Holby City Case Study

Rob Miller | Monday November 05, 2012

Categories: A Level, OCR A Level, OCR AS, GCSE, WJEC GCSE, WJEC GCSE Media Studies, Key Concepts, Audience,
Genre, Institutions, Media Language, Narrative, Representation & Stereotyping, Hot Entries, Television, Medical Drama,
Television Drama

Holby City is a BBC produced British Medical Drama set in the fictional Holby City Hospital near Bristol, close to
the Welsh border. It concerns the lives and ups and downs of its staff, patients and Doctors and borrows heavily
from the conventions of the soap opera (see Genre). Initially broadcast in January 1999 it is now currently in its
15th series and is aired weekly on a Tuesday night in 60 minute format in HD (from 2010) during prime time at
8pm filming is all year long for a minimum of 50 weeks from 8am to 6pm and like many long running
programmes has a factory output approach to production, employing both established actors like Patsy Kensit
and Robert Powell over the years and also actors relatively new to the profession.
Initially Holby City secured strong ratings with the first episode attracting 9.2 million viewers but has now settled
into an average rating of around 5.5 million which still just about justifies its prime time slot. Not without awards
however, Holby City won a 2008 award for Best Continuing Drama. The programme is a spin off from the
successful Casualty but also has connections with Eastenders not just because of the soap conventions
employed but because of actors that have appeared in both and also the fact that, like Eastenders it is filmed at
BBC Elstree Studios in Hertfordshire. A not so successful Police Crime Drama Holby Blue was a short lived spin
off from Holby City and an attempt to clone the commercially successful format of ITVs The Bill (19842010).

In terms of production values Holby City is relatively low compared to many high production value TV Dramas,
e.g. period dramas like Downton Abbey. It costs 350,000 to film per episode compared to 130,000 for
Eastenders reflecting the more complex set design and objects and props as part of the mise-en-scene, e.g.
recreating an Operating Theatre and also the research required to create a form of realism sets however can
be re-used to keep costs down and basic sets remain constructed in Elstree like in Eastenders. Actors are
taught basic medical procedures and Doctors advise on authenticity but the programme has been subject to
considerable criticism for failing to accurately represent hospital procedure, in particular resuscitation techniques
while choosing instead to focus on the nature of the drama. This, for a programme that borrows from soap
conventions is not unusual but it not as hyper real as the American medical drama, Scrubs.

Camera Shots, Camera Movement, Editing, Sound, Movement,

Composition and Use of Mise-en-Scene
Holby City has attempted in recent years to create a more filmic look to the programme to attract a younger
target audience but is now shot in HD making it appear crisper and clearer reflecting the desired clean, pristine
mise-en-scene of an NHS hospital (which it has also been subject to criticism for). The interior, day time hospital
sets are often bright, white and blue anchoring this representation but also connoting emergency and purity. In
the dramatic opening title sequences this colour palette of blue, white and silver (signifying high end technology)
is intercut with splashes of orange perhaps connoting the inpurity of some of the interpersonal relationships within
the programme. As with every BBC TV Drama the BBC Ident is foregrounded ensuring brand identity is
maintained with it connotations of being a provider of quality television.

Significant use of the close up of Doctors and Nurses faces during operations and procedures ensure tension is
maintained and allow audiences to experience the fear of a sometimes life or death situation close ups of
patients also encode emotion (bad news / good news) while reaction shots are common within this specific
narrative the camera will often cut away to the face of a nurse, relative or Doctor to ensure audience
understand the full range of emotions. Surgical and surface equipment is also often shot in close up emphasising
the nature of the drama and in small rooms and operating theatres is used to signify claustrophobia and tension.

