THE NATION'S HEALTH (1983)

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The Nation's Health

Channel 4 was barely a year old when G F Newman's searing drama about the NHS debuted. A commission from Euston Films, produced by the legendary Verity Lambert, The Nation's Health cemented the channel's reputation for hard hitting drama, particularly at a time when Thatcher's government was sharpening its knives ready to butcher the welfare state amidst her own drive to reverse what she saw as a national decline. There is no doubt she inherited a UK dubbed 'the sick man of Europe', crippled by high inflation, high unemployment and stagnant growth. The NHS was caught up in her desire to deregulate the finance sectors and labour markets and flog state owned assets and companies.

Newman was no stranger to controversy. His proposed script for Z Cars, in which he depicted Sergeant Watt accepting a bribe, was deemed unsuitable at the time. He then went on to write the four episodes of Law And Order in 1978, produced by Tony Garnett and directed by Les Blair in a distinctive documentary format, wherein he examined various aspects of the criminal justice system: police, criminal, courts and prison. Newman's depiction of a system riddled with corruption outraged both the police and the Prison Officers Association (who banned the BBC from filming in British prisons) and Garnett sealed his reputation as a drama producer by defending the drama against accusations of bias.

The central character of Detective Inspector Pyall (a remarkable performance from Derek Martin) was seen as simply one amongst many individuals who brutally twisted the system in their favour. As Newman himself said in 1993: "The person who becomes a policeman has almost exactly the same pathology as the criminal." According to Newman, questions about the terrible state of the criminal justice system were asked in the House of Commons and pressure applied to the BBC not to repeat or sell the series again (BBC Four did eventually repeat it and it was released on DVD in 2008).

By the time of The Nation's Health, Newman espoused some strong and often controversial opinions about the medical profession. After its broadcast, he was confronted by doctors outraged by his views that the profession was not interested in prevention only in treatment, being caught up in the interests of international pharmaceutical companies whose only interest was to trial drugs and get them onto the market. In an interview with the Independent in 1994, Newman said of The Nation's Health that it expressed his conviction that 'in the average general hospital, one-third of people are suffering from illnesses induced by the medical profession'. This view also translates into his proselytisation of alternative therapies and veganism.

These provocative ideas do thread their way into the four episodes of The Nation's Health which follow the trials and tribulations of a young doctor, Jessie Marvill, as she joins the surgical staff of a large teaching hospital, St. Clair's. The opening episode, as with all the others, reunites Newman with director Les Blair who films the drama with a documentary realism, using no incidental music, allowing the narratives to unfold as naturalistically as possible. Jessie is clearly conflicted from the beginning, unsure of what path to take in her career as a doctor, and we follow her as she explores her options within the hospital and NHS system, itself symbolically a patient under pressure and on the verge of collapse, as various public spending policies and cuts close wards, specialist units and sell hospitals to the highest bidders.

As we observe Jessie's progress through this crumbling institution we are shown a system wherein consultants, making money from their private patients, clearly have their own agenda for the closed wards; unions are aghast at the cuts to services but seem powerless to prevent them; administrators desperately try to keep services going by begging and borrowing resources from elsewhere to provide treatment and, most crucially of all, patients seem to be subjected to inconsistent levels of care and severe incompetency and we see an ageing GP who slogs his guts out all hours of the day.

It's a depressing but utterly riveting series with all four episodes showing an NHS on its knees, obviously suffering from serious under resourcing, staffed by doctors and consultants who have long since ceased to be human and where the treatment of patients can spiral into unreasonable demands on such a service. Yet, Newman can't quite offer up an alternative solution to this beyond admitting it's a mess and a rather tokenistic suggestion that treatment for patients might improve through alternative healing and veganism. He doesn't really get beyond showing a thoroughly disillusioned Jessie questioning her very reasons for joining the profession in the first place.

The first episode Acute deals very tragically with cancer patients, how cancer is diagnosed and treated and the potential alternatives to surgery, drugs and radiotherapy, the second Decline looks at the fate of GP admissions, the third Chronic focuses on the old and the fourth, Collapse, explores the issues of mental health and how patients struggling to put their lives back together are denied the opportunities to rejoin society because of objections from the public and lack of support within the NHS.

