Thousands of NHS workers bring cases to Freedom to Speak Up Guardians

NHS workers in trusts in England are speaking up to their Freedom to Speak Up Guardians, confidentially, knowing the right actions will be taken as a result.

Over 7,000 cases were brought to Freedom to Speak Up Guardians in NHS trusts and foundation trusts last year (1 April 2017 to 31 March 2018), it has been revealed in a new report published by the National Guardian’s Office.

A trusted alternative channel for speaking up where workers feel they can’t use other channels is being developed with 87% of over 2,000 workers who have already given feedback to Freedom to Speak Up Guardians saying they would speak up again.

Bullying and harassment featured prominently among the issues raised, with patient safety also high on the list. In total 45% of cases handled by Freedom to Speak Up Guardians included an element of bullying and harassment and nearly a third included an element of patient safety and quality of care.

Of those workers speaking up, nurses were the largest professional group, with nearly a third of the total cases coming from them. Worryingly there are still some organisations where this new route for speaking up is not being used – in six trusts either no data returns were made, or it was reported that no one had spoken up to a Freedom to Speak Up Guardian, in all four quarters.

The role of Freedom to Speak Up Guardians and the National Guardian were established following the events at Mid-Staffordshire NHS Foundation Trust and recommendations from Sir Robert Francis’ Freedom to Speak Up Report.

The National Guardian’s Office is an independent, non-statutory body leading culture change in the NHS so that speaking up becomes business as usual. It also provides challenge, learning and support to the healthcare system as a whole and reviews cases where good speaking up practice may not have been followed.

Dr Henrietta Hughes, National Guardian for the NHS, said, “Speaking up can take courage and it’s imperative that workers are thanked, listened to and their concerns are swiftly acted upon.

“The increase in the number of cases, quarter on quarter, that are being brought to guardians is encouraging as workers become more familiar with and confident in this new route for speaking up. It is very positive that so many of the workers who have given feedback have said that they would speak up again.

“It is worrying, however, that nearly a fifth of cases were from workers that felt the need to remain anonymous and that 5 per cent of workers have described detriment after speaking up. There is still much more to do to change the culture about speaking up from career limiting to business as usual.

“I would like to thank the workers who spoke up for their bravery and compassion which speaks volumes about the values of the NHS workforce. I would also like to thank all Freedom to Speak Up Guardians for their commitment to this challenging but important role. Speaking up improves the care of patients and service users, protects our loved ones and improves the working lives of staff in the NHS.”


Notes to editors:
1) In May 2018 the National Guardian’s Office asked Freedom to Speak Up Guardians
in all NHS trusts and foundation trusts to review data they submitted to the office on
speaking up cases covering all four quarters of 2017/18. This gave Freedom to
Speak Up Guardians the opportunity to reconcile this information to ensure the
accuracy of the data and information provided.
2) The National Guardian’s Office has analysed this data and published a full report on
the number of cases brought to guardians during 2017/18
3) Between 1 April 2017 and 31 March 2018:
o More cases (2,223, 31% of the total) were raised by nurses than other
professional groups.
o 7,087 cases were raised to Freedom to Speak Up Guardians in NHS trusts
and foundation trusts.
o The average number of cases per trust is largest amongst combined acute
and community trusts (an average of 43 cases per trust reported over the
o 3,206 (45%) cases included an element of bullying/harassment.
o 2,266 (32%) cases included an element of patient safety/quality.
o 1,254 (18%) cases were raised anonymously.
o 361 (5%) cases indicated that detriment as a result of speaking up may have
been involved.
o 6 NHS trusts either did not make a return or reported that they received no
cases through their Freedom to Speak Up Guardian in all four quarters.
4) The National Guardian’s Office supports the National Guardian for the NHS, Dr
Henrietta Hughes, in providing leadership, training and advice for Freedom to Speak
Up Guardians based in all NHS trusts.
5) Freedom to Speak Up feeds into the Care Quality Commission well-led inspection
framework, with guardians contributing directly to inspections.
6) A case review process was launched as a 12-month pilot in June 2017. Case reviews
can be implemented where the National Guardian’s Office recognises that the
handling of a speaking up case may not meet with good practice

September 24, 2018