BBC coverage of the NHS – Panorama “Britain’s Secret Health Tourists”: a case study

In Uncategorized on November 12, 2012 by chr1sr0berts

What follows is an edited version of a paper I have recently submitted for publication in an academic journal. The academic paper is approx 6000 words in length and contains “screengrabs” It will hopefully be published soon – although it first must be subjected to peer review (fair enough) but this sometimes take time. In the meantime, I wrote a shortened version for the Open Democracy Website Our Beeb. This edited version exists in part thanks to the editing skills of Jamie Mackay and Dan Hancox. It seems that at present, the blog is too long for Our Beeb, so in the interim, I post this shorter (approx 3400 words in length) post here on my own blog.

The establishment of the BBC as the publicly funded media organisation remains an important and potentially progressive act. As it stands, the BBC has a role to play as perhaps the embodiment of objectivity and impartiality. It forms an important part of British social, political and cultural life.

…a set of principles for public service broadcasting was established: universality of coverage; diversity in programming; reflection of national identity and culture; the servicing of minority interests; the provision of an impartial news and current affairs service free from the influence of business of government; and the delivery of innovative, ‘quality’ programming designed to inform, education and entertain. (Debrett, M. 2010) emphasis added

Notwithstanding the recent fall-out from the Jimmy Savile abuse allegations, the BBC continues to enjoy remarkable levels of both enthusiasm and trust among large sections of the population. This is in part because television, as a resource of scarcity, has an obligation to impartiality that is not expected nor demanded of newspapers

By the 1980’s, television had reached a point of maturity where, whatever the party of government, it was seen as a decisive weapon in the battle for electoral hearts and minds. Because it was not open to the same partisan approach as the press, it was implicitly trusted by voters. (Barnett, S. 2011: 118)

Therefore, and despite the fast changing media landscape of the twenty-first century, television still maintains its role as the most important source of news and current affairs information. It is in this tradition that Panorama can be located. Panorama, remains the flagship current affairs broadcast strand on British television, the standard bearer against which other broadcast strands are measured. Therefore, to what extent is Panorama upholding the practices and values of ‘impartial’ television journalism? What is more, are these practices and values sufficient? For if it is still the case that: “…television matters because it remains central to people’s lives, and television journalism matters, partly because it still commands proper resources and mass audiences, and partly because it upholds the central tenets of professional practice: truth telling and holding power to account. (Barnett, S 2011: 248) ..then are said ‘central tenets’ and ‘professional practices’ adequate to the task they have been set – and perhaps largely assumed to uphold?


Panorama “Britain’s Secret Health Tourists”

“Declan Lawn reports on how ‘health tourists’ are obtaining free NHS treatment they should be paying for – at a cost of millions to our health service. Panorama goes undercover inside a black market where NHS access is being bought and sold, and finds an NHS practice manager taking money to register health tourists. Declan also discovers how easy it is for foreign nationals to get free treatment – with many hospitals across the country not making the required checks” [Panorama broadcast 3/10/2012]

The above is taken from the BBC Panorama website: what follows is some analysis of the content. The analysis is limited to the opening two minutes of the broadcast. This opening montage essentially acts as a “trailer” for the remainder of the programme, as such it sets the frame and context through which the viewer is invited to understand the unfolding story of “Britain’s Secret Health Tourists” and the NHS

Visuals Diegetic score/Voice-over Non-diegetic score (if present) Brief description
Black and white library footage
Ambulance driving to Hospital. “The NHS” >> Eric Coates’ “Calling All Workers” Sepia tinted opening montage
Nurses receiving patient from ambulance outside hospital building.Patient smiles as disembarks << “a national institution since 1948” >> Eric Coates’ “Calling All Workers”
Nurse caring for individual patient (washing his face) << Promising free health-care Eric Coates’ “Calling All Workers” Visual demonstration of “care”
Dr taking the blood pressure of a patient << to the residents of Britain Eric Coates’ “Calling All Workers”

The programme opens with black and white library footage, complete with Eric Coates’ “Calling All Workers” as the diegetic score. Various shots of an ambulance, nurses caring for patients and finally a Dr taking the blood pressure of a patient provides a nostalgic sepia tinted opening tone. Laid over the top is the voice-over of BBC Panorama reporter Declan Lawn, who reminds us, “the NHS, a national institution since 1948/Promising free health-care to the residents of Britain” This suitably nostalgic opening serves to remind viewers of a perhaps better, more promising age, the sepia tinted images of care are designed to resonate as indicative of more innocent times. The romanticised image of the NHS thus established, the narrative then jump cuts to a contemporary and urgent scenario

