Connecting Voices in a Time of Crisis: NHS at 70 and Covid-19

OHR has committed to being a forum for discussions among practitioners regarding ways to ethically and logistically conduct interviews in the face of COVID-19. Kicking off this series is Stephanie Snow and Angela Whitecross from the Centre for the History of Science, Technology & Medicine, at the University of Manchester, project leaders of NHS at 70: The Story of Our Livesan oral history initiative documenting the UK’s legendary health system, which has now intersected and adapted due to the pandemic.

By Stephanie Snow and Angela Whitecross

“The interviews will be my legacy if I don’t survive the pandemic,” replied the junior doctor, when asked why she had agreed to participate in the NHS at 70’s Covid-19 oral history project. For our generations, unused to infectious diseases without cure, COVID-19 has produced seismic shifts across lives and communities. In the midst of this global crisis, oral history has a contribution to make, not just by capturing history as it unfolds, but as a social and therapeutic intervention.

NHS at 70: The Story of Our Lives is a national oral history project that is collecting testimony from patients, staff, and the public around the history of the UK’s public National Health Service (NHS) which was created in 1948. To date we have trained around 150 volunteer interviewers with ages ranging from 20 years to 70 plus years in oral history methodologies and recorded upwards of 800 interviews. Evaluation of the impact of participation on volunteers and interviewees was built into the project from the outset. Most volunteers were new to historical research and came from diverse educational and social backgrounds. They expressed the benefits of their involvement as increased self-esteem, feeling valued, and taking pride in the new skills they had acquired. Interviewees reported positive benefits for their wellbeing and social connectivity that arose from contributing their story to a national archive, alongside mental health benefits from reliving and processing previously undisclosed trauma through the interview process. Marginalized communities, not previously represented in NHS history, including people with disabilities and prisoners, testified that involvement created a sense of empowerment and stronger connections to a shared social history.

As much of the world moved into lockdown during March 2020, NHS at 70 suspended face to face interviews. Yet we recognized both the imperative to capture as much as possible of this extraordinary moment and that the project’s focus on the NHS gave us a unique opportunity to do so within the UK. The NHS provides healthcare for over 95% of the UK’s population and as COVID-19 spread, the UK’s private hospitals rapidly entered into agreements to support NHS services. Thus, the NHS determines and encompasses political strategy alongside patient, worker, and public experiences of the pandemic, and COVID-19 will be a watershed in its longer history. The NHS is also distinct from other nation’s health services in the place it holds in public imagination and beliefs. The 800 interviews to date speak to experiences of poor quality care, disillusionment with successive political reforms, and the stresses of working and being cared for in an overloaded system. Nevertheless, for most people in the UK the NHS is synonymous with freedom from the fear of consequences of illness. It has enduring value, whatever the everyday deficiencies in services may be. When asked what value the NHS holds for them, most interviewees reply, “I owe it mine and my family’s lives.” The NHS is a symbol of compassion, fairness, and equality and stands as the strongest example of humanitarianism and civilization in UK life.

Our aim for our COVID-19 focused work was two-fold: to capture experiences and reflections of patients, staff and the public as the pandemic unfolded, and to stimulate social connectivity during this period of physical distancing. Voice-to-voice interviews were a natural substitute for face-to-face interviews but this threw up a myriad of questions spanning technical, ethical, and logistical challenges. NHS at 70 interviews will be preserved longterm in a national repository and our WAV recordings are of broadcast and archive sound quality. One easy option would have been to record directly on mobile phones or on computers using online platforms such as Skype or Zoom, but that would have resulted in a set of recordings of inferior quality that would not mesh easily with the existing archive. We also know that some of our older interviewees who are in social isolation only have access to a telephone. We have therefore opted to continue to record on the Zoom H4N digital recorders which we use routinely but with the addition of a telephone earpiece with a built-in microphone. We also considered the preferences of our volunteers, many of whom are in their 70s. They were already skilled in using the Zoom digital recorders. Training them to use the earpiece was a relatively easy ask and we developed online support sessions to facilitate this.

