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PDF icon National Guardian for the NHS: Newsletter – February 2017

Available for booking

Freedom to Speak Up Information Session

The National Guardian’s Office is delivering Freedom to Speak Up Information Sessions. These sessions serve as Foundation Training for new Freedom to Speak Up Guardians.

These sessions are open to workers in NHS trusts and foundation trusts, independent healthcare providers, regulators, and other professional or oversight bodies.They are not open to those in supporting speaking up roles, such as champions and ambassadors who should liaise with their guardians about obtaining appropriate training and guidance.

These interactive workshops are designed to give a broad overview of the principles of Freedom to Speak Up and help participants:

  • Learn more about the background and expectations of the Freedom to Speak Up Guardian role and its importance in working towards a culture where speaking up is business as usual
  • Develop a better understanding of speaking up and how best to support and respond to the people who do so
  • Identify barriers to speaking up in your organisation and start to think about how to address these
  • Reflect on your feelings about the role and next steps to take whether you are a guardian or supporting speaking up in your organisation
  • Make connections with others in a similar role

Other Foundation Training sessions for new guardians in trusts may also be available locally – please check with your regional network lead.


Session times: Registration: 09.30, Start: 10.00, Finish: 16.00

  • Friday 6 December 2019
  • Friday 10 January 2020
  • Friday 7 February 2020

16 August 2019

October is Speak Up Month

Last year we launched our inaugural Speak Up Month to raise awareness of speaking up, increase commitment where possible and introduce it where no practical steps have yet been taken.

Organisations across England took part, holding over 100 events, publishing articles and blogs, filming videos and creating animations and reaching out to NHS workers to let them know Freedom to Speak Up Guardians are in post to listen to any issues they may have.

This year there are even more organisations with Freedom to Speak Up Guardians in post across a broader range of healthcare providers. This not only increases the potential for the scope of activity, but also creates greater opportunity for integration and collaboration.

Dr Henrietta Hughes, the National Guardian for the NHS, travelled over 2,000 miles to attend events last year, and has committed to visiting every region this year, so do email if you have an event planned that you would like NGO presence at.

If you can work with someone new to speaking up, perhaps from a primary care or other setting that has recently implemented Freedom to Speak Up arrangements, then please do. And of course, keep the NGO informed of what you are up to.

One great way of keeping the NGO and everyone else with an interest in speaking up informed of what you are up to this October is to tweet news and photos using the special hashtag for the month #speakuptome. Last year #speakuptome was used more than 5,000 times during the month.

The NGO has a range of communications materials available to organisations looking to hold an event or launch an initiative during Speak Up Month, so do email us at the address above for details.

23 July 2019
Statement from Dr Henrietta Hughes in reaction to the publication of the report from the All Party Parliamentary Group (APPG) on Whistleblowing:
“Speaking up is about listening and learning. Patient’s lives have been saved and untold harm has been prevented because Freedom to Speak Up Guardians have supported workers. Over 19,000 cases have been raised in the last two years and trusts have taken positive actions as a result.
“As a doctor I know how hard it can be to speak up in the NHS. I am very thankful to the courageous staff who have already spoken up and proud of the work of Freedom to Speak Up Guardians in supporting them. I can already see the difference this is making in the NHS, but I call on leaders to join me in taking further actions to make speaking up business as usual.”
1 March 2019
HSJ Award spotlight: Freedom to Speak Up at Staffordshire and Stoke on Trent Partnership NHS Trust

Freedom to Speak Up began life at Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP) when the Ambassador for Culture Change position was developed by nurse Helené Donnelly due to her experiences of speaking up at Mid-Staffordshire Hospital.

The Ambassador for Cultural Change role was established specifically to promote a positive speaking up culture to prevent harm and improve outcomes for workers and patients. It was deemed vital, not only to encourage workers to raise issues, but to foster an environment where staff are truly supported to speak up.

The role involved working closely with workers at every level of the organisation, including the Chief Executive, Chair, directors, trade unions, human resources, organisational development, communication teams and training departments.

Initial focus was placed upon promoting this new route, enabling workers to speak up via the Ambassador for Cultural Change in addition to supporting other conventional routes and methods to raise issues.

Board members upheld Freedom to Speak Up as a value within the organisation and promote this message as fundamental to a safety culture.

Managers are also aware that they have a responsibility to support a culture within their teams so that speaking up becomes business as usual.

The success of the Ambassador for Cultural Change role at SSOTP prompted much interest from other trusts and organisations and led to Helené giving evidence to the House of Commons Health Select Committee and Sir Robert Francis QC’s Freedom to Speak Up Review.

Helené used her experience to contribute to the Department of Health and Social Care roundtable events to tackle bullying and harassment in the health service and advised NHS Improvement on their Freedom to Speak Up: raising concerns policy for the NHS document.

Other changes to working practices or structures as a result of the trust’s initiatives includes the creation of a network of Culture Change Champions and the strengthening of a procedure for safety alarm system for workers.

Helené Donnelly said, “We know that staff are working in ever increasingly pressured situations. However, if workers don't feel able to speak up when something isn't right, potentially catastrophic things can happen which can have a devastating effect on workers – morale and their own emotional and physical well-being will suffer.”

She said, “The introduction of this initiative, including the creation of a network of Culture Change Champions offering advice and peer support throughout the trust, has shown workers the support is out there for them to speak up.”

