Annual Report
April 2025 – March 2026

About Us

At the National Guardian's Office (NGO), we lead, train and support the network of Freedom to Speak Up Guardians across England. More than 1,500 guardians now operate within NHS organisations, independent sector providers, hospices and national bodies. This offers workers an independent and confidential route to speak up – particularly when other avenues have not been effective or do not feel accessible.

We also conduct Speak Up Reviews, which identify learning and support improvements in speaking-up culture across the healthcare sector.

This ninth and final annual report is being laid before Parliament in line with the Government's commitment following the Gosport Independent Panel report:¹

"To further increase transparency, accountability and to promote culture change, the Government has requested the National Guardian to produce an annual report to be laid before Parliament."

¹ Department of Health and Social Care (2018). Learning from Gosport: The Government response to the report of the Gosport Independent Panel. https://assets.publishing.service.gov.uk/media/5bf55a80ed915d1827f17c39/government-response-to-gosport-independent-panel-report.pdf

About Freedom to Speak Up Guardians

Freedom to Speak Up Guardians make sure people who speak up are listened to, thanked and supported. They help secure appropriate and timely responses to the issues raised and make certain feedback is provided. Alongside this, guardians play a proactive role in helping organisations identify and remove barriers to speaking up, which contributes to open, learning-focused cultures.

As we present this final annual report ahead of closing the NGO in June 2026, we wish to acknowledge and express our deep gratitude to leaders across the system, to the Freedom to Speak Up Guardians' Network chairs and to our Freedom to Speak Up Guardian Mentors. Their dedication, professionalism and unwavering commitment have been central to embedding the right cultures for speaking up and strengthening the voices of workers across healthcare.

This has been a year unlike any other. A year in which we at the National Guardian's Office (NGO) have continued to serve – with unwavering commitment – workers, guardians and leaders, even as we prepared for closing the NGO and transitioning our functions. Yet, throughout this time of change, our purpose has remained constant: to improve workplace cultures so every worker feels confident and supported in speaking up.

In these pages, you will see evidence of that commitment. We have strengthened the Freedom to Speak Up Guardian network with new resources, including the Recruitment Framework, the Guardian Handbook, new training modules and practical tools such as our Freedom to Speak Up Champions animation. These achievements reflect the heart of our strategic framework: ensuring guardians feel equipped, valued and supported in their vital roles.

We have continued to support and challenge leaders, including delivering board development sessions and a national leadership event that focused on psychological safety, compassion and inclusive cultures. The transformation we have seen in organisations such as Dorset HealthCare University NHS Foundation Trust shows what is possible when leaders truly listen.

We have carried forward our independent voice, through national commentary, Speak Up Week and the amplification of lived experience, which shines a light on the barriers preventing workers from feeling safe to speak up. And through our reviews with temporary workers, overseas‑trained workers and the ambulance sector, we have offered clear, evidence‑based recommendations that will continue to guide the system long after our office closes.

We have also leaned into partnerships, working closely with NHS England, the Care Quality Commission (CQC), the Department of Health and Social Care (DHSC), and the wider guardian network. Their collaboration has been instrumental in supporting workers and guardians throughout a period of uncertainty.

Closing the NGO is not the end of speaking up, and it is certainly not the end of the impact we have made together. The legacy of this work lives on in the thousands of workers who bravely spoke up, the guardians who stood beside them, and the leaders who listened and acted. It lives on in the strengthened cultures, the improved practices, and the hard‑won understanding that speaking up, listening up and following up are essential to safe, compassionate care.

As we publish this final report, our overwhelming feeling is one of hope. Hope that the insight, learning and relationships built over these years will continue to shape a health and care system in which every worker's voice matters and where speaking up really is business as usual.

Freedom to Speak Up Cases in 2025/26

This section summarises Freedom to Speak Up activity for the 2025/26 financial year to date; the data is correct as of 27 February 2026. As data for only quarters one and two (Q1 and Q2, April to September 2025) is available to that date, the analysis focuses on trends emerging in the first half of the year. Comparisons to previous years are included where they provide useful context.

