Over 20,000 cases were raised with Freedom to Speak Up guardians last year. That’s over 20,000 cases which people felt they could not raise with their line manager, or through other channels. It may be that they had already tried to raise the matter, but nothing had been done, or worse, were treated badly for speaking up. And as a result, they sought out their Freedom to Speak Up Guardian. 

The number of these cases remains at the same level as the record set during the first year of the pandemic, and the themes shared by guardians also illustrate that the impact of the virus continues

As one guardian shared about the themes of the cases they had dealt with: “Some poor behaviours resulted from tiredness and staff still recovering post-COVID. 

“Some staff are still processing what they have seen and witnessed, which will go on for years. Some haven’t even started that process yet. Some are experiencing first anniversaries of personal losses through COVID, adding to emotions. 

“This is combined with trying to meet increasing demands, winter pressures address the backlog, and now increasing COVID levels. As a result, incoming demands continue to grow whilst staff, the organisation and services are still trying to recover and reset.” 

Working under the continued strain of these pressures, they are turning to Freedom to Speak Up guardians as one valuable additional route to raise matters getting in the way of workers doing their job. The percentage of cases which were raised anonymously has reduced to ten percent (10.4%), continuing the downward trajectory from 2017, when 17.7% of cases were raised anonymously. This suggests to me an increasing trust which people have in their Freedom to Speak Up Guardian; that they feel able to share their identity with them is to me a sign of growing confidence in both the guardian role.  

But I am concerned that the number of cases where detriment for speaking up is indicated is rising – this had been reducing. Freedom to Speak Up guardians reported that 4.3% of cases report perceived detriment for speaking up, a rise from 3.1% in 2020/21.  

I have been struck by the experiences of workers who have shared with me their experiences of speaking up in an unsupportive environment. Rather than being met with gratitude or curiosity for raising matters to protect patients or colleagues, they have instead felt victimised.  

The fear of retaliation for speaking up is one of the key barriers which stops people from coming forward. We have too often seen tragic consequences when workers are fearful of the consequences of speaking up.  

So when someone speaks up, I believe leaders and managers should consider the matter raised a gift – a gift of information which could prevent harm, or lead to improvement for people who use our healthcare services and those that work in them.  Leadership must send a clear message that treating people badly for speaking up will not be tolerated, and they must role model this themselves. 

Freedom to Speak Up guardians do not work in isolation. Their role is two-fold: to support workers who feel they cannot speak up in other ways; and to support their organisation so that speaking up can be business as usual. 

That is why I am delighted that the National Guardians’ Office has worked in partnership with NHS England to publish a refreshed range of Freedom to Speak Up  materials for leaders in NHS organisations and those providing NHS services. These include a new universal Freedom to Speak Up Policy for the NHS, and guidance for leaders to deepen their understanding of how to foster a healthy speaking up culture.  

These updates will help leaders throughout the sector identify the strengths and the gaps in their speaking up arrangements. Their publication is an opportunity to take a fresh look at your speaking up arrangements and assure yourselves that they are meeting the needs of all workers and support a positive speaking up culture that we all aspire to achieve.  

While organisations may vary in size, structure and business model, the promoters and barriers to speaking up are common to all settings and organisations. The refreshed materials can be applied in any setting, to ensure a consistent approach across the sector for embedding effective speaking up arrangements, including implementing the Freedom to Speak Up Guardian role.

As part of our aim to for all Freedom to Speak Up guardians to provide a consistent service, we have developed a new package of Freedom to Speak Up Foundation Training for guardians. Part one of this training is via elearning, and the second part consists of a reflective conversation with a Freedom to Speak Up Guardian mentor, to ensure understanding and application of the universal job description.

I expect all Freedom to Speak Up guardians already appointed to have completed this elearning, either as part of their annual refresher training, or when they are appointed to ensure that they are fully trained for this complex and demanding role. 

The National Guardian’s Office has repeatedly called for Freedom to Speak Up Guardians to have sufficient ring-fenced time to carry out their role. Our survey of Freedom to Speak Up guardians illustrates how important adequate ring-fenced time is for carrying out the Freedom to Speak Up Guardian role effectively. Lack of ring-fenced time has an impact, not just on the day-to-day fulfilment of this role, but also on Freedom to Speak Up Guardians’ ability to access the support they need for their own development and wellbeing.

This leads me back to the question of leadership, and with the new national Freedom to Speak Up Guidance, to how leaders can assure themselves that their speaking up arrangements meet the needs of the workforce.

A great place for leaders to start is with a conversation with your Freedom to Speak Up Guardian. Ask them how they are doing; what themes are coming to them from workers; what is their speaking up data saying. Ask them what could be done better; ask them for their feedback. And above all, listen to what they are saying and follow up.

By putting the principles of Speak Up, Listen Up, Follow Up into action, together we can make speaking up business as usual.