Science Museum Workshop, London

As the excitement builds towards celebrating 70 years of the NHS, a hive of activity is emerging to highlight the importance of this national institution. Visibility has become a key watchword in such activities – media representations in documentaries, news and radio pieces, theatre productions and exhibitions, to mention but a few, are each determined to explore and represent what the NHS means to the British public.

The Science Museum in London has taken up this mantle with no less gusto, with a section of its new Medical Galleries to include a display relating to the history of the NHS. Though not focused on an opening for the anniversary per se, this project opens up important questions regarding how we represent the NHS visually, and it was with this in mind that I was invited to run a standalone 2-hour artist workshop with their steering committee. This, however, is no ordinary steering committee. Composed of group leaders and representatives for the public groups that the Science Museum is working closely with in order to produce the NHS display, including Homerton University Hospital, Adelaide Medical Centre, Watling Medical Centre and A.S.A Disability, the aim for the Museum is that public participation should be a key driver in producing the final NHS display. Short films have been proposed that will be produced by collaboration with these groups, through their stories, memories and ideas of what the NHS means and has meant, with examples of how this might be presented visually. But as any ad execs worth their salt would undoubtedly point out, user-generated content may be the gold dust of today’s media and creative economy, but it is equally difficult to negotiate and produce. This task is made even more tricky when the subject under discussion is suffused with ideas that depend on so many intangibles.But this task is made even more tricky when the subject under discussion – the NHS – is suffused with ideas that depend on so many intangibles. Compassion, inclusion, pride, levelling and security are just some of the values that we associate with the NHS that appear to prove more difficult to represent visually. As one participant put it: ‘you have your work cut out for you’.

However, working from the material generated by participant interviews, and from photos that the participants were asked to send, representing their experiences and thoughts of the NHS, the group quickly ran full steam ahead. By the close of a very fast-flying 2 hours we were able to produce mood boards, images and ideas, that began to go some way to representing the NHS, and its complex network of meanings. ‘NHS word cards’ created from random selections from participant interviews were particularly successful, in which the team was split into groups and asked to create a ‘continuum’ using these words, having been asked to decide which words they most agree or disagree with when thinking about the NHS. The same cards were then used to create themes, and those themes were then used a starting-point, with the images sent in, for the mood boards.The activities were purposefully kept simple, with the workshop taking a much slower step-by-step approach than would otherwise be taken with a more experienced, practical art group, and the use of the usually (somewhat messy) materials I incorporate into workshops was inappropriate to the needs of the Museum and the setting.

The Museum will continue to work with the groups, as this is an ongoing collaboration for them that will take some time and dedication. However, as a standalone exercise there was much to be gained from this event, and not just for the Museum and the participants in moving forwards with the display. As I left the close of the session, that somewhat brutal, yet insightful, comment from a participant – ‘you have your work cut our for you’ – still rang in my ears. It left me wondering if it is indeed nigh on impossible to represent the NHS and its complex ideologies though static images or objects. Even in TV drama and film, we implicitly assume that the footage we see – an unfolding drama a&e drama, for example –  is the NHS. We assume so unless decidedly told otherwise because the NHS, fundamentally, is medicine for almost all of us.

But more than this, I wondered, when it comes to trying to get to grips with the NHS and its meaning through exhibits, objects and images, are we stuck with either quite literal images that fall short of saying anything meaningful or with depth, or else a collection of visual symbols that most would need a doctorate in Art History to comprehend? Perhaps not. For one thing, there is indeed space for both the literal display– through say, the material culture of campaign banners and protest photographs – but also, and alongside it, the more metaphorical exploration. Indeed, representing ‘intangibles’ is what art, film and even museums, very often, do actually do. So it is perhaps the greater disservice to assume that the public would not have the appetite, or visual literacy, to engage with such displays. Indeed, in my previous research on abortion I wrote 80,000 words explaining how abortion has been used in literature to represent wider, existential concepts, and produced a recent article for Feminist Legal Studies discussing the same obstacles around visual encoding for abortion, but without resigning to ultimate ‘visual defeat’. The British public literacy around the NHS, in fact, was evident in responses to the 2012 Olympic Opening Ceremony. While many nations watched on in utter confusion at the amalgamation of children in hospital beds, fictional heroines and dancing nurses and healthcare staff, the British public knew exactly what all this meant: this was ‘our NHS’. The most invisible visible institution of them all.

