There have been so many scary stories about the NHS, from nonagenarians abandoned for days on trolleys to the grisly crimes of Harold Shipman, that writers of medical soap operas need make nothing up.
Nonetheless, events portrayed in the newest hospital TV soap are made up, but they are very closely based on some of the more woeful incidents in today's health service. For unlike Casualty or ER, Snakes and Ladders is strictly for training purposes and so far it has been for internal consumption.
Snakes and Ladders: learning about the ups and downs of the patient journey, to give the full title, is designed to make everyone, from professor to porter, aware of the challenges of care, especially in communications and ethics, and it aims to show NHS employees certain things, perhaps for the first time, from a patient's or relative's perspective, and could be invaluable for the professional development of the NHS's million-plus staff.
The first series, performed by professional actors with occasional appearances by real staff, follows the experiences of Daniel Johnson, a boy with cystic fibrosis, through the care pathway from birth to adolescence.
Episode one gets straight down to the difficult issue of breaking bad news. An embarrassed doctor mutters at Daniel's parents about their son being "bunged up" and launches into an incomprehensible, jargon-filled ramble about surgery and tests.
When Daniel's distraught parents finally ask "Is he going to die?" the doc replies "I hope not," glancing at his pager, which has just bleeped. Then, with "I'm needed somewhere else, I'll keep you posted," he flees.
Like this classic example of bad news being broken appallingly, every episode is based on real cases.
The series has been devised by a team at London's Great Ormond Street Hospital for Children (Gosh). Gosh's associate medical director, Hilary Cass, who hosted the first series, has urged viewers to suggest how things should have been different and to hammer out ideas for change. Thus the drama, and an interactive forum on the hospital intranet, is contributing to an agenda for change across disciplines. And it is bringing staff, medical and non-medical, frontline and administrative, together in tackling vexed areas from dealing with complaints to juggling limited resources.
Tomorrow the curtain rises on a second series of Snakes and Ladders which is to be shown to a much wider health service audience, including staff from other hospitals and GP practices, as well as patients and families.
Dr Su Laurent, a consultant paediatrician at London's Barnet hospital, who is involved in this development, says: "Role play is commonly used in training, but this innovative approach goes beyond simply enhancing our communication skills. It tackles many difficult issues at the core of the NHS and encourages people to find solutions together."
Jean Simons, assistant director of family policy at Gosh and one of the Snakes and Ladders planning team, is now piloting "competencies" - the setting, teaching and testing of standards for all staff, in the skills of engaging with patients. She reckons the programme could also prove valuable outside the NHS, in areas where good communication is crucial.
"Teaching staff how to recognise what's really upsetting people, to ask open questions and to avoid giving premature reassurance lays the ground for truly shared decision-making and real engagement with each other," she says. "These methods are equally applicable whether improving interactions between health professionals and patients, or helping staff on the railways or in supermarkets to interact constructively with customers."
The publishers Routledge have now commissioned a book based on the series, due out next spring. In part a novel based on the Johnson family journey, it explores the problems which trouble both recipients and providers of care and draws together best practice guidelines and signposts to further information.
Sophie Petit-Zeman is a member of the Snakes and Ladders planning committee, and is writing the book based on the series
