Blogging is increasingly offering a colourful commentary of life in the NHS and writers argue decision makers would do well to pay attention. Jo Stephenson asks if managers should be afraid

Once upon a time when NHS professionals had a gripe they’d put pen to paper and dash off a strongly worded letter to a national newspaper.

Now a growing number are venting their spleen on the web in the form of frank, funny and sometimes alarming blogs - usually anonymous.

For those still bumbling about on the outskirts of the internet, blogs - or web logs - are like online diaries. The clue to their content is often in the title - Dr Rant, Dr Grumble and Mental Nurse, to name but a few.

Mixed opinions

But what about NHS managers? A scan of health service blogs reveals trust bosses are often the target of bloggers’ scorn but less likely to write them. However, a handful of chief executives are having their say online too.

Blogs offer managers the chance to communicate directly with staff and patients and show the human face of what they do.

One person giving it a go is North Cheshire Hospitals trust chief executive Catherine Beardshaw, who has just started blogging on her trust’s website. Her first post about car parking generated a flurry of comments but a second on the somewhat nebulous topic of quality was greeted with silence. “Maybe it was too complicated,” she muses.

Chief executives’ blogs are, naturally, tied to the public image of a trust and are not a space for managers to criticise board members or say what they really think about the health secretary.

Ms Beardshaw admits she gets her head of communications to cast his eye over her output. “It’s easy to get swept up in jargon sometimes and people don’t talk like that in the real world,” she says. “So he looks through it for me and tells me if he thinks I have gone over the top. But it is me.”

Get used to criticism

Managers will have to get used to more upfront criticism and comment, believes Ms Beardshaw, who was herself a victim of an internet slating in the form of an email sent to all staff by a departing employee. She admits she panicked a bit at first but then sent a “measured and courteous” open reply. “We’re going to get more of that in-your-face communication and senior managers are going to have to find a way of dealing with that,” she says. “You can’t try and push it under the carpet.”

And you can’t tell your staff not to blog. Ms Beardshaw adds: “My first plea to members of staff when they find things are not as they should be: don’t put it in a blog but talk to people in the trust about making it better.”

She acknowledges managers have a major role in ensuring lines of communication are open and that frontline staff feel confident speaking out.

Christie Hospital foundation trust chief executive Caroline Shaw blogs on topics including her efforts to raise money for the hospital’s charity by running the New York marathon and her addiction to shopping.

“Last time I was in London I visited the sales and bought a pair of beautiful shoes at less than a quarter of their price,” she wrote recently. “I’m saving them for a very special occasion and will be wearing them for the very first time at our annual members’ meeting.”

Ms Shaw, who started blogging earlier this year, says it helps her communicate and “show my personality”.

“The challenge is to keep it fresh and exciting, but so far it’s proving to be really valuable and I’ve received a lot of positive feedback,” she says.

Hidden dangers

Can chief executives compete with colourful characters like Dr Rant and Dr Crippen, who writes the successful NHS Blog Doctor?

The trouble with official blogs is that they can be dreadfully dull, says Swindon GP Gavin Jamie who compiles

“They tend to read like press releases. It’s difficult to make that kind of blog interesting and basically takes a particular kind of writer. I don’t think there are too many chief executives who have those skills,” he says.

Not that Dr Jamie claims his site, which publishes quality and outcomes framework data, is a laugh a minute.

But there are dangers in sharing your innermost thoughts online, as demonstrated by the recent case of a trainee medic who was suspended after posting unfavourable comments about Dame Carol Black on

Anonymous blogging offers freedom and the chance to tackle some difficult subjects without fear of reprisals. “Julie X” is among senior NHS staff who blog anonymously.

A commissioning manager with a nursing background, she’s been blogging on her site Life In the NHS for almost three years.

“I blog anonymously because I am not clear that people would be understanding about it,” she says. “Also it gives some freedom. I have found it a useful way of speaking out, giving my opinion and of reflecting on what it is like to work for NHS organisations.”

Michelle Tempest, who writes the Psychiatrist Blog, questions whether anonymity is the best way of promoting free speech in the NHS. “I think if you’re going to write something you’re going to be accountable for it whether you’re anonymous or not,” she says.

