People's History of the NHS

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Humour and the NHS: Is ‘laughter the best medicine’? Is NHS policy a ‘sick joke’?

The history of the NHS is full of a range of emotions, feelings and meanings: including moments of laughter and humour.  Jokes were shared between staff, patients, and families, through conversations, letters, diaries, and drawings, and at bedsides and even in board meetings.  Humour was used to celebrate and to criticise the NHS, through political speeches, artwork, novels, and in television programmes and films from Carry On Matron to Green Wing.  It’s time to start taking these diverse forms and mediums of humour seriously, because, as I will show, they tell us a lot about the hopes and anxieties projected onto the NHS; its social, cultural and political contexts; and its place in Briton’s daily lives.

From its inception until the present day, the NHS itself has used humour as a tool for health promotion.  In 1948, for example, the Ministry of Health commissioned the documentary-maker Richard Massingham (formerly a Senior Medical Officer at the London Fever Hospital)  to make a public information film about preventing colds.  The resultant production, ‘Don’t Spread Germs’, featured a man who knew what to do with a beer – to drink it all in one of course – and knew what to do with a handkerchief – to sneeze into it – but who needed further information about how best to use disinfectant, which he had initially assumed was also there to drink.  A tradition of comedy in public health videos has continued throughout the decades: in an example from 2014, ‘Things to Put Up Your Nose’, the use of a nasal flu vaccine was promoted as a better thing to put up one’s nose than a crayon, penny, smartphone, goldfish or indeed a pirate ship.  The idea that humour can promote health has since the 1990s been subjected to academic research, and subsequently brought into hospital settings with the development of ‘laughter therapy’.  Some studies suggest that laugher may improve the body’s defences against disease, and, when shared collectively, also raise people’s pain thresholds.  To take just one example of laughter therapy in action, in 2003 the Royal Brompton Hospital installed a ‘laughter booth’, allowing visitors to be ‘infected’ by watching videos of other people laughing.

Comedy has of course also been produced and disseminated outside of the NHS, and looking at cartoons from newspapers can tell us a lot about broader perceptions of key figures in NHS history.  Nye Bevan was portrayed by 1940s cartoonists as a patient, the NHS itself, and, memorably, as a version of Florence Nightingale, the ‘Laddie of the Lamp’.  This reflects an enduring interest in the figure of Bevan, also reflected in later portraiture and sculpture, as well as a dual representation of Bevan both as relatable person, another NHS patient, and also as transcendent symbol, more akin to Nightingale or the ‘spirit’ of nationalised healthcare.  The secretary of the British Medical Association (BMA) in 1948, Charles Hill, was not portrayed in such sympathetic terms by cartoonists.  As Hill negotiated with Bevan to determine the terms under which doctors would work in the NHS, cartoonists drew Hill as a patient suffering from ‘enlargement of the social conscience’, and also portrayed BMA members holding a private general election seeking to overthrow ‘the Attlee lot’ as a ‘cure for Democracy’.  These cartoons now tell us something about the moral politics being constructed in this period, and the ways in which debates between political and medical professionals were filtered towards public awareness.  Portraying both Bevan and Hill as patients may perhaps demonstrate cartoonists’ interest in the universality of this Service, as a levelling force for public and politicians alike.  In later years, reflecting a context of cuts to NHS provision, Ministers of Health – for example Enoch Powell – were more often represented as surgeons than as patients, seeking to brutally chop vital limbs off the NHS, often using faulty and inadequate equipment.

Looking at humour about the NHS can show a sense of appreciation, gratitude, or even love which many Britons have felt towards this service.  Many cartoons explain public love for the NHS as a product of its services being free.  Throughout the post-war period, cartoonists have compared the British welfare state to the American system of insurance.  In 2013, for example, the cartoonist Christoper Keelty imagined how the chief antagonist of Breaking Bad, Walter White, would have responded to his diagnosis of incurable lung cancer if living in Britain.  Under the NHS, Keelty suggested, doctors would have asked ‘What kind of barbaric society would allow medical care to hinge on a person’s wealth?’  Walter, in turn, would have returned to a peaceful career of teaching chemistry to high school students.  In addition to celebrating the universal provision of the NHS, cartoonists have also teased out a more uneasy or complex relationship between free healthcare and Britons.  As early as 1948, cartoons portrayed Britons developing a ‘deep-seated guilt complex about getting things free’.  Other cartoons suggested concern about how long free provision could last, portraying crowds rushing towards a ‘bonanza’ of free NHS spectacles, teeth, and wigs.

Humour has also been used to directly criticise the costs imposed by a nationalised health service, relative to other government spending priorities.  John Musgrave-Wood, drawing for the Daily Mail in 1968, featured a doctor with a dunce-cap pouring ‘Defence Cuts’ down the mouth of the overweight and decadent gentleman-NHS.  Examples of humour levelled against the NHS are numerous, and throughout its existence various right-wing newspapers have described as a ‘sick joke’ their perceptions of: the power of unions in the NHS, the organisation’s apparent lack of cost-efficacy, and its bureaucratic management systems.  To take just one example of the latter, in 1993 the Daily Mail sought to use humour to level the complaint that the NHS required six people seventeen stages to change a light bulb in a ‘typical hospital’.

Newspapers and campaigners have also used humour to challenge NHS reforms, particularly those initiated by the administrations of Margaret Thatcher and David Cameron today.  Throughout 2016, junior doctors’ placards have used word-play to question if the NHS in fact stands for ‘New Health Secretary’, ‘No to Hunt’s Stupidity’, or ‘Not Hunt’s Slaves’.  Looking back to the 1970s, a period of identity politics and protest movements, the feminist magazine Spare Rib regularly used satire and comedy to draw attention to the ways in which the NHS may operate in a sexist manner, and to highlight and challenge the sexist behaviours of some clinicians.  In one article, published in January 1988, a woman described how she had bonded with a ‘jovial young medic’ after having given birth, when he told her that ‘it’s nice to meet someone with a sense of humour’.  However, as he later sewed up her vagina, the new mother joked ‘Don’t stop, please.  Anything which could prevent a repeat performance of this must be good.’  The doctor, she recalled, clearly felt that her ‘trivial treatment of this noble state of childbirth was too much for him’ and even an ‘insult to his maleness’.  This article thus offered insight into how humour can improve but also complicate everyday interactions between doctors and patients, depending on shared understandings about respective roles, gender norms, and health and care.

Indeed, it is such everyday exchanges of humour in, around, and about the NHS which are the most interesting and important in understanding the meaning and significance of this institution to people’s lives.  Occasionally – as in this Spare Rib article – we can find exciting archival traces of jokes exchanged between patients, doctors, and families.  More commonly, however, such encounters are not recorded and are lost with time.  With this in mind, we invite you to share any and all of your own memories of humour in and about the NHS with us, either in the comments below or in the members area, to help us to write a truly collaborative people’s history of the NHS.

JC

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