Set in the fictional Holby General Hospital somewhere broadly in southwestern England, the show follows the character development and personal lives of the staff who work there — primarily within the Accident & Emergency (A&E) Department, which is the British equivalent of the US Emergency Room or ER and is colloquially known as 'Casualty'.
Coming in at a whopping 38 series and over 1300 episodes as of 2024, having passed its one thousandth episode in 2016 just before its thirtieth anniversary, the list of actors to have featured in the show's core cast is wide, varied and constantly changing — not to mention the numerous Patients of the Week. For decades the sole constant was charge nurse Charlie Fairhead (second-left in the page image), who was continuously played by Derek Thompson from the very first episode in September 1986, but the character finally departed in March 2024 after 37 1/2 years. Incidentally, Casualty has gained a reputation in later series, similar to that of The Bill, for featuring many well-known British actors in small roles, and helping launch the career of others who later went on to bigger things.
Holby City, a spin-off, was spawned in 1999 and followed the lives of those working on the surgical wards. After more than two decades running in parallel with its parent show it drew to a close in 2022, after 23 seasons.
This show provides examples of:
- Aborted Arc: Near the end of series 27, an abusive mother proved her "innocence" with an obviously faked video and was allowed to have her son back. A few episodes into series 28 and there's still no conclusion to this.
- Accidental Murder: Lara hits a policeman over the head with a brick because he tried to rape her.
- Action Girl:
- Lara, who had worked in a war zone before arriving at Holby. Kudos to the writers for a getting a Tomb Raider joke in while the time was right.
- Sam, who was a British Army doctor serving in the ED while on leave from active duty. When given the opportunity to go back to Afghanistan, she reluctantly declines.
- Adminisphere: Nathan is an Adminisphere unto himself, so much so that he makes all the other members of management look wonderful by comparison.
- Aesop Amnesia: No one seems to realise that getting too emotionally involved with patients or even just your co-workers never ends well. Much exploited for the Rule of Drama but may be partially justified since there is an element of Truth in Television and usually (but not always) happens to younger characters who haven't been around long enough to know better. Lampshaded by the episode ''You Can't Take Them All Home with You". Although
it doesn't help that characters such as Duffy or Maggie who get called out for being co-dependent on their work life and the emotional problems of others are portrayed as being better adjusted than most of their colleagues despite all of their personal mishaps. - All Lesbians Want Kids: Double-subverted by a couple where one of them is eager to adopt a difficult young boy while the other isn't quite as keen but comes around to being a parent in the end.
- Anyone Can Die: Lots of likeable characters and audience favourites died.
- Artistic License – Geography: Although called Holby City and the town is called Holby, -by does not appear in any place names around Bristol. -by is from Old Norse by village, and is only found in Northern England and Scotland, so by default it should really be Holton, with the last element being Old English tun village. Holby (or Holton as it should be) would mean either "village by the wood" from Old English holt "wood" or "village by the hollows", from Old English holh "hollow" and the endings mentioned above.
- Ascended Extra: Kath - given that she's nearly always in scenes where Yuki and Lenny appear. Provides Shipping material for fans...
- The Baby Trap: Harry accuses Ellen of this, to the point of inducing his own Shotgun Engagement. Turns out it was tumor.
- Betty and Veronica: Harry and Selena seemed to have quite a few of these orbiting around them. First there was Beth as Harry's Betty to Selena's Veronica - although Lara could have also been considered another Betty if you add her to the equation - until Beth was killed and Selena left. She then returned having Harry play Betty to her Jerkass Veronica husband, Will. This then changed to Ellen being a younger Veronica to Selena being the older, more cynical Betty, until Ellen's death. Finally, Selena gets another Jerkass Veronica in the shape of Nathan, with Harry as Betty once more up until her becoming the victim of acute lead poisoning. Would be Love Dodecahedron if it weren't for the fact that these triangles went one at a time.
- Both Sides Have a Point: In "Belief" Jacob is shot by an armed policeman who assumes he's one of the terrorists. Jacob assumes he was profiled because he's black. In the armed policeman's defence, Jacob was holding a gun.
- Bookends: In the first episode, Charlie Fairhead's first scene sees him arriving at the hospital in a yellow beetle. In the character's final episode 37 years later in March 2024, he departs the hospital in a yellow beetle.
- Bouquet Toss: A bride chucks hers at her erstwhile husband and Lara manages to catch it, after which Anna starts squeeing that she'll be next. She is. Well, sort of.