“I did mine because I felt there were a lot of things out there in the blogging world that were negative and I wanted mine to be about positive things.”

Knowing what people think

Should managers worry about blogging? In a word, yes, says one of the authors behind Dr Rant. He says writers on his site are not afraid to take individuals, including managers, to task, especially “when they’re doing something we see as corrupt”. He reckons managers should be thick-skinned enough to deal with some healthy criticism.

All the bloggers HSJ spoke to were clear on one thing: NHS managers would do well to read them. “People are increasingly fearful of speaking out in the workplace and perhaps it would do no harm to know what people think,” says Julie X.

And blogs can be positive, claims Jon Twinn, editorial director of the medical network. “People are sharing experiences, expertise and even academic findings in a way we’ve never seen before,” he says.

Blogs can also help promote better understanding between different healthcare professionals and highlight serious issues particularly around patient safety, he says.


Not everyone is a fan. “I never read them,” declares Neil Bacon. “They are just the unedited and ill-informed views of individuals who like the sound of their own voices.”

Dr Bacon has himself been a target of bloggers’ ire, after setting up the website I Want Great Care, which allows patients to rate and review doctors like a book on Amazon. The patient critiques are anonymous but Dr Bacon maintains there is a difference in that the site aims to gather the views of lots of people rather than provide a platform for a lone critic or admirer.

He believes managers can get a lot out of online communication - including blogs - but only if it is two-way. Editing negative comments or leaving them out defeats the purpose, he says.

Avoid the spin

“What you don’t want is a one-way dialogue on ‘this is what we’re doing and here’s a picture of us opening a new children’s ward’ and it just coming across to everyone as rubbishy PR spin.”

John Rostill, chief executive of Worcestershire Acute Hospitals trust, says he started blogging to try to engage more with staff.

“I didn’t do it to enter a competition and wouldn’t set out to make it funny,” he says. “The blog isn’t for my benefit - it’s not to vent my frustration but to educate and inform others and let them know what we’re doing.”

Would he be worried if he found out a member of trust staff was blogging about work? “It wouldn’t worry me at all as long as there was no breach of confidentiality,” he says. What if he featured in a blog? Mr Rostill pauses. “I say I wouldn’t mind but it depends what they wrote. It wouldn’t be the first time that people have written about me and I might not approve, but then we didn’t come into this job to be popular.

“If it generated a bit of healthy discussion, I’d encourage it.”

Bloggers beware

Blogs are a good way of communicating informally but anyone entering the blogosphere should know where they stand when it comes to the law, says NHS Employers joint acting director Sian Thomas. “Although relatively new, blogs are covered by existing legislation and anyone blogging needs to be sure anything published conforms to UK legislation and their own contract of employment,” she says.

Employers should have well-publicised policies covering the use of email and websites at work. Trusts should also have whistleblowing policies for employees. “Publishing inappropriate material in a blog is usually unacceptable,” says Ms Thomas. Most NHS staff have confidentiality clauses in their contract which, if breached, may lead to disciplinary procedures.

“Anything published on the internet is also subject to libel laws,” she adds.

HSJ Blogs go live on 1 September

In May we called for people to join the HSJ blog.

The response was phenomenal, with one blogger responding within 10 minutes of the announcement going out.

We whittled down the list to just five, based on professional credentials, the quality of a trial blog entry and the vision each had for their blog.

We can now reveal them:

  • Nadeem Moghul, manager and clinician

  • Paru Naik, business manager

  • Samuel Johnson, performance manager

  • Innate Prejudice, chief executive

  • Inside Out, regulatory worker

Oh yes, two chose to be anonymous.

If you wish to provoke Inside Out, challenge Mr Moghul, laud policy perspectives from Ms Naik, pooh-pooh Mr Prejudice (with prejudice) or enjoy a slanging match with Mr Johnson - do it all at

Whatever the viewpoints, the HSJ Blog promises to be amusing, unreconstructed, provocative and engaging.

To keep updated with each post - can you really afford to miss anything - simply email

Happy blogging!