This is Going to Hurt

Viewers of the doctor diarist turned comedian Adam Kay’s new BBC comedy This is Going to Hurt have started to notice something beyond Ben Whishaw’s compellingly elfin torso. They are struck by the year in which it is set: 2006, when NHS spending was rising at a faster rate, under New Labour, before the decade of austerity that kicked in with the coalition government four years later, and – erm – a devastating pandemic. “The fact that Adam’s story is set in 2006 – pre-Covid, pre-Brexit, pre-the last decade and more of Conservative rule, and all the de-staffing, defunding and privatisation by stealth that has marched in lockstep with it – is perhaps the most frightening thing of all,” wrote the Guardian’s TV reviewer Lucy Mangan. “First episode of this was really, really good, but my biggest takeaway was: if things were that squeezed 2006, at the height of the good times, then how horrendous must they be now?” asked the author and New Statesman columnist Jonn Elledge, in a tweet. The state of the NHS – with its beds full to bursting, rickety equipment, monster shifts and staff shortages – is already appalling in this series, which is based on diaries written by Kay when he was junior doctor between 2004 and 2010. European Working Time Directive rest provisions, which doctors are not allowed to opt out of, only came into force with full compliance by 2009, so theoretically shifts should be less terrible today. But since 2006, the situation for staff and patients has generally worsened. Firstly, government spending on health has risen at a slower rate than it did during the preceding decade, leading to operations being cancelled more frequently (there was a 14 per cent rise in cancellations from 2009 to January-March 2020), and the number of available overnight hospital beds falling by 11 per cent in the same period. In addition social care spending has been squeezed as council budgets have shrunk since 2010. The average council spend on adult social care per person fell 9 per cent in real terms from 2010 to 2019, making it harder for hospitals to discharge elderly patients, all while the population ages. Last of all, public sector pay, including for doctors, nurses and health visitors, was frozen in 2010 and is still far below 2010 levels today in real terms. "'It’s fine until isn’t' is the phrase that gets used a lot" There is also a damaging GP shortage, with the government set to break its pledge to recruit 6,000 more in England by 2024. According to paramedics and GPs I've spoken to, this is pushing more people to immediately dial 111 or 999 instead of trying to access primary care, thus channelling an unsustainable number of patients to A&E. All this is, of course, before you even consider the damaging impact of Covid-19, which has exhausted staff, delayed diagnoses and procedures, and taken up what precious little slack remained in the health service. The Health Secretary Sajid Javid’s plan to tackle the NHS backlog, announced this week, notably omitted resolving the recruitment crisis. There are 93,000 staff vacancies in the NHS today, with one in ten nursing roles vacant. Even back in 2006 hospital beds would fill up, taking the capacity to between red and black on the NHS 's operational pressure system (or “burgundy”, jokes Alex Jennings’s Aston Martin-driving, ever-absent consultant in This is Going to Hurt). Today, that’s a regular occurrence, according to one 26-year-old junior doctor working in a hospital in the south-west of England. He works on a general medical ward that is supposed to sleep 34 patients but is currently treating 36: extra beds have been "shoved in". “It’s quite interesting when it’s reported as news when hospitals declare internal critical incidents because they’re full – we probably have about one of them a week,” he tells me. “There’s a colour code system: green, amber, red and black – but I don’t actually know where it starts at because I’ve only ever seen it at red and black.” His hospital is so “clogged up” that it sometimes discharges patients to hotel rooms. “People’s care is worse due to the amount of pressure,” he says. He has regularly seen “15 ambulances queuing outside A&E” and says that people suffering strokes and sepsis are “never going to get” treatment in the required time window because of ambulance delays. "We basically have enough staff for one and a half emergencies" “We had a patient recently on the ward, an elderly woman who had fallen over, who was fine and hadn’t broken anything, but had been on the floor for 12 hours because of the delay for an ambulance,” he says. “That can break down their muscles, affect their kidneys, and there’s a flurry of downstream consequences for that. With cases like that, it’s quite a clear A-to-B correlation between a long wait time and the state of someone coming in.” Outside of the 8am-5pm day shift, he says his hospital “runs on the bare minimum number of doctors”. This is “basically have enough staff for one and a half emergencies. It’s fine until isn’t, which is the phrase that gets used a lot. “Overnight in A&E it can get sketchy. Weathering the storm in the health service generally means the doors are still open and the lights are still on. You’ve got people leaving the NHS because of the pressure.” [See also: Why Boris Johnson cannot blame the NHS crisis on Omicron]