Like many great British films made in the social realist tradition, The National Health was adapted from a successful stage play. But Peter Nichols’s play is also something of a curio in that it began life as a television script which was subsequently adapted for the stage, following an indifferent response from producers. The play had its first run at the National Theatre in 1969 and became an instant success, winning the Evening Standard award for Best Play and considerable critical acclaim. Nichols was wary of the creative compromise involved in letting go of the film rights (he had been burned in the past) but with director Jack Gold the film was in a pair of hands which were, if not safe, then certainly appropriate. Gold was a filmmaker with a strong preference for social and political subjects. Prior to The National Health his credits included realist drama The Bofors Gun (1968) and the The Reckoning (1969), a brutal, penetrating dissection of the British class system. But Gold’s stated preference was for working in the medium of television rather than film, and it is easy to see why: television production offered greater creative freedom and the ability to tackle more controversial subjects. And Gold also had something of a knack for coupling the humorous with the provocative, as he did with the outrageously subversive The Naked Civil Servant for Thames Television in 1975.
Given that a key theme in The National Health is the disintegration of the NHS, it was a stroke of brilliance to set the film in a derelict East-London hospital which was scheduled for demolition after shooting. A studio set would have been satisfactory, but the obvious dilapidation of the building adds a tenor of authenticity to a hospital ward which is running thin on resources, staff and compassion (one doctor has been on duty for 29 hours and keeps falling asleep on the job, while the senior staff are more interested in showing around foreign dignitaries than they are in the patients).
A television in the day room broadcasts ‘Nurse Norton’s Affair’, a mawkish soap opera in the vein of Days of our Lives which couldn’t be further from the reality of hospital life. But it’s at this point in the film that our expectations are really disrupted: the camera zooms in to the television set and the real and the fictional merge in a kind of disorienting dream sequence, with hospital staff from the actual hospital ward appearing in the television soap opera. Jim Dale plays ward orderly Barnett in real life and the handsome Doctor Neil Boyd in ‘Nurse Norton’s Affair’, while Lyn Redgrave stars as a glamourous nurse in the fictional show (and an exploited drudge in reality). Sheila Scott-Wilkinson plays Nurse Powell in reality but in the fictional soap she plays the star of the show, a young black nurse who must overcome racial prejudice in order to win the heart of the handsome Doctor Neil and the respect of Neil’s father, Senior Surgeon Dr Boyd (Donald Sinden).
Shortly after the establishment of the NHS in 1948, films set in hospitals tended to be government-sponsored propaganda of the type that was designed to inform the public about the government’s healthcare reforms. But in 1951 the new Health Service had its first notable cinematic outing in Pat Jackson’s White Corridors, a compelling drama which follows the fight of doctors to save a little boy from blood poisoning. Strangely enough, however, from the 1950s the subject of NHS hospitals was more likely to lend itself to comedy subjects rather than to tragedy. Doctor in the House, the 1954 comedy masterminded by the husband-and-wife team of Ralph Thomas and Betty Box, was so profitable at the box office and so popular among the public that it spawned six sequels, a television show and a radio series. The success of the film paved the way for the British hospital comedy and pointed to one inalienable fact: the NHS was box-office gold. Carry On Nurse reinforced the point in 1959 when it became the most profitable British film at the box office of that year. Ralph Thomas put the popularity of hospital comedies down to their relatability, arguing that: ‘People used to hold medicine in great awe... In our film, people liked and identified with the funny situations they had seen happen or which had happened to themselves as patients, doctors or nurses.’
It is tempting to view The National Health as a slightly morbid Carry On film. Indeed, one Time Out reviewer even described it as ‘A would-be blackly comic Carry On Doctor that never manages to work itself free from the deadly grip of Peter Nichols' script.’ Given the added presence of Jim Dale (star of Carry On Doctor), the comparison is perhaps unavoidable. Peter Nichols had realised what Carry On producer Peter Rogers had long known: that the beauty of the hospital setup is that it allows the writer to situate characters from all walks of life in one room and see how they interact. But in The National Health this clash of personalities takes on a serious, rather than comedic, tone.
