The Nineties were a good time for writer Andrew Marshall. They ended with Dad, a nice little sitcom starring George Cole and Kevin McNally, where Dad moved with the times but son Alan, although he liked to think he did, really was older in outlook than his father. He was always afraid of being shown up by his dad, and yet it was never his dad who showed him up; it was always Alan’s attempts to do whatever it was. It lasted for two series and a Christmas special – dropped by the BBC for no readily apparent reason for firstly a week and then a full year! – before disappearing into tv oblivion. A shame, because it worked very well.

But while 2point4 children kept coming back for more, Andrew Marshall didn’t rest on his laurels. He co-wrote If You See God, Tell Him, a comedy drama with Richard Briers, Imelda Staunton and Adrian Edmondson, with fellow writer David Renwick of One Foot In The Grave and Jonathan Creek fame and he also wrote another series of his own which was more short-lived as Dad, again for no readily apparent reason – Health and Efficiency.

Meet the staff

Set in St. James Hospital, it concerns the trials and tribulations of the medical and managerial staff of General and Surgical Ward B. Equal in seniority are doctors Michael Jimson and Kate Russell, played by Gary Olsen – in a break between series of 2point4 children – and Felicity Montagu respectively. Michael is similar to Ben Porter in many ways, but is far more intelligent as a character with a ready wit that he brings to bear on the many situations the team find themselves facing, and especially with regard to the chief surgeon. He was also once engaged to Kate to be married, but broke it off when he realised what she was like; even so, he still carries a torch for her, and whether she likes to admit it, she does for him.

Kate, like Michael, is an excellent doctor, specialising in diagnosis and it is mostly because of her that the surgeon doesn’t get his hands on too many of the hospital’s patients. Her major flaw in that in any personal situation, she always has to have the last word and won’t admit that she’s made a mistake about Michael unless she has to – in many cases she is right about him, as Michael, like the doctors in the many Doctor… series before him, has a roving eye for the nurses, or as she is inclined to put it when she goes off on a rant to anyone who will listen, ‘Miss clingy, skirt up to her gusset, girly-girly, toss her hair about, pouty, lick her lips, giggly-boots’ he claps eyes on. She is prone to making a bit of a fool of herself with these outbursts and other over-blown gestures, all designed to get back at Michael for leaving her at the alter. But even so, they still care for each other and they both care about the patients which is why they are of one mind when it comes to keeping them away from unnecessary surgery in the operating theatre under the ever-eager scalpel of Mr Rex Regis.

Rex, played with gusto by former Only Fools and Horses regular Trigger, Roger Lloyd Pack, is of the opinion that drugs do no good at all and the best thing in all cases is to get in there, have a root about and rip it out if it’s not working, usually in theatre to the sound of one of his many records with patient-panicking titles, such as one time when a patient under a local anaesthetic hears him singing along during the op to ‘The Joint is Jumping’ by Fats Waller It’s not without a great deal of foundation that Michael calls him on one occasion ‘Doctor Oh-Seven, licenced to kill’. Their on-going verbal ripostes are a regular feature, with Rex usually coming off worse, but where he loses verbally he more than makes up for in his general slimy demeanour, blood-soaked attitude to the patients and the buttering-up of the unit manager.

He also makes life a misery for his assistant, houseman Dr. Phil Brooke played by former Bread regular Victor McGuire (basically the same character Victor played in two episodes of 2point4 children a year earlier in. There, Rona’s abortive wedding had been the main backdrop to proceedings, but the hospital setting involved young David Porter at death’s door after contracting tetanus.) Phil is earnest, but lacks confidence in himself, is always given the short straw in everything from his career to his relationships, and is generally put-upon at every opportunity by Rex who treats like a glorified batman, sending him on trivial errands for sweets and newspapers. The others often use Phil as a sounding board, and while they don’t mean to put him down, they often do without realising it. Phil often works long hours into the night, and his knowledge of the most trivial things is just one thing that puts off any of the nurses from going out with him instead of Michael.

The only sympathy Phil might get without conditions is from Staff Sister Beth Williams, played by Adjoh Andoh long before her similar role as Sister Colette in Casualty. Beth is over-worked and under-paid like all the other nurses, but manages to somehow keep some guiding influence over the team and she is often the first to be able to alert them to the imminent arrival of the unit manager, who they can all do without.  As if this isn’t enough, Beth also has a family of four young children are another source of problems at home, so she never gets any letup. This probably accounts for her irritated demeanour much of the time, which is hardly surprising.

