Finally, a Television Show About the Damage Wrought by Austerity
The BBC’s new medical drama This Is Going to Hurt is set amid the chaos of an austerity-starved National Health Service. It comes at just the right time, as the pandemic forces the UK to take stock of the damage austerity has done to the NHS.
Over the course of the COVID-19 pandemic, the UK public watched as the National Health Service (NHS) under Tory leadership was pushed to its breaking point.
The BBC’s adaptation of ex-NHS doctor Adam Kay’s 2017 memoir, This Is Going to Hurt, comes at precisely the right time, as the nation now grapples with the emaciation of the health system that was once prized as the best of Britain. The tragicomedy is garnering praise for its many outstanding qualities, including a stellar performance from Ben Whishaw and writing that’ll leave you in stitches (pardon the pun). It’s also refreshingly honest about the pitfalls of an austerity-starved NHS.
The show’s protagonist Adam is a brilliant doctor who’s underpaid and overworked. He’s also rude and short-tempered in a charming, distinctly British sort of way. Breaking the fourth wall in Fleabag fashion, Adam’s casual asides and glances at the audience — handled with remarkable fluidity by Whishaw — heighten the theatricality of the show as it transports the viewer into the world of hellishly ill-organized maternity wards. (Warning: spoilers ahead.)
In one episode, Adam is teetering on the brink of broke. In need of some money, he takes a shift in a private maternity hospital. With its gargantuan chandelier and marble pillars, the private hospital seems like it would make light work of labor. But as we come to see, the facility suffers from inadequate resources, and so a birthing mother in crisis is rushed to accident and emergency services (A&E) at Adam’s NHS hospital. Although the NHS ward basks in the success of saving mother and baby, Adam laments that the staff won’t receive the cold hard cash for its work, which will of course be paid to the private hospital all the same.
Another episode details a press visit from a politician to the ward, like those Boris Johnson routinely performed during the pandemic. The hospital realizes it’s not quite suitable for public display, with an alarm that hasn’t worked for four years and shoddy, overcrowded rooms. To improve appearances, short-notice renovations take place around the ward. With wires hanging from the ceiling and dust from drilling covering all the surfaces, Adam’s senior consultant Lockhart (played by Alex Jennings, who brings his flawless acting from The Crown to this role too), remarks, “Jesus Christ, it’s like downtown Basra in here.”
“They must think the entire NHS smells like fresh paint,” bites one of the nurses with regard to the face-lift inspired by politician’s visit. “Still, new computer.”
“I wouldn’t get too attached, love. Once the right honorable bastard has done his little tour, that’ll all be gone faster than you can say ‘A&E closure,’” responds nurse Tracey, played by Michele Austin.
The real Adam Kay left the NHS after temporarily giving up his medical license following a faulty cesarean which resulted in the death of the baby. In the show, Adam delivers the baby, and it survives. He avoids having his license revoked by explaining how he’d been working an understaffed night shift, how he was the only doctor who was available to come in that night despite the fact it was supposed to be his night off, and consequently how desperately tired he was.
This story resonates with the experiences of a junior NHS doctor I spoke to. George Huntington told Jacobin that during his on-calls he covers ten medical wards, attending to emergencies or admitting patients to hospital from A&E. “Today is supposed to be a day off,” he said. “I have been called by my consultant asking why I am not in and who he can contact that is on the ward.”
Huntington said that “even before the pandemic, it was obvious things have become very stretched.” For example, in 2018, the NHS recorded its worst-ever A&E waiting hours. While he doesn’t think things will “collapse overnight,” he believes outcomes for patients may get worse and “there may be more malpractice lawsuits; nurses and doctors being struck off which creates a spiral of people leaving the workforce.” He adds, “I feel that the situation is likely to get worse before it gets better.”