Close ups also help to emphasise a theme that runs through the programme which is the much publicised
overextension of NHS staff.
The camera in Holby City is often at eye level to allow audiences the opportunity of making point of view
connections with the protagonists but also common is the hospital bed shot where the isolated patient is often
framed as vulnerable by use of high angle camera. This shot is exaggareted in the operting theatre by
occasional use of top shot or aerial shot looking down on the patient the audience almost feel omniscient or all
knowing as they join the dots from heavily laid narrative clues and to cause and effect, notions of predictability
drawn from soap opera conventions. These voyeuristic camera shots also help to encode fear, one of the
programmes key appeals and ensures the audience remain worried but from the safety of their living room. Fear
is used as a narrative hook in Holby City.
Single camera set up is used to film Holby City and characters are often followed down corridors using a
Steadicam ensuring narrative continuity and also resisting the temptation to cut prolonging a shot into a
longer take is another technique used to build tension. The camera set up and camera movement is no dissimilar
to Eastenders reflecting the fact that similar cameras are used in similar filming locations (BBC Elstree). There is
less hand held used however and close ups are often held for a period of time in conjunction with use of shot
reverse shot developing conversations/relationships between Doctor / Nurse and patient and between hospital
staff. Conversations between Doctors and Nurses are common with the Doctor often framed in a more deferential
way reflecting his authority in the centre of the frame while Nurses are often to the side of the frame.

Fast paced editing is generally only used during emergency situations e.g. during resuscitation and also to
create tension in the operating theatre with frequent intercutting between Surgeon, Nurse, Anaesthetist etc. As
identified earlier, long takes are common to build tension but also to ensure the significant parts of the narrative
that deal with the interpersonal relationships of the staff are emphasised hospital staff are often framed in two
shot in corridors having dramatic conversations which often include verbal confrontation. Wide shots and long
shots tend to be only used during exterior shooting (the city of Bristol is often the backdrop) and normally
involves the Doctors and Nurses in scenes where their feelings for each other are foregrounded after reflecting

on a dramatic situation in the hospital. Notions of outside are rare and this is deliberate to ensure audiences feel
the claustrophobic, often relentless nature of hospital work.
During the titles we see a significant amount of flash cut editing, similar to CSI to establish connotations of
cutting edge technology as the camera pans in an arc reflecting the constant movement in hospitals. The key
protagonists are framed in medium close up to dramatic non-diegetic music making excessive use of a drum
sounds while panels of light wipe them from right to left and left to right from the screen to reveal the next
character. The titles create a dramatic opening with the colour palette anchoring the connotations of technology.
Dramatic sound is important to Holby City throughout each episode after the titles non diegetic sound is used
sparingly and comes in the form of incidental music used as visual grammar to encode emotion and drama.
Songtages are also a feature that have been used in Holby City but most sound is diegetic to ensure realism is
understood up to a point by audiences e.g. in operating theatres the noise of heart monitors is very much
apparent to build tension to a climax.
Mise-en-scene is crucial to Holby City in establishing realism objects and props must be authentic and reflect
the workings of a day to day hospital. Scalpels, drips, tubes and monitors are common and help to ramp up the
tension while offices are decked with computer terminals and filing cabinets to ensure this authenticity. Setting
again accurately reflects an NHS hospital with corridor scenes, operating theatres and consulting rooms dressed
with NHS posters and signs to allow audiences to continually make connections in terms of location. Many of
these scenes will take the form of permanently built sets at BBC Elstree that are designed and re-designed to
create the required shot.

Dress code ensures status and authority are conveyed with junior Doctors seen in white coats while senior
Doctors and Consultants wear suits and are smartly dressed and presented compared to the working blue
uniforms of the nurses. Lighting is often high key, particularly in operating theatres reflecting the clinical nature of

the environment and the requirements of high key light during medical procedures. Three point lighting (key, fill
and backlight) allows for overall illumination but also some scenes at night are shot using softer, diffuse lighting
e.g. on Doctors faces when delivering news to a patient. Body movement, posture and pose is another way
Holby City establishes authority with the Nurses often seen scurrying about while the Doctors remain calm,
measured, upright and in control moving at a much slower pace reflecting their status and presence.

