Freedom to Speak Up hub

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The appointment of a National Guardian for speaking up freely and safely, and Freedom to Speak Up (FTSU) guardians in NHS trusts were recommended by Sir Robert Francis, following his review and subsequent report into the failings in Mid-Staffordshire. 

In July 2015, the Secretary of State confirmed the steps needed to be taken to develop a culture of safety, and supported Sir Robert's recommendations.

This section signposts you to key information provided by the National Guardian's Office (NGO) and the excellent work being done across the country to implement FTSU. 

What is the remit of the national guardian?

Dr Henrietta Hughes provides leadership and support to FTSU guardians and NHS trust employees who have raised a concern that has then not been effectively dealt with by the employer. You can find out more about her and her role in helping to improve the culture around raising concerns on the National Guardian's Office website. 

The priorities of the national guardian, and her office, over the next few months include:

  • establishing and supporting a strong regional network of FTSU guardians
  • highlighting the NHS organisations that are successful in creating the right environment for staff to speak up safely and share this best practice across the NHS
  • independently reviewing cases where NHS organisations may have failed to follow good practice and working with statutory bodies to take action where needed.

FAQ's in relation to the national guardian, her remit and where to seek further advice are available on the national guardian's office website

What is an FTSU guardian?

FTSU guardians have a key role in helping to raise the profile of raising concerns in their organisation and provide confidential advice and support to staff in relation to concerns they have about patient safety and/or the way their concern has been handled. 

Guardians don't get involved in investigations or complaints, but help to facilitate the raising concerns process where needed, ensuring organisational policies are followed correctly. They also don't have a remit to assist staff who are employed outside of their trust. The National Guardian's Office has outlined the purpose and key principles of the guardian role. 

You can find out more about guardians in shared learning examples we have developed with trusts in our resources, campaign materials and shared learning section. You can also keep up to date by reading regular guardian blogs from Christopher Hall, Heather Bruce, Wayne Walker and Judith Graham, by using the raising concerns filter within the blogs section.

Trusts with guardians

This guardian map shows at a glance which organisations have a guardian in place, their contact details and any associated shared learning. If your organisation has a guardian and he or she isn't on the map, please email raisingconcerns@nhsemployers.org

Please note that individuals with a public interest concern should only approach the guardian appointed within their organisation.

How can I support my local guardian?

Firstly, ensure he or she has been in touch with the National Guardian's Office and is booked onto any available training, regional networks or meetings.

Our checklist for employers to use with their guardians can help them think about their local activity and increase their visibility to staff. Download this resource from our case studies and resources section. 

e-Learning for Healthcare has produced two e-learning modules to help equip staff with the necessary knowledge and confidence to raise concerns and for managers to respond to concerns. You can download these resources from the e-Learning for Healthcare website. 

You can also signpost guardians to the Health Education England (HEE) raising concerns video resources that helps to raise awareness of raising and responding to concerns along with building confidence among staff to do so. These are available from the HEE website

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