The bane of their lives is the unit manager, Diana Ewarts, played by Deborah Norton who is best known for her role as Prime Minister Jim Hacker’s confidant and planner Dorothy Wainwright in Yes, Prime Minister. Norton does bear a slight resemblance to former PM Margaret Thatcher, and it is her that Diana reminds you of when watching. As the unit manager, Diana is a glorified accountant who sees all patients as units rather than people and is always trying to balance the books or, even better, turn the ward into a thriving business. She is also forever concerned with the public relations side of things, and it is only because of the latter that she really has to deal with the patients at all as she hates the lot of them since they cost her budget money. She has an on-off affair with Rex, and both are well-suited to each other – she is known by many of the staff as ‘the Spider Woman’ – but nothing really can come of it until Rex is able to leave his neurotic wife Pauline. This often means secret rendezvous at night which Rex is never able to make, leaving her sleeping in her car and making her even more ratty with the staff the following day. This accounts for much of the strife for the ward staff, as nearly every situation is instigated in some way by Diana’s attempts to do something with or to the ward in the name of efficiency.

The first series, broadcast in 1994, starts off with Diana focussing on the ‘marketing’ side of St. James, where she organises a promotional video to be shot with her aims and targets in mind. One of those targets, favoured by Rex, is to take the quicker, more cost-effective option for a gentleman with blocked arteries in his leg and order an amputation. The patient seems happy enough; if that’s what it takes, but he wants the leg afterwards and poor old Phil rashly agrees to get it. Luckily for the patient, Kate and Michael intervene and get him on a course of new, expensive drugs instead, saving the leg. Michael also manages to connive with pretty TV director Charmaine (Samantha Janus in an early role before Game On) to make sure that the patient ends up in the video, with Michael chipping in to Diana’s speech that they are dedicated to providing the best treatment – whatever the cost! It’s all on camera, so Diana can hardly retract it. The only fly in the ointment is that someone forgot to tell Phil that the old man’s leg has been saved – and he turns up after the time for the op with one he’s managed to get hold of for him to keep, whoops!

Diana returns to increasing the profits by arranging for the ward to specialise in a particular type of operation, but sadly all the lucrative ones have been snapped up by the other hospitals in the area; vasectomies it will have to be. However, this is nothing to the disruption brought about by Kate, for the date is January 11th – her and Michael’s abandoned wedding day of longstanding – and she has vowed that she will never let him forget it or let him sleep with another woman on that date as long as she can prevent it. Her various stunts include parading a desk calendar before his eyes in the reception area and having lunch in the canteen at Michael’s table wearing her wedding dress! However, this is nothing, as she saves the best for last; as a coincidence, one of her former friends is in for an op and after ‘apologising’ to Michael for her earlier behaviour, she tells him a sob story about how the friend could die unless they find enough blood plasma in his rare group for him to have the op – which they haven’t got. Funnily, his group is the same as Michael’s and to try and rise above the situation and prove how good he can be, Michael rushes off and gives far more blood than he really ought, tiring himself out completely. It’s a shame, as Kate says, her friend’s unlikely to need all the blood anyway – only being in for his vasectomy! However, it’ll stop Michael from doing anything athletic that night she is sure. Michael is able to get his own back though – by arranging a visit from his ‘date’ dressed in sexy nurse’s gear to Kate’s patient in the dead of night. For one thing you must never do immediately after having ‘the op’ so they say is to get at all aroused …

Next, Diana does an inventory of the ward pharmacy and is shocked at the amount drugs used, ordering that all prescriptions must have her authority including painkillers – after all, what’s a bit of pain if it saves money? Rex agrees, although even this does nothing to stop sending Diana into a brief depression when he tells her why he can’t take her to the Founder’s Ball, the hospital party, later that evening. Michael has meanwhile found a former mental patient, Stephen, in the reception and goes off to try and find out what his history is; he’s been released into the community. Stephen wanders into the pharmacy where Diana is having a cry and is nice to her; she offers to take him to the Ball. Michael, Kate and Beth find out about Stephen’s history and it’s nothing to worry about – it’s just odd. After playing each other off to see who will buy the tickets first, Kate and Michael go together. Rex arrives as Diana waits for her ‘date’ to turn up; he wanted to see her before the Ball to say that he will tell Pauline about them, when the time is right. Stephen arrives and Rex beats a hasty, confused retreat. Stephen asks to take her to the pharmacy because he wants to show her something and she agrees… unaware that Stephen’s history is that he’s a compulsive flasher! This episode is actually the weakest as we never find out whether Diana agrees to the use of drugs again without her say-so, though there’s some nice underplayed comedy from Mark Williams of The Fast Show and Red Dwarf as Stephen.