Genre Conventions
Holby City is a typical TV Drama in that is has multi stranded dramatic storylines based on character, a typical
soap convention from which the programme borrows many features including similar actors (Paul Bradley plays
Elliot Hope but also played the hard done by Nigel Bates in Eastenders). It is however a sub genre of TV Drama
Medical Drama along with programmes like Casualty, House, ER and Scrubs and as such follows its own
conventions dramatic non-diegetic titles music to develop tension, extensive claustrophobic shooting, frequent
shots of hospital equipment, fear as a key appeal, extreme high key lighting and notions of being in an institution
or being one part of a large machine (NHS hospital). Medical Dramas also develop narrative themes often
involving the need to make clinical and moral judgements on life or death situations. Grander narrative themes
are also touched on which relate to the programme e.g. the ethics of stem cell research and euthanasia. These
themes in medical dramas create interest but rarely challenge the audience beyond entertainment values or a
sympathetic display of emotion as one would for a character in a mainstream Hollywood film.
Soap Opera conventions include individual characters, each with their own familiar storyline, narrative themes of
good v bad (in Holby City there are ruthless Doctors who are power hungry while others are seen to be more
caring and empathetic) and familiar settings soap operas need audience identification to ensure characters and
situations are recognised. Soaps also commonly have low production values and are scheduled prime time
which is the case for Holby City. Many other higher production value TV Dramas belonging to other sub genres
like period drama and crime tend to be aired at 9pm or later. In many ways this puts Holby City in the bracket of
a melodrama like Hotel Babylon where the drama is seen as obvious and on the surface for a C2, D, E
mainstream, female skew target audience like soaps Holby City encodes realism and hyper realism to ensure
the nature of the drama is maintained. Characters that come into hospital often have back stories to their
situation which audiences are privy to.
The key to Medical Dramas is convincing audiences of their authenticity while also remaining entertaining and
character driven which is a difficult balance. Scrubs moves completely away from this formula in favour or a
hybridised comedy with the medical drama as a back story while Holby City attempts to maintain two strands
that simultaneously intertwine the day to day running of a hospital and patient care with the interpersonal
relationships of the staff. Medical Dramas often include short term and dramatic storylines (like soap operas) and
Holby City has had many of these in equal measure. Hanssen, the highly enigmatic and intelligent Doctor (see
intertextual references to House) played by Guy Henry was involved recently in a hostage plot when targeted in
a revenge narrative by a man who was the son of a patient who recently died while in the care of Holby City
Hospital. Typically with medical drama he cast in binary opposition to the bumbling Elliot who has a sweet tooth
and health problems but caring and affectionate with a heart of gold. New viewers to the programme can pick up

on storylines and swiftly understand representations of character from an ensemble cast through the Previously
feature which follows the titles. Like a soap opera the narrative is not difficult to follow and is often open ended
with narrative arcs running through the series.
Like many TV Dramas Holby City has a mass, mainstream target audience and has achieved some
commercial success but also has been criticised for wasting the taxpayers money TV Dramas are seen as
prestigious to broadcasters and are often cited as one of their flagship programmes whereas Holby City has a
more low brow reputation, common also to soap operas. Characters (including patients) are deliberately hyper
real and are over to top cultural stereotypes a common convention of TV Drama to ensure audience familiarity
with character and role within the narrative. Eddi Mckee for example is a non nonsense tomboy representation
who is a bit of hell raiser outside of work.

Representation
Star marketing is now common in Holby City and established actors are often used in relation to their
secondary persona iconic actor Robert Powell, better known for playing Jesus in Jesus of Nazareth in 1977
and Richard Hannay in the re-make of Alfred Hitchcocks 39 Steps played CEO (Chief Executive Officer) played
Mark Williams. Nurses respected him and fancied him while as a CEO he was through and meticulous and
maintained a gravitas that made him ideal for the role. Patsy Kensit has played sexualised Ward Sister Faye
Morton with a mysterious past while also suggesting a criminal inclination. The stars in Holby City do not litter
the cast but lend legitimacy to a younger body of actors with less extensive experience.
Holby City has been praised for its positive representation of multiculturalism and has won two Ethnic
Multicultural Media Awards actor Jimmy Akingbola plays Antoine Malick, a maverick registrar with a volatile
temper who is hungry for promotion to Consultant. Representations of sexuality are also referenced in this Malick
who despite being gay goes against any preconceived mainstream stereotypes about male homosexuality by
being alpha male and aggressive. He is also passionate and caring but works to his own rule book as a maverick
who often gets into trouble for not playing by the rules.

