BLOOD AND GUTS (THIS IS GOING TO HURT)

Never has the title of a TV drama seemed more apt.

BBC1 and AMC+'s 'This Is Going To Hurt' is a medical drama, the likes of which you have never seen before.

It will make you wince from the off as its exhausted National Health Service (NHS) doctors and midwives treat patients going through very difficult childbirths.

It will jolt you as those same doctors and midwives are covered in blood and other bodily fluids amid the chaos of a NHS ward.

It will emotionally wind you as the NHS staff suffer the ups and downs of a job where death is an ever present fact of life and you're expected to just suck it all up.

Adapted by Adam Kay from his own best selling, acclaimed memoir, Ben Whishaw is cast as the overworked, emotionally drained version of its author.

When we first see Whishaw's Adam, who is the Acting Registrar in an Obstetrics and Gynaecology Department of a busy London hospital, he has woken up in the same clothes from the day before in his car in the hospital car park.

His boyfriend, Rory Fleck Byrne's Harry Muir has been trying to contact him, wondering why he has not returned from his shift.

However he cannot go home as he is already late for his next shift.

Heading straight into the hospital, the shift begins in the most turbulent way possible.

As Adam is about to enter the building, he notices a pregnant woman outside who is in clear distress.

Checking to see what is wrong, he realises her baby's arm is already beginning to protrude.

Ushering her inside, Adam decides to use a rotating maintenance lift which they need to jump on and also jump off.

Breaking the fourth wall - a regular feature of Kay's darkly comic drama - Adam tells us she has suffered a cord prolapse and there is a real threat to her and her baby.

Somehow getting her to the ward for treatment, he is immediately taken to task by Alex Jennings' consultant Nigel Lockhart for being late and taking risks.

Adam is then immediately thrust into a discussion with a pregnant woman about to undergo a Caesarian section.

However when he detects racism from her and her mum towards Michelle Austin's head midwife Tracy, Adam puts his foot down and tells them they can leave if they continue to insult his colleague.

Tracy, however, is unimpressed by his behaviour and tells Adam she does not need a white knight to ride to her rescue every time a racist remark is hurled at her.

Later Adam is forced by Dr Lockhart to apologise for the way he spoke to the patient and her mother, even though they were in the wrong.

Adam also has to supervise Ambika Mod's SHO, Shruti Acharya who is eager to soak up as much experience as possible and to learn how to deliver babies.

Further down the pecking order, Adam initially treats her as dismissively as he is treated by his superiors.

In the middle of a particularly demanding shift, Adam fields phone calls from Harry about whether he can make a stag do for a friend, Tom Durant-Pritchard's Greg who Adam has asked to be his best man.

When he does eventually make it to the bar, he has barely put on an offensive stag do t-shirt when he receives a phone call from Lockhart asking him to do a double shift.

Reluctantly, Adam returns and is forced to hoke in a changing room bin for worn scrubs after the machine that dispenses them breaks down.

It will prove a traumatic shift as he soon realises Hannah Onslow's patient Erika Van Hegen, whose pain he had been dismissing earlier, is actually in the stages of pre-eclampsia, putting her and her premature baby at risk.

Forced to deliver the child at just 25 weeks by Caesarian, he has never carried out the procedure on a baby that young before.

The birth is complicated by Erika losing a lot of blood and while the baby boy is delivered and rushed into intensive care, Adam is overwhelmed by the extent of the blood loss.

He's also consumed by the guilt of being so dismissive of Erika's pain earlier in the day.

All of what I have outlined is in the first episode of Kay's seven part drama.

Over the course of the next six episodes, we see Lockhart encourage Adam to doctor the notes about Erika's case.

Adam, who is suffering flashbacks about her traumatic birth, obsessively visits her baby boy in intensive care.

Haunted by the case, Adam is shocked when he is summoned to a General Medical Counsel fitness to practice hearing which further drives his levels of stress on the ward through the roof.

Along the way, he encounters Ashley McGuire's bluntly spoken consultant Vicky Houghton who seems to take an instant dislike to him and openly derides him on the wards for being upper middle class.

Kadiff Kirwan's colleague Julian also treats him with disdain, regularly suggesting he is incompetent and appearing to relish reminding him of how he put Erika and her baby's life in danger.

Overworked, weighed down by exams and eager to please Adam and her proud parents, Shruti has crises of confidence too but is taken under the wing of Vicky.

Tracy and Phillipa Dunne's receptionist Ria attend a ridiculous seminar on the terminology NHS staff should deploy to describe patients and their exasperation shows.

Adam and Harry get engaged but he conceals it from most of his colleagues at work despite his long suffering boyfriend's eagerness to meet them.

This is partly because Lockhart is so old school he assumes everyone is straight.

Harry's first encounter with Adam's domineering mother, Harriet Walter's Veronique at the theatre also goes terribly.

