The wobbly camerawork, as if shot by a team of four-year-olds who have run off with the digicam; the mournfully drab municipal setting; the absence, God forbid, of a laugh track; the studiedly natural dialogue. The Office begat The Thick Of It which begat this, a downbeat comedy set on an anonymous NHS ward. It came as no surprise that this, the first episode of the second series (I've come to it late), was directed by Peter Capaldi and starred Joanna Scanlan - each a first-class honours graduate of the Armando Iannucci school of comedy.

And this, being the series opener, it was appropriate that this most self-effacing of entertainments kept the action to the bare minimum. An unconscious old homeless person was admitted whom neither Nurse Den Flixter (Joanna Scanlan) nor her underling Kim Wilde (Jo Brand) really wanted to deal with. A little later, a woman visited her ailing mother and challenges Dr Pippa Moore (Vicki Pepperdine) about the level of pain relief available. That was it. The comedy, such as it was, peeped out from the fraught exchanges between Den, Dr Moore and the male Matron Hilary (Ricky Grover) as they tussled for the upper hand among the dank beds and grey windows. Kim meanwhile rolled her eyes and tried to keep out of trouble.

Yet, days later, it's not the comedy that stays with you, but the show's portrait of the NHS in miniature. Brand, Pepperdine and Scanlan are co-writers, and one assumes Brand's early career as a psychiatric nurse keeps the tone right, if not the up-to-the-minute detail. The passage of the homeless woman from Kim and Den, to the reluctant care of a junior house officer, to the corridor as they try to offload her on another ward was as understandable as it was distressing. Similarly, a well-informed woman's request that her mother's meds be amped up wasn't so much wryly amusing as it was useful - so that, you thought, is how you get someone to pay you proper attention: bone up on the internet, be endlessly polite and don't let them off the hook.

Getting On is notable for its delicacy. Set in a geriatric ward, it's astonishingly bleak for a comedy and comes shot in wintry shades of blue and grey. However, it never revels in its grimness, but rather uses the proximity of disease and death as a wall to bounce its humour off.

Everything about it feels carefully - and perfectly - judged: the ghastly patronising doctor (Vicki Pepperdine) telling one of her juniors to 'have a root around' in the prostate form of a very smelly tramp, the ward sister (Joanna Scanlan) bossily refusing to admit the sister of a patient outside visiting hours, and then almost swooning in the presence of the lavishly camp male nurse, Hilary (Ricky Grover). Here is human nature - in its frailties, its contradictions and its efforts to keep desperation at bay.

It doesn't happen very often that we invent new ways of laughing at ourselves, but I think you could make a case that the awkward silence is a peculiarly contemporary mode of comedy. It's not that you can't find any antique instances of the humour of speechless embarrassment. It's just that it's only recently become one of the standard forms for which a sitcom can reach. It has its own associated visual style - that of hand-held documentary realism - and carries its own implication, which is that any programme that employs it is operating in that fertile (and upmarket) borderland between sitcom and drama. And Getting On - Jo Brand, Joanna Scanlan and Vicki Pepperdine's comedy about life on a geriatric ward - is a perfect example. It even has one of the style's most characteristic markers: a signature tune that is ostentatiously melancholy and distinctly retro (in this case Richard Hawley's "Roll River Roll"). Where a traditional sitcom tune would unleash the bassoons and brass and try to parp you into hilarity, this kind of theme song gives you permission to laugh ruefully - which will sometimes mean not laughing at all, but simply adopting an expression which sits somewhere between a grin and a wince.

None of this is meant to imply that Getting On is anything but excellent, only that it follows the trail blazed by a comedy like The Office, where the punchline often lay in the fact that a character couldn't think of what to say next and the dialogue dribbled to an excruciating halt. There was a textbook example here, in a scene where Pepperdine's odiously brisk Doctor Moore was sparring with a patient's relative over a course of treatment. Why isn't she being given Drug X, asks the anxious relative. Because it's not an appropriate drug at this point and I will make the clinical decisions, replies Doctor Moore, professional affront expanding like a lizard's neck ruff. Drug X is quite unsuitable for her current condition, she insists pompously. At which point, Sister Den (Scanlan) interjects to point out that the patient is actually being given Drug X and the scene ends in stammering damage limitation. Getting On is full of such embarrassments, beautifully acted and excruciatingly awkward.

There are more straightforward writing pleasures, too, last night mostly centring on a homeless patient with a perianal abscess, who arrives accompanied by an odour strong enough to discolour the curtains. "It's a kind of every-orifice cocktail," gasps Nurse Kim (Brand), blinking in the fumes as they undress her. "Can we just stop there and get used to that layer?" Then she pauses, distracted by a moment of nostalgia when it turns out that one of the patient's undergarments is a sheet of tabloid newspaper describing Dirty Den's webcam sex scandal (a story that broke in 2004). And if that sounds cruel, it wasn't - just an entirely plausible blend of black humour and grim reality, delivered with a fine grasp of understatement. Sometimes it's a beat or two before you even notice that a joke has been made.

TV review: Getting On

This hospital sitcom is great, but the shaky camerawork makes me feel as sick as the patients.

Getting On review

First, a confession: despite the top credentials of its cast and crew, I never got round to tuning in for the first series of acclaimed BBC Four sitcom Getting On. having seen last night's opener, I think I'll be putting the DVD of series one at the top of my Christmas list. Because, yes - despite the subject matter - it is very funny.

Getting On is the OAP answer to The Inbetweeners

Getting On has had its life expectancy extended to six episodes, but despite last night's opener feeling off-colour, our reviewer will be back for more.

Getting On's gags sneak up on you

It's brilliantly funny - though probably best avoided if you happen to have an elderly relative in hospital.

A welcome second series for this bleak comedy set in a geriatric ward. It's co-written by Jo Brand, Vicki Pepperdine and The Thick of It's Joanna Scanlan, who all star. Scanlan's Denise is bovine and grouchy, Brand's Kim perplexed and old-fashioned, and Pepperdine's Pippa neurotic and self-centred. Tonight, a homeless lady is wheeled in unconscious and then passed around like a hot potato, while a visiting daughter becomes increasingly irate at being lied to about her mother's treatment. Around all this swirl incompetent orderlies and inept students. It's great to see a trio of women at the creative helm of this brave and, at times, very funny show.

"Can we just stop there and get used to that layer?" says nurse Kim Wilde (Jo Brand) as she gingerly picks at the stinking garments worn by an as yet unidentified new admission to geriatric ward B4. Returning for a second series, Getting On remains about as far removed from conventional sitcoms as it's possible to get. Which, as the festering old lady is shunted around the hospital because the staff don't really want to deal with her and anyway they're preoccupied with their own personal psycho-dramas, is precisely why it's required viewing. Laugh-out-loud funny, tears-to-your-eyes sad. Marvellous.

Jo Brand's deliciously dark comedy returns for another series centred around a geriatric ward, and it's a healthy antidote to the soapy mania in Holby City and Casualty. There is a very grim streak of humour here, and as Jo used to work as a psychiatric nurse, you can probably assume what happens here is closer to the truth than you might like to imagine. Bleak, but also very funny.