Adam Kay: 'Before the pandemic the NHS was running on empty and it turned out those were the good old days'

The last time Adam Kay spoke to The Big Issue was towards the end of 2019. He explained, with quietly restrained fury, how every day was like Christmas in the NHS – and not in a good way, not as something to celebrate, but rather because on a daily basis there were barely enough staff to cope. The NHS, the doctors, nurses and all other workers within it, he told us, were running on empty.

Little did any of us know that we were on the verge of a global pandemic. Two years in, the adaptation of Kay’s bestselling 2017 memoir This is Going to Hurt – with Ben Whishaw in brilliant form as the fictionalised Adam, an exhausted, stressed, overworked and under-supported acting registrar – arrives on BBC One at a worrying time for the NHS. Waiting times for operations are longer than ever, staff shortages are at record levels and many see an existential threat to the NHS on the horizon. So we arranged another consultation with Kay.

THE BIG ISSUE: When we last spoke, we were talking about the NHS being in dire straits. And that was before the pandemic.

ADAM KAY: Everyone was running on empty and it turned out those were the good old days. We were extraordinarily badly prepared. It was impossible to fully prepare for the catastrophe that unfolded, no one would have that level of slack, but we had a system that was in minus slack already. There was no buffer whatsoever. Doctors have been saying for years that all it’s going to take is one really bad winter and things are going to fall apart. This was like 1,000 bad winters.

You often hear from people working in the NHS. What’s the mood like at the moment?
I’m not sure I know any doctors who don’t have a Plan B now. Everyone’s thinking, I can’t do this for ever. And they can’t. The NHS is 110,000 members of staff short at the moment – we can all work out where the problem is. It’s something no amount of soundbites are going to sort. It needs money spent and it needs money spent in the right places. We need to recruit and we need to retain – because there’s no point running the bath if the plug isn’t in. When I left in 2010, I was the outlier as someone who left the NHS. There had only been one other person in my cohort of 300. But, with no end in sight, you would have to be deranged not to think ‘I can’t maintain this level of work for ever.’

Watching the adaptation of your memoir, the exhaustion just exudes from the fictional Adam.
Goodwill is the key currency in the NHS. The extra mile is the standard distance. Out of your depth is the standard depth. That’s the world of the NHS. I’m really glad you picked up on the exhaustion because that was really important to get across. My dream for this show was for people who work in the NHS to go, yeah, this feels like my experience of it. I wanted to show the impact on your life at home, which was a big thing for me, and the relentlessness of it. It isn’t like a normal job. You are constantly being pulled in to do more – and you have to say yes. Because someone could die. Sometimes in a TV show, you watch someone in a terrible situation – a comically bad marriage or weird job – and you think, just leave if it’s that bad. I wanted to show why you couldn’t say, ‘No, I’m not answering that bleeper. I’m not helping that person.’

How are you still affected by your time as a doctor?
I left under very difficult circumstances. And that used to really, really haunt me. But in the absence of being offered therapy by my employer at the time, I’ve done my own therapy in writing it down and keeping talking about it. I’d be lying if I said I never think about that stuff because it never leaves you. But it’s not a feature of my day and my week in the way that it was.

What would have helped you then in terms of support and why isn’t it available?
The answer, of course, is that it should be available. I didn’t have anything in the way of support. There should be a standard protocol when someone has a very bad day at work in the NHS, in terms of being offered time off or someone to speak to. But how do you offer time off if there’s no slack? How do you offer counselling if the hospital doesn’t employ that person? Ultimately, it’s a mindset. Doctors are expected to bloody get on with it. And until everyone remembers that people working in the NHS are human, that probably isn’t going to change. Things are getting better. For all of Matt Hancock’s faults, he did take this as a bit of a focus. The pandemic has meant people are thinking more in terms of the wellbeing of healthcare staff. And we have to look for positives where we can in such awful times.

Doctors everywhere, but no one to heal you.
A friend of mine was a legal aid solicitor and they cut and cut and cut until the job was too stressful. He retrained as a train driver. Part of his basic training was a psychological assessment asking how you’d deal with it if someone jumps in front of your train. I realised that at no point in medicine did anyone ask the equivalent. How are you going to cope when the bad stuff inevitably happens? It’s not mentioned when you go in. You’re not taught how to deal with it when you’re doing the job. And when it actually happens, they leave you to it

Who did you talk to?
At the time, I didn’t talk to anyone. To the extent that my parents knew I’d left medicine but didn’t know why until they read the end of my book. I met my husband shortly after I left medicine. He knew I was a doctor, but it took half a decade of our relationship before we talked about it. The idea that you just keep it in is so entrenched and ingrained that even that long afterwards, when I was living a totally different life, it felt wrong to talk about it.

