Speaking up

The SPF encourages open environments in NHS workplaces, where staff feel confident to raise concerns.

4 August 2023

Embedding a healthy speaking up culture

Read top tips to creating a workplace speaking up culture that supports health and wellbeing on the NHS Employers website. Find out how leaders and line managers can develop a speaking up culture and read examples of good practice from NHS trusts.

External freedom to speak up policy for NHS workers

This policy provides information on how NHS workers can speak up to NHS England (NHSE) about anything they think is harming the NHS healthcare service their organisation delivers or commissions, to the extent that relates to NHSE's role.

Read the policy on NHSE’s website.

National speak up policy for the NHS

In April 2016, NHSE launched a national, integrated whistleblowing policy to help standardise the way NHS organisations support staff who raise concerns. The policy was updated in June 2022. All NHS trust and foundation trust boards have been asked to update their local policy to reflect the new national template by the end of January 2024.

The policy sets out:

  • who can staff can speak up to
  • the process for speaking up
  • advice and support for someone who speaks up
  • what the organisation will do and the process to be followed when an investigation is needed
  • what will be done with the findings of the investigation.

Read the policy on NHSE’s website.

NHS freedom to speak up guide

In June 2022, NHSE published the NHS freedom to speak up guide. The guide is designed to help senior NHS leaders to develop a culture that encourages workers to speak up and drives learning and improvement.

The guide includes eight principles:

  1. Value speaking up.
  2. Role-model speaking up and set a healthy freedom to speak up culture.
  3. Make sure workers know how to speak up and feel safe and encouraged to do so.
  4. When someone speaks up, thank them, listen up and follow up.
  5. Use speaking up as an opportunity to learn and improve.
  6. Support guardians to fulfil their role in a way that meets workers’ needs and National Guardians Office requirements.
  7. Identify and tackle barriers to speaking up.
  8. Know the strengths and weaknesses of the organisation’s speaking-up culture and take action to continually improve.

NHSE has also published case stories from NHS organisations that have used the principles to cultivate their own plans to develop healthy speak up cultures.

Read the freedom to speak up guide and case stories on NHSE's website.

Speaking up support scheme 2022/23

NHSE launched the redesigned ‘Speaking Up support scheme’, which helps to support individuals who have experienced challenges in moving forward with their professional or personal lives following a formal speak up process. This was formerly known as the Whistleblowers support scheme.

Speak Up

Speak Up offers free, independent, confidential advice on the speaking up process for employers and employees in the NHS and adult social care. You can find more information on their website.

Freedom to speak up guardians

Every NHS trust and foundation trust should have a freedom to speak up guardian. Their role is to work with the board and the executive team to support an organisation be an open and transparent place to work. They should act in an independent and impartial capacity, listening to staff and supporting them to raise concerns.

Find your freedom to speak up guardian on the National Guardian website

Freedom to speak up e-learning

The National Guardian and Health Education England have developed training for everyone in healthcare which sets out what speaking up is and its importance in creating an environment in which people are supported to deliver their best. To access the training see the e-learning for Healthcare website.

Freedom to speak up review

In February 2015, Sir Robert Francis QC published his report on the Freedom to speak up review. The review was set up in response to continuing disquiet about the way NHS organisations deal with concerns raised by NHS staff and the treatment of some of those who have spoken up.

The report sets out 20 principles and actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in future. These are designed to:

  • promote a culture in the NHS where staff feel safe and encouraged to speak up 
  • make sure all concerns are heard, investigated properly and the right support is on hand for staff
  • protect vulnerable groups, such as student nurses and medical trainees, from intimidation 
  • prevent discrimination against people who have been brave enough to speak up and help them get back into work.

Raising concerns at work: whistleblowing guidance

Raising concerns at work: whistleblowing guidance for workers and employers in health and social care, published in 2014, set a standard for whistleblowing/raising concerns policies in health and social care organisations. Key messages in the guidance include:

  • the importance of encouraging staff to raise concerns as part of normal day-to-day practice and how this can help employers identify poor practice and improve the quality and safety of care
  • an outline of the legislation – the Public Interest Disclosure Act 1998
  • a flowchart of the whistleblowing process
  • top tips for workers who wish to raise concerns and sources of advice and support
  • top tips for operational managers to respond positively when staff raise concerns
  • at a corporate level, the guidance sets national standards for whistleblowing policies for employers, together with a summary of their responsibilities
  • case studies of good practice, frequently asked questions, and further information and links.