- Bowdlerisation: Watch tends to cut out the stuff that's too hot for daytime tv with the reruns. Resulted in a bit of a problem for To Love You So - but the missing bits from that episode can be seen here
, here and here. - British Brevity: Averted. The shortest ever season of Casualty was season 3, with only 10 episodes (the first two had 15 each). Since then, the episode count per season has been rising more often than not, and now tops out at season 24 containing 49 weekly episodes. Some want it to go all-year 'round, but this hasn't happened...yet.
- Broken Aesop: Ryan taking off with all of Duffy's money in Hitting Home shows that a relationships can be financially abusive in addition to or opposed to physically. Her later taking him back breaks this episode's moral that still loving an abusive partner or even just trying to hold on too hard to any happy memories will never undo the abuse.
- Butt-Monkey: Lofty, who is incapable of going even one episode without humiliating himself in front of patients and staff.
- The Cameo: Amy Acker made an uncredited cameo, presumably as Samantha Groves aka Root, her character from Person of Interest.
- Childhood Marriage Promise: Duffy said that she would marry Charlie if he hadn't found the perfect woman by the time he was sixty.
- Deadpan Snarker:
- Jack, on occasion. Like when hiding from Rachel.Jack: Is she gone?Lara: Who?Jack: The Old Jill.
- Dylan seems to communicate almost exclusively in snark.
- Connie too, proving she hasn't changed that much since her Holby days.
- Jack, on occasion. Like when hiding from Rachel.
- Death by Ambulance: Barely averted at least once, albeit with a motorcyclist instead of a pedestrian who got away with a few bruises and a stern reminder to look both ways before crossing a junction in future.
- Delivery Guy: Charlie helps Duffy deliver her third baby at home. Charlie is a nurse and the implication is that Duffy planned it so that she could avoid going to hospital.
- Designated Victim: Being a medical drama, a lot of characters suffer, but few more than Ethan Hardy. He seems distracted in his first appearance because his mother has just died. Then he finds out he's working with his brother Cal, with whom he has a constant, bitter rivalry. His asshole brother steals £15000 from him to give to his girlfriend's medical charity — which turns out to be a scam. He later finds out that his late mother wasn't really his mother — he was adopted. His real mother has Huntingdon's disease, a crippling, irreversible illness that has a 50% chance of being passed down. As his helpless birth mother dies beside him not long after they first meet, he finds out he has inherited the disease, and of course Cal hasn't. Despite all of his brother's misdeeds, Ethan loves him and remains loyal to him — so of course, Cal is murdered by a cold-blooded racist who gets away with it. Cal's murderer ends up falling and getting gravely injured, and when he shows no remorse, Ethan watches him choke to death on his own vomit. This should be a victory, but Ethan is now haunted by how he allowed himself to betray his moral duty as a doctor. He hands in his resignation to the clinical lead, Connie, who doesn't accept it... because she would rather use the knowledge that he let a man die as blackmail. What's more when Ethan isn't being burdened by the universe, he's the type to get completely strung out with work and make mistakes that make him question his worth.
- Didn't Think This Through: Guppy snorting some heroin he stole from a patient because he thought it was cocaine.
- Disaster Dominoes: Every second or third episode is based around this idea. In the first episode of 2012 for example, a dog escapes from a back garden; this leads to a major traffic accident taking out 5 or 6 cars, which leads to one man being delayed in stopping a suicide attempt; in trying to save the suicide victim and dealing with the traffic caused by an accident, a gas main is accidentally destroyed causing an explosion which rips apart a housing estate. This in turn causes some nearby chemical drums to burst, creating a huge cloud of hydrogen chloride, which ends up getting into the drain system causing part of the town to be evacuated. We end up seeing several hundred people affected by various burns and in the following episode, it states there were at least 9 deaths. And all this happens on the same morning that the A&E department first reopens after a major fire so all the equipment is new and most of it untested. And this is just one episode.
- Downer Ending: It can vary, but as this is a fairly realistic show about emergency services, it would be futile to try to wrap up every single episode with a happy ending, even outside of ongoing story arcs. Of course, YMMV argues that is part of the show's charm.
- Dramatic Hour Long: About fifty minutes, but sometimes goes up to an hour and rarely any longer. One of the few exceptions to this was the series 24 episode "A Day in a Life", which was nearly two hours long, uninterrupted - although it was originally two separate episodes that had to be cobbled into one owing to scheduling problems.
