In 1977, O'Grady went to Manila where he worked as a waiter in Gussy's Bar. It was there he got the idea for Lily Savage, his drag alter-ego. He returned to London in the early 1980s and subsequently achieved fame with his creation of Lily, initially playing to gay clubs and pubs up and down the country.

O'Grady's Lily was best known at the time for an eight-year residency at The Royal Vauxhall Tavern in south London. As Lily Savage, O'Grady was in numerous double and treble acts such as 'High Society' with Adrella Peter Searle, 'L.S.D.' with David Dale and Sandra Hush (David Hunter), The Playgirls, again with Hunter and The Glamazons with Paul Banks, a former nurse. O'Grady toured Europe with some of these acts, appearing at Madame Arthurs in Denmark and various night clubs and theatres in Germany, Finland, Sweden, Holland, France and Israel.

After appearing at The Edinburgh Festival, for which O'Grady was nominated for a Perrier Award, the Lily Savage act became more mainstream. The Lily Savage character first became popular on television, making appearances on ITV daytime programme This Morning, and as the 'On the Bed Presenter' on The Big Breakfast. Appearing as Lily Savage, O'Grady was given several shows, by both BBC and ITV, and although they achieved reasonable ratings, they weren't the huge hits that either channel was hoping for.

For a few years O'Grady hosted the game show Blankety Blank, as Lily Savage, for the BBC and later for ITV. There was also a comedy show built around the character, Lily Live! appearing on ITV in 2000. Performing as Lily, O'Grady also co-hosted the 1996 Smash Hits Poll Winners Party with Ant & Dec. In a 2006 interview O'Grady stated that Lily Savage was now living in a convent in Brittany, although on several occasions he has announced that she has escaped the convent, which was interpreted by some as meaning that the character is returning.

Theatre

As well as numerous national tours, O'Grady has appeared on stage in Prisoner Cell Block H - The Musical, the musical Annie as "Miss Hannigan", Chitty Chitty Bang Bang as "the Childcatcher" and in the pantomime Snow White and the Seven Dwarves as the "Wicked Queen". He has been quoted as saying "I seem to be making a living frightening children".

O'Grady played a prostitute snout called Roxanne in several episodes of The Bill between 1988 and 1990.

In 1990 he appeared in the ITV miniseries Chimera as Tony Donaldson, a social worker skilled in signing for the deaf.

In 2000 he appeared in a six-part travelogue series as himself, entitled Paul O'Grady's Orient. Shot in Shanghai, Hong Kong, the Philippines, Bangkok, Bali and Singapore, it was produced by Gavin Hill and Collette Valentine and directed by Paul Watson. This was followed in 2001 by Paul O'Grady's America. These were amongst his first major television appearances out of drag. From 2002 onwards, he has appeared less as Lily and more often as himself. In 2002 he presented Outtake TV, a bloopers show, and in 2003 starred as the lead character in the BBC sitcom Eyes Down for two series, as the vicious yet hilarious manager of a northern Bingo hall.

He also appeared in Celebrity Driving School for the BBC. Since then, he has had success as the presenter of his own early evening talk show, The Paul O'Grady Show, on ITV. He won the position after he stood in for Des O'Connor on the now defunct lunchtime celebrity chat show Today with Des and Mel. The Paul O'Grady Show somewhat controversially ran head to head with Richard and Judy, who are close friends of O'Grady, and gave him one of his first TV breaks on This Morning on ITV back in the early 90's.

He has guest starred on Living's paranormal show, Most Haunted Live!, after presenter Yvette Fielding was a guest on his show and invited him on. He holds many awards, and in December 2005 he won the Best TV Comedy Entertainment Personality category of the British Comedy Awards. In 2005, he won a BAFTA and is also the recipient of two Royal Television Society and three National Television Awards.

On 10 January 2006, in a shock decision, O'Grady decided to defect from ITV and take his daytime chat show to Channel 4 after ITV apparently 'forgot' to renew his contract. It was said that he had wanted to produce the series with his own company and had wanted to from the start but Granada always refused.

