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Freedom to Speak Up

In health and care, we must all feel able to speak up when we believe people are, or may be, harmed, as well as when we see where services and ways of working could be improved.

Freedom to Speak Up in the NHS

Freedom to Speak Up Guardians are independent roles in NHS organisations who provide impartial support to workers to speak up when they feel that they are unable to do so by other routes. Workers are defined as anyone who works in health. This includes any healthcare professionals, non-clinical workers, senior, middle and junior managers, volunteers, students, locum, bank and agency workers, and former employees (Guardian Office).

Integrated Care Boards have a role in ensuring workers in primary care have access to Freedom to Speak Up. NHS England highlights that nationally, there are relatively very few trained and registered Freedom to Speak Up guardians that support primary care workers. Even where guardians are in place, levels of speaking up (both reported and not reported to the National Guardian’s Office) remain extremely low. NHS England and the National Guardian’s Office are working to improve access to guardians in primary care.

Freedom to Speak Up Guardians are having a significant impact in encouraging people to raise concerns in the workplace. The National Guardian Office’s national survey of Freedom to Speak Up Guardians in 2023 found that 45% of respondents felt there had been an improvement in the speaking up culture in healthcare, although 26% felt the culture had deteriorated. However, people still face barriers in speaking up, with the survey identifying that almost half of respondents did not feel safe to speak up about any concerns they had. Respondents were worried about potential detriments to them, and concern that nothing will be done. Despite this, 84% of respondents said their organisation was tackling barriers to speaking up.

Creating a ‘Speaking Up Culture’ involves:

  • Valuing workers’ views on their services and service changes, enabling them to speak up without detriment.
  • Creating culturally, physically and psychologically safe working environments.
  • Informing workers about the support available to those who speak up, and how to respond when a worker does Speak Up.
  • Tackling barriers to speaking up among some groups of workers including ethnic minority workers, trainees, locums and agency workers.
  • Viewing speaking up as an opportunity to learn and improve.
  • Treating those who speak up with openness, care, empathy, compassion and respect, respecting their confidentiality.

Enabling access to mediation.

Public Interest Disclosure

In some cases, people may feel they cannot report their concerns to their employer, or they have tried to do so without success. The Public Interest Disclosure Act 1998 provides protections for workers, including in health and social care, who whistle blow where they believe it is in the public interest to do so. The charity Protect provides information and advice on to anyone considering whistleblowing.

References and Further Reading

References & Further Reading

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Last Updated on 2 July 2024

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