Niamh Algar: ITV drama Malpractice exposes uncomfortable truths about NHS

New ITV drama Malpractice opens on an ordinary night on an ordinary NHS A&E ward. It is, in many ways, an unremarkable shift for Dr Lucinda Edwards. Sure, she is overworked and under-resourced as she takes life-and-death decisions, and the A&E department is understaffed. But this, we quickly gather, is not remotely unusual.

Dr Edwards, played brilliantly by Niamh Algar in Malpractice, is treating a young woman overdosing on opioids when a child with gunshot wounds arrives in A&E reception – alongside a man brandishing a weapon. Moments after having a gun waved in her face, Edwards must make a crucial decision. There are insufficient beds and her only back-up is an inexperienced junior doctor. 

Who to treat? Who to prioritise? Where to focus her attention? The repercussions of her response to this tense opening echo throughout the series. “The fact that it was written by Grace Ofori-Attah, a former A&E doctor with 10 years’ experience working within the NHS, was a huge contributing factor for me signing on to do it,” explains Algar, on a video call from Oxfordshire, where she is currently filming Sky’s new historical drama Mary and George with Julianne Moore (“she’s a real up and comer, definitely one to watch”).

“I come from a family of nurses, and good friends of mine are A&E doctors. So I grew up with and am currently exposed to stories about what it’s like to work in the public health sector. When I read this, I was able to identify those stories I hear. And that’s the whole point of taking on a role. You need to find the truth in it.”

And the truth is, says Algar – who has previously starred in Shane Meadows’ harrowing C4 series The Virtues, with Florence Pugh in acclaimed Netflix film The Wonder, and in Ridley Scott’s sci-fi series Raised By Wolves – that doctors on the front line are struggling. “I was blown away by the sheer exhaustion of the job,” says Algar. “I shadowed an A&E consultant in a hospital. The luxury of being given that opportunity, as an actor, to really walk around in someone else’s shoes and see firsthand how they live on a daily basis and how it affects them, was the most valuable experience.

 “From the time the shift started to when it ends, she was constantly moving. I was sweating buckets. I felt like I was running on adrenaline. And at the end of the shift, it was like I’d been out on the battlefield.”

If Malpractice’s opening scenes resemble a warzone, what follows shows the impact of working in such
an intense environment without appropriate support. 

“Everyone in the health service is there to look after other people. Yet they are the ones that are being looked after the least. It’s so unfair,” says Algar. 

“Lucinda is a good doctor. She’s smart. She has been battle-hardened from working in this profession but also working through Covid. There’s been this huge global trauma and you have these workers who were at the forefront of it and they are not getting the care and attention they need.”

But the under-resourced NHS is just the backdrop to a story that veers in surprising directions after a patient dies and an internal investigation, centring on Dr Edwards, is launched. 

Across five episodes, Malpractice evolves from a high-octane drama on the NHS front line into an expansive crime thriller. That it is produced by the same team as Line of Duty and Vigil comes as little surprise. “They know the formula,” says Algar, with a grin. “I think that’s what is so amazing about this. It is already this pressure cooker where the lid is about to explode off. And they just keep on throwing in more hot water.

“The stakes are incredibly high throughout. I remember reading it and thinking, wow, this is someone who’s hit burnout but has found the reserve canister of gas. And then they’re throwing more flames onto the fire.”

Malpractice also looks at addiction from new and interesting angles – how we treat it, the language used around it, who it impacts. 

“We see the implication of opioids from several perspectives,” says Algar, as we steer through a minefield of potential spoilers. 

“It’s not stereotyping. That was so important for me. I feel like it is handled in a really smart and educated and educational way. Because addiction is an incredibly sensitive subject. 

“So a doctor’s perspective on it is really interesting. You have a character who understands the complications around addiction, the causes of it, and yet she’s also stuck in the middle of it.”

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Before Algar leaves to return to the 1600s for her next role after Malpractice, she ponders what she has learned about the NHS – and how she would fix it if she were in charge of the modern-day health service. “I see how tough it is for health workers. They’re fighting for a better health system because they care. I just wish people who could make a change did what I did and spent time following people working in the NHS,” she says.

 “People are striking and they’re telling us exactly what it is that they need. You’ve got to fix staff retention, recruit more staff, create purpose-built hospitals with more space – because we need more beds. 

“But you also need to take care of the people who are working there. You can’t just install vending machines for people who are working a 12-hour shift through the night. They would not be on strike unless they had to – they’re doing it because they care about others. So we need to listen to them.”

Malpractice airs on ITV1 on Sunday nights from April 23 and is available to stream on ITVX

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