The trust also created a bespoke training programme for all staff on speaking up, which was designed specifically for managers on how to respond when workers speak up to them.

15 February 2019 
HSJ Award spotlight: implementing a Just and Learning Culture
Mersey Care NHS Foundation Trust wanted to develop a supportive culture where workers feel safe to speak up, report errors and learn from incidents.
Workers felt that there were barriers in the HR and patient safety processes. Trade union colleagues were concerned about the detrimental impact of these processes and that staff didn’t speak up because of perceived consequences. 
Equally, NHS Staff Survey results confirmed concerns that fairness of procedures were below average. The trust also needed to tackle the high number of employee relations cases which was perpetuating this fear.
To overcome these challenges, the trust delivered engagement sessions with staff and unions to help them understand the barriers workers faced and sought alternatives together.
At the same time, the trust’s Chief Executive, Workforce Director and Medical Director researched the evidence around ‘Just Culture’.
The trust found that whilst workers strongly supported the ideas behind a ‘Just Culture’, they wanted to make it their own, feeling that they should add a learning aspect to ‘Just Culture’. 
Amanda Oates, Executive Director of Workforce at Mersey Care NHS Foundation Trust, said, “Our work to embrace a new culture centres on the desire to create an environment where staff feel supported and empowered to speak up, rather than feeling blamed. It’s a culture that instinctively asks in the case of an adverse event ‘what happened’ rather than ‘who was to blame.’”
She said, “Engaged staff delivering best quality care is at the heart of what Mersey Care does, helping us strive towards our vision for Perfect Care. The success of the disciplinary investigations pilot was expanded to all trust divisions in 2017. Overall investigations and employee relation cases were reduced by 59 per cent trust-wide, whilst their workforce doubled.
In April 2017, Chief Executive Joe Rafferty, alongside Medical Director Dr David Fearnley and Amanda Oates agreed three priorities in consultation with staff. These were published in the Trust Quality Accounts and demonstrated that commitment from the highest levels of the organisation. 
The benefits included establishing an accessible staff microsite where good practice stories are shared and also recruiting nearly 50 ‘ambassadors’ - frontline staff from various locations - to lead bespoke practice. A roadmap booklet of the trust’s journey has been shared widely internally and externally.
A critical part of the tendering process and winning the contract for Liverpool community services was around staff and patient safety issues, highlighted in the Kirkup Report. The Just and Learning approach was key to the award of this contract by NHS Improvement, and was vital to the transformation of those services.
Other examples shaped through employee engagement included the development of a policy framework that supported workers when things do not go as expected and significant improvements to the 72-hour review process. As a result, colleagues now receive consistent and timely feedback with enhanced shared learning.
Paul Summers, Unison North West Regional Organiser, said, “The Just and Learning Culture introduced by Mersey Care in partnership with local staff side unions has seen amazing outcomes with a huge reduction in the number of disciplinary cases, improved staff morale, health and well-being and importantly improve patient care. 
“This is the best example of partnership working that I have been involved with and Unison commends Mersey Care NHS Foundation Trust and hopes other employers will adopt such practices.”
Amanda added, “Mersey Care employs more than 8000 staff, supporting some of the most complex and vulnerable people in society. Changing the organisation’s culture will take time but people are already feeling empowered. We frame our conversations differently and support each other more. We are in a much better place for making those steps towards a Just Culture.”
14 February 2019 
HSJ Award spotlight: Protect Yourself, Protect Your Patients training package
Protecting and supporting workers in the NHS empowers them to speak up about patient safety. An effective speaking up culture will enable all workers to feel included in the wider workforce and safeguard the needs of patients and staff alike.
Local Care Force’s (LCF) nursing team identified that agency nurses were often moved or prevented from working in a service after issues were raised, rather than being given the opportunity to learn from it. They were not experiencing the same level of support as permanent nurses.
The LCF nursing team’s aim was to protect agency nurses and, in turn, empower them to protect their patients and provide them with the highest standard of care. To achieve this, the team developed the ‘Protect Yourself, Protect Your Patients’ training package to support their induction. This includes training in mental health, professional issues and clinical skills. It also includes clinical supervision and peer support, revalidation workshops, appraisals and bespoke support for individual nurses.  
LCF produced an ‘Agency Nurse Survival Guide’, client feedback forms, a ‘Getting to know your Clinical Lead and Clinical Trainer’ handout, a revalidation support handbook and a comprehensive guide to the ‘Agency Nurses Protect Yourself’ project as part of their induction pack.
In addition, new nurses are provided with an overview of expectations, managing challenging situations, and safeguarding. LCF also developed a training package for non-clinical office staff to enable them to have an increased awareness of the day-to-day challenges faced by agency nurses.  
Amelia Greenwood-Blott, Senior Regional Clinical Lead for the Yorkshire and Lancashire Nursing Division, said, “First and foremost, the challenge we faced was to overcome the prejudices often held towards agency nurses and nursing agencies.