Do you think the pandemic has changed our attitudes towards the NHS?
Hopefully this is another positive from the pandemic and it has galvanised the importance of what the NHS is, does and stands for. Because it’s a global pandemic it means we can compare ourselves to other countries. In America, they’re still pissing around over whether Covid tests should be free or not. I will hopefully, as long as I live, never be worried about where my healthcare is coming from. We just don’t have that anxiety here. So I hope this means we will remember what a great thing we’ve got and if it comes under existential threat at any point soon, we will fight that. But then again, we’ve all got short memories, haven’t we?

How did you feel seeing the public applauding NHS workers on our doorsteps?
At the start I thought it was a wonderful and magic thing. I live in a village in the middle of nowhere. I know everyone in the village was banging their pans, because I’ve never heard so much noise there in my life. And friends on Facebook were posting videos from their flats in London and it really did feel lovely, like a proper reminder that everyone loves the NHS.

And when the politicians joined in…
That was the turning point. And they stopped saying ‘the NHS’ and started saying ‘our NHS’. It’s not your NHS! You are the only people who aren’t allowed to say ‘our NHS’. Only the rest of us can say that, you are the ones fucking it up – so just stay away from the banging of pans and clapping! So it was a lovely idea. But in the absence of proper protective equipment, in the absence of adequate staffing, in the absence of the stuff they need and rely on, it’s slightly empty. I don’t know a single doctor who wouldn’t swap clapping for some decent protective equipment.

If vacancies arise – and who knows, it might happen today – for a new prime minister, chancellor and health minister and you get offered all the jobs, what do you do on your first day?
Oh, that’s a good one. I’m not quite sure how this would happen – it would have to be some sort of hostage situation where I’m forced to be a politician!

That can be arranged.
Well, it’s quite a boring, simple answer because there are 20,000 things you could do to change and improve the NHS. But ultimately, if it isn’t adequately funded, staffed and resourced, then none of them will make a difference. When I talk about funding, the biggest thing is funding the people. Because the NHS isn’t buildings and bedpans – it’s one and a half million people and falling. So it’s about getting enough people trained up. It’s having enough of them there that they’re able to do the jobs that they’re trained for to the best of their abilities. And it’s keeping them there by making it an environment they want to work in. Where’s the pay rise for the nurses? Midwives have been asking for a 15 per cent pay rise just to catch up with the lack of pay rises in the previous 10 years. I mean, that’s a no brainer. So let’s sort out 110,000 job vacancies. Imagine working in any organisation where eight to 10 per cent of the people in your organisation are away and you’re having to cover them.

That’s like a football team playing all season with 10 players.
And yet you are expected to compete. You’re wondering why the league table is not looking great at the moment.

Junior doctors have a reputation of work hard, play hard. Was that your experience?
Mine was work hard, sleep hard. Medical school was work hard, play hard. When you were training, there had to be a bit of carrot as well as stick because you’re doing this six-year degree and all your mates, by the time you’ve qualified, are three years into their careers. They’ve got a car and have put a deposit down on a flat while you are still living in halls of residence, so it feels depressing. Also, it’s heavy going when you’re a teenager having to cut up a cadaver! And in the absence of being taught a coping mechanism, you find your own – for a lot of doctors, it’s not water.

Could you imagine, during the pandemic, a bring your own booze event for doctors?
I can’t imagine it. It’s so contrary to common sense and to what they’re doing every day. The rules were there to protect people. They weren’t rules, they were protections. I refuse to believe people would see the damage this virus does – seeing patients in intensive care units, saying goodbye to their relatives for the last time on a fucking iPad – and go straight from that to have cheese and wine. It just feels callous. Doctors were begging, and continue to beg, for people to just protect other people.

Is there a way to depoliticise healthcare? I’m thinking of how the Bank of England was taken out of government control in 1997…
There should be. And it’ll take someone a lot cleverer than me to figure out how it works. But there must be a way. Because every politician is thinking about the next general election. It needs unpopular decisions. Because if we’re going to train and recruit 110,000 more people, that’s going to be extremely expensive. The NHS isn’t free. It’s free at the point of service. We pay for it out of tax, which is great. But someone’s going to have to, at some point, say: by the way, it’s going to put 2p on your income tax. And if that’s the right decision to make, the factor shouldn’t be whether a politician is worried they might lose their job. If there could be some kind of cross- party, independent set up that controls it, that would be ideal. At that point, I will allow politicians to say ‘our NHS’!

THIS IS GOING TO HURT is on BBC1 and iPlayer from Tuesday 8 February

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