The next episode makes up for the non-event of the previous one. Diana invites a notorious anti-hospital journalist to look around and do a piece on them in the hope of good publicity, but at the same time Phil manages to mislay a baby. The staff manage to sort it out, though not without arousing the hack’s suspicions and they agree a pact not to drop each other in it. However, after leaving the Founder’s Ball with another nurse instead of Kate, Michael lied and said that he hadn’t accompanied her back to the nurse’s quarters; unfortunately the hack finds out that he did and threatens to tell Kate unless Jimson gives him a look at hospital records, where all the past cockups and misdemeanours are filed. Michael capitulates and shows him to the vault. Kate is scandalised that he of all people is willing to drop a colleague in it – even if it is Rex! However, the deal is that the hack gets a look at just one record of malpractice and Michael gives him just that. Unfortunately, the record concerned has the hack’s editor as the patient and reveals that he didn’t leave St. James’ with everything he though he had. Checkmate! Nicky Henson played reporter Anthony Bolt as a thoroughly disreputable character, a man you could see all staff would love to hate.

Diana then makes two decisions. Firstly, she has a painting she can’t stand removed from her office and hung in the ward. Secondly, she freezes all outside payments because of another crisis in funding. It also comes to everybody’s attention that the main hall is being hired out for a boxing match, something that should be anathema to all the staff though it seems only Kate is truly appalled; Michael and Phil even have tickets! When Diana finds out, she is delighted – she thought it had fallen through, but with the funding from that, the budget crisis will be no more. Kate is horrified, but doesn’t know what she can do to stop the match from going ahead. However, she discovers by accident from one of the patients that Diana’s picture is worth an awful lot of money and is about to tell her that she can cancel the match and sell it instead when she finds out – or thinks she does – that an inpatient is the artist. The painting is worth what it is because he had to give up painting; if he has his op, he’ll be able to paint again lowering the price. Not being able to deny him his treatment obviously, Kate reluctantly admits defeat, which is a shame as he only actually paints hospitals - the walls that is as he isn’t the artist she thinks he is! The painting ends up in the incinerator and the match goes ahead. Kate changes tack by going to it, hoping to shame Michael into leaving. However, she finds the sight of two grown men bashing each other to bits more than she can stand; in fact, it arouses her enormously and the last we see is of her pulling Michael out of there and back to her place! A couple of nice cameos in this episode from Hilary Mason as the patient who tells Kate of the painting’s worth and Timothy Bateson as the alleged artist-cum-NHS painter.

The last episode of the series introduces a new character when a new nurse, Mandy played by Jennifer Gibson, joins the staff and Phil takes a shine to her. Unfortunately, he’s pretty hopeless at opening a conversation around women and his opening gambits come from medical textbooks or hospital records do little to break the ice. He asks Michael for help, but he has his own problems; everything didn’t go quite as planned in the bedroom department when he and Kate left the boxing match and he’s quite anxious that his reputation in that area isn’t damaged. Kate, on the other hand, would be quite please to ruin his reputation and tells all and sundry! However, even she is keen to help with Michael’s ‘problem’ i.e. liking all the pretty nurses, and manages to con him into going to a hypnotherapist friend of hers. Unfortunately, the suggestion she places on him gets in the was of what the nurses really need when Diana unveils her latest plan; redeveloping the hospital into a new layout which includes turning the nurse’s quarters into a multi-storey car park. Kate is appalled and so is Michael, but he’s unable to do anything about it as any mention of the nurse’s quarters brings him out in a sweat. The nurses find out about the plan and go on strike, but Diana can do nothing – the contract has been signed and it will have to go ahead. However, to the rescue comes Phil – with nothing to read but hospital records during the night shift, he remembers that there’s a covenant where any attempt to sell the nurse’s block will mean that the whole hospital has to be offered to the buyer for the original asking price of the land, which is a mere pittance, and the trust will never do that. Even his relative popularity doesn’t get Phil a date though…