- Dropped a Bridge on Him: Mason Reede suddenly dies off screen from an undiagonsed heart condition.
- Dying Declaration of Love: Dixie declares her love to Cyd in "Lie to Me" with Now or Never Kiss. She does it so cheerfully that underneath she realises it looks like game over...
- Dysfunction Junction: In a big way, once you tally up the backstories. If you didn't have a Dark and Troubled Past before you came here, you will when you leave. Lampshaded by a (now removed) Youtube Poop crossover with Lee Evans, featuring a group shot of the Series 20/21 cast with the voiceover saying, "You think you've got problems?"
- Everybody Lives: At one particularly huge RTA, Anna sits down with the incident commander and the two of them realise that, apart from one driver who was DOA, everybody made it to the hospital. This is then kicked to the kerb when Patrick goes into arrest before the credits roll..
- First Guy Wins: Harry and Selena.
- Foreshadowing: Incredibly heavy handed, but sometimes it turns out to be a red herring. If they use a motor vehicle that isn't a car the chances of a road accident are 1:1. It's bit more of a random dartboard working out what the big medical emergency's going to be. If someone gets into a car, it's definitely worth betting that they're going to crash.
- Formula-Breaking Episode: Later series have been prone to the occasional episode that breaks from the norm, typically focusing on a single plot line in a very odd way. Series 29 has several; The Road Not Taken features Zoe reliving the same day three times to stop patients dying. Exile is set almost entirely in Bucharest and has Charlie and Connie clashing with a gang to try and stop Louis selling his kidney. Holby Sin City features a noir-like plot where Ethan discovers a murder, heavily lampshaded by Ethan struggling to remember the term Femme Fatale throughout the episode, only remembering after they've reported the fake-suicide murder.
- Gone Horribly Right: The result of Harry running for parliament. He doesn't actually expect (or want) to win, but it gives him a platform to highlight plans to close the hospital, and if enough people vote for him, that proves people want it to stay open. Instead he wins the election, meaning he has to leave the hospital and become an MP.
- Good Girls Avoid Abortion: Selena, but not before being thought to have averted it. Inverted with Ruth, who ends up only half aborting it and haemorrhaging at a surgeons' dinner.
- Head-Turning Beauty: Lara. Lampshaded by the following exchange:Dillon: Don't even bother.
Jack: What?
Dillon: Lara - she's not only out of your league, you're playing a different game.
Jack: You're just worried I'd get ahead before you, son. That's all it is.
Patrick: Forget it, children. I'm already there. - Heroic Sacrifice: In the tunnel crash crossover with Holby City, Woody grabs a leaking canister of toxic chemicals, and runs the length of the tunnel with it, before dropping dead outside from breathing a lethal dose.
- Hospital Gurney Scene: Every episode but considering the setting, it would be kinda hard to avoid.
- Hospital Hottie: The characters are considered sexy by the fans, but the sexiness is unintentional on the part of the production team. In fact, they don't emphasise it and they dress in a fairly ordinary way, the women sometimes even have no make-up on (unless they're injured, in which case, it's obviously make-up for special effects.). Jeff, for some reason is Mr. Fanservice. Same for its Companion Show Holby City.
- Intimate Hair Brushing: One girl asks her sister to cut her hair before undergoing chemotherapy. It turns into this right before, as a tender moment between sisters.
- Latin Is Magic: Joked about in one episode, when two extremely embarrassed patients of the week are young couple Tara and Ray, who became locked together when Tara suffered a stress-related spasm during sex. Nurse Faith, trying to handle the situation as delicately as she can, explains that the medical term for the situation is penis captivus, which Ray thinks "sounds like a magic spell".
- Lodged Blade Removal: Pretty much any time anyone gets stabbed, impaled etc., you can expect to see them screaming "Get it out, get it out!" despite the medical personnel trying to explain why this is a terrible idea — and, if they turn their backs for more than ten seconds, the patient will probably try and pull the thing out themselves. One episode had a man with a crowbar stuck through his leg, which he wrenched out himself in the hospital foyer, nicking an artery in the process. He survived, but only because, being in the hospital already, they were able to treat him in time.
- Look Both Ways: One of the most common accidents.
- Meaningful Funeral: The funeral of Paramedic Jeff Collier is a sombre affair attended by a good number of his colleagues, and family members (including his pet dog). His wife almost misses it, due to her deep reluctance to admit that her platonic soulmate is truly dead.