He is still in an ongoing dispute with ITV, regarding the use of props and studio design for his new daytime chat show. As a consequence of this, O'Grady has decided he never wanted to work for ITV again and has pulled out of appearing on a new talent show and was replaced as host of The British Soap Awards. He was very outspoken in his anger towards ITV for a while after his move to Channel 4, but less so recently.

On 27 March 2006, Paul O'Grady began hosting his talk show on Channel 4, now called The Paul O'Grady Show (previously The New Paul O'Grady Show). It is shown weekdays from 17:00 to 18:00 UTC. and the first series ended its run on the 16 June 2006. Channel 4's Richard and Judy and O'Grady shared the Channel 4, 5 p.m. - 6 p.m. slot with each show share taking 3 months of the Channel 4teatime schedule.

O'Grady retired his Lily Savage character around 2004. He claimed she had "seen the light, taken the veil and packed herself off to a convent in France" but recently on his current TV show, he said, "she's escaped the convent and she's heading towards these shores!", which may signal the return of the Lily Savage character. Also on 23 January 2007 on his show, someone wrote in saying is Lily Savage going to be working in a midnight burlesque club and O'Grady says that there's a 99.9% chance of that happening, so he could be bringing her back.

However, on the 30th October episode on his show, Lily Savage was one of 10 "smiles" examined by a body language expert. After finding out that it's Lily, O'Grady covered her up before revealing her again, claiming she's still in the convent. On 23 May 2008 on the 500th edition of the Paul O'Grady Show, guest star Julie Goodyear told O'Grady that Bet Lynch, the character she famously played in television soap opera Coronation Street, had joined Savage in the French convent.

On 16 March 2007, O'Grady presented part of Red Nose Day 2007, where he performed several circus tricks, including fire eating.

The fourth Channel 4 series (7th series when including the three original ITV series) started on 17 September 2007. On 24 August The Daily Mirror revealed that Paul had rejected a £5 million deal to return to ITV as the "New Parkinson." Instead he has signed a £4 million deal to remain with Channel 4 until the end of 2009.

On 28 June 2008 O'Grady appeared in the Doctor Who episode The Stolen Earth.^[6]

As of March 2009 O'Grady will front a regular radio show on BBC Radio 2 standing in for Elaine Page during her tour.^[7]

Despite being gay, he has previously had relationships with women, and was once married to a female Portuguese friend in a marriage of convenience. He is now very close to his daughter Sharyn, who married her childhood friend Philip Mousley at Liverpool Town Hall on 30 July, 2005. His long term lover and business partner of 20 years was Irishman Brendan Murphy, who died of cancer on 9 June 2005, five days before Paul's fiftieth birthday. After the first show of series three of The Paul O'Grady Show, there was a tribute to him.

O'Grady owns a flat in London, and a farm in Aldington near Ashford, Kent where his neighbour is Julian Clary. The farm is stocked with 32 animals, including a flock of geese which O'Grady refers to as the "Geese-stapo" (a pun on the Gestapo).^[8] O'Grady has a grey Shih Tzu/Bichon Frise crossbreed dog called Buster,^[9] who usually appears on his TV show with him, or occasionally will be replaced by Paul's other dog, Olga, a Cairn Terrier after whom O'Grady named his recently formed production company, 'Olga TV'.^[9] He also has another dog called Louie, who only appeared a few times (mainly due to his bad behaviour), in the first ITV series, before he adopted Olga live on air.^[8]

In April 2002, O'Grady suffered a heart attack after weeks of complaining that he felt unwell. After an emergency operation and weeks of rest, O'Grady's health recovered and he gave up smoking for two years.

O'Grady went back to his 40-a-day habit after his boyfriend and business partner Brendan Murphy died in 2005; he had continued to work on the show at the same time as nursing Murphy. He suffered a second heart attack on 30 June, 2006;^[12] again he was taken to the William Harvey Hospital and into intensive care. He was given an angioplasty operation before being moved to a cardiac unit. He was released on 4 July and again promised to give up smoking ^[13]. He therefore postponed the new series of his show from 4 September to the end of the month. The delayed second series started on Monday 25 September 2006.

In October 2008, O'Grady was appointed MBE in the 2008 Birthday Honours list for services to entertainment.^[14][15]