Hospital Art – guest blog from textile artist Ruth Singer

We are always interested in hospital art, graffiti, poetry, and culture.  This month, our researcher Natalie Jones, who is also a visual artist, went to Malta to speak at a conference about Beauty and the Hospital in History.  We are also currently building our programme for 2018, the 70th Anniversary of the NHS, which we hope will feature art work.

To start thinking about this, we’ve been looking at previous art projects commissioned to celebrate and document the NHS.  Here, we have a lovely blog from Ruth Singer, telling us about a recent project in this area.  We love how the art work uses personal stories from patients and local community members, as well as archival materials, to create such a beautiful document about the changing history of a local hospital:

To celebrate the centenary of Harefield Hospital, Royal Brompton & Harefield Hospitals Charity commissioned textile artist Ruth Singer to work with patients and the local community to create a commemorative quilt.   This project was par t of a 12 month project which, with the support of a Heritage Lottery Fund grant, aimed to re-tell the history of the hospital from a patient, staff and local community perspective.

A quilt was chosen as their major centenary arts project as a reflection on a 1917 Red Cross quilt made locally as a fundraiser to support the war effort during World War One. This new commission takes its inspiration from the heritage quilt but has been created in a mix of contemporary and traditional techniques. The interlinking honeycomb-like structure of hexagonal patchwork echoes the complex ecosystem of the hospital where each member of staff is vital to making the system work.

Over summer 2015 Ruth worked with staff, patients and local communities to create the quilt which is made from over 400 individual pieces. Archive images from Royal London Hospital Archives & Museum, personal testimony and hospital records have been combined with old nurses’ uniforms to create a subtle colour palette and a complex design filled with intriguing details. The pieces used in the quilt were made during a series of workshops at the hospital, starting with screen printing and natural dye to create patterned fabrics to use. We used plants from the hospital grounds to colour the cloth and images from the buildings and archives as screen prints and digital prints. Other workshops included hand sewing and embroidery to embellish the quilt.

Written quotes include oral history testimony from staff and patients, as well as comments from the hospital’s Facebook pages. Regular contributors have hand stitched their names onto patches and some contributors gave photographs of family members or documents which refer to their relationship to Harefield Hospital and to social activities related to the hospital. Hand stitched outlines of leaves refer to the wards named after trees growing in the grounds. We have also included details of the red and white ANZAC quilt and photographs of the ANZAC cemetery at Harefield Church.

Ruth says:

“Working with Harefield’s people, buildings and archives has been an inspiring process. It has been an honour to include many personal stories as well as to celebrate the achievements of 100 years of dedicated care and research. This was a dream commission for me and it is great to know that it will be on show in the hospital for many years, giving patients and visitors the chance to reflect and think about the many lives Harefield Hospital has touched in a hundred years.”

Karen Taylor, Arts Manager, Royal Brompton and Harefield Arts.

“With the support of the HLF we have been able to tell stories of patients, staff and local community to record the hospital’s rich heritage – from its origins as a war hospital to its current role as a leading heart and lung specialist – for the very first time.  Ruth’s quilt captures this history in a beautiful textile artwork which we are proud to display.”

Artist Ruth Singer &  Photographer Joanne Withers.

A Cultural History of Organ Donation Week 2016

The funniest joke at the Edinburgh Fringe festival this year, as chosen by a panel of critics for Dave TV channel, was, ‘My dad suggested I register for a donor card, he’s a man after my own heart’ (told by Masai Graham). This week, from 5th–11th September, is Organ Donation Week, an annual drive organised by NHS Blood and Transplant to promote the lifesaving potential of organ donation.  Whilst the jokes of the Fringe and the NHS’s campaigns may not initially appear to have much in common, cultural representations –in comedy, novels, newspapers, and television – have played an important role in reflecting and shaping public debates around the medical, moral, legal and personal implications of organ donation.