Overview of Case Volumes

Between April and September 2025, a total of 18,113 cases were raised with Freedom to Speak Up Guardians. This is broadly consistent with the volume reported in the first half of 2024/25 (18,163), which suggests a continued willingness among workers to raise concerns, despite ongoing pressures across the system.

April 2025 also marked the introduction of our new NGO records management system, which provides enhanced consistency and quality regarding how case data is captured and reported.

*2025/26 figures are for Q1 and Q2 (April to September 2025) only

Themes and Characteristics of Cases

Anonymous cases accounted for 12.2% of cases (2,217).

Experience of detriment for speaking up was indicated in 2.6% of cases (475), which is a trend that remains a critical focus for the system.

Worker Feedback

Of the 5,304 workers who provided feedback, 74.1% said they would speak up again, which demonstrates sustained confidence in the Freedom to Speak Up process.

The following are examples of the feedback received:

• "This was a really positive experience for me. My concerns were addressed and tangible actions have been made to change things. I felt heard and respected through the process."
• "The guardian was amazing and took the time to listen to my concerns without hesitation and supported me through a really difficult time."

Nature of Concerns Raised

The patterns seen in case themes remain consistent with previous years, with culture‑ and behaviour‑related concerns continuing to dominate:

• Inappropriate attitudes and behaviours was the most reported theme, which represents 41.6% of cases (7,535).
• Concerns involving worker safety or wellbeing were raised in 39.2% of cases (7,097), which reflects the ongoing pressures on the workforce.
• Bullying and harassment accounted for 17.7% of cases (3,202), which mirrors the proportions seen in recent years.
• Patient safety or quality issues featured in 17.0% of cases (3,083).

These trends reinforce the critical link between staff experience and patient outcomes, and they highlight the importance of strengthening organisational cultures, leadership behaviours and psychological safety.

The 2025 NHS Staff Survey shows a concerning decline in workers' confidence in speaking up, with the Freedom to Speak Up sub‑score falling to a five‑year low of 6.37 (down from 6.45 in 2024). All four measures within this sub‑score have decreased, with three dropping by more than one percentage point. Only 55.49% of staff felt confident their organisation would address clinical safety concerns, and fewer than half (47.59%) believed their organisation would act on concerns more generally.

While 71.1% of workers reported feeling safe to raise concerns about unsafe clinical practice, only 55.5% trusted their organisation to act on patient‑safety issues. Similarly, 61.5% felt safe raising any concern, yet just 47.6% believed action would follow. This widening 'action gap' poses a significant risk to trust and engagement; a culture that encourages speaking up but fails to respond meaningfully can create disillusionment and undermine the entire framework.

Ambulance trusts maintained similar levels to those for 2024, which reflects their ongoing sector‑wide improvement work. However, all other trust types saw reduced confidence in raising concerns and increased perceptions of organisational inaction. Declines were especially notable among registered nurses and midwives, whose Freedom to Speak Up sub‑score fell by 0.11 across a cohort of more than 200,000. Confidence among white staff also dropped further, which is widening an existing disparity with other ethnic groups.

Internationally recruited workers reported higher trust in organisational responses than UK‑recruited colleagues, with some improvements in acute specialist trusts and community trusts. Yet their confidence decreased in mental health trusts and ambulance trusts compared with 2024.

With the NGO closing in June 2026, system‑wide accountability becomes essential. Providers, regulators and national bodies must make certain that speaking‑up arrangements remain visible, accessible and embedded in everyday leadership. Freedom to Speak Up Guardians continue to offer vital support, but meaningful improvement depends on leaders consistently modelling positive behaviours, promoting psychological safety and acting decisively on concerns.

These findings reinforce the critical need for leaders to demonstrate visible follow‑up and to close the action gap that workers highlight consistently.

This year, our communications and engagement activities have reached a wide and diverse audience across the health and care system. Our National Guardian's Office (NGO) website received over 413,000 views from 122,000 users, with the Find My Guardian page accessed more than 154,000 times, which demonstrates the ongoing demand for support and guidance. Our LinkedIn presence grew significantly, generating 60,373 impressions (a 242% increase) during Speak Up Week and 341 new followers, bringing our total audience to 2,521. Across our multimedia channels, our YouTube content received 18,533 views. Together, this reflects strong, sustained engagement and increasing sector-wide interest in speaking up and fostering a safer culture.

