Speaking up

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 the Speak Up 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. Organisations are required to publish on their website, information about how their guardian(s) can be contacted.

Freedom to Speak Up guidance 

Access guidance from NHS England (NHSE) which helps staff and patients to understand the speaking up process, and supports freedom to speak up guardians and information governance professionals to manage any information raised in a safe and appropriate way.

Guidance for leaders and managers

Visit NHS Employers' Freedom to Speak Up webpage for guidance and resources to support NHS leaders and managers to create a culture where staff feel safe raising concerns. 

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 were requested to update their local policy to reflect this national template. The policy sets out:

• who 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.

External freedom to speak up policy for NHS workers

This policy provides information on how NHS workers can speak up to 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.

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 freedom to speak up guardians to fulfil their role in a way that meets workers’ needs.
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 published case stories from NHS organisations that have used the principles to cultivate their own plans to develop healthy speak up cultures.

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 set out 20 principles and actions 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.