Raising concerns hub


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 and improve the culture around raising concerns. 

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 Dr Hughes and her role on the National Guardian's Office website. 

The priorities of the national guardian, and her office, include:

  • 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, Dr Hughes 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 access a directory of FTSU guardians on the NGO website.

How can HR support guardians?

It is very important to forge good working relationships with your guardian. He or she can help ensure staff and managers are aware of policies and ensure these are being applied consistently and effectively. 

Firstly, ensure your guardian 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. 

Signpost your guardian to e-Learning for Healthcare and their 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

Latest Tweets

Why Register?

Great reasons to register with NHS Employers

  • A personalised website
    Manage your profile and select topics of interest to you
  • Access your dashboard
    Bookmark useful content to help you quickly find what you're looking for
  • Get involved
    Contribute to our Talking Points discussions, comment on and rate our webpages
  • Keep up to date
    Receive the latest newsletters and media summaries

Sounds great, what next?

Register Now

Not now, I will register later

Log In