“Agency nurses voiced to us that they often feel disenfranchised from their contemporaries in permanent roles. By helping them build their confidence through the support provided by a clinical lead nurse, they no longer felt distanced from their peers. This created an inclusive culture where they felt valued, supported and part of the larger workforce.” 
LCF surveyed 79 agency nurses at the Royal College of Nursing Job Fair in 2015 to inform the development of the project. Thirty-eight per cent said they did not feel fully supported by their agency and 60 per cent felt isolated while working for an agency. Thirty-seven per cent did not always feel safe and 40 per cent did not feel that they got a complete explanation of their agency placement.
Six months after the launch of the project, 87 nurses working for LCF were surveyed. Ninety-nine per cent felt supported, 79 per cent felt part of a team and 89 per cent felt safe when working. 
The project has now been recognised nationally, shortlisted as a finalist in a number of awards, including the Nursing Times’ Workforce and Improving Patient Safety Awards and the Burdett Trust Awards. It was also inducted into the Royal College of Nursing library of best practice 2018. 
21 January 2019
HSJ Award spotlight: The Royal College of Surgeons of Edinburgh’s anti-bullying campaign 
Creating an environment where workers feel able to speak up is key to eradicating bullying and harassment in the NHS.  
The Royal College of Surgeons of Edinburgh (RCSEd), within its remit of assuring safe surgical care for patients, resolved to identify and address the issue of bullying within the surgical and wider NHS workforce by launching the campaign, #LetsRemoveIt.
To develop the campaign, the RCSEd drew on the breadth of its membership to establish a working group tasked with reducing bullying in the surgical workplace. This group provided the college with valuable insight into the extent of the problem and shaped the campaign’s strategy, design and content. 
The working group convened in October 2016 and comprised trainees, specialty doctors, consultant members, fellows, communications teams and other professional staff group from the college’s membership.
Members of the group met with representatives from the GMC, CQC, NHS Employers and NHS England. They also sought advice from medical directors, directors of medical education, post-graduate deans, surgical training programme directors, foundation, core and higher training directors, medical students and representatives from human resources. 
Open-access online resources, including a free CPD-approved e-module, form the campaign hub. The campaign’s slides and e-learning module are now incorporated within all foundation doctors’ induction programmes. 
In addition, working group members have designed a one-day workshop that can be delivered to NHS trusts across the UK. 
Alice Hartley said, “We’re committing to driving through the culture change required to eradicate these behaviours from the NHS. To achieve this goal, we wanted to ensure the longevity and sustainability of this campaign.” 
She said, “Following the launch in June 2017, the response to the campaign has been swift and predominantly positive from government, professional and patient representative bodies and the RCSEd has made the working group a permanent Royal College committee. Our ambition is to promote this initiative beyond the surgical workforce to all medical and dental practitioners.”
Members of the group have contributed to articles for the Nuffield Trust, the Healthcare Leadership Academy, the Telegraph and the Guardian. The campaign has also been featured in articles in BMJ Careers, the Health Service Journal, the British Dental Journal, Clinical Services Journal and Hospital Doctor News.
17 January 2019
HSJ Award spotlight: Supporting staff wellbeing at Worcestershire Health and Care NHS Trust 
Creating a supportive environment where staff feel able to speak up about their health and learn about the needs of others helps them feel invested in and greatly improves overall staff performance and engagement.  
Whilst most NHS trusts provide occupational health and access to counselling and physiotherapy, Worcestershire Health and Care NHS Trust recognised that workers did not always understand the relationship between these activities and occupational performance. 
To help resolve this, Professional Lead for Allied Health Professions, Jo Gaffney, and Trust Wellbeing Lead, Kate Leese, facilitated an occupational therapy work placement. This provided students with an opportunity to understand health and wellbeing in the workplace and the impact this has on staff performance.
With no extra resources, the student placement was a cost-neutral approach. Each student took responsibility and leadership for a chosen campaign aimed at a workforce health issue, which in turn, enabled them to learn new skills and understand the various needs of staff. 
The students set up staff wellbeing noticeboards across multiple sites, which highlighted bite-size information, physical activities that staff could participate in during work hours, stress reduction and signposting.
They also used social media to encourage participation in promoted activities as well as enhancing the awareness of healthy quick fixes to support staff during the day.
Kate Lesse said, “The overall aim was to create a happier and healthier workforce providing quality care and role-modelling to patients accessing our services.” 
She said, “I would encourage Freedom to Speak Up Guardians to foster a holistic approach to speaking up by understanding the benefits of wellbeing activities designed to support staff and improve health, morale and engagement.”
Qualitative feedback gathered from staff was used to evaluate the benefits of their work and suggested that staff felt valued and grateful for these initiatives and were more likely to change their behaviours as a result.