- No Communities Were Harmed: Though the production has gone through phases of trying to pass it off as a generic Everytown, there's no getting away from it: Holby is Bristol. It's even got the Clifton Suspension Bridge!
- No Periods, Period: Averted, there is a patient with a heavy period. It turns out it post-partum haemorrhages.
- Non-Fatal Explosions: Lampshaded and then averted in a mid-90s season finale; a man comes into the hospital with a bomb strapped to his back, and in a conversation with one of the nurses, mentions that a bomb in a cartoon would leave you "with a charred face and holes in your pants" whereas a real-life bomb is a bit more damaging. It turns out that this bomb is a lot more damaging, as the bomb's detonation at the end of the story almost totally destroys the (thankfully evacuated) hospital, giving the producers an excuse to redesign the sets for the following season.
- Once per Episode: One of the main characters puking on another or themselves.
- Playing with a Trope: Done to Austin Powers proportions, but maybe not for parody/Lampshade Hanging purposes though.
- Pregnant Hostage: Inverted and subverted with a pregnant hostage-taker and another character making herself a pregnant hostage.
- Rape as Drama: Done a few times (as arcs compared to a Patient of the Week plot). Happened to Duffy, but in the first series so would now be considered Rape as Backstory. Also to GAWJUS Nurse Tina, proving that even good looking nice girls get raped
- Red Herring:
- There are two youths walking precariously along a very high wall, by the end of the episode no-one's fallen off a wall.
- One episode of series 21 featured a shark just off the coast, with people in the water. No one became shark food.
- Roadside Surgery: The resuscitation room may as well be made an OR with how often it gets used for this. One of the most notable is when Sean and Nick have to operate on Adam, Jessica, and their kids after getting in a car crash that results in them spinning off the road into a frozen lake. Though Holby does have an OR, it's still common practice.
- Romantic False Lead: Will Manning.
- Runaway Bride: Lara.
- Sacrificial Lion: Noel dies of COVID-19 in the first episode of series 35 as the department deals with the onslaught of the pandemic.
- Saving the Orphanage: The department comes under threat of being axed in order to streamline resources more than a few times, and a lobby group was set up during the latest crises. Much helped by Zany Scheme involving a fountain and Sexy Soaked Shirt.
- "Shaggy Dog" Story: Adam and Jessica's relationship. Jessica embarks on an affair with Adam (it takes several months for him to even learn that she's married whilst trying to begin a relationship), whilst her own husband, unknown to her, is also having an affair, which is eventually publicly revealed. Jessica breaks off her affair after her son is almost killed in a car crash, and stays with her husband, Sean, for the sake of the marriage. She then discovers that she's pregnant, and doesn't know who the father is, but decides to assume it's Sean's for the sake of the marriage. Sean finds out about the affair, assumes that it's Adam's baby, and abducts their (Jessica and Sean's) two children, taking them to Saudi Arabia. He also sells their house and clears out their bank accounts, effectively leaving Jessica destitute, having to move into a flat on an extremely violent estate. Ultimately, after the baby nearly dies at 7 days old and she admits to Adam it could be his, she kidnaps the children back and discovers that the baby, Harry, is Adam's. She gets engaged to Adam after over 18 months of will-they-won't-they. However, the relationship comes under pressure almost immediately: on his first day as head of the department, Adam witnesses a junior doctor die right in front of him, when she's crushed by a falling lift in a burning department store he sent her into. Just when it seems like he's managed to find a balance between his work and his family, Sean returns, and the whole relationship is briefly destabilised again as he tries (but fails) to break them up. Finally, their wedding day arrives, but before the marriage is made official, they are called back to the hospital to help with a minibus crash. Whilst the whole family is driving back to the wedding venue to complete the ceremony, Adam has to swerve to avoid a car, brakes too hard, and flies onto a frozen lake. Adam, Jessica and Harry are all submerged (the other two children get out fine), and back at the hospital, he has a meltdown in resus as he tries to operate on Jessica and Harry despite being in no fit state to do so. He then has to plea the only man capable of carrying out Jessica's life-saving surgery to do so, despite said man (Nick Jordan) no longer being in a fit state to work. The operation is carried out successfully, and just when it seems like things are finally going right, baby Harry dies before Jessica has come round from the operation. The storyline has thus far taken two years to get to this point, and if anything it's become worse and worse for the couple with very few patches of happiness.
