What are Freedom to Speak Up Guardians?

The Freedom to Speak Up Guardian acts as an independent and impartial source of advice to staff at any stage of raising a concern, with access to anyone in the organisation, including the chief executive, or if necessary, outside the organisation. The Guardians appointed have varying professional and seniority backgrounds within the Healthcare Sector.

The National Guardian’s Office supports the National Guardian for the NHS, providing leadership, training and advice for Freedom to Speak Up Guardians based across all NHS trusts. Led by Dr Henrietta Hughes, her office provides challenge, learning and support to the healthcare system as a whole by reviewing trusts’ speaking up culture and the handling of concerns where they have not followed good practice.

The National Guardian’s Office is an independent, non-statutory body with the remit to lead culture change in the NHS. The office is not a regulator, but is sponsored by the CQC, NHS England and NHS Improvement.

How did they come about?

The Freedom to Speak Up review by Sir Robert Francis QC in November 2013 reviewed the experience of whistleblowing in the NHS. His conclusion was that there is a serious issue in the NHS with whistleblowing that

“requires urgent attention if staff are to play their full part in maintaining a safe and effective service for patients”.

Sir Robert made a number of recommendations (Freedom to Speak Up Review) to deliver a more consistent approach to whistleblowing across the NHS and the report identified the Freedom to Speak Up Guardian as an important role

5 Ways FTSU Guardians are supporting Speaking Up

  • Broadening visibility and the diversity of the guardian network with over 800 Guardians, Champions and Ambassadors in roles across England with varying professional and seniority backgrounds. Leading culture change in the NHS so that speaking up becomes business as usual.
  • Speaking Up in the NHS in England Data Report 2017 recorded a total of 7,087 cases raised with Freedom to Speak Up Guardians, an average of 30 cases per trust (based on 234 trusts). Showing an increase of 51% from April 2017 to March 2018. View and download our infographic based on the data from this report.
  • Initiatives like Speak Up To Me Month (October) and 100 Voices campaigns to raise awareness of the role and the importance of speaking up. Communicating through learning and development to all staff who their Guardian’s are and how to speak to them. Gaining greater insights from workers into what their experiences of speaking up are so that learning and training can be improved.
  • To help primary care organisations implement speaking up arrangements, Regional Liaison Leads (RLLs) have been appointed to bring together local Freedom to Speak Up Integration Plans. The RLLs work across primary and secondary care boundaries to develop a cohesive and unified approach to speaking up within the different regions in England.
  • The National Guardians Office Case reviews identify where the handling of NHS workers’ concerns may fall short of the standards of accepted good practice in supporting speaking up. They make recommendations to trusts to help them take appropriate action where they have not followed good practice, while the reviews also commend areas of good practice.

Room for improvement

The National Guardians Office are carrying out continued evaluation and feedback with Phase Two of the case review process. This aims to identify where the handling of NHS workers’ concerns may fall short of the standards of accepted good practice in supporting speaking up. The NGO have also “taken into account the Government’s response to the report of the Gosport Independent Panel. Notably the desire for the office to ‘take a more active approach in looking at how organisations handle concerns raised by staff who speak up’”.

“Our case review process has led to some significant changes over the last couple of years for the trusts where reviews were carried out. More importantly, other trusts were also able to look at the recommendations and apply the learning to their own arrangements. In this way we have helped to diffuse the innovation across the NHS,” Dr Henrietta Hughes

While there have been improvements in the number of staff completing the 2018 NHS staff survey and reporting good communications between senior managers, it is worrying that there has been an increase in the number of staff experiencing bullying, harassment, discrimination or abuse from other members of staff, and the number of staff coming forward and reporting this has fallen. Find out how your Trust compared in the 2018 staff survey results.

Ways WorkInConfidence support Freedom to Speak Up

WorkInConfidence anonymous communications platform makes it easier for staff who otherwise may be reticent to raise concerns, problems or ideas. The system also enables Trusts to measure and report on their progress in this and other related areas. WorkInConfidence helps to support the work of the FTSU Guardians as another channel for staff to raise concerns within a number of NHS Trusts and other healthcare providers across the UK. To find out more, please look at our case studies.

image showing % of staff experiencing  harassment, bullying or abuse in the NHS in last 12 months 2017-2018

Referenced Documentation:

Speaking up in the NHS in England Data Report 2017-2018

September Freedom to Speak Up NewsNational Guardians Office Website

NHS Staff Survey Results 2018

Protect: Anonymous Speak Up: A safe and secure way for your people to anonymously raise concerns via phone, tablet, or PC, ensuring you are aware of any workplace issues and can respond quickly and accordingly

Consolidated Case Management: A secure online place to record, track, update, and report on all speaking up matters, whether raised through WorkInConfidence or directly.

Surveys: Easily set up, run and interpret surveys on engagement, respect, wellness or other topics to ensure you always understand your people, their needs and motivations.

Discussion Boards: Demonstrate your commitment to collaboration with discussion boards to accelerate employee engagement and gain greater insights – anonymous if required.