How ‘This is Going to Hurt’ turns life on the NHS frontline into TV drama

While the NHS is rarely ever out of UK headlines, the timing of the eye-opening This Is Going to Hurt, a new BBC/AMC comedy-drama adapted by Adam Kay from his own best-selling 2017 memoir, is especially piquant. The Covid-19 pandemic has highlighted both the cracks in an under-resourced system and the efforts of its 1.3mn employees to keep it going as the threat of privatisation looms ever larger, and the series tells their story in unflinchingly realistic detail.

“The NHS is a precious, fragile resource,” says Kay, whose book covers his years in medicine between 2004 and 2010. “There is no better, fairer model, but it’s short of 100,000 staff. At no point would I pretend that it’s something that it’s not, or ignore the stress it puts people under.”

Among those people in 2006, when the series begins, is Adam (Ben Whishaw), an acting registrar in the obstetrics and gynaecology department of a London hospital, trying to keep himself together in the face of 97-hour weeks and the expectations of aloof consultant Mr Lockhart (Alex Jennings), his monstrous mother (Harriet Walter) and long-suffering boyfriend (Rory Fleck Byrne). There are superficial similarities with Jed Mercurio’s fine, visceral 2004-06 BBC series Bodies, also set in an obs and gynae ward, though that show was more in thrall to established genres. While it eventually allows its anger to overwhelm its empathy, This Is Going to Hurt — like Mercurio’s pioneering 1994-96 BBC series Cardiac Arrest — deftly walks the line between glib comedy and sermonising and never feels anything less than rooted in reality.

It was this that drew Whishaw to the role. “I was struck by the authenticity of Adam’s book,” says the actor. “He wanted the series to be a love letter to the NHS and wanted it to have a social impact. I thought that sounded like a good thing.” For Kay’s part, he says that when he learnt Whishaw had come on board he “yelped so loud that I set the dog off”.

Kay describes the medical cases depicted as about as faithful to his true-life experiences as they can be “without causing court proceedings”, but stresses that the show’s Adam is a few removes from the real thing, “and a bit meaner than I hope I am”. A frequently misanthropic anti-hero, Adam is humanised by his fourth-wall-breaking asides, and while his professional experiences are based on real first- or second-hand events in Kay’s career, the event that haunts him is distinct from the disastrous C-section that eventually drove Kay to quit his medical training.

“No one offered me therapy at work, so I just didn’t talk about it,” he recalls. “The book was the first time my parents, my husband or my friends found out why I’d left medicine. It was only in doing readings or interviews that I started to talk about it. Initially it was almost unbearable, but I stopped waking up at night in a cold sweat. This series has meant I’ve exorcised a lot of demons, because I’d go home after visiting the set and write about things that happened 15 years ago. Adam’s flashbacks in the show might refer to a separate incident, but they capture that sensation perfectly.”

Whishaw also recognised aspects of himself in Adam. “He’s found strategies for coping with his life that aren’t working any more, they’re self-sabotaging. I have sympathy with that.” Yet he doesn’t wish to compare himself to the character. “I don’t know how you deal with all that and protect yourself. It’s extraordinary that anything goes well, because there’s so much room for human error.”

Filming took place in a former design college in east London, and the set feels instantly recognisable as an NHS wing, from leaky ceiling tiles to endless half-finished cups of coffee. The cast had training with prosthetic models so they could perform operations and conduct deliveries convincingly, and were aided by medical advisers on set, but the technical details were of less concern to Kay than reflecting the psychological realities of life on the NHS frontline.

“Medical series are very good at showing how you do CPR, what a drip looks like or the correct way to do a forceps delivery,” says Kay. “I wanted to show the other side: the collateral damage of the job on your mental health and your life. It’s understandable to want your doctor to be infallible when they’re cutting out a bit of your lung or prescribing your chemo, but doctors do get sad and angry and tired and make mistakes. They’re also very bad at looking after each other and themselves.”

While much of the turmoil on the ward feels all too contemporary, one aspect of the series that may feel a little less so is Adam’s struggle to come out to his friends, family and colleagues. Worried that Lockhart might hold his sexuality against him when considering promotion prospects, he fudges inquiries about his personal life.

Whishaw says that “2006 was a much more fearful time. Homophobic abuse seemed to be acceptable and there weren’t anywhere near as many out gay people on TV then, but happily we’ve moved quite fast in the last 10 years.”

So, according to Kay, has the NHS, which he describes as a more enlightened institution these days. “Every hospital has Pride events, there’s an LGBT medical Twitter group . . . Things are a lot better without being perfect.”

Not that Adam is portrayed as purely a blameless victim of the system; the product of private education and a long line of doctors, he crawls before Lockhart while bullying his perceived inferiors, making an indefensibly lazy assumption about the background and motivations of junior doctor Shruti (Ambika Mod), who is smart and eager but drowning in the demands of the job.

“Medical schools traditionally recruit more of their own,” says Kay. “You need loads of A’s at A-level for what is more a communication job than an academic job, and loads of extracurricular activities and work experience in a hospital environment, all of which are easier if you go to private school and your parents’ mates are surgeons. With the training being so expensive, class is still an issue.”

Kay will measure success not in viewing figures, but by that hoped-for social impact. “These are human beings dealing with an almost impossibly difficult job in the only way they can, because they aren’t getting enough support. It’s OK not to be all right, and that’s something we don’t think enough about.”

Whishaw finds reasons for hope amid the series’ dark turns — optimism that is essential in the face of mounting evidence to the contrary. “The NHS has been eroded for years,” he sighs. “There are terrible things happening, but we’re so bludgeoned by Covid and lockdown and insecurity and loss, we don’t know quite what’s coming at us. It felt very important and a privilege to be telling this story, celebrating this institution and the foibles of human nature.”

On BBC1 and iPlayer in the UK from February 8 at 9pm

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