Freedom to Speak Up: guardians, the national policy and what works

Freedom to Speak Up (FTSU) is the NHS speaking-up system in England. Organizations that provide NHS services under the NHS Standard Contract must appoint a Freedom to Speak Up Guardian, whom staff can go to with a concern. A national policy sets out how concerns are raised and followed up.

Picture a hypothetical guardian at an acute trust in October. The guardian has half a day a week for the role and 60 open cases in a spreadsheet. The twice-yearly report to the board is due at the end of the week.

Three of the cases arrived as anonymous emails, and there is no way to reply. Two people who spoke up in the spring have asked whether anything happened, and the guardian does not know. The board paper will not say how many people received feedback, or whether anyone was worse off for speaking up. Nobody has counted.

That guardian is not unusual. A 2025 National Guardian's Office survey of guardians found that 23 percent had no ring-fenced time. Another 25 percent had up to half a day a week.

What Freedom to Speak Up is

Freedom to Speak Up comes from Sir Robert Francis QC's review of that title, published on 11 February 2015. It recommended a Freedom to Speak Up Guardian in every NHS organization, and an independent National Guardian to lead them. The National Guardian's Office was set up in 2016, hosted by the Care Quality Commission (CQC).

The guardian is a named person inside the organization whom any worker can go to when they feel unable to speak up by other routes. The guardian does not investigate. The guardian makes sure the concern reaches the right people, that the worker is supported, and that the worker is told what happened.

The role is contractual. All organizations that provide services under the NHS Standard Contract are required to appoint a guardian. NHS England confirmed on 13 August 2025 that the role remains in the Standard Contract for 2026/27. As of 6 March 2026 there were 1,519 registered guardians across 820 organizations, according to the National Guardian's Office annual report for 2025/26.

In primary care a guardian is not a contractual requirement. Integrated care boards are expected to make sure GP practice staff can reach one independent of the practice.

The national policy, “Freedom to speak up policy for the NHS”, was published by NHS England in June 2022 with a guide for leaders. Trusts adopt it largely verbatim.

What the national policy requires

The policy is short. It works as a specification: a trust can check its own arrangements against each line.

• The policy's list of who can speak up is broad: “Anyone who works at the Trust including any healthcare professionals, non-clinical workers, receptionists, directors, managers, contractors, volunteers, students, trainees, locum, bank and agency workers, and former workers.”
• Workers can speak up openly, confidentially or anonymously. The policy is candid about the third. Anonymity “can make it difficult for others to ask you for further information” and to “receive any feedback on the outcome”.
• Any ordinary channel will do. “You should speak up to any of the people or organisations listed above in person, by phone or in writing (including email).” No dedicated hotline is required.
• The guardian is a person “who can support you to speak up if you feel unable to do so by other routes”. The policy adds: “The Guardian will ensure that... the person speaking up receives feedback on the actions taken.”
• Two leaders share oversight. A senior lead is responsible for reviewing the effectiveness of the arrangements. A non-executive director is there to “provide a fresh pair of eyes to ensure that investigations are conducted with rigor”.
• The board hears twice a year. “Our most senior leaders will receive a report biannually providing a thematic overview of speaking up by our staff to our FTSU guardian.”
• The policy rules out detriment: “We will not tolerate anyone being prevented or deterred from speaking up or being mistreated because they have spoken up.”
• External routes are listed too. They are the CQC, NHS England, the NHS Counter Fraud Authority, the professional regulators and Protect. Speak Up Direct is also listed, and “provides free, independent, confidential advice”.

The eight principles for leaders

The guide for leaders is addressed to “any senior team, owner or board in any organisation that delivers NHS commissioned services”. That includes primary care and independent providers. In summary, its eight principles are:

1. Value speaking up.
2. Role-model speaking up and set a healthy Freedom to Speak Up culture.
3. Make sure workers know how to speak up and feel safe and encouraged to do so.
4. When someone speaks up, thank them, listen up and follow up.
5. Use speaking up as an opportunity to learn and improve.
6. Support guardians to fulfill their role. “All guardians should have ringfenced time to fulfil workers' needs.”
7. Identify and tackle barriers to speaking up.
8. Know the strengths and weaknesses of the organization's speaking-up culture and take action to keep improving it.

