01/04/2012 19:09 BST | Updated 01/06/2012 06:12 BST

NHS: The Punchline

Please spare a thought for one group of vulnerable people who will be hit especially hard by the effects of the Health and Social Care bill that has just been hustled through parliament. Lonely, confused, and often delusional, these people are comedy writers.

For the last sixty years these tragic figures have depended on the NHS for the setting of jokes about clueless doctors, oversexed nurses, ferocious matrons and incontinent geriatrics. Some elderly comedy writers have based their entire career on these perceptions.

And now, in the twilight of their years, as they struggle to craft gags about sepsis and diarrhoea into 140 characters on Twitter, and to understand where the internet is kept when they're not using it, everything they relied on is being taken away.

Before we go any further, I'm assuming you agree that the new health bill is a despicable conspiracy to benefit greedy private businesses, deprive the public of a national treasure, and reform the NHS in the same way that a heretic is reformed by being burned at the stake. If you don't, please avail yourself of the following options:

• Stop reading now.

• Write a thoughtful comment explaining your reasons for disagreeing with me, even though I don't care.

• Write a torrent of vile personal abuse explaining why I am a hateful moron who should be boiled alive in battery acid.

• Have a nice cup of tea.

Okay, to proceed. Over the course of sixty years a particular strand of British comedy grew up around the extraordinary experiment that is our national health service. Two things made this comedy unique. The first is a distinctively British embarrassment about our bodies and their functions, which pre-dates the NHS and stretches back through the tradition of naughty seaside postcards and beyond. The second element is also what made the NHS itself unique: the fact that we were all in it together.

Difference in status is one of the engines of comedy, and the classic Carry On films that were set in NHS hospitals exploited the most obvious of these: class difference. The toff finds himself in the next bed to the plumber, and often the plot involves a reconciliation of sorts, as each learns a heart-warming lesson about life from the other, following the infallible formula of a transformational personal journey with added knob jokes.

Anyone who has been an NHS hospital patient will have experienced this social diversity at first hand. I once spent three weeks in ward where the bed opposite me was occupied by a well known actor; on one side of him a retired postman regaled us with tales from the sorting office in the 1950s; on the other side a wealthy young junkie negotiated cheerfully with the doctors over the fate of his ulcerated leg. Meanwhile, my neighbours were an elderly Jamaican gangster who was sinking into voluble but entertaining dementia, frequently surrounded by a vast, equally voluble family, and an old man who never once woke up and who eventually died quietly, alone and unvisited. It wasn't always funny, but it was never dull.

Back in the world of Carry On Matron, it wasn't just class distinctions that provided comedy. Hospital staff operate within a very rigid and codified hierarchy. The gulf in status between a consultant surgeon and a trainee nurse is immense, and so is that between a ward sister and a cleaner. Attempts to bridge these gaps are fundamentally transgressive and therefore potentially funny, and so are the collisions between people who occupy different rungs of the ladder but often find themselves interacting because of the unique circumstances of hospital life.

It's just like Upstairs, Downstairs but with more enemas. And finally, there's a subtle interplay of status between the patient and the staff: an ambiguous dynamic created by the tension between your vulnerability as a patient and reliance on others to help you, and the provision of that help by people who have - or had - an ethic of service informing their activity to some degree.

And while you were able to spend weeks or months in an NHS hospital, and never once be reminded - or even made aware - of what your treatment was costing, that's never the case with private medicine.

Private hospitals are all about profit, from the moment the doorman ushers you in with that particular combination of deference and contempt that only money can buy, to the moment you're thrown out again, attempting to stuff your appendix back into a gaping abdominal wound after your surgery was cancelled mid-operation because your insurance cover expired.

The experience of universal free health care is very different from that of privatised medicine, and it will surely change our tradition of British medical comedy. What you worry about determines what you joke about, and comedy is about things going wrong.

Even if things that go wrong in an NHS hospital are an indirect result of financial factors, you don't generally wake up after an operation to find the surgeon going through your wallet, unless he needs cash to tip his caddy at the golf club. But even undemanding US hospital shows like Scrubs take place in a world where cost and money plays a role that's absent from even a dark, downbeat British medical show like the superb Getting On, written by and starring the incomparable Jo Brand, Vicki Pepperdine and Joanna Scanlan.

I'm not sentimental about the Carry On films, mainly because they were crap, except for Carry On Up The Khyber. But the sight of Sid James in pyjamas leering at a busty nurse as a doctor called Sir Lancelot Spratt notes the increase in his pulse while puffing on a pipe, may remind you that this type of comedy was just one reflection of something that was part of our way of life.

I'll only miss British hospital comedy because it grew organically out of the exceptional shared British experience of the NHS, which was a great humanitarian enterprise that's never been equaled. Maybe we can still do something to save it, but it's beginning to look as if the grey forces of commerce and profit are going to have the last laugh.

Which is so depressing that I shall now ask the nurse to prick my boil, just to see if a hilarious misunderstanding ensues and I end up with horribly mutilated genitals.

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