Freedom to Speak Up Guardians act as an independent and impartial source of advice to staff at any stage of raising a concern.   They should have  access to anyone in the organisation they need to speak with, including the Chief Executive, Chair, Head of Governance and Head of HR or Workforce.  If necessary, they should be able to speak with appropriate bodies outside of the organisation.

The National Guardian’s Office (NGO) supports the Freedom to Speak Up Guardians in the NHS, providing leadership, training and advice for Freedom to Speak Up Guardians based across all NHS trusts.  The NGO 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 NGO 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 Freedom to Speak Up Guardians 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 was 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 Francis QC

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. 

Reporting on Freedom to Speak Up in the NHS

Speaking Up in the NHS England Data Report 2020/21 In 2021/21 there were 20,338 cases raised with Freedom to Speak Up Guardians.  This was an increase from 16,199 cases reported 2019/20. 

  • 18% of cases involved an element of patient safety/quality – down five percentage points from 2019/20
  • The proportion of cases (30.1%) involving elements of bullying and harassment was lower than 2019/20
  • Almost 12% of cases continued to be reported as being raised anonymously
  • Detriment for speaking up was indicated in 3.1% of cases, down from 5.1% in 2017/18
  • Over four fifths (84.3%) of those who gave feedback said they would speak up again.

Freedom to Speak Up Month – October 2021

Speak Up Month in October is the highlight of National Guardians calendar – a chance to shine a spotlight and raise awareness of Freedom to Speak Up Guardians and the work which is happening across NHS organisations to make speaking up business as usual. 


The 2021 theme is Speak Up, Listen Up and Follow. Up

Watch out for #SpeakUpListenUpFollowUP which will be used to share and collaborate all the great work being done across the NHS.

This year the National Guardian’s Office is encouraging everyone to play their part to Speak Up, Listen Up and Follow Up.

“We are planning a national campaign to illustrate the part which we all play in fostering a culture where people can speak up and be confident, they will be listened to and that action will followfor learning and improvement.

We will be supporting the National Guardian’s Speak Up Month campaign #SpeakUpListenUpFollowUp through highlighting solutions to challenges, sharing values and guidance, eBooks and useful content to help you achieve a speaking up culture within your organisation.


Supporting Healthy, Speaking Up Cultures

Working extensively within the NHS, WorkInConfidence help deliver healthier organisations where everyone feels respected, engaged, understood and able to participate.

Our easy to use, highly trusted, anonymous employee feedback platform provides a consistent, secure channel for employees to confidently raise concerns or ideas around any workplace issue.  Giving employers the insight they need to implement a fast resolution. 

Salisbury Plain is a PCN that places a great value on the emotional wellbeing of its team. Its Freedom to Speak Up Guardians were welcomed when it introduced the programme, but manual processes weighed them down until WorkInConfidence stepped in to assist. Implementing channels that included everyone, led them along a path of increased engagement, learning and understanding which has helped it improve. 

Read the case study to find out how this PCN used technology to open communication channels to increase participation and feedback.

Employee Engagement, Wellbeing and Staff Retention

Respect:  60% of people experience or witness workplace bullying – less than half raise it. This costs the UK £18b a year; 52% of women suffer workplace harassment – less than a quarter raise it. Improve understanding of ED&I and wellness at work. 

Engagement:  Highly engaged organisations with strong employee voice are on average 21% more productive, have 41% less absenteeism and enjoy 59% less staff turnover.

Operations:  Deep understanding of your people not only motivates them but means you work better, see problems earlier and never miss opportunities for development.  

Continuous improvement:  90% of millennials want senior leadership to listen to their input.  How much more productive are you when everyone feels they can contribute?

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.