21 December 2018

HSJ Award spotlight: Bringing people together at Barts Health NHS Trust
Barts Health NHS Trust were one of the organisations shortlisted for our sponsored HSJ Award this year, Creating a Supportive Staff Culture.
The Bringing People Together project was designed to empower staff by giving them the freedom to speak up. 
In the trust’s Eye Treatment Centre, there were ongoing concerns about patient safety and bullying dating back to 2014. Given that, Sudeshna Patra, Clinical Network Director and Shona Brown, Director of People and Organisational Development, faced several challenges including low staff morale, rifts between different staff groups and nursing staff leaving, which affected the ability to run a safe service. 
To turn this around, they needed to improve staff well-being and create an inclusive, flexible approach to organisational development (OD) with the help of the trust’s Freedom to Speak Up Guardian, Ashley Brooks. They re-opened channels of communications with a staff promise and an OD blueprint, “Bringing People Together”. 
One worker who felt able to speak up as a result of this work said, “The guardian empowered us to have the courage to liaise with the HR department. They listened to our concerns, and supported us to speak up about bullying and harassment” 
“They also provided us with the reassurance that we can call on them anytime if we struggled to be heard. It was a comfort for us knowing they were there to listen and guide us,” they said. 
The Bringing People Together project started with looking at how the team could improve the treatment of staff and how they treat others, a concept explored through Listening into Action. An early word cloud was the foundation of their staff promise, highlighting the things that matter: a smile, a friendly hello and mutual respect.
Also identified was a perceived lack of engagement from the trust leadership and staff not feeling valued. Their solution: a Twitter feed, newsletter and a Book of Inspiration to improve staff engagement and enable workers to connect with their teams and the trust’s leadership. 
“The project helped us to work together to turn a difficult and challenging situation into a positive experience and has had a huge impact on the health and well-being of staff,” Sudeshna said.
One area where this work may have impacted was on staff vacancies. These decreased from 42% in 2016 to 0% in 2018.
Mary Walsh, Freedom to Speak Up Guardian at Barts Health NHS Trust said, “By creating a supportive environment for workers to speak up, we can ensure that improvements to the trust’s internal culture are made. 
“This helps keep patient care at the heart of what they do and provides them with a sense of purpose and fulfilment when looking after their patients and colleagues.”

7 December 2018

HSJ Award spotlight: Engaging to make a difference at East Lancashire Hospitals NHS Trust

We are publishing a series of profiles highlighting the work of the organisations shortlisted for our sponsored HSJ Award this year, Creating a Supportive Staff Culture.

East Lancashire Hospitals NHS Trust won our sponsored HSJ Award for their project, Engage to Make a Difference, which promoted staff engagement and participation. This programme of work provided speaking-up mechanisms such as staff surveys, a rumour-buster email address and share to care meetings.

In 2013, the trust was placed into special measures. The impact this had on workers was significant. However, by improving its speaking up culture with the help of its Freedom to Speak Up Guardian, the trust was able to turn this around and improve the lives of patients and staff.

Listening and providing feedback is a key component to creating an effective speaking up culture. The trust recognised this and held listening events, such as Big Conversations, and identified 10 key enablers to encourage staff participation and monitored an annual employee engagement action plan.

This resulted in improved effective team working and greater staff engagement. 81% of staff recommended the organisation as a place to be cared for and 74% recommended it as an ideal place to work. The trust also achieved a ‘good’ CQC rating.

Receiving the award from Dr Henrietta Hughes, Freedom to Speak Up Guardian Jane Butcher, tweeted “I’m so proud of all us at East Lancashire Hospitals NHS Trust. This is for all 8,000 plus of us.”

7 December 2018

HSJ Award spotlight: Using an online staff platform to change values and culture

We are publishing a series of profiles highlighting the work of the organisations shortlisted for our sponsored HSJ Award this year, Creating a Supportive Staff Culture.

Providing a positive experience for staff is part of Norfolk Community Health and Care NHS Trust’s (NCH&C) annual priorities and strategic objectives. However, as the organisation has a wide geographical spread, they recognised that staff did not always feel involved or engaged.

NCH&C’s staff engagement score for the NHS Staff Survey 2016 was below average for community trusts and their CEO-led engagement sessions had poor attendance rates, with fewer than ten percent of staff attending.

The trust therefore needed a tool where staff could contribute to a shared conversation. Following detailed research, they invested in a crowdsourcing platform, hosted by Clever Together, launched as ‘Your Voice, Our Future’.

Your Voice, Our Future enabled senior management to speak to staff at every level and gather views on important questions and issues, which helped to shape the future direction of the trust. The Board was committed to using the platform to engage workers and then, through executive-led programmes of work, respond to issues raised on the platform.

The trust believe that this aided the implementation of Freedom to Speak Up and engendered‎ change in workers’ confidence in speaking up. This was reflected in an uplift in speaking up cases, with workers developing the confidence to report 82 cases in the first three quarters of 2017/18 to their Freedom to Speak Up Guardian.

Fostering an effective speaking up culture was also reflected in NCHC’s 2017 NHS Staff Survey results and their 55 per cent response rate was their best in several years, increasing from 37 per cent in 2015.

NCHC Staff Engagement Manager, Laura Palmer, who is also one of the trust’s many Freedom to Speak Up Champions, said, “Listening and responding to the needs of workers plays a vital role in creating an effective speaking up culture.

“Developing an open environment where staff can speak up gives them a voice in shaping the services and raising the standards of care they provide patients. It also allows them to adapt to the changing needs of the local population.” 

