I have watched pretty much every episode of the medical reality show 24 Hours in A&E (Channel 4, 2011–). Even though much of my research happens to focus on medico-scientific discourses in contemporary television, this is a programme I have watched for pure pleasure. But when the premiere of the programme’s 8th season, in early January 2015, happened to coincide with the mostrecent wave of media reports about the NHS being in crisis, I started asking myself why I find this particular show so compelling on a personal level.
Following the traditions established by hospital dramas and other examples of medical reality TV, 24 Hours in A&E features scenes of spectacular body trauma, fast-paced emergency care, and cutting-edge medical technologies. However, in comparison to US medical reality shows such as Hopkins(ABC, 2008) and Boston Med (ABC, 2010), as well as Channel 4’s other emergency care show Extreme A&E (2012), 24 Hours in A&E puts less emphasis on gore, excitement and medical marvels. Although injured bodies are certainly put on display, we rarely get to follow the patients into the operating theatre and explicit close-ups of invasive procedures are usually omitted. Unlike most of its peers, 24 Hours in A&E features plenty of minor and mundane ailments alongside storylines focused on severe emergencies and rare medical cases. Its use of parallel editing works to defuse some of the tension that is built up in storylines following time-sensitive cases; we are repeatedly given breaks from the life and death drama of stabbings, traffic accidents and heart attacks, by regular shifts in focus onto more humdrum cases.
The use of fixed rig, remotely controlled cameras (a technique that John Ellis examined in a recent CST blog) also helps construct a more toned-down version of emergency care. As has been pointed out by Kirsten Ostherr, US medical reality TV has usually used lightweight hand-held cameras to create an uneven and jostled aesthetic that conveys feelings of stress and excitement, and produces a heightened sense of liveness (193). 24 Hours in A&E also utilises a number of techniques to render storylines about potentially life-threatening injuries more dramatic (primarily fast-paced editing and non-diegetic music). But the static and repetitive nature of the fixed rig camerawork generally has a calming effect that provides a sense of lucidity, predictability and stillness amongst the hustle and bustle of the emergency ward. This effect is partly the result of the fixed rig technique’s own cultural associations with objectivity and authenticity. Helen Littleboy has shown that both the promotion and reception of Channel 4’s fixed rig documentaries The Family (2008), One Born Every Minute (2010-), Educating Essex (2011) and 24 Hours in A&E discussed the remote controlled filming process as suitable for capturing the ‘mundane, universal truths about human life’ because it completely removes the camera crew from the events (134). Of course, this belief can easily be deconstructed, but in the case of 24 Hours in A&E it still helps to produce a more down-to-earth portrayal of emergency care as everyday rather than exceptional. As someone who has hypochondriac tendencies and worries quite a bit about ending up at an emergency ward, this feeling of mundaneness is one of the reasons why I enjoy watching 24 Hours in A&E: I find it pleasantly soothing.
Another aspect that makes 24 Hours at A&E stand out from other medical reality shows, and that makes it more comforting to watch, is its narrative focus on emotional care. Instead of simply featuring generic narrative arcs that follow a course of medical treatment, 24 Hours at A&E’s storylinesconvey the affective experience of being at the A&E department by chronicling the emotional impact that accidents and illnesses have on patients and their loved ones (as well as the medical personnel, to some extent). This emphasis is effectively established by the show’s opening montage. It begins generically with a fast-paced sequence of thrilling shots, for example, showing flashing lights, an ambulance speeding through the streets of London, the red emergency phone being picked up, a helicopter landing on the roof of the hospital, and bloody and bruised faces. But then the tone changes as the action-packed shots are gradually exchanged with humorous scenes of patients and personnel goofing around, and finally, a series of touching images of patients being comforted and cared for, as well as multiple close-ups of relatives and friends crying. This final section of the montage is accompanied by voice-overs of doctors asserting how important it is to express your emotions at moments like this: “Life is unpredictable. So it’s important that your nearest and dearest know that you love them, you have to tell them you love them. Because there may come a time when you are not around to tell them.” So, even if emergency care is initially presented as a thrilling and dramatic subject matter, it is quickly reconstructed as both humorous and heart-warming.
Stills from the series 8 opening montage of 24 Hours in A&E.