The nature of the NHS at 70 project means that our interviewers are practiced in dealing with highly sensitive interview topics such as end of life care, terminal disease, and traumatic life events more generally. We have rigorous protocols for responding to distress from interviewees and/or interviewers but have reinforced these further to take account of the additional sensitivities around COVID-19. Our interviewers are able to debrief after each interview and also attend remote weekly drop-in sessions. There are new challenges presented by not being able to draw on non-verbal cues during the course of an interview although our older interviewees are from generations which are wholly familiar with using landline telephones. We sounded out our volunteers and stakeholders across health, community, and heritage organizations before beginning work and were reassured by the resounding support our ideas received. Initial mailings to existing interviewees inviting them to further participate in the project with either a single or regular series of interviews also brought highly positive responses. These interactions confirmed our initial gut reaction that the value of this work would lie as much in the process as the outcomes, and that bringing people together with the shared goal of capturing experiences would provide a point of stability in these uncertain times. We signed up over 100 people in the first ten days and in many instances we have been able to match them with the interviewer who did their initial interview for the archive. The first batch of interviews have been recorded and already interviewers and interviewees are reporting their delight in reestablishing contact through tears and laughter as they catch up with each other in this extraordinary moment.

Oral history is well-established as a key methodology for collecting, preserving and presenting the history of catastrophic natural and manmade disasters. The September 11 Digital Archive, the Fortunoff Video Archive for Holocaust Testimonies, and the Prisons Memory Project on the Troubles in Northern Ireland are just three examples in which first-hand accounts and other materials are brought together to create permanent records of the event.  But the critical difference is that this sort of work has often been undertaken in the aftermath of crises and with survivors, rather than amid crisis. At this moment in time, none of us know whether we will survive COVID-19. Interviewers and interviewees are all actors on the same stage. It is impossible to answer in the present what the impact on the oral history material from all of us being insiders in this global health crisis will be. What is certain is that we have is a unique opportunity to capture history unfolding in slow motion through the voices of people living through COVID-19. Oral history enables an interviewee to narrate their life through chiseling memories into sequential and meaningful order; to demarcate the highs and the lows, the shadows and the sunlight of their life from their unique perspective. Doing oral history during a crisis when the end point and outcome is unknown, is much more about capturing the raw data that will subsequently be processed and absorbed into an individual’s broader life history. Listening to the same voices share their experiences and reflections at regular intervals during the crisis will reveal the workings of the processing of life experiences giving much sharper focus to shifts in feelings and reflections. In retrospect, the NHS at 70 interviews will give texture and depth to the ways in which the consequences of COVID-19 spun out across the UK and beyond, marking an epochal chapter in the longer history of the NHS and all our lives.

Interview excerpts

Archie, a porter who has worked at a large London hospital for 40 years, interviewed on May 6, 2020, speaks of the impact COVID-19 has had on his life after moving out of his family home and living in a hotel opposite the hospital.

Natalie, interviewed on May 8, 2020, is a full-time electric wheelchair user. She is tube-fed and uses occasional oxygen after suffering a severe form of Guillian-Barre syndrome 18 years ago. She reflects on how being at home during the pandemic was everything she had wished for at the time of her illness when she spent 11 months in hospital.

Lalith, a consultant in pediatric emergency medicine at a children’s hospital in the UK, interviewed on April 22, 2020, reflects on the stresses of working during the pandemic, including how to deal with the daily information overload and also the impact of new procedures on effective team working to deliver patient care.

Dr. Stephanie Snow is a historian of medicine, science and technology and since 2007 has led the development of the contemporary history of health and medicine within the Centre for the History of Science, Technology & Medicine at the University of Manchester, UK. Since 2017 she has directed the NHS at 70 project which is supported by the National Lottery Heritage Fund.

Dr. Angela Whitecross is a historian of political British history within the Centre for the History of Science, Technology & Medicine at the University of Manchester, UK. She has cross-sector experience specialising in co-production methods, research collaboration, digital oral history, and stakeholder engagement. She has been Project Manager on NHS at 70 since 2017.