- Lev Malinovsky's whole storyline. Introduced married to nurse Faith, when their son falls ill, he turns to a man, Xander, for comfort. It becomes clear he is a closeted gay with a lot of internalised homophobia, as a result of his family stamping out romantic feelings he had for a male friend when young. He continues to hide this, playing the devoted husband and father, until Faith becomes suspicious and outs him. He starts exploring his sexuality with Xander while continuing to live with Faith and their children. Things come to a head when Lev gets into a fight with a youth who made homophobic comments about him and ends up on an assault charge because he doesn't want to tell anyone that he's gay and was provoked. He nearly gets the youth to drop the charges but it doesn't work. Just as Faith convinces him to be honest, his father turns up and he goes right back into the closet. He is eventually honest with his father, goes to the police and looks set for a future with Xander. Then, on his way home, he gets hit by a train and dies.
- Satellite Love Interest: The aforementioned Jessica Harrison, who was introduced solely to be Adam's love interest and spent over two years in the show serving no other purpose.
- Shout-Out:
- A rather nice one to Spartacus in one episode, except the dispute is over who dropped a sharp.
- To Thunderbirds: Comfort became a paramedic because, as a kid, she wanted to be a member of International Rescue, since they were heroes because they saved people rather than killed them.
- To Pulp Fiction, where Comfort and Nikki are seen sitting in the ambulance eating "Big Sahuna Burgers".
- Shower of Angst: When a female patient expresses a desire to take one of these it sets the staff's outcry senses a-tingling and they suspect Rape as Drama.
- Shown Their Work: They have medical consultants on the team, to ensure authenticity. That's if you read the end credits.
- Sliding Scale of Shiny Versus Gritty: Gets a lot of flack from people in the NHS for glamorising A&E and medicine in general, although it isn't actually that shiny, even going so far as to very occasionally sacrifice drama for a sideplot to show that there are still a lot of mundane tribulations involved in the job. It's pretty close to the gritty end with out being outright grey - uses a lot of blocks of watery greens, blues and formica-type colours and almost never any warm ones, although it is getting grittier in some places and shinier in others as time goes by.
- Sliding Scale of Silliness vs. Seriousness: Generally serious as a rule, usually taking a big but brief swing towards the other end every so often in the interests of contrast, which usually works well.
- Someone To Remember Her By: Angel.
- Soundtrack Dissonance: Have a Nice Day by Stereophonics plays at the start of episode where Lara goes back to work after being released from prison.
- Spaghetti Kiss: Lara and Patrick lips meet when both try to eat the last prawn.
- Spin-Off: Holby City (set on the wards of the same hospital), Holby Blue (a police drama in the same city) and Casualty 1906 (a historical Docudrama).
- Too Dumb to Live:
- Many characters are introduced in the Cold Open with a confident statement along the lines of "Of course I know how to operate a chainsaw!"
- Diane Stuart meets her end when she touches a patient as they're being defibrillated.
- Trash the Set: Holby City Emergency Department has been destroyed several times. For example, there is a fire, used to accommodate the show's move from Bristol to Cardiff. While the new set in Cardiff still retained the general shape and layout of the Bristol set, it is obviously quite different - both outside and in.
- Wacky Marriage Proposal: Patrick's numerous idiosyncratic attempts to propose to Lara fail, only for him to succeed when he proposes the normal way.
- Western Terrorists: An episode which would have centered around a Muslim suicide bomber was rewritten with animal rights extremists as the perpetrators.
- Why Couldn't You Save Them?: In the episode where Jeff Collier dies, the staff of the ED and the paramedics waiting at the entrance know there was an explosion at the crash site with some of their colleagues involved. When Dixie returns with a single patient and two other paramedics, when ambulances are double-crewed, Tamzin demands to know why Dixie didn't bring Jeff back.
- Worst Aid: Averted. The show is often used as a public information film to demonstrate best practice in first aid. It also demonstrates the catastrophic consequences of getting it wrong, or using out-of-date or wrong first aid moves; such as when an out-of-practice elderly retired doctor removed the crash helmet from a motorcycle casualty - thus removing the support preventing a broken neck from collapsing completely.
- Writers Cannot Do Math: When Duffy mentions that her kids are settled in boarding school in Singapore, Paul, her youngest, is between five and six - even if the school billeted him with a host family, it's still highly unusual for a child as young as that to go to boarding school full time (most take them from nine and up). Also, Peter would be 18, which would mean he'd probably would have finished school and could have stayed at home if he wanted.