With respect to championing workers, we continued to carry forward our independent voice, using national commentary and amplifying lived experience to highlight the barriers preventing people from feeling safe to speak up. Through articles published on our website and shared widely across our social media platforms, we brought national attention to the cultural and systemic factors that can silence workers. These publications have strengthened the call for culturally intelligent leadership and for ensuring that all workers – including those with an insecure immigration status – feel safe, supported and able to speak up without fear.

'Why NHS Leaders Need Cultural Intelligence'

Published: 24 July 2025 and available at https://wordpress-236493-6591990.cloudwaysapps.com/2025/07/24/why-nhs-leaders-need-cultural-intelligence/

This article emphasises the importance of culturally intelligent leadership in enabling people from diverse backgrounds to speak up safely.

'How Visa Insecurity Silences Healthcare Workers'

Published: 11 September 2025 and available at https://wordpress-236493-6591990.cloudwaysapps.com/2025/08/19/how-visa-insecurity-silences-healthcare‑workers/

This article explores how immigration status can create fear and silence among overseas‑trained healthcare workers, which highlights the systemic issues affecting worker safety, well-being and the ability to speak up confidently.

Temporary Workers' Speak Up Review

In summer 2025, we at the National Guardian's Office (NGO) commenced a Speak Up Review to examine the barriers preventing temporary workers from raising concerns in the NHS.² This work followed the 2024 Health Services Safety Investigations Body's findings, which highlighted longstanding issues of discrimination and cultures of fear affecting temporary staff. The review was published in March 2026.

Through surveys, focus groups, and interviews with temporary workers, Freedom to Speak Up Guardians and national stakeholders, the review has identified three core themes:

1. Workplace challenges faced by temporary workers
2. Barriers and enablers that are influencing their ability to speak up
3. Gaps in existing guidance and support

Around six in ten (60.4%) temporary workers reported feeling they did not have a voice in the NHS, and many described inadequate induction, limited advocacy, mistrust in processes and fears of detriment, including impacts on future shifts or placements.

² National Guardian's Office (2026). Temporary Workers, Permanent Voices: A Speak Up Review. https://wordpress-236493-6591990.cloudwaysapps.com/wp-content/uploads/2026/03/Temporary-workers-review_march2026.pdf

These insights informed six recommendations directed at national bodies, host organisations, temporary workforce providers and other bodies. Together, they aim to strengthen the consistency and safety of speaking-up arrangements, improve insight into temporary workers' experiences, reinforce protections against detriment, and promote cultures of inclusion and belonging.

In response to the review's findings and recommendations, early action has already been taken by the stakeholders. The Care Quality Commission (CQC) has updated its draft sector‑specific assessment frameworks, including the hospitals (secondary and specialist care) framework, to reference explicitly the temporary workers' access to speaking-up processes.

Overseas-Trained Workers Speak Up Review

In May 2025,³ we published a Speak Up Review carried out to examine the experiences of overseas-trained workers, who form a significant part of the NHS workforce and often face challenges when raising concerns. The review explored these issues in greater depth to understand how they affect workers' confidence, well-being and the safety of care.

³ National Guardian's Office (2025). Listening and Learning: Amplifying the Voices of Overseas-Trained Workers. https://wordpress-236493-6591990.cloudwaysapps.com/wp‑content/uploads/2025/05/NGO-Overseas-trained-workers-report_May-2025.pdf

Drawing on the voices of workers trained outside the UK, the review identified four core themes:

1. Transition challenges faced by overseas‑trained workers
2. The influence of national culture and societal norms on speaking-up perceptions and behaviours
3. Enablers and barriers to speaking up
4. Speaking-up arrangements and support

The findings highlight how unfamiliar systems, visa and immigration challenges, systemic racism, cultural expectations, power dynamics, and concerns about fairness can all affect whether workers feel able to raise concerns.

