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Two days before the 2019 general election, and the question of evidence has become central to a story about the state of the National Health Service. Debates about the NHS’s condition often mobilise numerical data - statistics about waiting times and funding - but this is a photograph of a boy lying on a pile of coats on a hospital floor, and it has had far more impact than any graphs or statistical evidence could. Partly this is because images have a greater power to shock and move, but it is also because of the disputes that are raging about its authenticity. We’re media savvy enough in the digital era to be sceptical of what we see, of course, and no longer believe that the camera never lies. But these disputes are not about digital image manipulation. They are not about the medium of photography at all, but about social media and news media.

The picture in question shows Jack Williment-Barr, who was waiting for treatment for suspected pneumonia at Leeds General infirmary. It was taken by his mother on 3rd December , who then sent it to the Yorkshire Evening Post where it appeared two days ago on the 8th December. It was then picked up by the national Daily Mirror who published it on their front page yesterday, at which point it was circulated widely on social media.

The Prime Minister Boris Johnson, confronted with the photo on a smartphone screen in an interview with a local TV journalist, at first refused to look at it and instead put the journalist’s phone in his pocket. The move was ironic, because this refusal to see it resulted in it becoming the most closely scrutinised photograph in the whole campaign. As the story erupted on both mainstream and social media, there was agreement it was evidence of something, but what? What exactly did it demonstrate? Underfunding of the NHS? Its mismanagement? Politically motivated or callous parents? Does the chair in the photo prove that the boy needn’t have been on the floor? Did he have an intravenous drip or oxygen? Was it connected to anything and was it in the wrong position, hinting the image was staged? Are we looking at authentic evidence of a health service in crisis, or a piece of political manipulation?

The authenticity of the image was confirmed early on by Dr Yvette Oade, Chief Medical Officer at Leeds Teaching Hospitals NHS Trust, who said: ‘Our hospitals are extremely busy at the moment and we are very sorry that Jack’s family had a long wait in our Emergency Department’ (quoted in the original report). She confirmed that there were no beds, only chairs available. Health Minister Matt Hancock was dispatched to Leeds following criticism of Johnson’s behaviour, apparently to demonstrate the Conservatives compassion and regret for the situation, (although this visit itself was marred in controversy and disinformation, after unsubstantiated accusations were circulated on news media that his aide had been attacked).

But, several hours later, something presented as counter evidence emerged. It was a facebook message from ‘Sheree Jenner-Hepburn’ claiming that her friend - an unnamed nurse at the same hospital - had witnessed the incident and that the boy had been placed on the floor by parents in order to take the photograph, when in actual fact there was a trolley available. Jenner Hepburn’s account then disappeared, and she has claimed (under conditions of anonymity) in a Guardian article that her account was hacked. While its origin remains a mystery this statement was shared many thousands of times on both Facebook and Twitter. But what did the message - copied, pasted and shared by many different accounts - really show? According to analyst of disinformation, Mark Owen Jones, it was initially being circulated by coordinated ‘sock puppet’ accounts - all using the exact same words and all claiming to know the same nurse - and then later shared by real social media users. If so, are we seeing evidence of political manipulation and disinformation coming from the right, not the left?

The story made its way to two journalists known for provocative right wing opinions, Julia Hartley-Brewer, a radio talk show host and Allison Pearson, columnist for the Daily Telegraph. Both amplified this alarm about fakery. It was ‘100 percent staged’ Pearson declared on her twitter account, quoting an apparent source in another hospital. She has subsequently deleted the tweet, but suspicion of the photograph had become embedded in the information stream overnight. On Facebook especially, large numbers of users now seem to have swallowed the idea that the photograph was staged. Watching the BBC news coverage of the episode through the lens of Facebook, they condemn the broadcaster for giving prominence to a ‘fake’ story. The focus has shifted from what the photo showed to who manufactured it and whose agenda it was serving. Having begun just a day ago as a news item about NHS cuts, it has now morphed into a controversy about media bias, in which any and all evidence may be tainted.

There has been much talk this election about lying, and the debasement of political discourse by a creeping, endemic dishonesty. Politicians, Boris Johnson in particular, have been criticised for a willingness to tell outright untruths, seemingly with little consequence. The dangers of this are clear: Once it’s accepted that ‘they all lie’, then any claim, any policy, any manifesto pledge can be dismissed instantly. The truth becomes impotent and even the concept of truth itself is undermined. But the controversy over the ‘staged’ photograph shows the situation is more febrile and more dangerous than this, even. The map is shifting so it is no longer about a binary choice between lies and the truth, but between degrees of deception and fakery. The real danger to the political process is not that lies will be taken as truth, but that visual evidence (and perhaps any kind of evidence) is unstable and discredited from the start, subject to inevitable claims that it is inauthentic, a fake or a staged set-up.

What’s a stake is not merely a denial that a particular event occurred due to lack of credible evidence but the idea that the evidence is itself a deliberate deception. According to this logic, the photo of the child on the hospital floor is not proof that the NHS is underfunded or in crisis, but rather that there is a conspiracy to deceive voters. In claiming that the photo is ‘staged’, those on social media are not merely demonstrating either their scepticism or their political affiliation. They are demonstrating the creeping spread of a much more dystopian view that consensus reality can’t be trusted, and that we are besieged by fakery and staged images by the media. This is the logic of conspiracy theory, which has infiltrated the heart of political discourse. The 2019 UK election campaign has become an information war as much as a ideological battle, and evidence is one of its casualties.

Gill Partington