Freedom to speak up - employer actions

This page outlines key considerations, resources and case studies useful when reviewing and developing local arrangements for speaking up.

30 September 2022

Having a speaking up and listening culture is critical to enabling an open dialogue, including time for reflection and learning, when things go wrong. It is important for working in partnership with your staff to drive improvements. This page outlines a number of key considerations, resources and case studies which will be useful to take into account when reviewing and developing local arrangements. 

Updated national Freedom to Speak Up policy for the NHS and new guidance

In July 2022, NHS England updated the national Freedom to Speak Up policy for the NHS, providing the minimum standard for local Freedom to Speak Up policies across the NHS. This means that those who work in the NHS know how to speak up and what will happen when they do. It is designed to be inclusive and support resolution by managers wherever possible. Read the revised policy in full for more information.

NHS England has also published Freedom to Speak Up guidance to help senior leaders in NHS organisations develop a culture where leaders and managers encourage workers to speak up and where matters raised drive learning and improvement. To accompany this, a self-reflection and planning tool has been developed, which will assist in highlighting areas that need improvement and where employers are succeeding.

All NHS trusts and foundation trust boards have been asked to update their local policies to reflect the new national template by the end of January 2024. By this time, they should have also seen the outputs from using the self-reflection tool and provided at least one progress update.

Communicating the policy and engaging with staff

Staff should have a clear understanding of the definition and process of raising concerns. There are multiple ways organisations can ensure that this is the case. For example, posters and leaflets can be displayed around the building, in team meetings, or in designated staff areas.

Organisations should also consider how they can assure themselves that all staff receive the same information and are clear about how to raise a concern and where to seek advice from, including those working across different sites, out in the community or who choose different working patterns (for example, shifts and working from home).

Understanding intelligence

It is important to work closely with relevant parts of your organisation to better understand how effective local arrangements are in fostering a positive raising concerns culture. HR teams will find it beneficial to forge strong links with their Freedom to Speak Up Guardian and wider management teams, to understand areas of concern and identify actions for improvement. Working in partnership with local trade unions and communication teams will be helpful to ensure all workers understand how to raise concerns they have, and the responsibility of managers to ensure they have a platform where concerns are listened to and responded to in an effective and timely manner.


Mandatory training should be provided to all staff so that they understand the organisation's policy and local arrangements. It should also be provided to those with responsibility for handling concerns so they feel confident and equipped to handle issues effectively. It is good practice to include the handling of concerns raised as part of any disciplinary and grievance training.

Health Education England (HEE) provides an online training package on raising and handling concerns in the NHS. The training package was produced in partnership with Protect (formerly Public Concern at Work) and can be used by staff and managers.

Supporting staff who raise concerns

Speaking up can be a difficult and stressful process for all parties concerned. Employers should ensure staff understand where they can seek further help, advice and support from, at all stages of them raising a concern - to assure their health and wellbeing. The same level of support should be offered to individuals who have had concerns raised about them. In all cases, it will be important for managers to check in with individuals once an investigation into a concern has concluded, to make sure they have access any support they may need.

There are a number of resources available on our health and wellbeing pages which will be helpful for managers to refer to when supporting staff.

National Guardian's Office (NGO): Principles for Responding to Speaking Up

The NGO has developed 12 key principles together with the Speak Up Partnership Group to ensure that an aligned, consistent and supportive approach is embedded when employees speak up to them. These principles should be used by employers in the NHS to ensure that employees that speak up are supported correctly. Access the Principles for Responding to Speaking Up over on the NGO's website. 

Leadership and culture

Having a speaking up and listening culture is critical to enabling an open dialogue. It is important for working in partnership with your staff, that this culture is reflected in leadership and actively promoted in the trust. Read how The Leeds Teaching Hospitals NHS Trust actively encourage the board to listen up and follow up on the National Guardians Office website.

Compassionate leadership involves understanding, empathising with, and supporting your staff. The purpose of compassionate leadership is to help create conditions where all your staff are listened to and supported. The National Guardians Office have released a podcast series in conversation with inspirational leaders within healthcare and how they speak up, listen up and follow up.  

Supporting the wellbeing of Freedom to Speak Up Guardians

A new report published by the National Guardians Office highlights the experience of freedom to speak up guardians amid the continued pressure on the NHS. It looks in detail at the responses from guardians about how their own wellbeing has been impacted since taking on the role, and how employers can further support freedom to speak up guardians. Check out the report on the National Guardians Office website.

Good practice

  • Read about how Northumbria Healthcare NHS Foundation Trust was awarded the Freedom to Speak Up Organisation of the Year Award at the 2021 HSJ Awards for its demonstration of an integrated approach to speaking up via the National Guardian's Office website.
  • Read about how Northern Lincolnshire and Goole NHS Foundation Trust (NLG) spoke up about burnout to improve its worker experience on the National Guardian's Office website. The commitment of senior leaders to listen to workers and demonstrate Speak Up, Listen Up, Follow Up also earned NLG a place in the final of the 2021 HSJ awards, read about this on the National Guardians Office website.
  • Find out about work from Chesterfield Royal Hospital to follow up on how leaders can set the tone for speaking up on the National Guardians Office website.
  • Take a look at Worcestershire Acute Hospitals NHS Trust's work to promote accessibility to support hard-to-reach groups on the National Guardian's Office website.
  • Read about how Manchester University Hospital NHS Foundation Trust reacted to concerns over health and safety and low team morale within the domestic team on the National Guardians Office website.
  • Check out how NHS Business Services Authority launched a new network of freedom to speak up guardians as part of a wider communication campaign linked to celebrating Speak Up Month on the National Guardians Office website.
  • Take a look at Royal United Hospitals Bath (RUH) and how they embedded freedom to speak up as business as usual for all staff on the National Guardians Office website. The dedication from the freedom to speak up guardian resulted in RUH being shortlisted for the Freedom to Speak Up organisation of the year award at the HSJ 2022 awards.

Further information

The National Guardian's Office provides leadership and support to freedom to speak up guardians, including supporting regional networks and sharing good practice and learning from organisational case reviews.

The National Guardians office has launched a podcast series in celebration of Speak Up Month:

  • Listen to Lord Victor Adebowale, chair of the NHS Confederation, discusses the importance of inclusion in leadership and ensuring staff are psychologically safe, to be honest and open with leaders - #SpeakUpforInclusion.
  • In the final episode of Speak Up month specials, Danny Mortimer, chief executive of NHS Employers and deputy chief executive of NHS Confederation, interviews Dr Jayne Chidgey-Clark on the theme of freedom to speak up for everyone. Danny discusses the importance of a good culture in an organisation and why the role of national guardian for the NHS is so important to Jayne.