Unlike most hospital-setting TV dramas, everyone in This Is Going to Hurt looks like a normal person instead of a supermodel-cum-surgeon (I’m looking at you, Grey’s Anatomy). The show doesn’t shy away from reality in other aspects, either, from medical crises to social ones. There’s some typical social-issue fare, such as when Adam struggles to come out as gay to his colleagues, while his coworker Shruti struggles to choose between the right job for her and pleasing her South Asian immigrant parents. But there’s also a hilarious scene depicting a workshop on politically correct language, such as replacing “patient” with “client” and “disabled” with “differently-abled.” Tracey, a black nurse with a disabled child, asks how beneficial changes like this really are when workers don’t have “a working printer on our ward. We’ve had a leak in the ceiling for over four years, and this is what they’re spending their money on?”
Shruti Acharya is the show’s most tragic and sobering character. The subject of Adam’s repeated bullying, Shruti’s endurance as a doctor is put to the test multiple times throughout the show. Sharp teasing from Adam and other senior doctors quickly wears away at the young training doctor.
The show breaks our heart before its culmination with Shruti’s devastating suicide. The script thus hones in on the NHS’s “last taboo” — the disproportionately high rate of suicide of NHS doctors. According to a report from the Office for National Statistics from 2018, a health care professional takes their own life every three and a half days in the UK. The pandemic has only worsened NHS workers’ mental health, with a record-high number of staff resignations — 27,000 over three months, leaving around 6 million patients on a waiting list.
“A lot of nurses I worked with on ITU [intensive therapy unit] through the first and second wave are leaving intensive care . . . or nursing altogether. As much as I hate it, I really don’t blame them,” Huntington tells me. Almost half of intensive care staff surveyed by Kings College London during the first wave of the pandemic were reported to be suffering from PTSD, severe anxiety, depression, or drinking dependencies, and one in eight workers claimed they’d experienced suicidal thoughts or had thoughts of harming themselves.
Low pay isn’t helping matters. In 2021, a 3 percent pay raise was awarded to NHS staff but not junior doctors, despite the fact that take-home pay for junior doctors has fallen by 23 percent since 2009. Moreover, says the British Medical Association (BMA), “a three per cent pay uplift . . . does nothing to address years of pay erosion.” Junior doctors Sarah Hallett and Mike Kemp said in a BMA press release:
With days spent on Covid wards with no end in sight, being redeployed into unfamiliar departments, wearing ill-fitting or non-existent PPE that left us fearing for our own safety and the safety of our patients, to be excluded from any additional reward is an extraordinary insult.
Afshan Sharif has worked in the NHS for two years as a mental health nurse, and used to work in intensive care as a health care support worker. “The biggest problem is understaffing,” she told Jacobin, “There’s too much workload, which adds to the stress and people taking time off because they’re unwell physically and mentally. But we don’t have the budget, so . . . ” she trailed off.
Sharif was hired during the peak of the pandemic to work in COVID wards, and although it was “emotionally draining,” she explains that her team were “so amazing that it didn’t feel so bad sometimes.” Sharif, being a recent addition to the NHS, didn’t experience conditions before the pandemic, but she does believe that staff have become burned-out, and she’s witnessed many people “leaving or switching to private because of it.”
Although Sharif herself has not faced bullying akin to Shruti’s, she knows people who have been subject to racism. “I think a lot of black health care workers suffer the most. I’ve seen it, and try to speak out when I can. It’s definitely an issue.”
The issue is exposed and interrogated, with a good dose of dark humor, in This Is Going to Hurt. In one episode, Tracey is subjected to racism from a patient who’d rather not have her tests handled by Tracey, a black nurse, or her baby delivered by Shruti, a South Asian doctor. This type of treatment isn’t uncommon for the 22 percent of NHS staff who are Black, Asian, and “minority ethnic.”
Huntington says that one of the main issues currently facing the NHS is that “there isn’t the funding for more training places,” which he believes will “lead to a worse staffing crisis in about five to ten years’ time.” If he could change one thing, it would be “more money going into the right places.” Huntington adds:
The service needs to be run at a loss. Obviously, the public needs value for their money, but you need to build redundancy in so that we have surge capacity for the next pandemic or winter crisis. If money is the bottom line, then people’s health becomes secondary.
The truth is that public health is already taking a back seat to belt-tightening in the NHS. And although the truth can hurt sometimes, we have to face up to it if we want any chance of healing a wounded national health care system.