Further surgery

When the second series appeared a year later, it looked as if Phil was still in the doldrums as his birthday had come around and he still hasn’t got promotion or a date. Michael and Kate both decide to do something about it, though each misunderstands what the other wanted to do; Kate blackmails Rex into giving Phil some more responsibility and Michael indulges in a little private enterprise, arranging a prize draw for the nurses where the winner will go out with Phil in the evening – neither the nurses or Phil are aware of this of course… In the meantime, Diana discovers a discrepancy in inpatient/outpatient figures which Michael manages to cover by saying the extra ‘ins’ never went out – except in a box. But in fact they are all long-term patients in comas and when Diana finds out she brings in a new diagnostic aid to determine if a patient should be given care or not by checking their chances of recovery. With its ‘Funeral March’ and coffin graphics, it appals everybody – bar Rex, who has managed to give Phil the responsibility Kate wanted. The only problem is it puts him in charge of the machine, gets him the nickname ‘Doctor Death’ and makes him even less popular! However, Michael discovers that the example statistics they used from a current patient – which the machine says will die – are identical to his father, who was treated there twenty years ago and is still walking around large as life! He checks some others and manages to arrange an interesting little mortuary visit for Diana that scares her into scrapping the machine. His draw works out for Phil as well, though Mandy the nurse is not too pleased, under the impression the night out would be with him…

Kate also seemed to be as unstable as before, this time stopping an entire outpatient clinic to have everybody searched when her childhood fluffy toy, Mr Floppy, goes missing and when everybody starts talking about her ‘little quirks’, it really makes her paranoid though she is still a professional and manages to save a patient from coming into contact with Rex’s scalpel. However, when Diana orders that everyone has to take psychometric tests, she is worried in case she may lose her job. Michael meanwhile struggles to find out why a young girl keeps having allergic asthma reactions, even in hospital away from everything familiar. Kate performs a colonoscopy on a patient and learns halfway through that he is a psychiatrist. However, he is understanding of her problems when she unburdens herself and manages to reassure of her – just as well he’s at her mercy! Meanwhile, Rex has decided that even though there are no patients to operate on that day for him to demonstrate his techniques to the students, he will still operate and invites Kate to watch from the gallery – the patient is the missing Mr Floppy who he gleefully butchers in revenge! Michael comes to the rescue, as his allergic patient had just got a new soft toy, which he has arranged to find a good home for – Kate. When the psychometric test comes around, they discover the test papers are a sham – the real test was being watched all day by an undercover tester. The only mad person he can find is Rex – after all, what sane surgeon would operate on a soft toy?

Kate agrees to go away for the weekend with Michael and has kept him on the edge for nearly 2 months, shoving temptation in his path at every opportunity. He has resisted, stopping all his behaviour that she despises but it’s almost been too much for him. In fact, he hasn’t stopped everything and is still indulging in betting with Phil on test results etc, which Phil manages to let slip in Kate’s presence. The weekend looks like being off, but Diana’s latest news gives him hope; Health Secretary Virginia Bottomley is coming to the hospital – hence all the tarting up of reception – and she will speak to one member of the medical staff; Rex. But Rex has gone missing and Michael ups the ante with Kate; if he can speak to and kiss the minister, the weekend will be back on and a lot more beside. If he fails, he will stop betting forever and all the other things she doesn’t like about him. She agrees and even though Rex is found asleep on Diana’s office floor where he has been dosing after being thrown out by Pauline, Michael indeed does look like winning the bet. In fact, he does, but it does nothing for his reputation because, as Kate reminds him, he agreed to talk to and kiss the Minister, not the Health Secretary, and the Minister is a bloke…

The following week, all the staff receive invites to endorse a particular drug and even the rep comes calling with offers of free holidays, gifts etc. But other matters are occupying everybody else. Beth finds out that Diana has reduced the hours the hospital staff nursery is open and has no one to leave her kids with. Michael, on hearing that Kate likes a man who’s good with children, offers to keep an eye on them – as long as she tells Kate! However, he gets more than he bargained, as Beth’s stories of them being little horrors prove to be true. Kate goes to see how he’s getting one and both wind up imprisoned by the kids! The drug rep still attempts to get Diana to reorder it by bribing her, even though she finds they stock it and have never used it because of its side effects. Rex is interested in dispensing some to get the numbers down and is about to do so to a woman patient when Michael comes crashing in – literally through the ventilation system that one of Beth’s kids has escaped into! He stops him as they find out that the reason the patient couldn’t communicate with any of the staff all day is because she is suffering the side effects of already being prescribed the drug. Rex is defeated and Diana is forced to tell the rep to leave, although she was tempted by his offers. Michael is about to release Kate from the nursery when he finds out that she had been stringing him along about being good with kids and decides that maybe she should have more time to get to know them better… Former Young One Christopher Ryan played the rep.