His friendship with Greg becomes strained, thanks to his brief appearance at the stag do and a tetchy encounter over dinner with his bride to be, Alice Orr-Ewing's Emma.

Later,through Lockhart's connections Adam lands a lucrative shift at a private maternity hospital that feels more like a luxury hotel.

However for all its luxury, the facility turns out to be ill equipped when a procedure goes hideously wrong.

'This Is Going To Hurt' is one of those shows that is not going to suit everyone's tastes.

Those who fall for it will passionately adore it.

Those who are repulsed by its trench eye view of life in the NHS will probably switch off.

Those in the middle of a pregnancy should probably tuck it away to watch at a later date.

Kay's drama has, however, triggered a vigorous debate with some people accusing it of misogyny in the way it treats expectant mothers.

But as Ambika Mod has argued, that kind of misses the point.

Kay is not interested in well worn depictions of the miracle of childbirth.

Yes, childbirth is amazing but it it is messy and sometimes difficult.

Deliveries go right for the vast majority of people but they can also go very badly wrong.

What Kay is trying to do is convey the experiences of the NHS staff who deliver babies as they really are.

Given his background - he spent six years as a doctor and then as an obs and gynae trainer - few can doubt the show's authenticity.

But it is worth stressing again this is not a patient's eye view.

This is very much a doctor's.

All of us know Britain's NHS is a remarkable institution.

That's why Danny Boyle had a particular tribute to it during the Opening Ceremony of the London 2012 Olympic Games and people took to the streets to applaud its staff at the beginning of the COVID pandemic.

We also know it is not perfect, that waiting times in A&Es and for operations can be horrendous, that the systen hoovers up a lot of government money and that it can be terribly bureaucratic.

However it's free at the point of access for everyone and unlike other countries, it doesn't lumber citizens with massive hospital bills, forcing the poorest people to avoid treatment because of the cost of health insurance.

Kay's drama is unflailingly honest, though, about the NHS's shortcomings while passionately defending the concept.

It raises questions not about the value of having a National Health Service but about how it is run and the way it puts tremendous strain on its staff.

Adam and his colleagues are brutalised by a system buckling under the weight of the huge pressures on hospital services.

They adopt a cynical sense of humour because that is the only way they can cope with being overworked and underresourced.

They are so stressed that the system can be tough and hierarchical, with junior doctors often being derided and made to feel inadequate.

Superbly directed by Lucy Forbes and Tom Kingsley, Kay's show is rooted in a barnstorming central performance by Whishaw that should be a strong contender for all the major TV acting awards on both sides of the Atlantic.

Those who thought Hugh Laurie's Dr Gregory House was a complex figure in 'House' will really have a wake up call watching Whishaw.

Away from the hospital ward, Adam is hard to warm to.

He is tetchy, socially awkward and too exhausted to care. He treats his boyfriend poorly.

And yet when we see the demands of his job, we understand why he is like that and he engages our sympathy.

The other outstanding performance is Ambika Mod's as Shruti and she should also be vying for major awards.

As the series develops, we watch Shruti slowly metamorphise from a wide eyed, enthusiastic yet scared SHO into a jaded, emotionally bruised junior doctor.

Taken on its own, her performance in the penultimate episode of the show is simply an outstanding piece of acting.

The always reliable Alex Jennings doesn't disappoint.

He amuses as the consultant at the top of the professional tree - offering dubious advice and encouragement to Adam one minute and savaging him the next.

Michelle Austin is excellent tooas Tracy, whose frustration with the job and with Adam occasionally boils over.

Ashley McGuire of 'Man Down' and 'This Country' fame shines as Vicky Houghton and it is great to see her in a different role from her usual sweary chav routine in sitcoms.

Fleck Byrne is on point as Harry but so are Walter, Kirwan, Dunne, Durant-Pritchard, Orr-Wing, Onslow and the parade of actors who play the patients who cross paths with the medical staff.

Audiences will no doubt flinch at how stupid some civilians who present themselves for treatment can be - particularly in the sequences where Adam is called into A&E.

They will reel too when they hear Adam's impassioned speech in the final episode about the levels of depression and suicide among NHS staff.

However they will mostly be struck by the goriness of the show and its depiction of an overworked, underresourced staff struggling to keep their necks above water.

Even if they are repulsed and reach for the remote, that very act illustrates the power of Kay's vivid writing.

With its unflinching honesty, 'This Is Going To Hurt' sets a high bar for future medical dramas.

If it achieves anything, it is in the way it hammers home how applause for NHS workers is a well meaning butempty gesture.

The best thing we can do for staff is reform a public healthcare system to boost frontline services and relieve the pressure on NHS employees.

As we all know, that's easier said than done.

It requires honesty on the part of politicians, civil servants and health service administrators about what the system is getting right and what it is getting wrong.

'This Is Going To Hurt' is a start.

('This Is Going To Hurt' was broadcast on BBC1 in the UK from February 8-March 21, 2022)