29 November 2018

HSJ Award spotlight: Delivering cultural change across North East Ambulance Service NHS Foundation Trust

We are publishing a series of profiles highlighting the work of the organisations shortlisted for our sponsored HSJ Award this year, Creating a Supportive Staff Culture.
In 2015 North East Ambulance Service NHS Foundation Trust (NEAS) recognised that their organisational culture needed to change.
This followed poor regulatory reports and a change in leadership, which provided a fresh perspective on the trust. The trust carried out a culture survey in 2015, which indicated that most workers felt able to speak up, but 45 per cent of respondents were unclear about appropriate guidance. Obstacles to speaking up also included a fear of peer criticism and an inability to influence change.
Trust Secretary, Jennifer Boyle, was appointed Freedom to Speak Up Guardian in 2016 and formed a new network of local Freedom to Speak Up Champions, among a number of other changes aimed at improving behaviours and engagement across the trust. 
“This helped the leadership team to transform NEAS into a great place to work with a supportive, open and effective speaking up culture,” said Jennifer
“Among the improvements were the introduction of new clinical care managers to support frontline ambulance crews, and a re-design of the serious incident review process to create a supportive environment where workers felt confident that the right actions were taken when they spoke up within a no-blame culture.”
As a result, the trust has seen some significant improvements against key indicators. In the NHS staff survey they achieved the best results across the whole ambulance sector for questions relating to errors and incidents. They have also seen an increase in the number of reported incidents.
“This indicates that workers are now more comfortable to speak up and report incidents, which has improved the quality and safety of care provided,” said Jennifer. “The percentage of patient harm incidents as a proportion of total incidents has also decreased.
“I’m delighted that the trust’s journey to improve its speaking up culture has been recognised by the prestigious HSJ Awards. There has been a real commitment from leaders across all teams to embed speaking up so their workers are supported, invested in and feel empowered to make a difference and that patients remain safe and receive the best possible care.” 

Friday, 23 November 2018

National Guardian launches second annual report at CQC board meeting

On Wednesday 21 November Dr Henrietta Hughes presented her latest annual report to the CQC board, marking her second year in post as the National Guardian for the NHS.
The new report highlights the progress that the office has made during Dr Hughes’ second year and outlines her future priorities. These include:

  • Recommendations from the 2018 Freedom to Speak Up Guardian Survey to improve how the guardian role is being implemented, including an honest assessment of the time required by guardians to meet the needs of workers.
  • Producing a universal guardian job description for organisations in the healthcare system, including independent providers of NHS services and arm’s-length bodies, and developing an Education and Training Guide for guardians.
  • Partnership working with other bodies, including developing guidance for trust boards with NHS Improvement, producing e-learning with Health Education England and revising guidance on the use of settlement agreements.
  • Supporting the growth of the guardian role in primary care, with additional funding from NHS England.
  • Developing a post-pilot case review process that continues to support learning across healthcare.

The report also features a foreword from Secretary of State for Health and Social Care, the Rt Hon Matt Hancock MP, and several case studies highlighting the difference Freedom to Speak Up Guardians are making to the lives of NHS workers and patient safety, including:

  • A guardian escalating a case to Barking and Dagenham Council resulting in an investigation into a modern slavery and trafficking ring.
  • An NHS trust responding to concerns raised by healthcare workers in prison services to improve the prison’s connection with the trust.
  • Issues raised regarding the working environment of a surgical laboratory, which impacted on the safety of patients and workers.
  • A worker speaking up about poor practice when cleaning spilt body fluids, resulting in a formal alert being raised across the organisation to ensure that all staff knew their responsibilities.

Friday, 23 November 2018

East Lancashire Hospitals NHS Trust win our sponsored award at HSJ ceremony

We are delighted to announce that Jane Butcher, Freedom to Speak Up Guardian for East Lancashire Hospitals NHS Trust, accepted our Creating a Supportive Staff Culture award on behalf of her organisation at last night’s HSJ Awards ceremony in London.

Huge congratulations to Jane and her trust, and to Norfolk Community Health and Care NHS Trust, who received a commendation on the night for using an online staff platform to change values and culture.

Well done to everyone who entered this year’s award – it was great to see so many friendly faces at the ceremony last night. All of our shortlisted candidates should be very proud of their achievement and we will be sharing details of the entries over the coming weeks to share the good practice.

Thursday, 15 November 2018

HSJ Awards: good luck to the shortlisted candidates

On 21 November 2018, HSJ will be hosting their awards ceremony at the InterContinental Hotel in London to celebrate, recognise and reward the outstanding contribution of staff and organisations in the healthcare system.

This year we’re sponsoring our first-ever award category for the HSJ Awards, ‘Creating a Supportive Staff Culture’. We sponsored this award because it provides an excellent opportunity to celebrate the contribution guardians and other workers make to create a culture where workers are supported and speaking up becomes business as usual.

The following organisations and projects have been shortlisted for our HSJ Award this year:

  • East Lancashire Hospitals NHS Trust, Engage to Make a Difference
  • Local Care Force Nursing Team, Agency Nurses Protect Yourselves, Protect Your Patients
  • Mersey Care NHS Foundation Trust, Implementing a Just and Learning Culture
  • Norfolk Community Health and Care NHS Trust, Using an Online Staff Platform to Change Values and Culture
  • North East Ambulance Service NHS Foundation Trust, Delivering Cultural Change Across North East Ambulance Service NHS Foundation Trust
  • South West Academic Health Science Network, Improving Safety Culture: a Whole System Approach in South West England
  • Midlands Partnership NHS Foundation Trust, Freedom to Speak Up
  • The Eye Treatment Centre, Barts Health NHS Trust, The Eye Treatment Centre and Organisational Development: Bringing People Together
  • The Royal College of Surgeons of Edinburgh, #Letsremoveit Anti Bullying & Undermining Campaign
  • Worcestershire Health and Care NHS Trust, Occupational Therapy Student Placement to Support and Enhance Staff Wellbeing

Thursday, 25 October 2018

Freedom to Speak Up Guardian Survey 2018

In June 2018 the National Guardian’s Office carried out a survey of guardians and those in a supporting speaking up role in NHS trusts, independent providers and Arm’s Length Bodies. The survey sought views on speaking up culture in the NHS and how the guardian role is being implemented locally.

