Elliot first appeared in Casualty at the beginning of series 12, as manager of A&E. He was not popular, and the doctors and nurses often argued with him about how the budget was spent. When there was a huge motorway pile-up just after Christmas, Elliot happened to be with the paramedics, and the scenes he saw gave him a shock. He acted strangely in the following weeks, trying to resuscitate a dead patient and turning to drink. He told Charlie Fairhead some of what was going on, but did not take Charlie's advice about counselling.
On the day of Charlie and Baz's wedding, Elliot agreed to Mike Barratt, Duffy, Ash and Megan Roach helping out without proper authorisation, and later agreed to re-opening the observations ward without permission from his superiors. When his boss heard about it, she confronted him, and Elliot, fed up of being treated like a villain by his colleagues, resigned. When asked what he was going to do, he said, "For the first time in my career I have absolutely no idea, and I feel great."