In Acute, Jessie (a quite hard nosed performance from Vivienne Ritchie which does make Jessie hard to like) arrives at the hospital to take up her surgical training and enters a world where consultants hold sway over the prescribed treatments for patients and refuse to brook with any alternatives. She also meets the very angry and disillusioned Dr. Vernon Davis (a young Ian McDiarmid) whose fate, as the series progresses, is equally unfortunate and there is a discussion with a therapist on how cancers develop at an unconscious level that specifically reflects Newman's views about treatment.

As this unfolds, the hospital kitchens are in complete chaos as an outbreak of food poisoning occurs whilst the facilities are being redecorated, the unions are getting jumpy about ward closures and, shockingly, a consultant refuses to accept a new registrar simply on the basis of racial origin. She later clashes with the same consultant about his directions for one patient, believing his treatment is perhaps not in the best interests of a patient, Mr. Taylor. Mr. Taylor, is a tragic cancer patient who undergoes surgery, and whose wife, utterly devastated by this, spirals into depression and an equally upsetting fate in the third and fourth episodes. Both Tony Calvin and Eileen O'Brien, as the Taylors, offer truly memorable and heart breaking performances here.

In Decline, we meet local GP Dr. Thurson, a sympathetic performance from Sebastian Shaw, as an old man who copes with the burdens of his practice by heavy use of medication and yet he offers one of the more compassionate and human depictions of the medical profession in the series. As well as a packed surgery, he has to deal with pharmaceutical reps barging into his workplace. We follow the stories of a number of his patients, Mrs. Grant, Chloe Shallcross, Henry Staples and Bernice Attwood as well as a contrast with a consultant's private patients who receive treatment according to their status and wealth. Jessie clashes with consultant Montagu over the radiotherapy treatment of a cancer patient Mrs Downes after she implements an alternative much to his chagrin. Newman again shows his hand by showing a recovering Mrs. Downes after the cessation of the radiotherapy.

What's clearer here is Newman's assertion that the way these patients are treated actually does more harm than good and as the series progresses we see what he considers would be the results of such harm in the final two episodes with Bernice (traumatised after a miscarriage), Chloe (suffering from post-natal depression) and Henry Staples (descending into senility after the death of his wife) all ending up as patients on a psychiatric ward in Collapse.

In the final two episodes we follow the tragic story of Henry Staples and of Bernice Attwood where in Chronic Henry is admitted to hospital at the same time as his wife against a background of strikes and ward closures. Sadly, his wife is recovering when she takes a fall and dies. The story follows the man's decline despite the best efforts of his GP and social services when he's convinced his wife's body has been inappropriately disposed of. He joins Bernice in a psychiatric unit in Collapse where we see her emerge from her depression, taking an active part in her own rehabilitation until changes of policy, lack of funding and a sadly outdated public view of mental health forces the unit to close. The series ends bleakly with Bernice under heavy sedation after attempting to burn down the unit and with Jessie Marvill considering leaving the profession.

The series is hard hitting and asks a great deal of uncomfortable questions about health, well-being, the kind of treatments that doctors prescribe and the alternate therapies and strategies within the very powerful notions, best expressed by post modernist theorist Michel Foucault, of the clinical gaze, bedside teaching, physical examination, the patient confessional as well as the profession's methodology in categorising disease within the institutions of clinic and hospital where we as patients are classed as docile bodies subjected to the allegedly authentic but equally dehumanising knowledge of the medical expert.

The great shame is that Newman can't offer solutions to these issues, which we were all aware of at the time and which continue to be of major concern even now, beyond a vague bit of vegan soap-boxing (meat eating=cancer) by Jessie in the last episode and the rarely mentioned suggestion of alternate therapies. Despite this, it's a well made series, brilliantly performed. The Channel 4 transmissions were followed by live discussions and it's a shame these weren't included as extras here to give the series a contextual setting within the debates about the NHS at the time and within those that are still ongoing.

Review: : Frank Collins

for Television Heaven
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