National Guardian's Office
The National Guardian’s Office provides leadership, training, and advice for Freedom to Speak Up Guardians in NHS and Foundation trusts and 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.
The role of the National Guardian was 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.
Guardians are appointed by their trusts and lead the culture change within their own organisations. This involves 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.
Guardians also work proactively to tackle barriers to speaking up and to promote openness and transparency. Dr Hughes and her office provide advice, guidance and training for the national network of guardians.
The office has also started a case review process to assess the speaking of culture in trusts where it appears that accepted standards of good practice have not been followed. The National Guardian makes recommendations to promote best practice in speaking up and provides national leadership to the NHS and surrounding organisations.
There is now a guardian in place in every trust in the country, and in fact, there are over 565 individuals playing an active part in delivering the Freedom to Speak Up agenda across all 232 trusts in England. The National Guardian has also helped train guardians for organisations in the independent sector, Arms’ Length Bodies, and other sectors.
Over the first nine months of this financial year, the National Guardian’s Office has been collecting data from guardians. In that time over 4,600 cases have been raised with guardians in trusts and a third of those cases have included an element of patient safety. The feedback that guardians have gathered from people who have spoken up has shown that nine out of ten respondents said they would speak up again.