Professor Clare Gerada and Dr Phil Hammond: Why we are performing at the Fringe

Ahead of their 16-show run at the Edinburgh Fringe, former RCGP chair Professor Dame Clare Gerada and Private Eye columnist and retired GP Dr Phil Hammond and sat down with Pulse to tell us what they are up to

How did this duo and show come about in the first place?

Dr Phil Hammond: I did a series on radio four called Doctor Doctor where I interviewed eight doctors. We chose people who really enjoyed their jobs, because there’s so much anger and gloom about at the moment that we thought it would be nice to find people who really love being a doctor. Clare was one of them, and the episode with her was actually surprisingly funny, as well as interesting. The original idea was to see if we could do a podcast together, but I suggested that we do Edinburgh together. 

Professor Dame Clare Gerada: I’ve never done the Fringe before, but Phil is a veteran. He is the professional comedian – I’m just there as the Wise to his Morecambe, or the Laurel to his Hardy. I’m going to be the voice of reason and evidence, and he’ll be the one trying to demolish it.

Being a GP is de facto a comedian, because you have to work magic – turning wine into water and feeding the 5,000 with only a few loaves and fish. But I haven’t done anything like this before and I am not sure that I’m a particularly funny person, so good luck to us!

PH: I first went to the Edinburgh Fringe in 1990, as part of a double act called ‘Struck Off and Die’ with Tony Gardener. We were both junior doctors complaining about junior doctor working conditions, as junior doctors do. That was my first taste of the Fringe, and I’ve been doing comedy for 34 years now, over which time the NHS seems to have gotten far worse. So I thought if I joined up with someone sensible like Clare – especially with an election coming – then we might get more progress. Obviously the buggers then went and called the election before the Fringe. So we are looking at this show as a perfect ‘post-election’ wind down. 

How did you come up with the show’s title?

PH: Well, I did a show called ‘59 minutes to save the NHS’  in 2001, after Tony Blair said it. I didn’t tell Clare this before she signed up to it, because ‘saving the NHS’ is such a grabbing title! But the two of us do disagree about the use of the word ‘saving.’ Clare will say that the NHS has been with us for 76 years and that it doesn’t really need saving – it just needs improving. But that sounds like a series of tedious management consultancy lectures. And Wes Streeting says the NHS is broken and he wouldn’t lie to us.

CG: I don’t think the NHS needs saving, but Phil does. I think the NHS is struggling to deliver. ‘Saving’ implies that it is about to die – and it isn’t. It is just struggling because we’re not putting enough funding into it. Everyday, 1.2 million people access the NHS and most are getting very good care. We were the first nation to immunise against Covid, the first to immunise against meningococcal, Scottish health services have eliminated cervical cancer and herpes, and earlier this year NHS patients in England were offered trials for the world-first cancer vaccine.

I think that we need less health care and more health. We need fewer hospitals. We need every single doctor, irrespective of the endpoint, to work in primary community care at some point – not just as junior doctors, but further up track.We need a shift of funding from hospitals to primary community care. If we do that, we will have a health service fit for the future. So I don’t think the NHS needs saving – it needs changing. 

PH: I’m more sceptical than Clare. I’m slightly worried we’ve got over the point of no return. The NHS is just a way of funding a service through taxes that’s free at the front door, free at the point of provision, and largely – but not exclusively – publicly provided. There are lots of other systems that do it, and there are systems that do it better because over the course of their lifetime, they’ve had more money and resources plugged into it. 

So I think there are two issues really. One, we’ve tried to get first world health care on the cheap – paying American-style taxes and expecting to have free universal health care. But the other point – that Clare makes very clearly – is that successive health secretaries have treated the NHS like a train set. I’ve been in the NHS 35 years, and Clare for 40 odd, and we have probably had about 15 reforms in that time where people were thrown all the bits up in the air again and re-done it.

What should people be expecting from the show?

CG: So the show is a manifesto to save the NHS, done within 50 minutes, with audience participation. 50 minutes is actually a surprisingly short amount of time, so although we are involving the audience, we aren’t doing a ‘Q&A’ as that would take too long. Instead, we will be asking the audience, as they wait to come into the theatre, what their manifesto would be; what they want from the NHS. We’ll then use their suggestions in the show as manifesto motions, and get the rest of the audience to vote on them. By the time the first one rolls around, we will have had the first 20 or so days of a new government, and so should have some sort of indication as to what direction we might be moving in.