Visuals Diegetic score/Voice-over Non-diegetic score (if present) Brief description
Jump cut to contemporary scene
Image of an ambulance rushing through the frame Ambulance siren Generic music resonant of BBC Casualty Cut to ambulance passing through the frame accompanied by siren to signify “emergency” in contrast to previous images of “hope”
Lawn, shot close-up driving through the streets <<But now, we reveal how NHS managers>> Generic music resonant of BBC Casualty Cut to shot of Lawn in car, on his “journey inside the NHS”
Covert filmed sequence of one of the aforementioned “NHS managers” counting out £20 notes << can cash-in on that promise >> Generic music resonant of BBC Casualty Visibly Counting out notes, visibly and literally “cashing in”

The image of an ambulance rushing through the frame, accompanied by a siren and the generic emergency Casualty style non-diegetic score serve as a visual and aural (televisual) reminder that the contemporary NHS scenario is urgent and far removed from the past. Lawn shot in his car, a classic trope of television thus signifying that our reporter is “taking us on a journey” through the story.  There follows the first (of many throughout the programme) shots of undercover, covert filmed sequences, designed to cast and characterise many of the protagonists as the principle cause of the crisis in the NHS. At this point the voice-over matches the visuals insofar as, one of the “NHS managers” is covertly filmed counting out £20 notes – a visual and literal representation of his “cashing-in” (at “our” expense)

Visuals Diegetic score/Voice-over Non-diegetic score (if present) Brief description
Billowing Union flag Early visual call to patriotism to defend the NHS (from the ‘Other’)
Jet plane passing through the frame in grey sky Every year, the NHS is being used >> Generic music resonant of BBC Casualty Plane passing through the frame to signify the arrival of the ‘Other’ “using” the NHS
“Thrown-focus” sped up footage of a bustling and busy contemporary hospital << by thousands of ‘so-called’ health-tourists >> Generic music resonant of BBC Casualty Post production effect – “throw-focus” to capture “thousands” streaming through hospital – struggling to cope.
Suitcases being wheeled through arrivals lounges << foreign nationals who are not entitled to its care >> Generic music resonant of BBC Casualty Foreign nationals visually signified by suitcases tracking across airports
Extreme close-up (ECU) of Lawn’s eyes << and who don’t pay >> Generic music resonant of BBC Casualty Extreme close-up (ECU ) of Declan Lawn, his eyes to signify close attention to detail – on “our” behalf
Computer screen containing numbers and charts (costs of care) << for the privilege Generic music resonant of BBC Casualty Decontextualised shot of large numbers

The Union flag is the first visual call to patriotic defence of the NHS. This is further enhanced by the next sequence of shots combined with the voice-over. A jet plane passing through the frame; then a “throw-focus” shot; sped up footage of a bustling, busy contemporary hospital; suitcases being wheeled through arrivals lounges  – clearly representing the en-mass arrival of “thousands of ‘so-called’ health-tourists…foreign nationals who are not entitled to its care and who don’t pay for the privilege” (Lawn, D BBC Panorama “Britain’s Secret Health Tourists” broadcast 3/10/2012) We then cut to extreme close-up (ECU) of Lawn’s eyes signifying his investigative prowess, followed by computer screen containing suitably large numbers and charts that may or may not bear a relation to the cost of care – it is never explained, the image is designed to merely stand-in for contextual explanation.

Visuals Diegetic score/Voice-over Non-diegetic score (if present) Brief description
Interior shot of Declan Lawn in car, on a journey Generic music resonant of BBC Casualty Return to Lawn on another journey inside the NHS
Exterior shot of person entering car. Leg and foot in shot, face “framed out” Using journalists from all over the world >> Generic music resonant of BBC Casualty
Car Interior – shot from rear seat. Lawn in focus, accomplice/investigative undercover journalist face blurred out of focus << We go undercover >> Generic music resonant of BBC Casualty Visual representation of “undercover” signified by out of focus shot on one of protagonists (undercover journalist)
Cut to exterior. Undecover footage (secret filming) of “Middle-man” counting out cash. << in a ‘black market where access to GP’s is being bought and sold >> Generic music resonant of BBC Casualty Undercover shot of the “black market” in which a suspect counts out cash
Lawn shot through Venetian blinds << we find out how easy it is for health tourists >> Generic music resonant of BBC Casualty Staged shot of Lawn captured through blinds – viewers offered opportunity to see into spaces normally denied
Lawn switches on an X-ray display << to get X-rays >> Generic music resonant of BBC Casualty Visual signifier supportive of the voice-over – so we can literally see the expensive, technological procedures given to “Health tourists”
Shot of patient entering an MRI Scanner << MRI scans >> Generic music resonant of BBC Casualty Visual signifier supportive of the voice-over – so we can literally see the expensive, technological procedures given to “Health tourists”
Exterior – Lawn walking through the streets << and blood tests in hospital for free>> Declan Lawn back on the streets walking purposefully

Declan Lawn continues on his journey, visually displayed by the car. We then witness a sort of visualising of the methodology. Shots of “framed out” investigative assistants with the voice-over confirming the “undercover” nature of the investigation. A shot from the rear of Lawn’s vehicle with one journalist blurred out of focus. This is quickly followed by more “undercover” covert filming of another villainous character, in a “black market” again, counting out notes. We then see staged shots of Lawn filmed through blinds or half hidden, signifying the “undercover” espionage style of his journalistic engagement and that we the viewer are privy to information previously concealed. The voice-over referring to “health tourists” overlays shots of obviously expensive medical procedures which are visually displayed for us. Then a cut to Lawn walking purposefully through the streets looking pensive – but active(ly) engaged on our behalf.