The report made four recommendations aimed at national and local healthcare leaders: ensuring recruitment and retention guidance supports speaking up, designing speaking-up arrangements that work for all staff groups, making better use of data to understand and improve experiences, and strengthening cultural competence to remove barriers. The review also outlined the practical steps needed to build cultural intelligence and promote fair, inclusive systems that support the confidence of overseas-trained workers to speak up.

Following the publication of our review, early improvements have already been made, including updates to NHS Employers' international recruitment resources, which signals positive attention has been paid to the issues highlighted.

Throughout 2025/26, at the National Guardian's Office (NGO), we continued to support senior leaders in creating environments in which workers feel safe to speak up. Five board development sessions were delivered across ambulance trusts and acute trusts, which reflects the ongoing demand and the increasing pressures leaders face.

National announcements linked to the NHS 10‑year plan – alongside sustained operational, workforce and regulatory pressures – have significantly reshaped the leadership landscape. In this context, responsive, compassionate and accountable leadership remains critical. Our development offer is helping boards reflect on their responsibilities, understand worker experience and take practical steps to strengthen speaking‑up cultures.

Board Development Sessions

In 2025/26, five board development sessions were delivered as follows:

1. 24 April 2025 Bolton NHS Foundation Trust
2. 27 June 2025 Sandwell and West Birmingham Hospitals NHS Trust
3. 4 September 2025 East Kent Hospitals University NHS Foundation Trust
4. 11 December 2025 Great Western Hospitals NHS Foundation Trust
5. 29 January 2026 Yorkshire Ambulance Service

The sessions focused on governance, accountability, teamwork and clarity of roles, and they were targeted at organisations with low Speak Up scores from their NHS Staff Survey or those requesting support. All sessions were delivered by members of our NGO leadership team.

The following are samples of the feedback provided about the sessions:

"The board development session provided expert insight and cross-sector analysis, enabling us to assess our approach against best practice and identify concrete actions to take forward."– East Kent Hospitals University NHS Foundation Trust Board

"As the chair of the four acute provider trusts in the Black Country system, bringing our leaders together [and] the system-wide board development truly demonstrated our commitment to sharing best practice across organisational boundaries for our patients and our staff. The session supported the board members to understand the impact of when concerns are not heard or followed through."– Sir David Nicholson, Chair, Sandwell and West Birmingham NHS Trust, The Dudley Group NHS Foundation Trust, The Royal Wolverhampton NHS Trust, and Walsall Healthcare NHS Trust

"The collaborative board development session enriched the board's knowledge on the importance of organisational follow-up. It is a true pleasure extending the invite to our partners in the ambulance service, mental health trust and ICB [integrated care board] for true collaborative working and sharing best practice."– Diane Wake, Group Chief Executive Officer, Sandwell and West Birmingham NHS Trust and The Dudley Group NHS Foundation Trust

This year, at the National Guardian's Office (NGO), we have developed and released a new animation to support organisations in embedding and strengthening the role of Freedom to Speak Up Champions. This resource complements existing guidance by clarifying the purpose of champions, illustrating how they work in partnership with Freedom to Speak Up Guardians and offering practical suggestions for how organisations can use champions to reinforce their speaking-up arrangements. Having been designed as an accessible tool for induction, training, awareness campaigns and internal communications, the animation supports leaders in developing cultures where speaking up is understood, encouraged and embedded as business as usual.

Guardian Numbers

The Freedom to Speak Up Guardian role is complex, and the landscape in which guardians operate is evolving constantly. The guardian network has grown from just 200 guardians in NHS trusts in 2017 to more than 1,500 registered guardians supporting a wide range of organisations currently.

As of 6 March, we have 1,519 registered guardians (who are fully onboarded) aiding 820 organisations. During this annual report period, we have also stepped down 304 guardians who informed us they are no longer in the guardian role or who were non-compliant with training requirements.

This is the breakdown across organisation types:

Freedom to Speak Up Guardian Mentors

From April 2025 to March 2026, 271 reflective conversations took place between newly appointed Freedom to Speak Up Guardians and trained Freedom to Speak Up Guardian Mentors. Together with the quarterly mentor meetings facilitated by our National Guardian's Office (NGO) Guardian Support and Policy Team, these conversations provide a valued space in which to share challenges, successes and learning across the network.