PH: As we’re both doctors, it is obviously important for us to know what to do if somebody collapses. So, at the beginning of the show, we ask people if they want to be resuscitated or not. And it is usually about 50/50: some say they want to be defibrillated, and others say ‘I’ve good innings already so don’t bother!’ So then we go around and draw an asterix on the forehead of people who don’t want to be resuscitated, just so we know!

Given that the show uses audience participation, each show will be quite different, depending on audience members. In your rehearsals, have there been any recurring themes? 

CG: We’ve touched on quite deep subjects like assisted dying repeatedly which is obviously very unusual in comedy.

PH: I tell the story about my step dad’s death, which could have been a bit kinder if we’d been able to do it a bit sooner. When I told the story at a comedy festival in Somerset, this farmer told me that it’s the same thing that had happened to his dad – it had gone on and on for ages and was really inhumane. And so, as a farming family, they got together around the table and they came up with this idea called ‘clingfilm assisted suicide’, which sounds outrageous – so maybe he was lying to me! But he said, what they do in their family, when people get towards the end of life, they just wrap them in a big clingfilm. They can pull it off if they want to, or can leave it be and die quickly. I’m hoping he was joking but we’ve put that in the show as a manifesto choice, and every audience has voted for it!

What do you think are the biggest problems facing the NHS, or that the NHS needs to address right now?

DCG: Prevention. Unless we narrow the gap between ill health and death, no health service in the world is going to be able to afford the rising costs. That can only be done by empowering patients, funding proper general practice and community care, and looking at use of digital and data. 

PH: Public health and prevention are key. We need to give prevention the attention it needs. It is like the dog that doesn’t bark – you never know when you prevented something, but it is the single most important thing we can do to improve health and take pressure off the NHS. It also gives you bang for buck. 

The show is donating profits to Doctors in Distress. Why have you chosen to support this cause?

CG: Doctors in Distress is a charity that aims to reduce the rate of suicide amongst all health professionals, by creating reflective spaces, allowing them to come together to talk about the emotional impact of their work. We currently spend about a billion pounds on regulating doctors, monitoring doctors, and punishing doctors. But we spend very little on actually supporting them. 

I’ve cared for people who’ve lost loved ones through suicide; people who – if they’d had a space to talk about that complaint, or talk about the patient that died, or their workload – may not have killed themselves. I am absolutely convinced of that. The average healthcare worker has zero space in their work time for reflection. Instead, the system forces doctors to do 30-40 hours of online training into things that go in one ear and immediately out the other. Doctors in Distress not only provides a space for reflection, but is also lobbying incredibly hard for a change in how we use the time that health professionals have to reduce the impact of their work on their emotional state. We aren’t asking for much – just for every single frontline health professional to have nine hours once a year for a space to talk about their work. One doctor being off sick for a year will cost their trust £200,000, so this is a cost-saving measure.

Are you looking forward to the Fringe experience?

CG:  Well, we’re doing 16 shows in 16 days so it’s going to be exhausting! But I have loved the rehearsals we’ve done so I am sure it will be fine…

PH: Absolutely! The Fringe is always stressful as there are so many shows and you have to stick to your allotted time. I also have another show going on: The Ins and Outs of Pleasure. It is important to talk about the NHS obviously but, if we as individuals want to remain healthy, then talking about how we pleasure ourselves is crucial! And we don’t like to talk about it as a society as we think it is rather saucy and disgusting. But, I am looking forward to doing both shows: the one with Clare being political comedy; and then lots of innuendos and profanity in the second. It’s a good balance to have!

This interview has been edited for clarity and length

Professor Dame Clare Gerada is a London-based GP and chair of Doctors in Distress. Dr Phil Hammond is a retired GP and the medical correspondent for Private Eye.

Their show ‘Fifty minutes to save the NHS’ is running at the Edinburgh Fringe from August 2-17. More information and tickets can be found here.