Diana’s staff training weekend proves to be to be another disaster in the making. Phil goes with Michael on his motorbike and looses his suitcase under a wagon so is not in the best of states when he and his remaining luggage arrives! Diana has booked the rooms, and is still smarting at Rex so has booked a really grotty one for him; he manages to swap with Phil so everything’s going really well for Dr. Brooke, who even manages to get himself mixed up a murder mystery weekend taking place in the same hotel! Kate manages to organise that her room and Michael’s are on separate floors in case he gets any ideas, which is not exactly fair to him as he resists the come-on from nurse Mandy who turns up unexpectedly; he turns her away only to have Kate appear through the connecting door of his room – she has swapped with Beth as the sister didn’t want a ground floor room. She wants to try again with Michael over the weekend. Mandy calls down and he tells her, pretending she’s room service, that he’s not interested. However, Mandy takes it as a yes and says she’ll come down. Michael decides that perhaps it might be better if they went to Diana’s ‘team bonding’ meeting after all; he was planning to ignore it! There, Diana sets them the totally pointless task of transferring an egg from their room to the ground below without touching it or breaking it. After a lot of bickering and getting nowhere, Phil decides to go to the lavatory. On his way back, he overhears Mandy at reception leaving a note for Michael. He collects it for him, goes back and punches Michael, believing that he has been seeing her behind his back all the time and blurts it all out in front of Kate; he’s so infuriated he even tells Rex to shut up, which stuns the surgeon! However, it turns out that the note was to say that she came to see Phil really, but that she wanted to warn Michael that the test is a fix; the egg is a fake that can’t be broken. Diana reappears after her lovely meal in the hotel restaurant and admits that it was all about how well they would work as a team, and they have failed miserably. However, all is not yet lost as when they all wander back through reception to go to their rooms, they discover most of the guests and staff have been struck down by food poisoning – from the restaurant. They snap into action and save the day between them, although Diana is looking a little green about the gills…

The end of the series shows everything coming to a head at St. James where due to a computer malfunction in the accounts section, various large bills haven’t been paid and Diana is forced to advise everyone that she will be closing the ward at the end of the day. A patient with memory loss booked in for respite care looks like being sent home and a kidney patient looks like losing the chance of a transplant organ that Michael and Phil have only just managed to acquire. However, there is no donor card for the patient and when they ask his widow for permission, she also agrees for them to use anything that may be of use. This is good for the hospital as Michael and Rex know; in the free market economy, all the organs they don’t need can be sold to the other hospitals that do need them. Rex is in his element! Soon, everything is underway and it looks like the ward can stay open after all. However, the widow’s husband suddenly walks in, after having his wallet stolen that morning and it looks like a case of mistaken identity could close the ward and the hospital if it goes to court. However, the wife of the memory loss patient, who has been asked to come and collect him because of the impending closure, turns out to be a barrister and she advises them that if it was some thief the chances are that his family wouldn’t take out a civil case against them as they wouldn’t want him known for what he was. The kidney transplant goes ahead and everything looks like ending well – except they do hear that a clerk from the barrister’s court has gone missing. Apparently he had left to go and hand in a wallet that he’d found to the police and never came back…

A victim of hospital cutbacks?

The last episode of Health and Efficiency was transmitted on 10th February 1995. Of the main cast, Roger Lloyd Pack continued with his Only Fools and Horses appearances and later turned up as a regular in The Vicar of Dibley with Dawn French. Victor McGuire moved into Goodnight Sweetheart, the time-travelling sitcom with Nicholas Lyndhurst and Dervla Kirwan. Gary Olsen continued with his role as Ben Porter in 2point4 children right up until he moved to Australia following his diagnosis with cancer. He died in Melbourne in 2000, aged only 42. The final series of 2point4 children, which is thought to have been recorded in full before he moved, has never been aired.

So why did Health and Efficiency not last longer? Who knows? A third series could have been made as the ratings remained pretty constant all the way through both runs; it is likely that a change in department management just decided it wasn’t what they wanted any more. The scripts were good, with only one episode being in any way weak or unresolved and the main cast were all excellent players. It was a different kind of hospital comedy, even from Doctor At The Top, the remake of the Doctor… series screened a couple of years earlier, reflecting the changes appearing at the time. It worked and it was funny. So was Fawlty Towers and they both lasted the same number of episodes. One is a celebrated classic, the other a footnote in tv comedy. These things happen. A shame, because actually Health and Efficiency was far better than a lot of the comedy on today, and it could certainly stand a terrestrial repeat.

this article copyright PPS / M.Hearn 2003