At the NGO, we are proud to recognise the contribution of the 44 trained guardian mentors, whose support continues to build confidence, capability and consistency across the speaking-up community.

By drawing on their extensive experience, guardian mentors offer new guardians a reflective, confidential environment that builds confidence and helps clarify expectations of the role. This support can reduce the sense of isolation they feel when navigating sensitive or complex issues for the first time:

"Being a Freedom to Speak Up Guardian Mentor matters to me because I know first‑hand that the guardian role can feel like holding a lot on your own."– Sue Pike, Freedom to Speak Up Guardian, Network Chair and Guardian Mentor

Mentoring also brings practical benefits as it helps new guardians identify where constructive challenge may be needed in their organisations. It promotes the meaningful implementation of the role and supports local culture change. Mentors often describe the work as being mutually beneficial due to it offering renewed insight into their own practice:

"Being a mentor is an honour and a privilege… it's something that makes me a better Freedom to Speak Up Guardian."– Liz Houchin, Freedom to Speak Up Guardian and Guardian Mentor

Collectively, the mentor network strengthens resilience, consistency and compassionate practice across the Freedom to Speak Up landscape, which enhances both individual guardians and the wider speaking-up culture.

Support Calls

The Freedom to Speak Up Guardian Support and Policy Team handled 184 support calls between April 2025 and March 2026:

• 37.2% were from guardians seeking support in their role, which was often relating to limited organisational leadership support or insufficient ringfenced time
• 29.5% related to support with specific cases being managed by guardians
• 24.4% concerned clarity around the guardian role
• 6.4% involved concerns about detriment
• 2.6% were well-being support conversations

The support calls offered by the Guardian Support and Policy Team help guardians gain clarity on their role, explore options in complex situations and discuss the challenges they face. Guardians consistently provide positive feedback about the team's responsiveness and the reassurance it provides to make certain practice aligns with national guidance:

• "Sincere thanks for your time on the call this week and for kindly following this up and providing the suggestions below."
• "This has really helped to clarify my actions, and I am grateful to you and your team for the prompt guidance and feedback."

Freedom to Speak Up Guardian Network Meetings

Our NGO members attended 44 Freedom to Speak Up Guardian regional and national network meetings between April 2025 and March 2026. This figure includes quarterly meetings with mentors and network chairs. An in-person chair-and-mentor development session was held in October 2025.

Training

Training data from 1 April 2025 – 25 February 2026

The Freedom to Speak Up Guardian Training offer has continued to play a central role in both strengthening guardian capability and ensuring a consistent, professional standard across the guardian network.

Foundation Training

The Foundation Training package comprises two essential components designed to equip newly appointed guardians with the skills and confidence they need from day one:

• Part 1: Seven e‑learning modules, including end‑of‑module assessments, which are to be completed within the first month of appointment
• Part 2: A reflective conversation with a trained guardian mentor, which provides personalised support and space to explore early learning

A total of 456 new guardians completed Foundation Training during 2025/26, which is a significant contribution to maintaining national consistency and supporting safe, accessible speaking-up routes across all organisations.

Learner experience and impact

The evaluation feedback received indicates the training is continuing to be well‑received and effective. Guardians have consistently highlighted that the training has deepened their understanding of barriers to speaking up and has assisted with their transition into the role:

• "The training made me think more deeply about barriers I had not considered. The workbook was very useful, and I will refer back to this when needed."
• "Very well presented, educational and useful e-learning course that provided a sound induction for a new FTSU [Freedom to Speak Up] Guardian."
• "Happy to go ahead and start my role and seek help where needed. I shall be very eager to learn from Freedom to Speak Up buddy/mentors."

This feedback demonstrates how the Foundation Training programme not only equips new guardians with core knowledge but also builds their early confidence and encourages a reflective, supportive approach to the role.