There are obvious signs that the film isn’t just playing for laughs: the lack of dignity afforded to a patient who accidentally relieves himself in the middle of the ward, the relationship between socialist Foster (played by Bob Hoskins) and upper-class patient Mr Mackie (David Hutcheson), which takes on a real tinge of hatred, and the obvious debilitating pain of Mr Mackie, who has terminal cancer. But the real satirical bite arrives in the form of a Christian evangelist woman who wafts around the ward announcing the ‘Good News’ and cheerfully trilling ‘there is no death!’ to increasingly bemused patients. The darker subtexts at play can be seen in cheerful ex-public schoolmaster Mervyn Hatch’s none-too veiled ‘interest in boys’, as well as in Barnett’s inappropriate monologue about how to prepare dead bodies for transport. Indeed, Jim Dale’s performance as Barnett is one of the most striking of the film because it is so layered. Barnett is no Jim Kilmore. He jokes and laughs, but he also hides a sociopathic streak which becomes evident in his macabre stories and in the secret contempt he has for his patients.
The idea that The National Health is limited by its origins in theatre seems like an unfair accusation. If anything, the film adaptation is able to lend the parodic soap opera storyline a great deal of visual intensity. In the film Gold is able to employ hyper-dramatized television soap opera techniques, clichéd music, fast pans along corridors and close ups of actor reactions. One issue is that this does feel slightly jarring, and this is partly because, in the stage production, these fantasy sequences are clearly signposted to the audience. In the film, they are not, and the overall effect can be a little disorienting.
The juxtaposition of the sparklingly clean environment of the soap opera and the grim reality of an NHS hospital is certainly stark, and this lends the scenes in the ‘real’ hospital a certain grim poignancy. The lack of non-diegetic music in the ‘real’ hospital scenes and the use of an extremely dramatic non-diegetic soundtrack in the soap opera scenes emphasise that contrast between realism and fantasy. British cinema embodies a long historical tradition of realism, a fact which can be traced to the documentary movement of the 1930s but also to the strong literary tradition which has run through British cinema from its beginnings. Some of the greatest works of British social realism have been adaptations of novels (such as Love on the Dole, Saturday Night and Sunday Morning and A Taste of Honey). Conversely, formalist, non-realist styles have often occupied an uneasy place in British cinema. This goes some way towards explaining why Hammer’s gothic horrors never really captivated the critics, why films by the creative producer/director team of Powell and Pressburger (The Red Shoes, Black Narcissus) were released to mixed responses and only rehabilitated as ‘classics’ retrospectively, or why My Beautiful Laundrette (Stephen Frears, 1985) is widely seen as being one of the best British films of the 1980s but the brilliant psychological horror-fantasy The Company of Wolves (Neil Jordan, 1984) is not. But The National Health doesn’t just engage with fantasy; it tries to engage fantasy and social realism together in the same visual space. It is no small wonder that the competing styles do not sit comfortably with each other, but the effect is interesting.
The 1960s was a halcyon time for the British film industry, which was riding high on an unprecedented wave of funding from major Hollywood studios keen to benefit from competitive UK tax breaks. However, by the early 1970s American companies had withdrawn their financial interests. British domestic production, which had enjoyed something of a creative ‘boom’ period in the 60s, soon consisted of low-budget adaptations of television sitcoms like Steptoe and Son and On The Buses, as well as bawdy sex comedies like Stanley Long’s Adventures Of… series. In a 1973 survey of the industry, The Board of Trade found that it was impossible for most British films to make their money back in the domestic industry alone. International sales had always been a key avenue of recoupment for independent producers, but now the ability to sell a film abroad was crucial to its ability to break even. This renders the The National Health even more of a curio in that its subject (the National Health Service) is too regionally specific for it to have hoped to achieve wide audience abroad. And unfortunately, the film never enjoyed more than a limited run at a few select North American cinemas.
While American audiences might have some trouble understanding the vagaries of a public health service designed to be universal and free at the point of use, some of the racial issues explored in the film would presumably have translated. In ‘Nurse Norton’s Affair’ the racial politics are caricatured (‘this is greater London and in Greater London it is not common practice for a white skinned senior doctor to be seen off duty with a black-skinned nurse!’) while in ‘reality’ they are all too painfully recognisable in the character of recovering alcoholic Edward Loach, (played by Colin Blakely) who hurls abuse and racial slurs at the doctors and nurses (‘no blackie orders me around!’).
The release of The National Health came nine years after Life in Emergency Ward 10 had portrayed an interracial relationship between surgeon Louise Mahler (Joan Hooley) and Doctor Giles Farmer (John White). Perhaps what is most notable about The National Health is just how relevant it feels to us today. It’s a jumble of race and class politics which never really seems to land its blows, but there’s still a lot to like about this curious, unapologetically idiosyncratic film.
 See Brian McFarlane, An Autobiography of British Cinema 1997 p. 557.