'It had to be a medical miracle': Behind the scenes of Casualty's emotional Christmas special

There are 2.5 million units of blood transfused each year in the UK, requiring 200,000 new donors in England alone. As executive producer of BBC’s BAFTA award-winning Casualty, tackling state-of-the-nation health issues such as these is always at the forefront of my mind.

And dramatising a frenetic city centre A&E trauma unit means blood (fake, obviously!) is often central to the treatment of the fictional patients that come through the doors from our thrilling, epic accidents and emergencies.

For Casualty‘s standalone festive special, we didn’t want to do a Christmas story that any other drama could. It had to be a Christmas medical miracle. The initial pitch of following the journey of a blood bag came from our then story producer Siôn Crowle in his interview for the job.

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And we couldn’t think of anything better than an episode of Casualty that put blood donation at its core. One donation can save or improve up to three lives. But during winter, donations plummet. This can lead to blood shortages. We knew this could provide a dramatic, tense, urgent race against time, while also shining a light on an important topic.  

In April, life imitated art for me when my anaemic 81-year-old father needed several transfusions. Thanks to people’s generosity in donating blood, he will, touch wood, be here with us to celebrate this upcoming Christmas. As I sat watching the four-hour transfusion, I thought about how much a blood bag even looks a bit like a stocking… 

It became clear that there were real-life stories much more poignant than my own. From other recipients to super donors. And they were too important not to be part of our drama. Rather than directly dramatising anyone’s story, we made the bold decision to interweave moving real-life, direct to camera testimonies within the gripping rollercoaster of the fictional drama. 

We worked with factual producer Ryan Saunders (BBC Children in Need, ITV’s Concert for Ukraine, Amazon Studios’ Ben Stokes Phoenix from the Ashes) to find our real-life contributors. I asked him how he did it.

He told me: “We began by opening a conversation with NHS Blood and Transplant teams across the UK alongside charities who work within local communities to drive donations. The best part of the job is to sit and listen to incredible personal stories and then earn the trust to tell them onscreen. We took time to meet with families across the UK, have a coffee at their local cafe and lunch around their kitchen tables… All little things that together help to build a relationship well before cameras appear at their door.

“Throughout the process, it was important to find a balance of stories that showed how blood could save a life or offer a glimmer of hope in the darkest of times. The blend of incredibly powerful stories, alongside contributions from NHS staff and donors, help show the reality of blood. Working across this film has shown that when fact and fiction combine with care and time to tell the same story, the result is incredibly moving.”

BBC’s Casualty has a rich history of striving for authenticity and reflecting our changing NHS since the show’s inception almost four decades ago, in 1986.

Our current series medical advisor and A&E sister Sarah Tosh is at the forefront of this. She told me about why we need blood to survive: “Just as a road network delivers goods across a city, blood, coursing through an intricate network of vessels in our circulatory system delivers oxygen, nutrients, and hormones to keep our organs functioning and our bodies thriving. In medical emergencies, blood can make the difference between life and death.

“Major trauma patients may require between four and 10 units of blood to survive catastrophic injuries. Without timely blood transfusions, these injuries can be fatal. Similarly, patients with chronic conditions like cancer, sickle cell anaemia, or haemophilia often need regular blood transfusions to maintain healthy blood levels and support their ongoing treatment. This underscores the vital importance of blood donation: for patients to survive and lead healthy lives, the NHS needs a steady and reliable supply of blood. That’s why blood donation is so crucial — it is the lifeline that allows patients to recover, thrive, and heal.”

Casualty is used to regularly working closely with charities, NHS and public health organisations to ensure the medical information we present is both cutting-edge and accurate. While we dramatise sensitive medical scenarios for storytelling purposes, we strive to do so with compassion, authenticity, and respect. 

Writer Erin Kubicki showed true dedication in engaging with the research and the result was a beautiful realised, moving script built upon brilliantly by director Steve Hughes who took steps to elevate the naturalism of the drama, working closely with actors to develop a performance style that heightened authenticity.

We hope this fact and fiction hybrid delivers an emotionally powerful story that’s both gripping and thought-provoking for audiences. So, while the one-click, next-day packages leave no room under the nation’s Christmas trees, we collectively take a moment to think about how no present is more priceless than the gift of blood.

Casualty: All I Want for Christmas is on BBC One and iPlayer from 21 December and will be followed by a new series later in the month.

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