Get Him Into Crash Duffy: Watching Casualty

Darren Slade

Talking Pictures alias






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Casualty - every episode of which plays like a politically correct disaster movie - is one of the most downright entertaining shows on British television. This article attempts to look at the programme's content and structure to discover what makes it so enjoyable. 

Casualty has become the slickest example yet of a particular TV genre (and a BBC-dominated one): the 'institutional' drama series of which Z Cars, Angels, Juliet Bravo etc. were all examples. This genre can be defined by its setting, by the way its self-contained and ongoing plots operate, by its relationship to ideas of 'realism', and by its concern with social and ethical issues of the day. 

1. Structure

One of the first things the viewer notices about Casualty is that each episode moves very fast. Each 50 minute episode consists of around 50 scenes, with (usually) three major plots plus a couple of self-contained sub-plots and still more sub- plots which develop between episodes to reward regular viewing. 

As an example, here's what goes on in the episode 'Tender Loving Care': 

Major Plots: 

    A. An elderly man collapses in a synagogue. He's saved by staff on Holby Hospital's accident and emergency ward, but afterwards his wife - a stroke victim - collapses and dies. 

    B. A boy being bullied on a school trip collapses from sickle cell disease. The A&E (Accident and Emergency) team manage to revive him. 

    C. A man deliberately self-induces an asthma attack to keep his estranged wife with him. A hospital blunder leads to him being given the wrong medicine. He intends to sue, but his wife stops him by threatening to reveal that he's been assaulting her. 

Sub-Plots This Episode: 
    A. A homeless woman is stopped from sleeping in the A&E ward, and turns out to have been stealing its charity boxes. 

    B. The reception staff get into trouble for ordering pizzas for patients. 

    Sub-Plots Continuing Between Episodes: 
    A. Duffy (the ward sister) goes for a biopsy examination and is asked to return for more tests. 

    B. A nurse, Sandra, continues her awkward romantic relationship with the irascible consultant Julian. 

    C. Receptionist Norma becomes increasingly worried about her elderly mother, with whom she lives.

For the regular viewer, part of the pleasure of watching Casualty is in watching the regular formula unfold.

Watching Casualty - TV with guts...Illustration by Brindley Newton.In the first 20-25 minutes, the narrative interest is focussed on what accident is going to befall the characters (often played by well-known TV faces) who have been introduced in this episode. In this episode, for example, we start to guess that the boy Ben is going to collapse from sickle cell disease, and we can see disaster looming when the staff are distracted from treating the asthmatic Adam. 

The remaining 25-30 minutes are generally spent resolving each accident or crisis. Normally, we can expect an episode to contain three emergencies, at least one of which will end in death. It's not unusual for the show to end with one patient still fighting for life. The disparate plots are often linked by having scenes change their subject in mid-flow, so that (as in Hill Street Blues) the camera will follow one character or group and then pick up on a different character as their paths cross. 

Yet the fact that Casualty runs to formula doesn't diminish the suspense. On the contrary, it increases the tension for the viewer, since we know that at least one of this week's characters is not going to make it to the end alive - and we want to know who and why. 

2. Characters

Casualty's paradigmatic structure. Soap opera critics have talked about the paradigmatic nature of their genre: we enjoy the show more if we know the characters' history and can relate occurrences in the story with a network of past experiences and relationships. Something similar happens in Casualty, which builds elements of the soap opera into essentially self-contained episodes. 

There are 10 main characters in the programme's 1992-93 season, besides a couple who appear occasionally. (A checklist: Charlie, Duffy, Ash, Sandra, Norma, Rob, Max, Josh, Jane and Julian, who was re-placed by Mike in mid-series.) We are given an insight into the private lives of a couple of characters per episode: Charlie's fight with alcoholism and his unhappy relationships; Duffy's affair and engagement, and her worries over a smear test; Julian and Sandra's ill-fated affair, etc. 

The show rewards regular viewers by building up a soap opera style paradigm of relationships. For example, in the 'Tender Loving Care' episode, when the receptionist Norma consoles an elderly man about the death of his wife, she tells him he should be glad she didn't linger for years like some people. The scene means more to regular viewers because we know Norma has an aged mother to care for - a situation which has been affecting her life and her work throughout the series. 

A side effect of this paradigmatic structure is that the show doesn't depend on any one character. It's already survived the departure of several of its most popular personnel, including one played by Oscar winner Brenda Fricker, and would probably be able to carry on even if Derek Thompson (Charlie) should leave, because other characters are being groomed for succession. Actors need the series more than it needs them. 