On the eighth, the guide tells boards to triangulate. Speaking-up themes are set beside complaints, claims, safeguarding, incidents, never events, grievances, tribunal numbers, exit interviews, sickness, retention and the staff survey.

The guide names two red flags. One is “A high proportion of the cases raised are anonymous”. The other is “A high proportion of the cases raised include an element of detriment”.

What the numbers say

The National Guardian's Office published its last full-year data on 2 July 2025, for 2024/25. Guardians recorded 38,158 cases, an 18.6 percent increase on the 32,167 of 2023/24. Of those, 17.8 percent included an element of patient safety or quality.

Anonymous cases were 11.6 percent, up from 9.5. Detriment for speaking up was indicated in 2.9 percent, down 1.1 points, which is still more than 1,100 people in a year. Of those who gave feedback, 79.9 percent said they would speak up again.

The first half of 2025/26, April to September, is in the office's final annual report. It shows 18,113 cases, 12.2 percent anonymous, 17.0 percent involving patient safety, and detriment in 2.6 percent.

Speaking up in the NHS, 2023/24 to 2025/26 H1

The staff survey shows the gap the case data cannot. In the NHS Staff Survey for 2025, published on 12 March 2026, 71.1 percent of staff felt safe to raise concerns about unsafe clinical practice. Only 55.5 percent trusted their organization to act. For any concern, the figures were 61.5 percent and 47.6 percent.

The gap is about 15 points, and it is not closing. In the 2024 survey the clinical figures were 71.5 percent and 56.8 percent.

The guardian survey from 2025, with 586 responses, explains part of it. Sixty percent of guardians said they had sufficient time for the role, up from 55 percent in 2023. Twenty percent had more than four days a week and 23 percent had none, so many guardians do the role in the margins of another job. Ninety percent would recommend the role.

What changed in 2025 and 2026

For a trust, the practical change is three duties and a new CQC check. NHS England's “The future of Freedom to Speak Up” requires providers to keep their guardian's contact details publicly available and to submit their speaking-up data (for 2026/27, trusts and integrated care boards only). Providers must also make sure guardians complete the mandatory foundation training.

From July 2026, the CQC's trust-level well-led assessments would “consider how effectively trust leadership ensures that guardians are appropriately trained”. Dr Penny Dash's review of patient safety had already said that assessing “whether every commissioner and provider has effective Freedom to Speak Up functions” should be a core function of the CQC.

The national structure around those duties moved several times in eighteen months.

• 7 July 2025. The Dash review examined six national bodies, the National Guardian's Office among them. It said the office's responsibilities “should be incorporated into providers. This means that the distinct role of National Guardian is no longer required”. The government accepted all nine of its recommendations.
• 21 July 2025. The Department of Health and Social Care (DHSC) said a statutory barring system would cover “board-level directors and their direct reports within NHS bodies”. Wes Streeting, then Health Secretary, said: “If you silence whistleblowers, you will never work in the NHS again.”
• 16 April 2026. NHS England said that from 1 July 2026 it would run guardian networks, guardian foundation training and national data collection, and review the national policy.
• June 2026. The National Guardian's Office closed.
• 15 September 2026. The Thirlwall Inquiry reported.

The Thirlwall Inquiry is the independent public inquiry into events at the Countess of Chester Hospital, set up after the convictions of the neonatal nurse Lucy Letby. It made 17 recommendations. Recommendation 13: “DHSC and NHS England must develop and put in place a barring system for all managers (clinical and non-clinical) by September 2027”. That system is to be reviewed in 2030, with a view to full statutory regulation by September 2032.

Recommendation 16: “The functions of the National Guardian's Office should be taken over by the Parliamentary and Health Service Ombudsman in England”. The Ombudsman would gain new powers to investigate complaints that NHS whistleblowing “has not been dealt with adequately”.

The same day the Health Secretary, Yvette Cooper, said that “Staff who speak up must be protected and taken seriously”. She said a barring scheme will apply “to senior leaders and managers, not just to clinicians”. The government, she said, will legislate “as soon as Parliamentary time allows”.

