Doctors in deep trouble

On a cold and wet January morning, I’m ushered into Pinewood Studios in Buckinghamshire. Nearby, production has just wrapped on an impressive scale-replica of the New York backstreets, which can be seen in the latest Marvel movie Spider-Man: Brand New Day. But on the other side of the studios’ sprawling backlot, another gang of fictional heroes are hard at work, with the cast and crew of Casualty calling the historic site their home for the week.

You see, while extensive, the usual Holby City set doesn’t boast a 20ft-deep underwater stage, with actors Olly Rix and Elinor Lawless about to take the plunge for one of the medical drama’s most ambitious stunts yet.

“I love that sense of the industry that’s gone ahead of you [at Pinewood],” says Rix. “I’ve seen the dinosaurs from Jurassic Park, the Bond stages. I guess that’s a statement about what the show is intending to do. There’s been a conscious effort to level up with the storytelling and the production value in these instalments.”

This “level up” is in aid of the series’ 40th anniversary, which will see Rix and Lawless’s characters, Flynn Byron and Stevie Nash, face a life-or-death situation when an ambulance sinks beneath the murky waters of a flooded quarry.

And while both stars have undertaken days of diving training before the dip, these environs are just as alien for the crew as they are the performers, with stunt performers on hand to “block” a more complex take.

In a make-up trailer outside, Lawless laughs, describing her “mini breakdown” during rehearsals. “I was worried about letting everyone down,” she admits, “but the team here are amazing, and I can’t believe that I now feel so relaxed in this environment. Though I don’t have to dig too deep to find something authentic in terms of Stevie’s fear.”

One small mercy is the fact the water is heated to 32⁰ centigrade. “You really feel the cold when you step out, though,” says Lawless, “So I do enjoy getting back into the ‘spa’!”

It’s a long way from where it all began. In 1986 Casualty was conceived as an exploration of the NHS during Thatcher’s Britain, but the strain that our frontline doctors and nurses face today is even greater than it was four decades ago. With record-high waiting lists, severe limitations on social care and an ageing population, some storylines effectively write themselves.

Casualty is getting broader and bigger, the production value is increasing

“There are certainly elements of the show that are very reflective of the inevitable fall towards privatisation,” says Rix. “I’m by no means an expert, but from conversations I’ve had, it certainly seems to be a consideration that a lot of doctors face.”

Later, when I join the team back at the Holby General set in Roath Lock Studios, Cardiff (until 2011 the series was shot in Bristol), the key role that medical advisers play in ensuring the accuracy
of procedures onscreen is clear.

“We’ve had doctors who have been involved in mass casualty events giving us ideas of what would happen in a city of Holby’s scale,” script editor Daisy Hayes explains. “They consulted on the different kinds of injuries you’d see, and most of them were inspired by stories that patients had told us.”

The person responsible for bringing these stories to life through special effects is series make-up designer Kirstie Stanway, a 30-year industry veteran who’s been with Casualty for the last decade. Her office is littered with open wounds, severed body parts, and a 3D printed chest cavity that was recently used to portray heart surgery.

“We sit in a lot of meetings to thrash things out,” Stanway says, “and I often turn up with what I call my book of horrors: images I’ve pulled off the internet that can make everyone feel a bit sick but
are crucial to the process.”

Despite the inevitable tragedies that are part and parcel of the drama, there’s a celebratory tone to these anniversary episodes, with the overriding message being that “Life Begins at 40”. It’s a nod to the changes coming behind the scenes for the crew in Cardiff, where Holby General’s emergency department is currently being dismantled.

Soon, as part of the BBC’s plans to “include authentic representation of Wales and reflect the reality of the Welsh NHS”, the action will move from the fictional Holby to a Welsh hospital, with a new set built in Roath Lock. As for how that will be explained in the series, the Beeb is keeping tight-lipped, but RT has been assured this won’t mean an exodus of viewers’ favourite medics. Perhaps the Clifton Suspension Bridge will allow for an easy commute from Holby, just as it did for legendary nurse practitioner Charlie Fairhead in the very first episode.

In fact, the 40th anniversary episodes pay homage to Charlie and his little yellow VW Beetle in the opening scenes, a similar vehicle rolling past Flynn when he witnesses an explosion engulfing the skies of the fictional Wyvern Valley.

“It’s a nod to the past, with a lot of warmth and gratitude, but also a recognition that Casualty is in a different era,” Rix says. “It’s the show as you remember it, but in a new phase of evolution. It’s changing and getting broader and bigger, the production value is increasing. We’re modernising rapidly, and that’s just as exciting for us actors as it is for the fans.”