3. 'Realism'

People often praise Casualty for being ‘realistic’ or criticise it for being ‘unrealistic‘. Holby (its fictitious setting) is clearly based on Bristol (where the show is shot); the series often draws its plot ideas from the headlines; and publicity is always keen to stress the authenticity of the medical scenes. But the insistence on using the word realism tells us more about British critics' obsession with that word than about the programme itself. 

Plainly, an episode of Casualty isn't representative of reality on an A&E ward - otherwise its running time would be largely taken up by people waiting to be treated for sprains and zip fastener injuries. Casualty makes exciting drama precisely because it depicts incidents which are atypical in an A&E ward: squash players impaled on their rackets, farmers whose feet have been chopped off by their machinery, hunt saboteurs trampled by horses and children crushed in ram-raids, for example. 

But the programme's medical authenticity is a vital part of the viewer's enjoyment, because it presents us with an endurance test. We like to watch its gory moments without flinching because it somehow enables us to feel we've seen something horrible and conquered our squeamishness. The series depends on convincing special effects, otherwise this part of its appeal -based on the viewer's faith that the gory moments are depicted accurately - would be lost. 

4. The liberal view

Each episode of Casualty raises a host of political, social and medical issues. To take the 'Tender Loving Care' episode as an example again, the issues dealt with here are: 

    • Domestic violence
    • Homelessness
    • Bullying
    • Under-staffing of the NHS
    • The dangers of 'hooking' patients on prescription drugs. The need for women to have prompt smear tests
    • The ethics of suing hospitals for their mistakes.

Another episode, 'Body and Soul' explores blood sports (taking care to feature 'good' and 'bad huntsmen), rape (along with the problems involved with reporting it to the police) and the ethics of non-violent protest versus direct action.

Like other shows in whose footsteps it follows, Casualty adopts a liberal/left of centre political position. The series depicts the problems created by the NHS reforms (Holby Hospital has become an NHS trust), yet union militancy is usually ruled out as a solution: Charlie struggles on under the new management but has to deal with complaints from the more political union rep Ash. 

The show's attention to social issues was demonstrated in the last episode of the 1992-93 season, 'Boiling Point' , and it would be almost impossible to discuss the series without mentioning the furore surrounding this edition. 

Re-scheduled to go out after the 9pm watershed, the episode was the subject of hundreds of complaints, and the outcry prompted a disgraceful climb down from the BBC, which said the programme had "gone too far". 

The plot had a gang of thugs setting fire to the hospital, and the complainants said it could have prompted copycat attacks. Setting aside the fact that a similar incident had already occurred in reality, this knee-jerk response to violence on TV shows once more the Mary Whitehouse lobby's assumption of a hypodermic model of audience response: the complainants think potential yobs would not only be at home on a Saturday night watching Casualty, but would be tempted to try burning down their local hospital. 

Yet the 'Boiling Point' episode was an instant TV classic. It tackled some of the most important issues of the 1990s: the lawlessness of Tory Britain, the public belief that the police can't help and the ethics of vigilante action. And it worked all this into a hugely exciting thriller which had a hospital under siege, patients dying on the hospital forecourt, and a regular character (Rob) being badly injured in a disaster. 

Despite its serious treatment of important issues, the protesters could see nothing except the fact that violence took place on screen. The BBC's lily livered response - and reports that the producers have been told to tone down the next series - may mean the 1993-94 series of Casualty is more timid. That would be a great loss to television. 


Nearly ten years later the BBC is still producing Casualty and it has bred a spin-off series, Holby City. Meanwhile ITV has produced a rival series A & E, and there is the US series ER. ER’s fast pace and action has had a big influence on the British hospital dramas. 


The episodes referred to are from the 1992-93 series of Casualty, produced by Geraint Morris for BBC Bristol. Series devisers: Jeremy Brock and Paul Unwin. Script editors: Sally Haynes, Laura Mackie. 
Regular cast for this series: Derek Thompson (Charlie Fairhead), Cathy Shipton (Lisa Duffin), Patrick Robinson (Martin Ashford), Maureen Beat tie (Sandra Nicholl), Anne Kristen (Norma Sullivan), Jason Riddington (Robert Khalefa), Nigel Le Valliant (Julian Chapman; left mid-season), Clive Mantle (Mike Barratt; joined mid-season), Emma Bird (Maxine Price), Ian Bleasdale (Josh), Caroline Webster (Jane). 

In particular, I've referred to the episodes 'Body and Soul' (transmitted October 31 1992; writer: Peter Bowker; director: Bill Pryde), 'Tender Loving Care' (November 11 1992; writer: Barbara Machin; director: Alan Wareing) and 'Boiling Point' (February 201993; writer: Peter Bowker; director: Michael Owen Morris).

Also see: TV Makes Me Sick
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