Where the national functions sit now

The guardian sits in the Standard Contract and reports inside the trust. Since the National Guardian's Office closed, NHS England has run training, networks, data collection and policy. The government announced the abolition of NHS England on 13 March 2025.

Subject to the Health Bill, which is still before Parliament, NHS England is due to be merged into DHSC in April 2027, and those functions would move with it. That would change if the government adopts the Thirlwall recommendation to give them to the Ombudsman.

The CQC assesses whether speaking up works and, from July 2026, whether guardians are trained. The inquiry wants a barring scheme for managers by September 2027, and the government has promised legislation but has not set a date. Of all these pieces, the organization's own program is the only one that does not depend on which national body ends up in charge.

The law underneath

Freedom to Speak Up sits on top of the Public Interest Disclosure Act 1998, which forms Part IVA of the Employment Rights Act 1996. NHS workers are covered like any other. Section 47B gives a worker the right not to suffer detriment for making a protected disclosure, and section 103A makes dismissal for that reason automatically unfair.

The CQC is a prescribed person, so a disclosure to it can be protected if the worker reasonably believes the matter falls within its remit and that the information is substantially true. The test and the remedies are set out in Confide's guide to whistleblower retaliation.

NHS whistleblowing also has one protection no other sector has. Section 49B of the 1996 Act covers job applicants. “An NHS employer must not discriminate against an applicant because it appears to the NHS employer that the applicant has made a protected disclosure.” The 2018 Regulations, SI 2018/579, brought it into force on 23 May 2018, and a tribunal can award compensation.

Social care

Adult social care has no guardian requirement. DHSC said in April 2023 that “the previous commitment on Freedom to Speak Up in Adult Social Care is not being taken forward at this stage”.

What applies instead is the CQC framework. The CQC's well-led quality statement applies to every registered provider, including care homes and homecare. It reads: “We foster a positive culture where people feel that they can speak up and that their voice will be heard”.

Beneath it sit two regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17 requires that “systems or processes must be established and operated effectively”. Their purpose is to “assess, monitor and improve the quality and safety of the services provided” and to “seek and act on feedback”. Regulation 20 is the duty of candour.

A care provider with no route for staff to raise a concern, and no record of what happened to the concerns raised, is likely to struggle to show the CQC that it meets Regulation 17, before culture even comes into it. Social care workers in England also have Speak Up Direct. It is the free, independent and confidential helpline operated on behalf of DHSC.

What the cases have cost

There is no published national total for NHS whistleblowing litigation. Dr Raj Mattu settled for £1.22 million in February 2016. Dr Kevin Beatt was awarded £857,110 in March 2020. In January 2026 the Countess of Chester trust agreed a £1.4 million settlement with Dr Susan Gilby, its former chief executive, after a tribunal found in 2025 that she had been unfairly dismissed and subjected to detriment for whistleblowing.

Dr Chris Day's claim, begun in 2014, settled in October 2018. By December 2018 Health Education England and the trust had spent more than £700,000 fighting it. That sum was later reported to have passed £1 million. The Employment Appeal Tribunal dismissed his later appeal on 19 August 2025.

Across the first three cases, awards and settlements came to more than £3.4 million. Public bodies spent more than £1 million resisting the fourth.

What a program that works looks like

The policy, the guide for leaders and the CQC's well-led statement describe the same system from three angles. Some parts are written requirements, such as foundation training and the twice-yearly board report. Others, such as checking for detriment at intake and again later, are practice the documents point to rather than spell out. The system has seven parts.

1. Offer three routes, and make the anonymous one work in both directions. The routes are open, confidential and anonymous. The anonymous route lets the guardian ask follow-up questions and give feedback without the person having to give their name.
2. Give a trained guardian ring-fenced time. Foundation training is mandatory, and the CQC looks at it from July 2026. Without protected hours the guardian cannot follow up or give feedback.
3. Name an executive lead and a non-executive director. One is accountable for the arrangements. The other sits outside the executive line and checks that investigations are rigorous.
4. Give feedback to every person who spoke up. Record it per case with the date, so the board report can say how many people were told what happened.
5. Track and escalate detriment. Every case asks whether the person has suffered for speaking up, at intake and again later. A yes is a new case, owned above the line manager, and a number the board sees.
6. Triangulate. Set speaking-up themes beside incidents, complaints, claims, grievances, exit interviews, sickness and the staff survey.
7. Put the red flags in the twice-yearly board report. Report themes as well as counts. Show the proportion of anonymous cases and the proportion with detriment against the national 11.6 and 2.9 percent, plus feedback given and time to close.