The report expands on a similar survey carried out last year and, for the first time, includes responses from people in Freedom to Speak Up roles in independent providers of healthcare and other organisations such as Arm’s Length Bodies. The survey looks at the guardian role in a systematic way so that recommendations can be made to ensure that the role continues to be effective and changes can be made to support continuous improvement.

The National Guardian’s Office and its partner organisations have now analysed this data and will publish the full survey report here on Thursday 1 November 2018

Monday, 1 October 2018

October is Speak Up Month

Sometimes workers find it difficult to speak up about issues affecting patient safety or staff experience. They may not know who to speak up to. They may feel that anything they do raise might not be taken seriously, or that nothing will be done as a result.

When there are obstacles to speaking up patients, workers and the organisation itself can suffer because the right actions and learning are not put into place.

Now every NHS trust and Foundation trust in England has a Freedom to Speak Up Guardian and last year they handled over 7,000 cases brought to them by NHS workers.

Dr Henrietta Hughes, National Guardian for the NHS, said, "It’s so important that when workers want to speak up that they can do this in a supportive environment. Thanking staff, listening and acting on the issues raised allows organisations to embed the learning and improve more successfully. Speaking up can really make a difference."

This is the first Speak Up Month and over 100 events will be taking place in England to celebrate speaking up. On 16th October a national event will be held at the House of Commons. You can keep track of what is going on via the Twitter hashtag #speakuptome

If you would like to know more about Speak Up Month or become involved by launching your own event or activities, then please drop a line to

Friday, 28 September 2018

Joint statement from Dr Henrietta Hughes, the National Guardian for the NHS, and the Royal College of Surgeons of Edinburgh

On 26th September, the Royal College of Surgeons of Edinburgh, together with the National Guardian for the NHS, Freedom to Speak Up, hosted an inaugural meeting of organisations from across healthcare engaged in addressing the unacceptably high levels of undermining and bullying throughout the NHS.

The NHS staff survey reported a quarter of employees in trusts and Foundation Trusts in England were subject to bullying and undermining last year, with devastating consequences for both staff morale and patient outcomes. This is also borne out by published data that shows that 45 per cent of cases dealt with by freedom to speak up guardians involve bullying and harassment.

The widespread scale of the problem, as well as the complex cultural, behavioural and systemic issues behind it, mean that it can only be tackled through a persistent, multi-layered approach. Therefore, participants agreed to form a collaborative alliance to coordinate activity, share best practice and develop resources on an ongoing basis.

Dr Henrietta Hughes, National Guardian for the NHS, Freedom to Speak Up, said, “The evidence shows that civility saves lives and that the freedom to speak up is a characteristic of the best organisations.

"We are acutely aware of the need urgently to redress the unacceptable levels of undermining and bullying to improve patient outcomes and the working lives of NHS staff. We realise that no one single initiative can do this.

"We also realise that change will only come through long-term and sustained interventions to support all workers in the NHS. The meeting was the beginning of this process and one we want to broaden to include as many organisations and initiatives as possible."

Miss Alice Hartley, Chair of #letsremoveit, the Royal College of Surgeons of Edinburgh’s campaign on undermining and bullying, said, “We are extremely grateful that such a broad section of organisations showed a real willingness to work collectively on this issue and build on the excellent work that is already in place.

"More can always be done, so we would extend an open invitation to Royal Colleges, trade unions, regulators, system leaders and any NHS organisation across the four nations of the U.K. to join us to create an alliance for change."

Those participating in yesterday’s meeting included:

  • Academy of Medical Royal Colleges
  • Association of Anaesthetists of Great Britain and Ireland
  • Association of Breast Surgery
  • British Medical Associations
  • Civility Saves Lives
  • Department for Health and Social Care
  • General Medical Council
  • National Guardian for the NHS, Freedom to Speak Up
  • NHS Improvement
  • Point of Care Foundation
  • Royal College of Anaesthetists
  • Royal College of Obstetricians and Gynaecologists
  • Royal College of Midwives
  • Royal College of Nursing
  • Royal College of Physicians of London
  • Royal College of Surgeons of Edinburgh
  • Scottish Government.

Thursday 21 June 2018

Statement from the National Guardian on Gosport War Memorial Hospital

“Freedom to Speak Up – freedom is when the environment supports speaking up, with the right actions being taken as a result. Without this freedom workers are enslaved in a culture of fear

“It is an insult to everyone that spoke up about the issues at Gosport War Memorial Hospital to say that staff should have raised concerns. It is clear that the reason why dangerous practice persisted was due to the lack of decisive actions by leaders, in many parts of health but also the wider system

“Once again it is the persistence of elected politicians which has shone the disinfectant of sunlight onto the inadequate response to speaking up from workers and families.

“Leaders in all parts of the health system need to take heed from this report – to be aware that individuals in their organisations know about issues about which they do not feel safe to speak up. The call to action is for everyone to listen hard, take the right actions and ignore speaking up at your peril.”

