The NHS holds a profound power over British national consciousness, and can inspire deeply-felt loyalties, convictions and responses from the public that it seeks to serve, and those that serve it. This is evident when turning to the many different representations of the NHS, and literature clearly forms a complex part of such cultural representations. Literature can tell us a great deal about the role that the NHS assumes within British daily life, while also challenging us to look more closely at the nuances and complexities of the cultural significance of this institution. And literature may even tell us something about the perceived power of the NHS, and of the written word itself.
In terms of such literature, the genre of medical ‘physician fiction’ might immediately spring to mind, in which Mills & Boon romance novels sit alongside such favourites as Country Doctor by A.J. Cronin (made into the television series Dr Finlay’s Casebook for the BBC), My Brother Jonathan by Francis Brett Young, or A Fortunate Man by John Berger. But there are also more recent, and revealing, texts and initiatives that explore the cultural meaning of the NHS. Some of these sit in avowed defence of the Welfare State generally, and the NHS in particular, while others function as literary ventures where the NHS workforce itself contributes to the emergence of an NHS aesthetic and ethos. For example, the Hippocrates Initiative for Poetry and Medicine, set up in 2010, holds an annual poetry competition where, alongside an open submissions section, NHS staff are also invited to submit entries reflecting on medicine and exploring the nature of their work within the health service. These selected entries offer a stimulating counterpoint to the international submissions within the Hippocrates anthologies, and hint towards a curious conflation between all medicine and the NHS. In the British mindset, it seems, the NHS is often implicit in any representation of medicine and health care, so embedded is the idea that medicine is the NHS.
At the same time, anthologies such as David Morley’s The Gift: New Writing for the NHS, published in 2002, in fact came out of a Government initiative which, as part of the ‘National Plan for the NHS’, sought to find new ways to help NHS staff reflect on their role within the service and help it develop for a new century. Contributions were made by established authors, emerging writers and NHS staff – all freely donated – and the first 31,000 copies of the book were given free to NHS staff in Birmingham. Again we see literature here not only reflecting on and representing the NHS from the perspective of an ‘outside’ service user or patient, but also being used as a vehicle for the expression of its significance and value by those it employs. Tellingly, very few entries in the anthology actually mention the NHS explicitly by name, yet again revealing a complex relationship between medicine and the Health Service (and it is equally instructive that a large majority of the literary entries focus specifically on representations of the hospital). And while the pieces of prose and poetry within the collection are perhaps more ambivalent towards everyday experiences of the NHS than might be expected, the resounding sentiment and ideology underlying the book is undoubtedly one of the NHS’s necessity and intrinsic value to health, society and the public good. This tells us that while the NHS may suffer regular criticism for its perceived weaknesses and failures in its actual operation, its function as a marker of ‘civilized success’ remains ultimately impervious to sustained critique. In other words, regardless of any ‘flaws’ perceived within the actual Service (or indeed its gradual erosion from within), ‘the NHS’ – as a purely ideological concept and cultural phenomenon – appears resilient to any final dismantling. Like a wayward or frustrating relative who we may love to criticise, we are still nonetheless protective when it comes to what’s seen as ‘outside’ disapproval or interference
That such creative work (and time) is given freely when it comes to the NHS is itself an indication of the way in which it is valued, but the very idea behind such a literary venture may also tell us as much about the value – and assumed impact – of the written word, particularly for the NHS itself. The Gift states as much in its Preface and Introduction, but this is also borne out by the increasing resources and programmes within the NHS set aside for the delivery of arts-based initiatives. Patient- and staff-centred writing workshops sit alongside the collections of art in hospitals, art-as-therapy, commissioned art and artist-in-residence projects. Schemes such as ‘Poems While you Wait’, ‘Poems in the Waiting Room’, and ‘Poems for Those Who Wait’ testify to an increasingly complex relationship between the NHS and literature (and indeed art generally), including the NHS’ power to motivate the (often free) circulation of creative work. The first of these came out of a writer’s residency, while the latter projects derive from an Arts in Health charity and the charity Hyphen-21, respectively.
So while The Gift marks a project that seeks to both represent and ‘serve’ the NHS, there is clearly a distinction to be made generally between literature that works for the NHS, and that which works to represent it. Such a difference can be telling, for in the current ‘canon’ of 20th and 21st Century British Literature (including the work of the ‘Angry Young Men’ of the 50s), while some select authors have engaged with the emergence and social implications of the Welfare State, any sustained or explicit focus on the NHS and its attendant impact remains conspicuously absent. A more recent anthology that does attempt this – Alan Morrison’s edited collection Emergency Verse: Poetry in Defence of the Welfare State (2010) – shares with The Gift an overt ideological impetus, which in this case is to valorise and reinforce the importance of the Welfare State. Here the NHS is ‘included’ as a special illustration of the successful principles of universality and egalitarianism, and where The Gift offers the written word as a force to inspire (mass) staff commitment and reflection, Emergency Verse invests literature with the power to rouse and effect political change. Both, however, ultimately hold some sense of political affiliation, with The Gift as a commissioned output from a policy directive, and Emergency Verse overtly stating its political drive from the outset. Green Party Caroline Lucas MP is the book’s patron, and the preface sets out the anthology as a call-to-arms following the Coalition’s ‘Emergency Budget’ of 2010. The book is accordingly referred to as a ‘petition of 112 poets’ and a ‘literary campaign’ (Caroline Lucas, Emergency Verse, Preface) in a way that makes no bones about the relationship between literature and politics, and the word’s power to motivate action. ‘NHS’ would appear to be words just as powerful for such campaigns. The NHS only appears by name in the titles of three of the poems, with the majority of the anthology necessarily focused on politics and the Welfare State more generally. Yet the preface uncompromisingly places the book as a defence ‘of the Welfare State and the National Health Service’, with the front cover design also lending itself to associations with health emergencies, and a significant portion of the essays engaging directly with the significance of the NHS and the need to protect it from further privatisation.
From the controversial and contested suggestion that A. J. Cronin’s Citadel was a formative influence on the establishment of the NHS, the relationship between the Health Service and literature has remained curiously complex, and complexly curious. Ambivalent representations within policy-based anthologies jostle with radical verse that reifies a national establishment. Workers within (and outside) the NHS contribute literature (freely) to different literary collections that explore and defend it, while artists increasingly become part of the NHS’ paid workforce. And in the content offered by such literary endeavours, it is clear that the cultural value of the NHS means that it appears to be able to undergo relentless criticism while its status as a sacred institution remains (at least conceptually) intact. Whether or not literature has the potential to move us and inspire us to action always has, and perhaps always will, remain open to question, but its relationship with the NHS suggests that the cultural force of the National Health Service may have a more incontrovertible power.