Visuals Diegetic score/Voice-over Non-diegetic score (if present) Brief description
Exterior – the grounds of a hospital. Mid shot of Lawn and another investigative journalist Diegetic – “did anyone ever ask you if you were ordinarily resident in the country?” Shot from a distance
Close up of journalist Diegetic – “Nobody” Zoom to focus attention as protagonist speaks important words
Exterior – Lawn’s car  driving up the street (headlamps on) << Critics say the system is flawed>> Generic music resonant of BBC Casualty Another signifier of the journey into the heart of the NHS complete with “light shedding” visual symbols
Interior – interview with expert “critic” Diegetic – “This is the poor old NHS being given the task of implementing something which is unworkable” The narrative of this broadcast is legitimised by use of those on the inside

Another car journey then a sweeping shot of Lawn entering the grounds of the hospital sets up the next sequence. Shot from a mid-distance on slightly shaky camera, thus signifying covert filming. The need for this shot as covert though is merely to position the audience. Because both journalists on screen at that time are aware of, and are in fact a part of the investigation, this short sequence and the camera work is designed to give the impression that the audience are “overhearing” information, a series of “quick zooms” invite the viewer closer to (important bits of) the story. A quick cut to Lawn (again) in his car, shot from distance with the headlamps on – perhaps a “light-shedding” metaphor. The voice-over introduces us to “critics” of the current system with a short interview clip in which the “poor old NHS” is fore-grounded. At this point, it seems germane to mention that it is not in doubt that the NHS faces issues of cash-flow and funding. The point of this analysis is: the broadcast invites viewers to identify that the (at least partial) cause of this funding crisis in the “Poor old NHS” is to be laid at the feet of “foreign nationals” and unscrupulous “NHS managers”

Visuals Diegetic score/Voice-over Non-diegetic score (if present) Brief description
Exterior – shot of two Union flags hanging high in the street << We discover how the >> Generic music resonant of BBC Casualty Second visual call to patriotism
Lawn walking through crowded London street – just visible through crowds << NHS is losing millions of £ >> Generic music resonant of BBC Casualty Perhaps third call to patriotism combined with Lawn’s purposeful walk through recognisable environment
Close-up of Lawn’s hand placed on a computer mouse << to other European countries >> Generic music resonant of BBC Casualty ECU of Lawn again to signify close attention to detail
Close-up of Lawn working on computer, looking at screen >> and how our NHS>> Generic music resonant of BBC Casualty CU of Lawn again to signify close attention to detail and his stealthy undercover work
Graphic display – European Identity card >> slides out of frame << passport >> Generic music resonant of BBC Casualty Post production edit of “European” health insurance card >>
<<slides into frame: Library footage of Eurostar train << into Europe Generic music resonant of BBC Casualty Eurostar Train slides across screen
Crowded platform and crowded escalator complete with European passengers disembarking << is wide open to fraud Generic music resonant of BBC Casualty European passengers disembarking
Cut to exterior and another undercover, covert filmed sequence of “middle-man” counting out cash (complete with sub-titles demarcating how much cash) Generic music resonant of BBC Casualty Undercover footage, again unscrupulous protagonists visually displayed counting out money
Interior: Nurse busily walking through a hospital corridor Tonight, join Panorama Generic music resonant of BBC Casualty Interior of hospital – recognisable scenes
Medical glove wearing hospital worker pushing a hospital bed as the NHS Generic music resonant of BBC Casualty Shots of expensive medical equipment
Generic (expensive) medical equipment Struggles to makes savings Generic music resonant of BBC Casualty Shots of expensive medical equipment – as “the NHS struggles to make savings”
Exterior: Aforementioned NHS Dr (already seen “cashing in”) walking hurriedly down the street being pursued and challenged by Declan Lawn We show how secret health tourists are costing the NHS millions Generic music resonant of BBC Casualty The denouement of the broadcast is trailered here – the “Roger Cook” style confrontation with an already seen cashing in unscrupulous individual.
Graphic – In style of Casualty bearing the title of the broadcast: “Britain’s Secret Health Tourists” Generic music resonant of BBC Casualty (louder) Casualty style graphic – signifying drama, recognisable signifier; emergency

