This is Going to Hurt: Adam Kay’s poignant drama-comedy about junior doctors and the NHS

This is Going to Hurt—BBC drama based on the book by Adam Kay. Currently available in the UK on BBC iPlayer

The tone of This is Going to Hurt is set with its first shot, a close-up of junior doctor Adam (Ben Whishaw) asleep in his car. The camera angle straightens up as Adam wakes, uncomfortably, in the front seat, where he has fallen asleep in the hospital car park instead of driving home.

With its continuous background noise and camera movement, jump cuts and unflinching detail of medical procedures, This is Going to Hurt portrays the daily carnage and chaos of a National Health Service (NHS) Obstetrics and Gynaecology ward, Obs and Gynae, or “brats and twats,” as Adam puts it in one of many direct-to-camera addresses.

The series is adapted from the bestselling book, This is Going to Hurt: Secret Diaries of a Junior Doctor, by Adam Kay, based on his own experience in the NHS between 2004 and 2010. Its gritty realism showing the unrelenting pressures on NHS staff has been well received by NHS workers and the public.

Kay’s book sold more than one million copies after it was published by Picador in 2017 and it remained on the Sunday Times bestseller list for more than eight months. It became a political event, with thousands attending launch meetings across the UK.

The TV adaptation follows junior doctor Adam, temporarily assigned as Assistant Registrar to the Obs and Gynae department. Adam goes out of his way to impress the Consultant, Mr Lockhart (Alex Jennings), who drives an expensive car and manages to go home on time.

Adam, by contrast, who is taking on more shifts and “volunteering” to come back into the hospital regularly, misses more social engagements than he makes. This includes his best friend’s bachelor party, which he was supposed to have planned. This is the life of a junior doctor.

Ben Whishaw delivers an at times heart-breaking performance as Adam. He is easy to dislike sometimes for his rudeness and flippancy toward fellow staff and patients. His apparent coldness and sense of entitlement attracts criticism, both professional and personal. But there is clearly an element of self-defence involved in his “gallows humour” and he is far easier to empathise with—permanently exhausted, irritable and short of time to do anything, including sleep. We can feel his misery at the plight of an NHS system which keeps him working in dire and often dangerous circumstances.

Central to the storyline are the flashbacks Adam experiences after delivering a baby pre-term, having failed to identify the mother’s health condition. Obviously suffering from PTSD, Adam contrives to visit the baby and discloses his thoughts and feelings to him rather than to his long-suffering boyfriend Harry.

The child’s mother (Hannah Onslow), under instigation from her sister, lodges a complaint against Adam over his failure to correctly diagnose her. This further increases the stress on Adam, resulting in his frequent outbursts of tears, anger and, finally, a breakdown.

Some of the programme’s comedic moments are particularly effective for their swipe at government-bureaucratic stupidity and hypocrisy. Head midwife Tracy (Michele Austin) and other staff are forced to attend a “language in healthcare” course of the type ushered in by Tony Blair’s New Labour government (1997-2007) even as it continued the assault on the NHS. Instructed that their patients must now be referred to as “clients”, Tracy asks, “What does that make us? Prostitutes?”

Later, quizzed about the preferred language for “birth defect,” Tracy responds: “We haven’t got 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 the money on?” Her remark encapsulates the frustrations of staff whose good will and humanity has been propping up the NHS for years.

The savage inequalities in healthcare delivery are shown in episode six when Adam lands a shift at an exclusive private hospital in London. Its elegant Georgian façade, plush lobby, silver service menu and odd quietness forms a stark contrast to the manic chaos of life on the NHS ward. But a medical emergency soon exposes the hospital’s deficiencies, driving home to Adam the supreme value of the collective expertise and resources embodied in the public system.

Alongside Adam is another junior doctor, Shruti (portrayed by the actor and comedian Ambika Mod), who is at the beginning of her career in Obs and Gynae. We see her constantly studying for exams, on top of gruelling shifts shadowing Adam and trying to learn on the job. The pressure is constant, with Adam frequently telling her “See one, do one, teach one.”

Shruti, from a working-class family, looks to the larger-than-life Miss Houghton (Ashley McGuire), the only consultant from a similar background, to try and forge a mentor relationship. When Shruti asks what support is available to help her deal with work stress, Miss Houghton, not with hostility but in an attempt at “tough love”, tells her she can either accept the realities of the job or get out.

Things end tragically. Ambika Mod’s moving performance as Shruti lives with the viewer long afterwards.

In the final episode, Adam explains in monologue that “one doctor in the NHS takes their own life every three weeks.” In the first six months of 2020, a period that includes the start of the pandemic, 64 health care workers took their own lives, according to data from the Office for National Statistics. Over the same period, 226 nurses, 79 paramedics and ambulance staff, and 17 medical students tried to end their lives, according to the Laura Hyde Foundation (LHF) named after a nurse who took her life in 2016.

Adam Kay resigned from the NHS in 2010, traumatised by the near death of a patient after earlier diagnostic failures. He published his book in direct response to then Health Secretary Jeremy Hunt’s claim during the 2016 junior doctors contract dispute that they were being “greedy”.

Beginning in January 2016, junior doctors, members of the British Medical Association (BMA), voted by 98 percent to strike against the imposition of a new contract that reduced payments for unsocial hours and lifted safeguards against excessive hours, one of the issues dealt with so tragically in the series. This was the first time in more than 40 years that junior doctors had taken industrial action over their pay and conditions.

As the World Socialist Web Site reported, throughout that year, “junior doctors—all those below consultant grade—fought with determination to oppose the contract, striking on five occasions in the face of a right-wing media campaign aimed at demonising them for daring to oppose the destruction of their jobs, terms and conditions. Opposing a relentless battery of government-led propaganda, they took the first all-out strike, without emergency cover, in the nearly 70-year history of the NHS.”

Their courageous stance was betrayed by the BMA. With 15 days of strikes set for October, November and December 2016, the BMA abruptly called off all action at the end of September, allowing the Conservative government to impose a vastly inferior contract with bitter repercussions.

This is Going to Hurt portrays NHS staff pushed to their limits during the years of Tony Blair and Gordon Brown’s Labour government. Things have only gotten worse since then.

Wage freezes, long and unsociable hours and chronic underfunding had taken their toll long before the pandemic. COVID-19 transformed hospitals into a war zone, with around 400 staff le aving the NHS each week during 2021, citing burnout, poor work-life balance and poverty pay.

The experiences depicted in This is Going to Hurt are a daily reality for millions of healthcare workers and patients, testimony to an irrational social order that prioritises profits over lives. Adam Kay, the programme’s directors Lucy Forbes and Tom Kingsley, and its talented cast including Ben Wishaw and Ambika Mod, are to be congratulated for their heartfelt portrayal.

But for all its evident fury over the conditions endured by staff and patients, the series ends on a note of frustration evident in Adam Kay’s own personal decision to leave the profession. When Adam asks if there will be an investigation into the circumstances surrounding Shruti’s fate, Miss Houghton replies, “This hospital has about three doctors and a budget of £12.50. If you want to change it, become a government minister, because there is bollocks-all any of us here can do.”

However, opposition to the intolerable situation in the NHS and health systems around the world is growing. The central problem facing health workers is the suppression of such sentiment by the health unions and the Labour Party. The necessary fightback can only proceed in direct struggle against such false friends who are as committed to the defence of capitalism, profit and private health as the Tories.

We invite health workers to contact NHS Fightback and subscribe to the WSWS Healthcare Newsletter.