How Confide supports it

The guardian's hardest cases are the anonymous emails with no way to reply. In Confide's Whistleblowing Software, a worker can report without giving a name and keep a two-way conversation open with the guardian. The guardian can ask the follow-up questions the policy says anonymity makes difficult, and send feedback, without the person having to reveal who they are.

Each concern, its evidence and the messages about it stay in one case until it closes, and every access and action is logged. If a user is named in a report, Confide automatically revokes their access to that case.

The twice-yearly board report is where this pays off. Sentinel, Confide's AI agent, answers plain-language questions across recorded cases and cites the cases it used, and it can build a dashboard from the answers. A guardian could ask how many people received feedback, or which cases recorded detriment, provided the cases record those things. The guardian should check the cited cases before anything goes in the board paper, and the organization decides whether to switch Sentinel on at all.

Freedom to Speak Up FAQ

What is a Freedom to Speak Up Guardian?

A Freedom to Speak Up Guardian is a named person inside an NHS organization. Any worker who feels unable to raise a concern by other routes can go to the guardian. The role comes from Sir Robert Francis's 2015 review.

Every organization providing services under the NHS Standard Contract is required to have one. The guardian supports the worker, gets the concern to the right people and makes sure the person receives feedback. In March 2026 there were 1,519 guardians across 820 organizations.

Is Freedom to Speak Up the same as whistleblowing?

They overlap but are not identical. In UK law, whistleblowing means a protected disclosure under the Public Interest Disclosure Act 1998. The Act gives a worker the right not to suffer detriment or dismissal for making it.

Freedom to Speak Up is wider. The NHS policy covers any concern a worker raises, including about culture and behavior, whether or not it would qualify as a protected disclosure. A concern raised through a guardian can be both.

Can NHS staff speak up anonymously?

Yes. The national policy gives three choices: openly, confidentially or anonymously. It warns that anonymity “can make it difficult for others to ask you for further information” and to receive feedback on the outcome.

In 2024/25, 11.6 percent of the 38,158 cases recorded by guardians were anonymous. A route with two-way anonymous messaging lets the reporter answer questions and receive feedback, which are the two difficulties the warning names.

What happened to the National Guardian's Office?

It closed in June 2026. The Dash review of 7 July 2025 had said the distinct role of National Guardian was no longer required, and the government accepted the recommendation. From 1 July 2026, NHS England took on guardian training, guardian networks, national data collection and policy review.

On 15 September 2026, the Thirlwall Inquiry recommended that the office's functions go to the Parliamentary and Health Service Ombudsman. NHS England itself is due to move into the Department of Health and Social Care in April 2027, subject to the Health Bill.

Does Freedom to Speak Up apply to social care?

Not as a guardian requirement. The government said in April 2023 that its commitment to explore guardians in adult social care was not being taken forward. What applies instead is the CQC's well-led quality statement on speaking up, which covers every registered provider, including care homes and homecare.

Beneath it sit Regulation 17 on quality systems and feedback, and Regulation 20, the duty of candour. Social care workers in England can also use Speak Up Direct, the free and confidential helpline run for the Department of Health and Social Care.

Before the next board report

The national office has gone, and the inquiry wants an Ombudsman with powers to investigate how a trust handled a concern. The CQC is asking whether the guardian is trained, and the inquiry wants a barring scheme for managers who silence staff.

Each of those asks for the same evidence: what came in, who saw it and what was done. Each also asks whether the person was told, and whether they were worse off afterwards. Before the next board report, check whether your trust can answer those questions from its case records or only from memory.

If the answer is memory, Confide's Whistleblowing Software gives the guardian one case record and a two-way anonymous route from the first concern.