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Dr Henrietta Hughes marked her first year as the National Guardian for the NHS with the publication of her first case review report and her annual report highlighting the work of Freedom to Speak Up Guardians.

Dr Hughes published a set of recommendations following concerns raised by staff about the speaking up culture at Southport and Ormskirk NHS Trust. The trust was the first to undergo a case review into its speaking up processes, policies and culture. Case reviews assess the handling of NHS workers concerns where they did not meet the standards of accepted good practice in supporting speaking up.

With a guardian now in place in every trust in the country and over 530 individuals playing an active part in delivering the Freedom to Speak Up agenda, the National Guardian 2016/17 annual report reflects significant progress over the last 12 months. Amongst other highlights, the report outlines the fact thousands of cases have been brought to guardians, including over 1,000 relating to patient safety, and regional updates from the network of Freedom to Speak Up Guardians.

The National Guardian’s Office provides leadership, training and advice for Freedom to Speak Up Guardians based in all NHS trusts and 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. Dr Hughes’ role was a key recommendation from Sir Robert Francis’ Freedom to Speak Up Review in response to the Mid-Staffordshire scandal.

These webpages provide information on how to submit case reviews to the National Guardian’s Office, upcoming dates for the Freedom to Speak Up foundation training, and a comprehensive list of publications from the office including guidance for the Freedom to Speak Up Guardian role.

Her annual report was welcomed by the chief executives of her sponsoring organisations

“It’s great to see that the National Guardian’s Office has accomplished so much in its first year, making real progress in supporting staff in hospital trusts to raise concerns at work – to improve the service for patients. There is clearly more to do and we will continue to work closely with the National Guardian to ensure we support Freedom to Speak Up across the NHS.”
Jim Mackey, NHS Improvement

“Sir Robert Francis’ seminal inquiry report into Mid Staffordshire NHS Foundation Trust exposed unacceptable patient care and a culture which meant staff did not raise concerns. His report ‘Freedom to Speak Up’ focused on creating a more open and honest culture in the NHS where staff could raise concerns.

“The creation of Freedom to Speak Up Guardians supported by the National Guardian for the NHS were a fundamental contribution to supporting a more open culture within the NHS. I am delighted to see in the first annual report from Dr Henrietta Hughes, the National Guardian and her team, the progress that has been made at a national and local level to establish the roles of the guardians.  Changing the culture of a system is not easy. This report shows that the Freedom to Speak Up Guardian involvement has begun the work.”
Sir David Behan, Care Quality Commission

“Recognising the importance of Freedom to Speak up Guardians, NHS England is now increasing from one to 15 the number of guardians within our own organisation, and we want at least a third of them to be from black and minority ethnic backgrounds. We are also funding and supporting broader action across the NHS on safe spaces for staff to raise concerns and on better support for staff health and wellbeing."
Simon Stevens, NHS England

Last updated:
11 January 2018