The National Guardian’s Office carried out a Speak Up Review of NHS Ambulance Trusts in England to understand their speaking up culture, including the enablers and barriers to speaking up.

Our objectives in carrying out this review were:

  • To describe the speaking up culture in ambulance trusts – including key challenges – and to understand why regulatory ratings did not seem to reflect the perceptions of ambulance trust workers.
  • To identify areas for improvement for ambulance trusts and make recommendations which can also be applied to all organisations supported by Freedom to Speak Up guardians.
  • To identify key areas for improvement to the regulatory and inspection regime.

Our report  – Listening to Workers: a Speak Up review of ambulance trusts in England,  sets out the five key themes which emerged from our review:

The culture in ambulance trusts is having a negative impact on workers’ ability to speak up. We heard from some ambulance workers experiencing bullying, harassment and discrimination. Workers spoke about cliques between directors, managers and workers which was stopping people feel able to speak up.

We heard many examples of workers having poor experiences when speaking up, including experiencing detriment, lack of regard for confidentiality and where some cases had not been handled in a timely manner or in accordance with policies and good practice.

There was significant variation among leadership and management in their support and understanding of speaking up and the Freedom to Speak Up Guardian role.

We found different approaches to the implementation of the Freedom to Speak Up guardian role which did not follow National Guardian’s Office guidance, with insufficient time and resource given for the role to be effective.

There was a lack of alignment between workers’ perceptions of the speaking up culture and CQC’s ratings – Workers told us about CQC inspections; they felt the “red carpet is pulled out” and that workers’ views are not captured on inspection or in the published reports.

The report makes four recommendations, which if actioned in full will be reflected in improved speaking up culture within the next three years:

  1. Review broader cultural matters in ambulance trusts
  2. Make speaking up in ambulance trusts business as usual
  3. Effectively regulate, inspect and support the improvement of speaking up culture in ambulance trusts
  4. Implement the Freedom to Speak Up Guardian role in accordance with national guidance to meet the needs of workers


Download the report: Listening to Workers: a Speak Up Review of ambulance trusts in England