A whirlwind of real voices from the NHS

by Sally Carter, technical editor, The BMJ.

“It’s a parade performance,” said the woman at the box office, “but some of it is outside so I’d keep your coat on if you think you might get chilly.” I had never been to a parade performance before and became nervous—any hint of audience participation and I’m ready to bolt from a theatre—but I needn’t have worried. It just meant I had to walk to different parts of the Royal Court Theatre in London that had been turned into hospital corridors, operating theatres, waiting rooms, and cubicles for the performance of Who Cares by Michael Wynne. It was an impressive transformation.

This was a verbatim play made up of the results of interviews with people working in the NHS at all levels—general practitioners, porters, nurses, consultants, accountants, and chief executives—and that alone makes it an important piece of work. I hope some politicians found time to see it.

The audience was split into three groups, and each was shepherded to various places to hear from various characters. Their stories were engaging, funny, and practical—as you would expect from NHS people. I especially liked the nurse, Marjorie (Eileen O’Brien), whose experiences as a patient and as a member of staff seemed to sum up the organisation.

We were given a lot of facts—from the size of the NHS as an employer (fifth largest in the world), the number of GP consultations each year (300 million), to the cost of a vasectomy (£250) and the amputation of a toe (£901.50). Being herded around added to the “NHS feel” of the play, but I found it a relief when, in the last part of the play, the whole audience was brought together into one room with seats for a finale that included the Mid Staffordshire scandal and the effects of government reorganisations of the NHS.

I’m not sure if there was an overall message in the play. All the characters and facts overwhelmed me and I couldn’t find one. Perhaps fewer voices might have said more in this case. I do recommend going to see Who Cares though. I enjoyed it. Plenty of action was packed into the hour and a half performance. The acting was excellent, and I got to see areas of the theatre that I didn’t know existed.

Who Cares? We all should

by Emma Parish, editorial registrar, The BMJ. 

Michael Wynne’s play, Who Cares, at the Royal Court is a tour through a virtual hospital, charting the decline of our national institution, the NHS. The verbatim structure of the play, not something I had experienced before, uses the words of those interviewed by Wynne to say things that don’t often get space to be heard.

What this production achieves so well is to provide an intimate and considered environment, conducive to quiet reflection and contemplation of the issues. From the crowded A&E, to the quiet of a patient’s cubicle, and the outside spaces where teams are resting, or waiting for the next ambulance to arrive, audience groups have time between scenes to follow the narrative and learn how the NHS is being overwhelmed, and expectations are changing. It is a fitting, and welcome, contrast to the often curt, hostile and aggressive settings the issues of health are usually played out in; by jostling politicians in the Commons, slated on the sheets of our national newspapers, or in the glare of media backlash.

Remarkably balanced in political stance, this production does not shy away from asking some hard questions of the audience—does our national nostalgia for the NHS hold it back from changing to cope with new priorities? Should the Health and Social Care Act really be debated again? Do healthcare professionals and the public just need more realism? Have we been sanitised from the reality of illness, and death, and are shirking responsibility for our own health with poor diets and vices?

Certainly the most compelling scenes are those describing the experiences of patients or carers. Listening to the stories of Marjorie, a patient and charge nurse (Eileen O’Brien) and Louise and Julie Bailey (both Elizabeth Berrington) I once more felt shamed as a doctor that these were the experiences of people within a healthcare system I work in. Yet, the play does not simply rest on the power of personal stories, but addresses the less comfortable reality of balancing the needs of one with the collective demand of many.

Where the play stopped short was in offering solutions—perhaps this is the most pertinent audience participation required, to consider your own actions to make the NHS better? The performance I attended was followed by a panel discussion with the playwright, cast, directors, producer, an interviewee and a health correspondent from The Guardian. There were few solutions offered here either, but certainly outrage—people in the audience expressed their want for a voice to these issues, they want to see them debated in the media, and responsibly. There was agreement the play should be seen by as many people as possible to both inform and ignite people into action. Wynne admitted one of the biggest difficulties was getting people who worked in the private sector, or management of NHS Trusts, to speak. Many of the “voices” in the play are familiar however, the production did manage, to some degree, to give a voice to those quietly passionate people who would not usually be heard.

Some will say this play covers the same old ground—staff shortages, the Mid Staffordshire Trust Inquiry, financial constraints, and political influences—but for me that was where it hit hardest—these are the same issues, raised again, debated again, and potentially dismissed again. Let’s stop the nostalgic dance around the NHS and start addressing whether politics and health can ever be separated, invest in staff, and show compassion and respect for those using the service. If the NHS belongs to us, we all need to care.

Who Cares runs until 16 May at the Royal Court Theatre, London.