ITV’s new drama, Malpractice, set in an overstretched A&E department will certainly get your pulse racing and at the centre of it all is Niamh Algar’s exceptional albeit anxiety inducing performance. Here, Niamh joins Josh Smith for his latest GLAMOUR UK column, Josh Smith Meets to talk about bringing a very real NHS crisis to screen…
There are stressful TV shows and then there is ITV’s ‘will I have an actual heart attack watching this’ show, Malpractice. Now, if you haven’t watched it yet it’s the stuff of our collective nightmares, given that our NHS is at breaking point post COVID and mid strikes. It follows Niamh Algar’s DR Lucinda Edwards, an A&E doctor whose life is thrown into chaos when an overdose victim dies in her care and she is soon under investigation. Think Grey’s Anatomy meets Line of Duty on roller coaster speed, without any of Hollywood’s rose tinted hues.
And this anxiety ride even shook its star. “I was so anxious for the character in the first 10 pages when I read it and you don't know when there's gonna be a respite for the character,” Niamh tells me over Zoom, whilst we talk about the show’s script, written by former doctor turned screenwriter, Grace Ofori-Attah. Unfortunately for Lucinda, there is zero respite in this show. Even in the first episode, within minutes, there is an overdose victim admitted to A&E, the department comes to a standstill when someone turns up waving around a gun and then there are patients with gunshot wounds to attend to. Oh, and, plot spoiler: it only gets worse for Lucinda from there, that seems like a walk in the park in comparison to what comes her way.
I wonder how Niamh managed the anxiety that comes with filming a show that induces so much anxiety in its audience. “I don't think I was prepared for the residual feeling that your body goes through,” Niamh admits. “You know you're acting and this is all complete make believe, but regarding the emotional intensity, the character feels so much immense shame and guilt. And even though she does not feel responsible for Edith Owusu’s death, Lucinda is still human, she's still someone who has experienced loss, literally losing someone that she's responsible for.”
“Sometimes it is hard to separate yourself and not take away parts of the day where you have someone crying at you, blaming you or telling you that you're a terrible person. You do go home with that feeling of, ‘God I've done something really wrong.’ That feeling of responsibility was definitely a hard one to shake at the end of the day because you're going back into it the next day. It's not like there's a moment in the script where suddenly she's on holiday and we're all having a great time,” Niamh laughs.
There are zero sun loungers and cocktails at 1pm in this drama and there is equally no such daily luxury for the real A&E workers who Niamh shadowed to prepare for the role. “What really stuck with me is someone said it was, ‘like feeling like you're a cog in a wheel of a machine that is falling apart and there is nothing that you can do other than continue to work as hard as you can.’ The odds are always stacked against you and there didn't ever seem to be respite,” Niamh shares. “And what really struck me is the longevity of the hours and that there isn't enough time for someone to recompose. There's not enough downtime or duty of care and what's been really amazing about the response on the show so far is that it has started conversations online about the duty of care for doctors and medical staff.”
The lack of care for doctors was eye opening for Niamh. “I was there for a night and at two/three in the morning and the only available place where you could get something to eat was a vending machine,” she says. “These doctors are really not being looked after in a caring way. You have to treat the system like a service which you want to get the best quality of service from. How do you expect someone to work 14 to 15 hours and then not have a hot meal available for them? There was the police coming in with a lot of stab victims, but also there was a huge amount of mentally unwell people that were in A&E and suddenly the medical staff are also in a position where they are also trying to navigate around all of these physical threats. I wouldn't be able to do that job. I really wouldn't. It is an incredibly thankless job that medical staff do in A&E and they should be given the most amount of respect because it's extraordinary how they do it when they never know what is coming through the door next, which gave me such anxiety.”
The new A&E drama is airing on ITV.
The show certainly shines a spotlight on the mental wellbeing of our NHS staff through Lucinda, whose need for time off during the pandemic because she couldn’t cope with the relentless mental pressure, is dissected and debated throughout the show. This in turn has sexist undertones as she buckles under the age-old pressure to try and balance a career and having a family whilst being ruthlessly judged for it. Something that Niamh found equally eye opening.
“You should be allowed to be a mother and be allowed to be a doctor,” Niamh says and can we get a, ‘hear, hear’ up in here before we move on? Great! “You have the right to be both. She’s made to feel shameful for having to ask for help and for seeking help at that time. That is seen as a weakness and it's not. Healthy people look after their mental health and seek mental health advice. She's in a state of anxiety and burnout. She’s in a fragile situation, and nobody ever asks, ‘are you okay?’”
Burn out and its toxicity is certainly one villain in the show, and it is also one we all deal with, something which is not lost on Niamh.“I was only just talking about this to someone,” she shares, “in school you do physical education, so from a very young age you're taught: in order to look after your body you do like 30 minutes of exercise a day. But we don't educate from a young age how to emotionally regulate. That's suddenly a revelation as you become an adult and you have to know how to emotionally regulate and look after your mental health. But it should be instilled from a young age because it's as equally important to look after your body as it is to look after your head.” Too true!
Away from the important topics Malpractice platforms, ultimately the show asks us the question: who is to blame for the ‘accidental’ death in the A&E department? Is it another consultant who clocked off early? A junior doctor who didn’t follow instructions? The lack of beds? The random man waving a gun? Is it Lucinda’s negligence? Or is something more systemic? When I ask Niamh who she thinks is to blame she doesn’t hold back and rightly so. “From this situation, it's an overwhelmed department. There's not enough hands. Therefore you need to hire more people and spread out the workload. You can't just throw that amount of workload on a very small group of people and just get on with it. That's not gonna solve the problem, you need more staff. The answer is that burnout is a dangerous thing, a really, really dangerous thing.” And maybe that is true of the very real situation our NHS finds itself in now, too.
However, we are not here to get into politics. Nor am I a medical official by any stretch of the imagination but one thing that I would definitely prescribe for Niamh is temporary bed rest from intense dramas. After all, since she burst onto our screens in the bleak Shane Meadows drama, The Virtues alongside Stephen Graham, Niamh hasn’t stopped. She has starred as a police officer trying to honey trap a killer in Deceit which gave her a BAFTA TV nomination, given us the creeps in Netflix’s Victorian gothic saga The Wonder and attempted to fend off drug gangs in her BAFTA film nominated performance in Calm with Horses opposite Barry Keoghan.
Maybe just one romantic comedy would be good for her soul? “We’re putting it out into the universe,” Niamh laughs. “It's gonna be a joyous rom-com because that’s all I watch and reality TV shows like Below Deck. It's so funny because then I go to work and go, ‘let's do intense.’ That’s the great balance, I am lucky I don’t have to put myself through real life stress.” Lucky Niamh, because I need to lie down in a dark room after watching Malpractice.
Malpractice with Niamh Algar continues on ITV this Sunday at 9pm and is available on ITVX now.
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