programme became an institution in its own right, which was ironic because it was a critique of the government’s attitude towards an institution.

We moved on, but we’re very proud of the show’s DNA. Built into the show’s DNA is a flexibility that means it can respond quickly to any set of circumstances, whether they’re political or internal institutional politics. There’s different ways in which the show reflects the zeitgeist. One is to try to reflect what is going on with governments, and the other is to reflect how an institution of that size functions or how it can sometimes be dysfunctional. The show has been able to look at that with a really clear eye. I do believe that’s a consequence of the A&E department being on the frontline