Resource Library: Freedom to Speak Up

The role of Freedom to Speak Up guardians and the National Guardian for the NHS were established in 2016 following recommendations from Sir Robert Francis’ Freedom to Speak Up Inquiry. Freedom to Speak Up Guardians support workers to speak up when they feel that they are unable to do so by other routes. They ensure that people who speak up are thanked, the issues they raise are responded to and that the person speaking up receives feedback on the actions taken. 

Freedom to Speak Up guardians are appointed by the organisation they support and abide by the guidance issued by the National Guardian’s Office. They work proactively to support their organisation to tackle barriers to speaking up. Guardians come from a wide range of professional backgrounds and seniorities.

Freedom to Speak Up Champions and Ambassadors (nationalguardian.org.uk)

We want everyone that works within the NHS to feel valued and respected at work and to know that their views are welcomed. By meeting their needs, we also enable them to deliver the best possible care.

We have published a new and updated national Freedom to speak up policy for the NHS, which is applicable to primary care, secondary care and integrated care systems. It focuses on the importance of inclusive and consistent speaking up arrangements and driving learning through listening.

NHS England and the National Guardian’s Office have also published new and updated Freedom to speak up guidance and a Freedom to speak up reflection and planning tool.  Each will help the NHS deliver the People Promise for workers, by ensuring they have a voice that counts and by developing a speaking up culture.

NHS England » Freedom to speak up national policy, guidance and planning tool

The experience of Freedom to Speak Up Guardians reflects the continued pressures of the pandemic and its effects on the healthcare sector.

FTSUGuardian Survey Report.pdf (nationalguardian.org.uk)

This training is for everyone wherever they work in healthcare and explains in a clear and consistent way what speaking up is and its importance in creating an environment in which people are supported to deliver their best.  It will help you understand the vital role you can play and the support available to encourage a healthy speaking up culture for the benefit of patients and workers.

The training is divided into three parts.

• Speak Up: Core training is for all workers including volunteers, students and those in training, regardless of their contract terms and covers what speaking up is and why it matters. It will help learners understand how to speak up and what to expect when they do.
• Listen Up: This training for all line and middle managers and is focussed more on listening up and the barriers that can get in the way of speaking up.
• Follow Up: This training is aimed at all senior leaders including executive board members (and equivalents), Non-Executive Directors, and Governors to help them understand their role in setting the tone for a good speaking up culture and how speaking up can promote organisational learning and improvement.

This is the NHS England report on the whistleblowing disclosures made to us under the Employment Rights Act 1996, covering April 2022 to 31 March 2023.

The Employment Rights Act 1996 sets out the circumstances in which a disclosure made by a worker will be a ‘protected disclosure’, granting the disclosing worker with the legal protections set out in that legislation.

One category of person to whom a worker can make a ‘protected disclosure’ is a ‘Prescribed Person’. ‘Prescribed Persons’ are persons or organisations who are identified by The Public Interest Disclosure (Prescribed Persons) Order 2014 (as amended) as having ‘Prescribed Person’ status.

NHS England » Freedom to speak up – annual report on whistleblowing disclosures made to us by NHS workers for 2022/23

The Freedom to Speak Up (FTSU) Index can help build a picture of what the speaking up culture feels like for workers, drawn from four questions in the NHS Annual Staff Survey

The NHS Staff Survey has undergone significant changes – in line with the People Plan. As a result, some of the questions which comprised the FTSU Index have been dropped. In light of this, the National Guardian’s Office will no longer be publishing the FTSU Index.

FTSU Index - National Guardian's Office

This guide has been produced jointly by NHS Improvement and the National Guardian’s Office, with input from a group of executives and non-executive directors (which included chief executives and chairs), FTSU Guardians and leading academics in culture and leadership. 

The guide sets out our expectations, details individual responsibilities and includes supplementary resources.

Report template - NHSI website (england.nhs.uk)

In June 2022, NHS England and the National Guardian’s Office published an updated Freedom to Speak Up guide and improvement tool to support organisations with delivering a speaking-up culture for their workers. In addition, an updated national Freedom to Speak Up policy was published. These documents apply to primary care, secondary care and more widely in health and care systems.

NHS England » Integrated care boards, integrated care systems and Freedom to Speak Up

The National Guardian’s Office has carried out case reviews in NHS trusts across England where it had information to suggest that speaking up had not been handled in accordance with good practice.1 The reviews sought to identify learning, recognise good practice and celebrate innovation. 

Recommendations were made for remedial action where we found that good practice had not been followed. As a result, a body of recommendations has arisen from these reviews to improve speaking up in healthcare. 

In line with guidance for trusts boards in England on speaking up produced by the NGO and NHS England and Improvement (NHS E/I), trusts should undertake gap analysis of recommendations made in case reviews. 

Although these recommendations arose from reviews carried out in NHS trusts, the principles of speaking up that they refer to apply in any setting and the learning is applicable to organisations across healthcare.

Learning from Case Reviews.pdf (nationalguardian.org.uk)

This new guide links to the universal job description and the foundation training for guardians, which will soon be delivered regionally, following our train the trainer programme. The guide can be used at a personal level to identify and address learning needs but also at a regional and national level to identify strengths and areas for development so you can share and learn from each other. 

We recognise that Freedom to Speak Up Guardians come from a wide range of professional backgrounds and bring with them a host of skills and competencies. However, it is likely you will have some areas in which you can develop and, using the self-assessment tool in this guide, you will be able to identify your own learning needs and take steps to address these.

Education_Training_Guide.NationalGuardian.org.uk

The National Guardian's Office (NGO) leads, trains and supports an expanding network of Freedom to Speak Up Guardians. The NGO challenges and supports the health system in England on all matters related to speaking up.

Freedom To Speak Up data_report.pdf (nationalguardian.org.uk)

The National Guardian's Office (NGO) leads, trains and supports Freedom to Speak Up Guardians, who support workers to speak up and work within their organisation to help identify and reduce barriers to speaking up. 

The National Guardian’s Office supports and challenges the healthcare system in England on speaking up.

Supporting the Wellbeing of FTSU Guardians.pdf (nationalguardian.org.uk)

Sir Robert Francis wrote the The Freedom to Speak Up Report following the inquiry into Mid Staffordshire NHS Foundation Trust where he identified that workers who had spoken up had been ignored or victimised as a result. As a practising GP I am fully aware of the concerns that workers have about speaking up and this is why I am certain that the culture needs to improve. Workers are best placed to see what gets in the way of delivering great care to patients and service users and need to be able to speak up in order that the required changes are made. 

The current culture does not support all workers to raise concerns and this is seen in staff surveys across the NHS which show that upwards of 20% of staff report bullying and harassment. Workers may also lack the confidence to raise concerns or do not believe that the investigation process will be fair. 

The evidence shows that staff experience is linked to patient experience and that when staff are engaged patient mortality decreases. In order to foster a culture of openness and transparency organisations need to show that they are genuinely interested in feedback from workers and patients and that this feedback is acted upon to improve patient care and staff experience. As governors you are in a particularly strong position to help the culture change we need for these benefits to occur

Freedom to Speak Up Guardian.pdf (nhsproviders.org)