The Royal is a medical drama set in St Aidan's Royal Free Hospital in the sea-side town of Elsinby.
Jill and Gordon's wedding day finally arrives, but a huge explosion at a nearby care home disrupts proceedings in spectacular fashion. As the Royal staff help pull the elderly residents out of the rubble, the horrifying truth behind the cause of the accident is discovered.
Mr. Harper prepares for the arrival of an important private patient, who proves useful when a badly injured teenager is brought in after an industrial accident after Dr. Goodwin puts his career on the line to fight for justice for the accident victim. Sister Brigid helps a terminally ill alcoholic called Rory, and Lizzie comes to terms with her husband's recent behaviour and looks ahead to the future.
A routine visit turns into a nightmare for Jill when she is taken hostage by a psychologically damaged ex-prisoner of war, who has barricaded himself into his house and booby-trapped the surrounding land with mines. Meanwhile, Harper is spotted paying frequent visits to a woman in town and Alun is suspended from duty when his noisy band practice causes a woman to slip and break her hip.
Dr. Weatherill is involved in an air rescue to save an unconscious girl and finds herself braving a cliff abseil to reach the youngster. Dr. Ormerod faces a difficult time when he misdiagnoses a patient who is left fighting for life later in hospital. Sister Brigid has an accident on her bike, while Harper faces a staff revolt.
New recruit Thelma Parker catches the eye of Harper, but proves to be less popular with the rest of the team, and an injured boxer causes concern for the staff at the hospital. Dr. Weatherill finds herself caught in an ethical battle when the parents of a dangerously ill baby refuse treatment, while Samantha receives unwanted news.
Samantha struggles to cope with the reality of her recent discovery and takes desperate action which leaves her life hanging in the balance. Frankie and Gordon attempt a daring rescue to help a teenager in danger on the weir, while Ken has something to hide from Harper. Jeff's casual encounter with a friend of Lizzie's suddenly turns serious when he realises his career could be at risk.
Nurse Stella Davenport arrives at the Royal with a less than favourable reputation, and soon causes a stir among the staff and patients as rumours about her circulate the hospital. Matron and Harper discover a new approach to interviewing when they try to fill a ward domestic vacancy, while Dr. Ormerod is left to deal with the dramatic aftermath of a domestic dispute, and Lizzie realises her new scooter might have been an ill-advised purchase.
When Matron is attacked by a thief, everyone is surprised to discover who was responsible - but there appears to be more to the case than meets the eye. Goodwin is upset when it becomes clear he has acquired a bad reputation around the hospital and the staff worry about the threat of a tuberculosis epidemic.
Sister Brigid faces a struggle as she tries to convince her superior at the convent to seek medical help when it becomes obvious she is seriously ill. Jill discovers the answer to a puzzling medical case in an unlikely source, before receiving news from Samantha about the father of her baby. Frankie tells Lizzie his amorous plans, then finds them thwarted when he sees Staff Nurse Taylor with Dr. Goodwin.
Dr. Goodwin faces the pressure as rumours about him frantically circulate the hospital and when Dr. Weatherill passes on some important news, he wastes no time in using it to set the record straight. Nurse Taylor's happiness about her future with Frankie is sensationally shattered as the extent of his dishonesty is revealed, while Matron is shocked to see a familiar face on the ward.
Johnny Lomax's proposal to Matron causes Nigel Harper to worry about the effect her decision will have on the hospital, and Jill comes into conflict with a strict Catholic family. Ormerod and Frankie face a tough rescue operation as they try to save an injured fisherman trapped on board a sinking ship, while Staff Nurse Taylor's plans for the future are once again scuppered.
Matron is forced to change her plans after a tragic turn of events and decides to withdraw her resignation. Nurse Taylor grows closer to Jeff as they tackle an unusual medical emergency, but later finds herself confronted by an angry Frankie. Harper's money-saving schemes backfire in spectacular fashion, while an argument over a patient's health sparks off a chain of events which leaves Gordon's life hanging in the balance.