Refresher Training 2025

Refresher Training remains a mandatory annual requirement and supports guardians' continued professional development. In 2025, the new module focused on reflective practice when responding to challenging behaviour and on fully utilising the Development Guide to support growth and consistent professional standards.

This year saw 1,070 course completions, which reflects strong engagement from across the network.

Learner experience and impact

The feedback received demonstrates that the refresher module has strengthened confidence, enhanced reflective capability and supported guardians in navigating complex interpersonal situations:

• "Comprehensive, thought-provoking and definitely helped me to reflect… acting in the interests of those who speak up."
• "Challenging behaviour is a tricky area to navigate. It made me reflect on my behaviour and what tools I would use… It also signposted me to more learning."
• "My key reflection is that creating a psychologically safe environment is just as important as resolving the concern itself."

Guardians have also highlighted the value of the training video, which modelled constructive challenge and professional resilience:

• "Seeing how the guardian spoke to the manager and politely pointed out how they needed to recognise problems… was really useful."
• "I would highlight Teisha's calmness and consistency… it showed people are not always happy when approached."
• "It demonstrated how to maintain purpose even when challenged."
• "It tackled real-life pressures, and it's important to get to the end goal."

These reflections show the 2025 refresher module not only supported knowledge consolidation but also helped deepen emotional intelligence, communication skills and confidence – all of which are essential to delivering high‑quality, psychologically safe speaking-up cultures.

This year, at the NGO, we have delivered nine national webinars, which were attended by 1,096 Freedom to Speak Up Guardians; this has facilitated the continued development of their knowledge and practice. These sessions included a presentation from our colleagues at NHS England on sexual safety in the workplace; it outlined the requirements of the Worker Protection Act 2023, explored the different forms of sexual misconduct and emphasised the importance of trauma‑informed approaches. The webinar reinforced the principle that everyone has the right to be free from harassment and abuse in their work, and it highlighted the vital role guardians play in supporting staff and promoting respectful, safe working environments.

We also facilitated a well‑received session delivered by the Patient Safety Library to introduce the Red Flag System, which is an evidence‑based framework informed by a decade of inquiry reports into avoidable harm. The webinar set out the recurring cultural patterns associated with dysfunctional environments, including complacency, avoidance, denial, and failures in reporting, accountability, teamwork and learning. The framework provides guardians with a shared language and clear indicators to help identify early warning signs that something may be 'not quite right', which facilitates taking timely and well‑informed action.

Together, these sessions have strengthened guardians' abilities to recognise risks, support colleagues, and contribute to organisational cultures in which people feel safe, supported and heard when speaking up. High attendance rates across sessions on a wide range of topics reflect the system's growing appetite for practical guidance and the opportunity to learn from national subject matter experts.

Recruitment Framework for Freedom to Speak Up Guardians

This year, we at the NGO have strengthened our organisational capability by developing and publishing our Recruitment Framework⁴ to support best practice in appointing and embedding Freedom to Speak Up Guardians. The framework provides clear expectations for leaders and organisations to standardise recruitment processes and make certain the guardian role is understood, supported and effective. It outlines the principles of fair and open appointment, the competencies required for the role, and the organisational responsibilities necessary to enable guardians to carry out both the reactive and proactive elements of their work. This resource ensures greater consistency across the system and helps organisations recruit guardians who are well prepared to promote the workers' voice, address barriers to speaking up, and facilitate positive workplace cultures.

⁴ National Guardian's Office (2025). Requirements for Recruiting and Embedding Freedom to Speak Up Guardians. https://wordpress-236493-6591990.cloudwaysapps.com/wp-content/uploads/2025/05/NGO-recruitment-framework.pdf

Guardian Handbook

At the NGO, we have strengthened our support for Freedom to Speak Up Guardians this year through the introduction of the Guardian Handbook, which is a single accessible resource that brings together all key guidance, documents and links needed for the role. Located within the guardian area of the NGO website, the handbook provides clear, practical information to help both new and experienced guardians deliver a consistent, high‑quality speaking-up service.