These final sequences begin with another call to patriotism with a shot of two union flags billowing in the London streets. More sequences of undercover “secret” filmed footage – in the “black market” – and more visuals of “middle-men” counting out cash.  Throughout the broadcast we are treated to an abundance of “Pull-focus” shots. These are designed, as one might expect, to “pull-focus” of the viewer into the narrative. Significantly, the “pull-focus” is a characteristic trope of television drama. The dramatic is in keeping with the style of current affairs broadcasting

Being an eminently visual medium, television excels at constructing powerful meanings, at creating vivid impressions, associations and eliciting emotional involvement. It is not so good at presenting lots of facts and the kinds of messages where attention to nuances, reservations and contradictions is vital … The medium lends itself to aesthetically appealing and dramatic representations but is less appropriate for logical and factual argumentation, discriminating descriptions of reality and in-depth analyses. (Ekstrom, M 2002.)

In this concluding section of the “trailer” the foreign nationals arriving is visually displayed by the Eurostar train sliding into frame, thus signifying the ease of movement, and to extend the analysis, in the context of this broadcast, to signify the ease with which rules are sidestepped. The passengers are seen in their hundreds disembarking the Eurostar, to signify “a mass”, and a wide open border, possibly even a border “wide open to fraud” (Lawn, D BBC Panorama “Britain’s Secret Health Tourists” broadcast 3/10/2012). The denouement is classic combative and dramatic confrontation journalism in the style of Roger Cook, so we are offered a sense of (partial) resolution. The opening 1 minute and 45 seconds sets the tone for the remainder of the episode. In this particular broadcast the viewing public are offered the narrative that the NHS is under threat – which is certainly true – and that the intrepid, espionage like, undercover journalistic skills of Declan Lawn will reveal such menace. However, Panorama: The Secret Health Tourists locates said menace and threat in the form of the “foreign national”.

One of the reasons such brief but detailed textual analysis is undertaken is to outline the ways in which Panorama, in some respects constrained by the discourse of broadcast television journalism, deploys classic dramatic signifiers in order to “tell the story” The story told here though – the story of “health tourism”, a fear inducing tale of foreign nationals stealing “your” tax payer funded NHS care – is manifestly not the story of the NHS in 2012. Whilst it is perfectly in keeping with the traditions of the form, one could argue that such traditions as broadcast here, are inadequate. In the context of 2012, and the changes brought about by the “Health and Social Care Act”, it is surely incumbent on the UK’s flagship current affairs broadcast strand, located on the principal Public Service Broadcaster, to devote significant attention to the de facto privatisation of the NHS. But, in utilising the tropes and characteristics inherent in the form of BBC current affairs Public Service Broadcasting, Panorama discursively reproduces the normative ideals perfectly commensurate with perceived “values” of neoliberal hegemony. In this specific case, Panorama’s coverage of the NHS focussed on reimagining and reproducing an already established fear of the “Other” within a narrative of “…the NHS struggling to make savings” [Lawn, D Panorama broadcast 3/10/2012]. Significantly, as is common in the contemporary television journalistic landscape, the narratives and stories told are both of, and by a narrow range of individuals. The focus on individuals is perhaps the most urgent signifier of current affairs television’s inability to critically interrogate wider structural issues. It is easy to tell the story of individual failings; individual flaws; and the individualised mendacity of ‘Othered’ identity forms – after all, through repetition, “we” already *know* the ‘Other’ is to be distrusted and feared. Surely more worthwhile and urgent to critically interrogate the systemic structural flaws of neoliberal capitalism and their likely introduction to and affect on the NHS. That critical analysis remains largely absent from the narratives of current affairs broadcasting is both problematic and self-fulfilling. “It is always much easier to create frames than to change them” (Wolfsfeld, G. 1997) One could argue that in absenting any consideration of the “reforms” contained within the “Health and Social Care Act”, and the very real possibility that it lays the ground for privatisation, Panorama’s Britain’s Secret Health Tourists was in fact a staggering waste of journalistic resources. In place of critical interrogation of NHS privatisation, through entirely absenting such considerations, the neoliberal “market knows best” “consensus” is left unremarked upon in favour of a narrative of exclusion and fear.


Barnett, S (2011) ‘The Rise and Fall of Television Journalism’ London. Bloomsbury Academic Press.

Debrett, M (2010) Reinventing Public Service Television for the Digital Future. Bristol. Intellect Books.

Ekstróm, M (2002) Epistemologies of TV Journalism: A Theoretical Framework in Journalism Vol 3 (3): 259-282.  

McNair, B (2009) ‘News and Journalism in the UK’. London. Routledge.

Wolfsfeld, G (1997) Media and Political Conflict. Cambridge. Cambridge University Press.


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