Dr Henrietta Hughes, National Guardian for the NHS

Friday 8 June 2018

Surrey and Borders Partnership NHS Foundation Trust – the ‘Speaking Up Together’ Award

This year the National Guardian’s Office is sponsoring a new category for the HSJ Awards, ‘Creating a Supportive Staff Culture’. In the run up to these awards we are highlighting the winning entries from last year’s Freedom to Speak Up Awards.

Last year Surrey and Borders Partnership NHS Foundation Trust won the ‘Speaking Up Together’. This Freedom to Speak Up partnership award recognised the connections and partnerships that are being forged to enable all staff to speak up.

The trust’s Black and Minority Ethnic (BME) staff network and the Human Resources leadership team worked in partnership to co-design the ‘People Before Process’ programme, which was developed to ensure that the trust’s BME workforce experience respect and dignity at work and are treated fairly through processes.

The programme encourages open communication to improve the lives and wellbeing of the trust’s BME staff and support equality, diversity and inclusion where everyone feels comfortable about speaking up.

Wednesday 23 May 2018

Andrew Crerar, Royal National Orthopaedic Hospital NHS Trust – ‘Freedom to Speak Up Guardian of the Year’

This year the National Guardian’s Office is sponsoring a new category for the HSJ Awards, ‘Creating a Supportive Staff Culture’. In the run up to these awards we are highlighting the winning entries from last year’s Freedom to Speak Up Awards.

Last year Andrew Crerar, the previous Freedom to Speak to Up Guardian for Royal National Orthopaedic Hospital NHS Trust (RNOH), won the ‘Freedom to Speak Up Guardian of the Year’. This recognised the excellence in promoting and supporting Freedom to Speak Up across a trust.

Andrew believes that visible leadership and regular access to senior leaders is key to speaking up. He embedded the guardian role within internal staff engagement campaigns, including the VAL-YOU Behavioural Charter, to drive forward the trust’s organisational focus on staff and quality of care.

To ensure that leaders have the right skills to support speaking up, he created a Leadership Development Portfolio and a suite of tools to help managers embed and role-model the behaviours set out in the VAL-YOU charter. Andrew also helped to pull together a Leadership Compact which outlines the expectations of managerial staff, including listening to their staff.

He instituted monthly Executive Open Clinics in the Outpatient Department. This is a chance for staff to speak with a senior leader of the trust in a private, one-to-one conversation. Workers use this as an opportunity to pass on how well teams are doing, share a specific instance of great patient care, raise a concern or suggest something that will improve the working lives of your colleagues.

He also created a Freedom to Speak Up road map and intranet page which outlines all the tools and resources that are available to staff to report incidents, give feedback and suggest improvements or how speak up about any issues.

Andrew Crerar said, "Having the opportunity to support the RNOH as a Freedom to Speak Up Guardian was a privilege and one that provided me a great deal of satisfaction. I enjoyed the chance to meet colleagues from across the trust and help make it a better place to work for everyone.

He said, “The recognition we received through the national award was humbling, as it validated the great work of a committed team of people across the RNOH. A real change in how safe we feel to raise concerns and challenge the things we know to be wrong takes more than just a team of guardians, but the support of leaders, teams and patients – a journey we are making great progress towards."

Friday 9 May 2018

Heather Bruce, University Hospitals of Morecambe Bay NHS Foundation Trust – ‘Speaking Up: the Freedom to Speak Up Communications Award’

This year the National Guardian’s Office is sponsoring a new category for the HSJ Awards, ‘Creating a Supportive Staff Culture’. In the run up to these awards we are highlighting the winning entries from last year’s Freedom to Speak Up Awards.

Last year Heather Bruce, Freedom to Speak to Up Guardian for University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT), won the ‘Speaking Up: the Freedom to Speak Up Communications Award’. This recognised creativity and innovation in spreading the Freedom to Speak Up message.

As a clinical member of staff, Heather understands that not all NHS workers have time to access trust communications on the intranet and utilised other channels to provide accessible and alternative routes for staff to speak up to her.

Heather worked in partnership with the trust’s communications team to broadcast speaking up messages that increased the visibility and accessibility of her role. These included obtaining an innovative app for mobile devices, site visits, messages for hospital posters and the fortnightly corporate induction. The trust also installed the Freedom to Speak Up app on the ward iPads.

She also publicised her role in the local and national press and, due to the success of this promotion, she was invited to speak at various national events and Radio 4, which has helped increase the role’s visibility within and outside her trust.

Heather Bruce said, “Communication is key for speaking up to be successful. It helps ensure that the Freedom to Speak Up Guardian remains an accessible, proactive and visible role for all who work in the trust so that they do not hesitate to speak up about patient safety and staff experiences.

She said, “It is essential that everyone who works at UHMBT including staff, students, volunteers, locums and governors can easily go to the guardian. Successfully communicating the role with all helps them understand how to speak up and know that their concerns will be welcomed and addressed.”

Heather acknowledges that she is lucky to have the firm support of the Board to continue with the Freedom to Speak Up campaign.