The strength of these networks is driven by the exceptional commitment of the network chairs, co‑chairs and deputy chairs. Their leadership, coordination and compassion underpin the networks' effectiveness and ensure guardians remain connected and supported in their role, which can often feel demanding and emotionally challenging. Their generosity in giving time, expertise and encouragement continues to shape a resilient and engaged guardian community.

Freedom to Speak Up Guardian networks form a vital support infrastructure for guardians. There are seven regional networks – North East and Yorkshire, East of England, London, Midlands, North West, South East and South West; and there are five national networks – the National Ambulance Network, Hospice Network, National Non‑Provider Network, Primary Medical Services Network and the Integrated Care Board (ICB) Network. Together, these groups represent a powerful community of practice, which is sustained by the dedication and professionalism of those who lead them.

At the National Guardian's Office (NGO), we have continued to play a central role in sustaining and strengthening these networks. This has included managing membership, coordinating the recruitment and support of network chairs, and maintaining terms of reference to promote clarity, consistency and robust governance. Our members have also attended network meetings throughout the year; these offered updates and made sure guardians remained informed as the national landscape evolved.

During the period of organisational closure and the proposed transition of functions, network chairs have played an especially influential role. Acting as trusted conduits between the NGO, NHS England, Department of Health and Social Care (DHSC), Care Quality Commission (CQC) and the wider guardian community, they have provided insight, feedback and constructive challenge that has informed decision‑making and ensured transparency during a time of uncertainty.

These networks' continued strength highlights the importance of collective learning and the value of communities of practice. They remain essential in sharing emerging themes, promoting good practice, and offering timely, practical support that enhances guardians' confidence, capability and consistency in delivering their role.

At the NGO, we hosted an in-person development event in October 2025, which was designed to celebrate the efforts of the chairs and co-chairs of the 12 guardian networks and the 44 guardian mentors.

The session was expertly led by an experienced coach and facilitator known for their work in inclusive leadership and neurodiversity awareness. The session provided practical strategies for improving psychological safety and promoting genuine inclusivity, which reinforced the importance of understanding neurodiversity, not only as a difference but as a strength. This equipped the group with the skills and confidence to nurture inclusive, compassionate and effective speaking-up cultures across the healthcare system.

The feedback from participants was overwhelmingly positive, with many expressing thanks and appreciation for the workshop. Attendees described the session as relevant, insightful and energising, with several of them noting that they gained valuable knowledge to apply in their roles. The comments also highlighted the clarity provided around neurodivergence and the importance of self-reflection and self-kindness, which reinforced the workshop's impact, both professionally and personally.

This is an example of the feedback received:

"Well presented, stimulating, interactive and thought-provoking. I've come away with lots of ideas to improve my practice and I feel energised to implement these."

Freedom to Speak Up Week 2025 showcased a powerful collective commitment across the guardian network, with organisations and workers demonstrating that speaking up – and, crucially, following up – remains central to creating psychologically safe and responsive healthcare workplaces.

The theme, Follow-Up in Action, inspired engagement that went far beyond raising awareness. Across England, guardians highlighted the proactive work already underway, shared examples of improvements made in response to staff concerns and encouraged colleagues to reflect on how listening leads to meaningful change. Workers from a wide range of roles took part, which reveals the continued strengthening of a system‑wide speaking‑up culture.

Throughout the week, we at the National Guardian's Office (NGO) shared daily top tips to support stronger follow‑up practice. These focused on offering personal support, giving regular and structured updates, demonstrating visible change, and seeking feedback to improve processes. Together, they helped organisations translate the theme into practical, everyday actions.

A programme of well‑attended webinars reinforced these messages. A session led by A Kinder Life explored the role of kinder feedback and how compassion and clarity can turn difficult conversations into opportunities for organisational learning. Another session, which was delivered with the participation of Parliamentary and Health Service Ombudsman clinicians, highlighted the importance of candour, transparency and reaching seldom‑heard groups – to ensure every worker's voice has the potential to drive improvement.

'Wear it Green Wednesday' again provided a powerful visual moment. Teams across the healthcare sector shared photos and stories that demonstrated their commitment to speaking up and following up, which reinforced that when staff feel heard, valued and supported, both people and patients benefit.

