The BBC medical drama "Casualty" is celebrating its 40th anniversary, marking four decades as the world's longest-running medical show. The milestone is being commemorated with a two-part special that opens with a dramatic explosion mirroring the very first episode from September 6, 1986.
That inaugural episode featured Charlie Fairhead, the hospital drama's longest-serving character, driving a yellow VW Beetle involved in a gas explosion at Holby City Hospital. The show's creators, script editor Jeremy Brock and theatre director Paul Unwin, intended "Casualty" to be a realistic portrayal of an NHS emergency department, a stark contrast to previous, more sanitized depictions.
Inspired by American dramas like "MAS*H" and "Hill Street Blues," their pitch highlighted the struggles of the NHS. "In 1948 a dream was born. In 1985-1986 that dream is in tatters," read the opening line. The show's realistic portrayal of chaos and its depiction of staff smoking and drinking on duty, alongside the NHS as a flawed institution, sparked controversy. Then-junior health minister Edwina Currie famously called it "anti-NHS propaganda."
Despite the controversy, the series gained a large following, resonating with audiences due to the universal experience of visiting an A&E department. "We've all been to A&E so there's a sense of recognition," said series producer Liza Mellody. "You go at your worst time... You need help. You're seeing humans at their worst, and hopefully meeting people who are heroes – doctors and nurses – but also just normal people."
"Casualty" has not only served as a platform for guest actors but also as a launchpad for numerous British talents. Stars like Kate Winslet, Martin Freeman, Nicholas Hoult, Tom Hiddleston, Minnie Driver, Ray Winstone, and Orlando Bloom appeared in early episodes. Winslet noted that appearing in the show taught her "a big lesson in how to be natural in front of the camera."
The show has tackled a wide range of sensitive subjects, including murder, train crashes, riots, sexual assault, and mental health issues. To ensure authenticity, writers meet with experienced NHS frontline medics four times a year. "We have guest days and our writers will sit in a room with doctors, nurses and paramedics," explained Mellody. "We'll say, 'We're thinking about doing this' and they'll share their experiences. The key is to be entertaining but absolutely authentic."
The 40th anniversary special episodes feature a major incident, thought to be a terrorist attack, with scenes filmed at Pinewood Studios' underwater stage. The narrative follows Dr. Flynn Byron, an ex-special forces doctor, and the hospital staff as they cope with the influx of wounded. "Casualty" is also undergoing a significant change, relocating its production from the fictional Holby City to Cardiff, Wales, where it has been filmed since 2011.
"We'll be moving our fictional world to Cardiff," Mellody stated. "Practically, there is a lot to be said for not having to pretend we're somewhere else. We can really be in Wales and it will allow us to show its beauty, plus we have a new set, a new hospital."
The anniversary episodes aim to satisfy long-time fans with nods to the past while also attracting new viewers. "Casualty fans are so loyal," said Melanie Hill, who plays clinical nurse manager Siobhan McKenzie. "A lot of them have watched every episode. And the fact that it's the 40th anniversary, I'd like to think of it as a way a new audience can latch on."
The anniversary special episodes began airing on Saturday, September 5, 2026, on BBC1 and BBC iPlayer.