Adam Kay: “It’s Christmas everyday in the NHS – but not in a good way”

The NHS is definitely on the table in this week’s Big Issue. Doctor turned million-selling author Adam Kay tells us what politicians need to do if they’re serious about saving the NHS

Adam Kay trained as a junior doctor before the hours and stress became too much and he sidestepped into writing and comedy. Years later, he wrote up his diaries. This Is Going To Hurt, was in equal parts hilarious and harrowing, offering insight into life on the stretched, strained and very messy frontline. It sold more copies than any other non-fiction book in 2018, and its follow-up, Twas The Nightshift Before Christmas, has been top of the bestsellers chart since it was released last month. In this week’s Big Issue, the unlikely unofficial spokesperson of the NHS explains why healthcare is always a big issue, not just at Christmas or when there are elections coming up…

Why every day is like Christmas for the NHS

In hospitals, you go down to the bare minimum of staff for Christmas so as many people as possible can spend time with their families. But the bare minimum seems to be where we are every day at the moment. The NHS is short over 100,000 members of staff. That’s an unthinkable number. Over 10,000 doctors alone, over 30,000 nurses. It is Christmas every day and not in the good sense. Depressingly, things have got significantly worse since I left the NHS in 2010. I don’t think my book paints a particularly relaxing picture of a job but in retrospect, those were the good old days.

The eight years of underfunding after 2010

I thought I’d left medicine behind, then the government decided they wanted to take an axe to junior doctors. It was very difficult hearing the lie that doctors are striking because they wanted money and they were being greedy knowing what the truth actually was. I didn’t feel like I had any choice but to get my side of the story across. Immediately after I left there was significantly less funding. In boring terms, health inflation is the amount of money more than the year before it costs to provide exactly the same level of service. Over the decades, the NHS generally commits to three per cent every year – that’s enough to tread water. But there was a period of eight years where it only got one per cent more a year in real terms.

Can we avoid adding extra burden to the NHS at Christmas?

I’m always slightly nervous about being asked how can people take the burden off the NHS and not come in with minor fixes because I think most doctors will say that it’s much better that they see a dozen things that people could have dealt with at home than one person stays at home when they should have come in. You can phone NHS Direct, visit pharmacists, but ultimately, if you need the NHS, they are always there.

Granny dumping is a thing – don’t do it

Families who want to want a break from their aged relatives will manufacture some spurious set of symptoms curiously close to Christmas Day and that’s them in hospital for a few days. It’s utterly heart breaking. The first time you see it, you think that must be callous and unusual. Then you realise it is just a feature of the festive season. It also speaks to the fact that we have grossly underfunded social services, and not to excuse it, you can understand how families reach breaking point and need a bit of time off when they’re filling a gap that in an ideal world social services would be helping with.

Hunt Saboteur: Jeremy Hunt’s terrible legacy

I found the Conservative leadership campaign very depressing to watch. Jeremy Hunt was claiming that he was a great negotiator and one of his great successes was steering the NHS through the doctors’ strike. I felt like we were being gaslit. He was a disaster for the NHS, and he caused harm. I do believe that he has blood on his hands. Everyone was prepared to totally forget his years and years and years of systematically under funding the NHS, waging war against junior doctors, and leaving it in the worst position that it’s been in since it was founded 71 years ago. Not that I’m happy with the current Prime Minister though.


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The NHS is already reeling from the Brexit effect

We can’t at time of press say what the effects will be. However, one thing we do know for certain is that Brexit has already had a huge deleterious effect on staffing. The NHS is the best example of the melting pot that we’ve got in this country. You can’t go into hospital and not be treated – often having your life saved – by people from dozens of different countries pulling together. They are moving back to where they were born and there isn’t enough slack in the system to let that happen. It’s not just Europeans, people who were born all over the world are suddenly feeling that the atmosphere is changed. They’re starting to feel unwelcome and are going back.

We need to hear from more NHS experts

Funding. It simply comes down to that. We need to have a big grown up conversation as a country about what we want the NHS to provide. If we want the NHS to do what Nye Bevan intended it to do, i.e. it’s free at the point of service and based on clinical needs rather than bank balance, then the NHS needs more money. If we decide that’s not the case then we work out how we make up a shortfall. That would be beyond sad but we need to have that discussion. The government has announced more money, and that’s better than no more money, but it doesn’t undo the years and years of damage. I don’t think these decisions should be made by here today gone tomorrow politicians who have half an eye on the electoral cycle. Funding for the NHS needs to be above politics, like the Bank of England, so it’s sort of autonomous. Have experts making expert decisions and listen to the people on the ground, whether they are patient groups, doctors, midwives, physiotherapists, pharmacists, paramedics, those are the people who you need to listen to.

NHS workers being stretched atom thin

The NHS is our greatest achievement as a civilised nation. Everyone knows its value but underneath it all is remembering that doctors are human. The culture is one of a stiff upper lip, which comes down to not just patients not thinking of their doctors as humans, but doctors not thinking of themselves as human. They need support for the bad days, and the bad days by definition outnumber the good guys because otherwise you wouldn’t need hospitals. You can have all of the staff wellbeing measures and Zumba classes and psychologists that you like but whilst the system is underfunded and under resourced and people are stretched atom thin, then nothing will work.

The most rewarding job in the world

It’s a job to go into with both your eyes wide open. You need to know the bad as well as the good – but the good is amazing. It’s the most rewarding job in the world. I delivered a couple of thousand babies and there’s no high like that. But the height of the highs is always set off by the depth of the lows. The NHS is as close as we’ve got to a national religion. It’s a brilliant thing. I feel very proud to have been a part of it. And I know the 1.4 million people who work for the NHS all have to put in a lot more than it says in the contract. And you do it, because you know you’re doing a good thing for an amazing organisation.

Twas the Nightshift Before Christmas is published in hardback by Picador (rrp £9.99) also available in ebook and audio. For dates and tickets for the live show go to

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