Most characters in Holby City are deliberately young and good looking and are framed for the male and female
gaze on one level this would attract a younger target audience and keep the programme fresh. Characters
Chantelle Lane and Chrissie Williams are good looking, sexy blonde characters who are very much framed for
the male gaze. Chantelle is stereotypically blonde and naive and a classic Daddys girl who is fresh out of training
and set in binary opposition to the more functional, boyish Eddi who has more stereotypical masculine traits and
the ruthless, driven female Consultant Jac Taylor. Ward Sister Chrissie Williams is also blonde and sexy but is a
character who is represented as having more substance returning to work after the birth of her first child.
Gender in Holby City offers some challenging representations e.g. Jac Taylor but arguably fundamentally
underpins mainstream cultural stereotypes. Most Doctors are male and are represented as dominant, authority
figures who are well respected within the hospital even in the opening title sequences men are on screen first,
and for longer than the female characters and have a more obvious and frequent on screen presence than
female characters. Like Eastenders, a soap opera often criticised in the past for its female victim narratives
Holby City presents most female characters as weaker and less powerful than their male counterparts, with
exceptions. Men more frequently make crucial decisions and are often seen telling off the female characters for
something they have done wrong. Some male characters are however framed for female audiences Jonny and
Luc are sexy, unconventional, witty and roguish with an eye for women while the noble, moral and idealistic Ric
appeals to the older female demographic.
Holby City both challenges and reinforces cultural stereotypes but as a mainstream, prime time BBC drama errs
on the side of tradition in terms of representation to ensure mass audience appeal.

Marketing
As a BBC brand Holby City is subject to much in-house marketing, for example dramatic trailers broadcast
before and after existing BBC programmes like Eastenders advertising either a major storyline or a up and
coming new series. Use of trailers is normally dependent on measured rising and falling ratings as the BBC

cannot afford to divert too much funding to a show that brings in an albeit respectable 5.5 million viewers. Most
marketing of the show is to existing viewers and fans maintaining their interest in storylines have become stilted.
Star marketing is another key marketing tool used by the show and this is a similar technique used by soap
operas to legitimise what to some audiences is low brow genre television. As well as Robert Powell and Patsy
Kensit a host of well know actors have graced the Holby screens including Phil Jupitas playing a morbidly obese
patient and the veteran comedian Eric Sykes and current comedian and writer Adrian Edmondson - Holby City
sits in between by offering the more prestigious association with TV Drama (Medical Drama) whilst also
remaining associated with soap opera conventions. Established actors give the show depth while also ensuring
audience identification with character. Holby City markets to audience via associations with character and for
some audiences this is why they tune in an watch; a form of personal identity.
The levels of realism of the show are a key marketing tool most audiences have some form of experience of an
NHS hospital and Holby City markets on that level with the authentic representations combined with escapist
representations. Audiences watch trauma and drama safe in the knowledge that at that particular time it is not
them but with the added fear (and draw) that they could find themselves in that situation. The programme is
acutely aware of this and exploits audiences voyeuristic curiosity in all things medical and has successfully
adopted an audience for are also fans of the show Casualty which Holby City originated from which has
successfully worked and evidenced a form of synergy through association with the BBC badge or brand. This
BBC association is one form of marketing in itself with the show co-created by the well know ex Head of BBC
Drama and now Executive Producer Mal Young. His name is as firmly associated with programme as it Julia
Smith with Eastenders.
Other forms of marketing have included billboard posters and the shows website which offers convergent links
to clips, whole episodes, character profiles and background information on Holby City. The website and social
networking links are crucial in maintaining links with a youthful target audience which has always been the
intention of the show evidenced in recent years by the increased use of sexualised narratives.

Mini Glossary of Terms

Ensemble Cast: Where TV Drama for example has number of recognisable characters that often
for part of tea.

Star Marketing: Where an established star is cast in a particular role.

Secondary Persona: The representation of a star / celebrity through other media.

Multiculturalism: The positive referencing of people from different racial and ethnic backgrounds.

On Location: Where filming is in real life locations, not in a studio.

Critical Success: Success that is evidence by awards and positive reviews.

Commercial Success: Where success is measured by financial gain e.g. DVD sales.

