Image: NHS from Esther Simpson's Flickr Photostream

We have medical programmes to suit our every taste. Currently viewers can choose high drama with Channel 4s’ ’24 Hours in A & E‘ filming around the clock in Kings College Hospital, London or everyday stories of sore throats, stress and depression from St John’s Medical Centre, Lewisham (Channel 5 ‘GP’s Behind Closed Doors’). The explosion of health programmes can be traced to the early 1980s with medical historian Anne Karpf in her book ‘Doctoring the Media’, observing:

The media’s long standing obsession with health and medicine has swelled in recent years into an obsession. Pages and programmes are crowded with patients offering up their illnesses, physical and emotional for the viewers’ gaze; doctors parading their novel skills and micro-instruments; philosophers pondering medico-ethical conundrums; and testimonials from ex-hedonists renouncing their former ways and flaunting their health new routines

Karpf suggested that these programmes typically took one of four approaches: ‘look after yourself’; ‘medical’; ‘consumer’; and ‘environmental’. Each approach conceptualised audiences in a specific way. In a fascinating book ‘Broadcasting and the NHS in the Thatcherite 1980s: The Challenge to Public Service’ Patricia Holland (with colleagues Hugh Chignell and Sherryl Wilson) explores the links between health in the political domain and broadcasting output. Holland argues that all four categories feature during programming in the 1980s where three consecutive Conservative governments oversaw changes to the broadcast environment.  At the same time NHS patients were re-envisaged as consumers with ‘wants’ rather than ‘needs’.  These developments had momentous consequences.

In the early period of Conservative government there were three official documents published on the NHS (Royal Commission on the NHS (1979), Patients First Consultative Paper December (1979), and The Black Report of the working party on Inequalities of Health finally published in August 1980). The ‘Patients First’ statement focused on streamlining the NHS and shifting to a more managerial culture, NHS consultants would be free to take up opportunities in private practice and alternative revenue would be encouraged through charities and voluntary workers. This report had little to say about the experiences of patients in direct contrast to publication of the controversial Black Report which emphasised the negative impact of inequalities in life expectancy, frequency of illness, child poverty and general health and well-being.

Despite the Conservatives attempting to ‘bury’ the Report by publishing on a Bank Holiday and producing limited copies for the media this nonetheless became a ‘media event’. The themes of poverty and inequality were discussed across the media. Radio 4 current affairs documentary series ‘File on 4’ focused on Liverpool (including a housing estate in Toxteth where riots were to break out months later) in an edition addressing the problems of the NHS and deprivation – a familiar ‘NHS in crisis trope’. The reporter observed harsh conditions on a working class estate where doctors refused to use stairs or lifts for fear of being mugged but there was also an undertone of criticism of the patients:

The health service was failing the district because GP’s could not give enough time. However, young parents were often ignorant about their own and their babies’ health and the reporter described them as part of the problem…’A lot of the parents are, of course, not highly motivated are they? That seems to be the focal point of the problem…Mothers in the doctors’ clinic who had just given birth couldn’t wait to carry on smoking.

These are familiar themes for contemporary audiences accustomed to hearing about working class deprivation coupled with a ‘right wing critique of the ‘underclass’ with implications of welfare dependency and irresponsible behaviour’. Holland also points to the importance of BBC annual event ‘The Reith Lectures‘ where under the title ‘Unmasking Medicine’ Ian Kennedy launched an attack on the NHS which focused on illness rather than a society promoting well-being and social conditions for good health. He argued that ‘need should be the sole criterion of the receipt of a service’ and supported the views of the Royal Commission and the Black Report in attacking poor nutrition, inadequate housing and social inequality.  Kennedy called for a reorientation of values describing doctors as ‘the new magicians’ with the power to decide what counts as illness, treating patients as ‘an ambulatory assemblage of parts, with no attention to their environment.

The advent of ‘glamorous’ morning television in 1983 introduced significant opportunities to explore illness as individually experienced and caused.  The theme of ‘Look after yourself’ was most evident in daytime slots where (largely assumed to be female) audiences were addressed as patients or potential patients. Programmes had strong themes of eating healthily and giving up smoking and these appeared alongside national Health Education campaigns which were using soaps and plays to promote positive health behaviour. This gave way to a more critical approach to the NHS where inadequacies were highlighted and ‘bad doctors’ were disciplined. This consumer focused approach in which doctors’ expert status is challenged and medical practices held to account involved users perspectives and raised concerns about medical mistakes. Holland describes the mood of ‘patients’ rights’ as follows:

Patients were less patient. They were visibly asserting the right to complain, to be awkward to demand information and involvement. Consumer programming on medical topics could venture into dangerous territory. It could make space for the users of the NHS to question its arrogance and opacity, and raise concerns about medical mistakes and prescribed drugs which caused damage to their users.

The launch of Channel Four facilitated more deliberately provocative programming including the series ‘Kill or Cure’ which focused on injury from prescribed drugs. The producer was a journalist who had herself suffered from a medically induced condition. In what was described as ‘campaigning consumerism’ viewers could receive a booklet which listed details of patients and their distress, referring readers to activist groups and Community Health Councils (later abolished). The programme reportedly led to questions in the House of Commons and inquiries into the pharmaceutical industry and the drug watchdogs.

Yet as Holland argues, within political rhetoric concerning the allocation of resources and empowering patients as ‘consumers’ there was little discussion in these documentaries and current affairs of the physical and mental experience of sickness itself. In this context, programmes such as Dennis Potter’s The Singing Detective (1986) were an important rare opportunity for viewers to witness the ‘full subjectivity of being a patient in hospital’. Holland and colleagues argue that both public service broadcasting and what constitutes a ‘service’ changed considerably during this period and what had seemed like extreme neoliberal arguments moved into the mainstream with ‘ideas about what that ‘public’ consisted of and what constituted a ‘service had changed. The concept had been first discredited and then redefined’.

NOTE:  Patricia Holland will be discussing ‘Margaret Thatcher’s Legacy for Broadcasting’ with Professor Steven Barnett and David Elstein at a special seminar at Brunel University 26 June, 4-6 pm – BOOK HERE –