What stood out most throughout the week was the high level of proactivity. Some guardians shared improvements they had already achieved, while others showcased new initiatives that had been designed to strengthen trust in speaking up. The energy and engagement demonstrated across the network reaffirmed that Freedom to Speak Up Week is not a one‑off event but is part of an ongoing, year‑round commitment.

When people speak up and organisations follow up, meaningful and lasting change becomes possible.

Over the past decade, the National Guardian's Office (NGO) has played a pivotal role in transforming how health and care organisations listen to their workforce. Having been established in response to the Freedom to Speak Up Review – also known as the Francis Report – the NGO has helped embed a culture in which workers feel safe, supported and empowered to speak up.

A central achievement has been the growth and professionalisation of the Freedom to Speak Up Guardian network. What began as a small cohort has developed into a national workforce of over 1,500 guardians supporting thousands of organisations as of February 2026. Since national data collection began in 2017, guardians have handled more than 190,000 speaking‑up cases, which has provided a trusted route for concerns that might otherwise have remained unheard. In 2024/25 alone, they supported staff with 38,158 concerns, which demonstrates increased confidence in the system.

The NGO has strengthened the network through national training, enhanced guidance and professional standards, which has driven greater consistency in how organisations embed and support the guardian role. However, national analyses continue to highlight variation in how effectively workers' voices are heard. As speaking‑up functions transition into NHS England, the Department for Health and Social Care (DHSC), the Care Quality Commission (CQC) and providers, ensuring there are clearer expectations and more consistent implementation will be essential to sustaining progress.

The NGO's legacy extends beyond processes. It has reinforced that organisational culture is inseparable from patient safety and that staff experience is fundamental to quality care. Numerous case studies illustrate the compassionate, impartial support guardians provide, which is restoring confidence for individuals and enabling concerns to be resolved.

As the NGO enters its final phase, its legacy reflects substantial progress in professionalising and strengthening speaking up across the NHS. Yet the landscape is not yet uniformly safe or reliable. Continued leadership from NHS England and DHSC will be vital to maintaining momentum; to making certain speaking up remains visible, valued and impactful; and to making sure the culture change of the past decade continues to deepen.

Accountability and Liaison Board members for 2025/26

• Suzanne McCarthy, Independent Chair
• Sir Andrew Morris OBE, Deputy Chair, NHS England
• Dr Ronke Akerele, Director of Culture Transformation, NHS England
• Ruth Owen OBE, Chief Executive Leonard Cheshire Organisation and CQC board member
• Toli Onon, Chief Inspector of Hospitals and CQC's Executive Lead for Freedom to Speak Up
• Ben Widdicombe, Deputy Director Quality, Patient Safety and Investigations, Department of Health and Social Care (DHSC)

The board meets four times a year. Its overarching purpose is to provide strategic advice to the National Guardian and the NGO on all matters related to the work portfolio, acting as a link to the sponsoring organisations' boards. The NGO reports at least annually to the CQC's and NHS England's boards.

The NGO previously received advice and support from the Partnership Working Group, whose members were senior leaders drawn from the NGO's funding bodies and the DHSC. That group's purpose was to support the delivery of the National Guardian's work programme by providing insight on emerging priorities and acting as a sounding board for ideas. In preparation for closing the NGO, the Partnership Working Group was formally stood down in autumn 2025, with the final liaison ensuring a smooth transition and continued alignment across organisations supporting speaking up in healthcare.

Finances

The NGO was allocated an annual budget for 2025/26 of £1,646,667.00, of which £1,153,476.97 is the total budget for pay and £493,190.03 is the budget for non-pay. The total spend for pay is £917,529.73 and for non-pay is £538,924.49.

Prescribed Person

The NGO is a 'prescribed person' for the purposes of section 43F of the Public Interest Disclosure Act 1998. The NGO reports annually on the number of 'qualifying disclosures' workers have made and how it has responded to those disclosures.

Enquiries to the National Guardian's Office (NGO)

In 2025/26, the number of enquiries to the NGO was 4,196. Of these, 90.1% were responded to on the same day or within five working days.