Emotionally charged imagery of people crying, comforting each other and expressing their love make up the ‘money shots’ of 24 Hours in A&E, so the programme clearly favours cases where relatives or friends accompany the patients. In cases where patients arrive alone this type of affective imagery is substituted by an increased emphasis on the empathic and caring nature of the medical personnel. Talking-head interviews with doctors and nurses are often used to underline that the personnel truly care for their patients and have been personally touched by their stories. Emotional care is thus constructed as a crucial part of the medical treatment, and in extension, as a universal human right. 24 Hours in A&E’s fondness for affective imagery works in tandem with its amiable tendency to represent a wide range of patients (varying greatly in age, class, and ethnicity) to promote the British universal health care system by asserting the moral value of freely available medical care and emotional support. On 24 Hours in A&E it doesn’t matter if you are upper class or penniless, a British citizen or an immigrant, law-abiding or a criminal, a health freak or an addict: you still deserve the same level of respect and care.
Littleboy has already argued that 24 Hours in A&E functions as an advert for King’s College Hospital (or, presumably, St George’s Hospital in series 7 and 8) and could be seen as an attempt, on behalf of the hospital, to increase charitable donations (142). Like most recent medical reality shows, 24 Hours in A&E utilizes a strict episodic narrative structure and generally tends to favour ‘uplifting’ cases where the patients eventually recover (Ostherr, 196). As pointed out by Ellis, the viewers are often made to wonder if patients will ‘make it’ by witholding the patient interviews (recorded after they have left the hospital) until the end of the narrative arcs. This means that the patient interviews work in tandem with the inclusion of summarizing on-screen graphics (which tell us something about each patient at the very end of each episode) to provide a satisfying sense of closure. Even in the cases where patients actually die, the closing interviews and graphics usually provide comfort by assuring us that they were well cared for and died in the company of their loved ones. While these narrative devices definitely work to promote the individual hospitals and their employees, they also contribute to a wider celebration of the universal health care system as a whole. 24 Hours in A&E presents the NHS as successfully providing both cutting-edge health care and emotional support to anyone in need, even when faced with funding cuts and ‘a chronic lack of investment in emergency medicine, in general practice, in public health’. How the viewers receive this idealized image of the NHS will no doubt vary depending on their cultural background, personal experiences and political beliefs. Personally, I find 24 Hours in A&E’s celebratory stance both comforting and energizing. As a Swede I have a deep-seated belief in universal health care, which has remained firm throughout the aggressive privatisation of the Swedish heath care system in recent years. 24 Hours in A&E speaks to me because it affirms my political beliefs and shows what universal heath care should look like and could look like if properly funded and supported.
Of course, 24 Hours in A&E’s portrayal of the NHS stand in stark contrast to the media coverage on the problems that the British heath care system is currently tackling. There are reports of the worstwaiting times for a decade, yet 24 Hours in A&E does little to capture the boredom, frustration and fear that seethe in waiting rooms when people have to wait well over four hours to get treated. As most people who have recently received emergency care know, periods of extended waiting (for the doctor to see you, for test results, to be transferred, to be discharged) are to be expected. But 24 Hours in A&E edits out most of the waiting time and when we do see people waiting these sequences are usually humorous or touching, which makes it seem like waiting around for care is actually quite nice. Apart from the occasional raucous drunk we rarely see people complain or become frustrated. Similarly, amidst reports that an increasing number of hospital workers have to go on sick leave due to stress, 24 Hours in A&E portrays the medical personnel as having plenty of time to take personal interest in every single patient. The same doctors and nurses are rarely seen caring for multiple cases at once and because the on-screen interviews have been recorded at a later date (in a far less stressful and more intimate environment that the emergency ward), the medical personnel appear exceptionally calm and focused – we get the sense that they have all the time in the world to reflect on individual cases. Moreover, the medical personnel never comment on their workload. While they occasionally acknowledge that their job is fast-paced and demanding, they generally assert that they love what they do and are happy to go to work.
24 Hours in A&E can easily be critiqued for lacking in ‘realism’ and for refusing to investigate, or even acknowledge, the difficulties that the NHS is currently facing. Littleboy has, for example, argued that Channel 4’s fixed rig documentaries, in spite being positioned as quality ‘public service’ documentaries, must be understood as participating in reality TV’s general move away from the ‘critical impulse’ traditionally associated with the documentary form (130). But 24 Hours in A&E ‘s celebratory and idealized portrayal of the universal health care system can still be understood as a political stance and if it helps boost public support for the NHS, this soothing form of medical programming might even be seen as a form of implicit activism. It at least bolsters my belief that the universal health care system needs to be preserved and strengthened. 24 Hours in A&E is not critical, realistic, or even ‘authentic’ (in the sense that David Levente Palatinus has used the word in a recent CST blog on medical programming), but it makes me want to pay more tax and it makes me less worried about getting sick. And for that I keep coming back for more.
Sofia Bull is a postdoctoral researcher in the Department of Film and Television Studies at University of Warwick. Her current project examines contemporary discourses on genetics, biomedicine, kinship and reproduction across a range of different television genres on UK and US television.