Organ donation has a long history.  Whilst there are accounts of skin transplantation dating back as early as the second century, transplants of other organs were not documented until the early twentieth century, alongside improvements in blood transfusions.  Through time, and particularly from the 1940s, surgeons developed their understanding of why certain organs were rejected, and developed immunosuppressive drugs to prevent this.  The NHS’s website writes that the organisation has been ‘at the forefront’ of transplant technology since its own inception in 1948, with the first NHS kidney transplant in 1960, and the first NHS heart and liver transplants in 1968.  The NHS established its first organ donor card, initially just for kidneys, in 1971, and the national organ donor database was created in 1994.  In 2016, we continue to see medical innovation in transplant surgery (for example as surgeons transplant organs between donors and recipients who are HIV-positive).  We also see controversial cases of medical waste, with donor organs in America sometimes thrown away due to an inefficient donor matching system, or weekend under-staffing.

As organ donation becOrgan donorame more common from the 1980s and 1990s, newspapers and factual television programmes paid attention.  In 1985, the BBC consumer programme That’s Life!, presented by Esther Rantzen, appealed for a donor liver for the sick child Benjamin Hardwick.  A liver was donated, and Ben became the youngest liver transplant patient.  The programme also raised £150,000 from viewers and, contemporary newspapers speculated, contributed to a cultural shift empowering parents and clinicians to discuss paediatric organ transplantation.  Echoing this line of thought, in 2014 Matthew Whittaker, who received a liver transplant in 1984 aged 10, told the Daily Mail that ‘I’m 41, but my liver is just turning 30. . . and it’s all thanks to Esther’.

The close relationship between media and medicine was criticised at the time in the Guardian, arguing that journalists had become ‘recruitment officials for organ donors’, and should return to their role as ‘devil’s advocate[s]’, analysing medical research findings and government health policy.  Some newspaper coverage did operate in this critical manner, however, for example investigative journalism exposing an organ trade between Britain and less affluent nations in the 1980s and 1990s.  In one distributing example of this practice, in 1994 The Sunday Times reported that people from Bombay and Madras were selling their organs to British patients for as little as £200, making the ‘middlemen’ organising these deals up to £12,000 per operation.

Films, novels, and television programmes have also invited the public to think about the ethical, legal and personal implications of organ donation.  The film Return to Me (2000) raises issues about identity, emotion, and transplantation, as a man falls in love with a woman who received the heart of his deceased wife.  Similar debates were raised by media coverage around Jeni Stephien in August 2016, who was walked down the aisle by a man who had had her father’s heart transplanted years before, and told assembled media that, ‘It was just like having my dad here, and better’.  Debates about informed consent, and emotional repercussions for donors’ relatives, were also played out in the Mills & Boon novel On Wings of Love (2013), where a transplant nurse falls in love with a grieving widower.  In the American film John Q (2002), a desperate man with inadequate health insurance holds clinicians hostage in a hospital, forcing them to give his son a heart transplant.  This raises questions about the responsibilities of the state in relation to organ transplantation – also discussed in Britain in relation to immuno-suppressive drugs, which recipients of organ transplants currently pay for themselves.

These fictional representations likely invited reflection amongst viewers.  Television producers have also explicitly sought to engender such debate.  In 2005, a Casualty/Holby City crossover special asked viewers to vote to determine the outcome of an organ donation-related storyline.  98,800 viewers called, with 65 per cent voting that a heart donation should be received by Lucy, a young cystic fibrosis patient, over Tony, an older widower.  Demonstrating an entwinement between fact and fiction, the programme also featured an informative section presented by Robert Winston explaining the guidelines governing organ donation.

Cultural representations of transplants can encourage us to think through our positions in relation to organ donation, and to discuss these with friends and family.  A study of 1993 also found that when transplants were featured in newspapers and on television, this made it easier for intensive care professionals to raise the subject of organ donation with grieving relatives.  Cultural representations of transplants can also have a negative effect on discussion, however.  In 2013 the NHS Blood and Transplant group criticised the portrayal of organ donation in an episode of Holby City as ‘inexcusable and reckless’, for representing clinicians treating grieving relatives with ‘callous disregard’.  Demonstrating the real effect of television, the Blood and Transplant group also stated they had been contacted by many people who wanted to be removed from the Organ Donor Register, as a direct result of this programme.

Newspaper articles, television programmes, even junky American films and Mills & Boon books, have all shaped how and when we think and speak about organ donation, by framing and highlighting issues such as consent, emotion, and bodily autonomy in particular ways.  Please do let us know if you see any examples of this sort of thing during Organ Donation Week and beyond.