The Freedom to Speak Up Guardian network has evolved since the role was created in 2016. There are now over 700 Freedom to Speak Up Guardians in over 400 organisations, in primary and secondary care, the independent health sector and national bodies.

We recognise that there are a growing number of guardians from organisations such as national organisations, professional bodies and regulators. Freedom to Speak Up is about anything which gets in the way of doing a great job. As those who support and regulate the health and care system, it is important these organisations role model effective speaking up cultures themselves to make speaking up business as usual throughout health and care. At the National Guardian’s Office, we want to ensure we are providing them with the right support they need to embed Freedom to Speak Up effectively.

As part of our Annual Internal Audit, we asked auditors to review the National Guardian’s Office’s policies, guidance and support and assess the extent to which these were effective for these types of organisations. As well as reviewing documentation, the auditors interviewed stakeholders and Freedom to Speak Up Guardians.

We are grateful to those organisations who took part in the review.

The report following the review made recommendations for the National Guardian’s Office to help us to strengthen our guidance and support for non-patient facing organisations.

NGO Guidance

The Freedom to Speak Up role had initially been rolled out in NHS trusts, and many of the guidance documents were developed with NHS Trusts in mind, so could be seen as not as applicable to other types of organisations. The auditors’ review shared this observation, which we have also identified as part of our research into embedding Freedom to Speak Up in Primary Care.

We will be updating our guidance and resources so they are more universal and easier to apply and interpret for a range of organisations. We will also work alongside others so that their guidance is universally applicable.

Conflicts of interest

Freedom to Speak Up Guardians work impartially.  In order to be effective as an additional route to speak up, they should be aware of any conflicts of interest (whether perceived or actual).

The review recommended that the National Guardian’s Office strengthen our guidance on (actual and perceived) conflicts of interest for Freedom to Speak Up Guardians, which we will be providing in due course.

Freedom to Speak Up Champions and Ambassadors

Some organisations have Freedom to Speak Up Champion or Ambassador networks who work alongside Freedom to Speak Up Guardians to complement their work. These internal Freedom to Speak Up networks seek to raise awareness and promote the value of speaking up, listening up and following up.

The review recommended that the NGO develop guidance on the roles and responsibilities of Champions and Ambassadors. Our guidance for developing champion and ambassador networks has now been published, alongside some suggested training materials for these networks.

Capturing workers views on speaking up culture

The review found that although the participating organisations had questions about speaking up in their staff surveys, the questions asked varied among organisations. It recommended that the NGO should suggest questions for national bodies to seek feedback on, and to gather the feedback to help inform assessment of their speaking up cultures.

This year a new question was included in the NHS Staff Survey asking if workers feel safe to speak up about anything that concerns them in their organisation. We would encourage all organisations to consider including this question in their own surveys to help build a picture of the speaking up culture in their organisation.

We will continue to work with the National Non-Provider Network of Freedom to Speak Up Guardians to explore opportunities for measuring speak up culture and to clarify expectations on seeking feedback from workers.

NGO potential conflicts of interest

The review recommended the NGO have a clearly defined process for identifying and managing conflicts of interest which might arise in relation to organisations or individuals.

All NGO staff are required to complete an annual declaration of interest which is held by the CQC. The NGO has since implemented additional guidance from CQC to further strengthen this.

Contacting the NGO

The review recommended that the NGO provides further clarity for Freedom to Speak Up Guardians around our process for handling enquiries and how matters are escalated.

Our privacy and confidentiality policy is shared in the fortnightly guardian bulletin and on is also available here  We will work with Freedom to Speak Up Guardian networks to further clarify this process.