Wednesday 2 May 2018

Guidance for NHS trust and foundation trust boards on Freedom to Speak Up

We are pleased to announce today the publication of guidance for NHS trust and NHS foundation trust Boards on Freedom to Speak Up. This guidance has been produced jointly by the National Guardian’s Office and NHS Improvement. It sets out expectations of boards and board members in relation to Freedom to Speak Up. It also includes important guidance for Freedom to Speak Up Guardians on their relationship with Board members, and reporting to their Boards

Wednesday 2 May 2018

Kirsty McMullan, Mid Yorkshire Hospitals NHS Trust – Leading the Change for Speaking Up to Becoming Business as Usual

This year the National Guardian’s Office is sponsoring a new category for the HSJ Awards, ‘Creating a Supportive Staff Culture’. In the run up to these awards we are highlighting the winning entries from last year’s Freedom to Speak Up Awards.

Last year Kirsty McMullan won the award for ‘Leading the Change for Speaking Up to Becoming Business as Usual’. This recognised anyone or any team who demonstrated leadership that will create the change to make speaking up business as usual.

Kirsty McMullan, Freedom to Speak Up Guardian at Mid Yorkshire NHS Trust, has worked to establish a network of support across her trust to respond effectively to concerns that are raised. The Chief Executive and other directors make regular site visits and speak directly to staff and hear their perspective on the concerns they have identified.

Kirsty has also built strong relationships with the board, executive directors, divisional managers, human resources and the her trust’s diversity team to ensure that actions are initiated by the right person at the right time and fed back to colleagues.

Kirsty said, “I’m delighted to have won this award. Adopting an outcome focused approach has helped me to maintain a clear perspective on issues of safety to improve patient experience. When workers speak up they are not only being listened to, but actions are being taken.”

She said, “Attending staff roadshows, drop-in sessions and publicising anonymised case details in regular newsletters helps reassure colleagues who have spoken up that they can make a difference. It also demonstrates to the wider staff community that speaking up is celebrated as a means of improving quality of care for patients and staff.”

The feedback that Kirsty receives from colleagues who have spoken up gives a real sense that workers in the trust are starting to develop confidence in the Guardian role.

One worker commented, “I felt my concern was dealt with appropriately and my identity was protected.”

They said, “I received regular feedback on progress and felt like my concerns were taken seriously. Kirsty was proactive in pursuing a response. I felt that speaking up made managers consider more appropriate actions, and I felt confident that if those actions are not implemented, then Kirsty will support me to speak up again.”

Click here to enter this year’s HSJ Awards. The deadline for entries is Thursday 31 May.

Friday 20 April 2018

Guardian Education and Training Guide now available

The National Guardian’s Office has announced the publication of the Education and Training Guide for Freedom to Speak Up Guardians. The guide has been produced in partnership with Health Education England and the NHS Leadership Academy.

The new guide will help guardians improve their skills and knowledge so that they can offer the best possible service for NHS workers who wish to speak up about issues such as patient safety, quality of care or staff experiences.

The National Guardian’s Office recommends that this guide is used alongside the new universal job description and Foundation Training for guardians, which will soon be delivered regionally following the Train the Trainer programme.

The Education and Training Guide is designed to be used at a personal level to identify and address learning needs, but those achieving success will be able to share their learning at a regional level to help everyone in their network raise their level.

7 February 2018

Anonymous report of barriers to speaking up in a Greater London hospital trust

The National Guardian's Office has recently received an anonymous letter from a group of consultants at a hospital trust in Greater London. The letter concerns reports of bullying and intimidation at the trust, and failure to adhere to the trust's speaking up policy.

We would like to thank the individuals who have brought this to our attention. We understand that regulators intend to take action to look into these issues. If anyone involved wishes to submit a case for this office to review, we would encourage them to do so. Details of our case review process can be found here.

Government to extend protections for NHS whistleblowers

NHS whistleblowers will be better protected by new rules that prohibit discrimination against them if they seek re-employment in the NHS.

On Monday the Department of Health published, and launched a consultation closing on 12 May 2017 on draft regulations to protect whistleblowers seeking jobs in the NHS.

The plans will prohibit discrimination against whistleblowers when they apply for jobs with NHS employers, strengthen the legal recourse they can access if they believe they have been discriminated against because it appears they have blown the whistle - with appropriate remedies if their complaint is upheld.

The published consultation includes draft regulations that aim to:

  • Give the applicant a right to complain to an employment tribunal if they have been discriminated against because it appears they have previously blown the whistle.
  • Set out a timeframe in which a complaint to the tribunal must be lodged.
  • Set out the remedies which the tribunal may or must award if a complaint is upheld.
  • Make provision as to the amount of compensation that can be awarded.
  • Give the applicant a right to bring a claim in the County Court or the High Court for breach of statutory duty in order to, amongst other things, restrain or prevent discriminatory conduct.
  • Treat discrimination of an applicant by a worker or agent of the prospective employer (NHS body), as if it was discrimination by the NHS body itself.

This consultation aims to address this discrimination and provides the Secretary of State with a power, through regulations, to prohibit certain NHS public bodies from discriminating against an applicant because it appears to the NHS employer that the applicant has previously made a protected disclosure under the Employment Rights Act 1996.

Since the tragic events of Mid Staffs we have made considerable progress to making the NHS the safest healthcare system in the world including appointing a National Guardian and making sure every NHS organisation has a Freedom to Speak Up Guardian.

Last updated:
14 November 2019