Scheduling: Programmes are deliberately scheduled to be broadcast at a certain time depending

on their content.

Prime Time: 6pm 9pm.

Ratings: How many viewers watch a programme.

Clone: Copying the format.

HD: High Definition (viewing format).

Anchoring: Giving something definite meaning.

Connoting: A meaning that is established through interpretation of audio-visual symbols.

Brand Identity: Where audiences are aware of the name of a media text or in advertising, the
name of the manufacturer of the product.

Encode: How meaning is put in by the writer/producer of a media text.

Voyeurism: The pleasure of looking at other people.

Narrative Continuity: Where the storyline continues and audiences see no obvious break or
interruption in this.

Hybridised: A mix of two genres.

Sub Genre: A division of a genre e.g. a genre within a genre (Medical Drama and TV Drama).

Enigmatic: Little is known about a character, audiences are kept guessing.

Intertextuality: Where one media text references another.

Binary Opposition: Two very different things that are placed against each other to create
meaning for audiences e.g. hero v villain.

Mainstream: Traditional, dominant representations expected by a mass audience.

High Production Values: Where a programme has significant funding which can be evidenced by
things like Star Marketing, Set and Production Design.

Post Watershed: A television programmed that is broadcast after 9pm.

Cultural Stereotyping: A common, over generalised and often exaggerated representation based
on limited information and often used for entertainment purposes.

Male and Female Gaze: The male gaze is where women are sexually objectified in front of
camera and the female gaze is when men are sexually objectified.

Mass, Mainstream Audiences: Lots of viewers!

Demographic: A detailed breakdown of the target audience.

Conventions: Common features found in TV Dramas like Medical Dramas.

Escapist: Drama that allows audiences to leave the realism of their everyday lives into a world
that they are not familiar with.

Hyper Real: Exaggerated, non realist representations.

Mise-En-Scene: Everything in the shot lighting /colour / setting / dress code / objects and props /
pose / body language / facial expressions / make up / acting / camera movement.

High Key Lighting: Lighting that is bright and illuminates a scene and help to construct
mood/meaning.

Diffuse Lighting: Softer lighting.

Three Point Lighting: Three different types of lighting that illuminates a whole scene Key
lighting (main), Fill Lighting (from the side), Back Lighting.

Two Shot: Often used to show two characters within the frame communication with each other,
one of the left and the other on the right.

Shot / Reverse Shot: A shot where the camera is placed behind the shoulder of one character,
looking in talking to him/her and vice versa (the camera cuts to the next shot behind the shoulder
of the other character again looking helping audiences understand the relationship between them).

Reaction Shots: Where the camera cuts away to a person for a reaction to something in the
narrative.

High Angle Camera: A camera that is placed higher than a subject stereotypically it can make
them seem more vulnerable although this is not always the case.

Aerial Shot / Top Shot: A camera that is directly above a subject to give a different perspective
which can be voyeuristic.

Steadicam: A camera that is held at the waist on spring suspension that gives the camera
operator the chance to film without the frame moving. It also allows for the following of a character
through space without the need for a cut.

Intercutting: Where the camera alternates between cutting between scenes.

Long Takes: A shot that is not edited or cut for a length of time.

Flash Cut Editing: Where the edit / cut is accompanied by a flash of white light.

Diegetic Sound: Sound that is coming from the scene.

Non-Diegetic Sound: Sound that is overlaid in post production e.g. music or narrative voice over.

Narrative Arcs: Common themes that recur throughout a programme or series.

Multi Stranded Narrative: Several storylines happening at the same time.

Narrative Theme: A serious social issue that is explored in a media text e.g. a TV Drama.

In-House Marketing: Where all the advertising and marketing of a programme is by the
organisation that made it e.g. BBC adverts on BBC on programmes.

Low Brow Genre Television: Poor quality television.

Audience Identification: Where audiences recognise the narrative, genre conventions of issues
of representation they are familiar with it.

Escapism: Where audiences can escape from the reality of their lives.

Synergy: The ability of two or more compatible forms to sell each other e.g. Casualty and Holby
City.

Convergence: Where links are available to other media forms normally in digital media.