National Guardian

The National Guardian’s Office was established as a key recommendation from Sir Robert Francis’ Freedom to Speak Up Review in response to the Mid-Staffordshire scandal. Dr Henrietta Hughes, the National Guardian for the NHS, took up the post in October 2016. Her office is an independent body, sponsored equally by the Care Quality Commission, NHS Improvement, and NHS England, with a remit to lead the culture change in the NHS so that speaking up becomes business as usual. 

The National Guardian’s Office provides leadership, training, and advice for Freedom to Speak Up Guardians. Initially focused on NHS and Foundation trusts, its remit has recently expanded to include Primary Care and other healthcare providers. The National Guardian’s Office also provides the challenge, learning and support to the healthcare system as a whole by reviewing trusts’ speaking up culture and the handling of concerns where they have not followed good practice. 

Guardians lead the culture change within their own organisations, supporting workers who wish to speak up, ensuring that they are thanked for speaking up, that the issues they raise are responded to, and making sure that they receive feedback on the actions taken as a result of them raising an issue. 

There are now over 1,000 guardians in healthcare provider organisations and arm’s-length bodies in England playing an active part in delivering Freedom to Speak Up. During the first two years’ over which the National Guardian’s Office has been collecting data from guardians in trusts, over 11,000 NHS workers have spoken up to a guardian. A third of those cases included an element of patient safety and the feedback that guardians have gathered from people who have spoken up has shown that around nine out of ten respondents said they would speak up again.