NHS England » External freedom to speak up policy for NHS workers

1. Speak up – we will listen

This policy outlines how we will respond to and support workers who speak up to NHS England.

NHS England takes reports of wrongdoing within NHS organisations seriously. Anyone working for the NHS in England can report serious wrongdoing to us which relates to our regulatory and oversight role and is in the public interest – this is known as a protected disclosure, whistleblowing or speaking up. For consistency we will use the term speaking up throughout this policy.

By speaking up at work you will be playing a vital role in helping us to keep improving NHS services for all patients.

2. What can I speak up to NHS England about?

Before speaking up to us, it will be helpful to consider whether your concerns meet the criteria for speaking up to NHS England in our role as a prescribed body.

1. You must be a current or former NHS worker, or work (or have worked) for a service providing NHS services.

2. Your speaking up needs to be in the public interest, which means it must affect others, rather than being a personal issue or grievance.

3. The speaking up should relate to 1 of the following categories:

a. a criminal offence
b. a breach of a legal obligation
c. a miscarriage of justice
d. health or safety
e. environmental damage
f. the deliberate covering up of wrongdoing in these categories

4. The speaking up must be in relation to a matter we regulate:

a. the regulation and performance of English NHS trusts and foundation trusts
b. matters relating to the delivery of primary medical, dental, ophthalmic and pharmaceutical services in England
c. matters relating to the licensing and oversight of providers of NHS healthcare services or the NHS Payment Scheme
d. matters relating to NHS England’s education and training functions
e. matters relating to NHS England’s oversight and support of integrated care boards pursuant to its functions under the National Health Service Act 2006, as amended

Examples of this might include matters relating to (but by no means restricted to):

serious and/or widespread matters related to unsafe patient care
a widespread bullying culture (that is, bullying that is taking place across a team or organisation and not being addressed by the senior leadership of the organisation, rather than individual instances of bullying. Individual instances of bullying should be reported within your organisation)

serious financial irregularities or mismanagement (suspicions of fraud should also be reported to your organisation’s counter-fraud team)
serious conduct matters related to senior leaders (that is, board members, senior partners)
poor overall governance of an organisation
poor oversight of an NHS system
how an integrated care board is managing a system’s finances
serious matters relating to the education and training for healthcare workers (not personal concerns about an individual’s training)

If in doubt, please speak up. It does not matter if you are mistaken or if there is an innocent explanation for concerns you raise. We will consider all information we receive and decide whether any action is required, taking account of the wider information we hold.

Concerns which do not meet our threshold for taking action

As a national body we focus on issues that fall within NHS England’s remit (section 2.4, a to d) and which either inform our regulation and oversight of NHS organisations, and/or present the highest levels of risk or seriousness.

Where this threshold is not met, we may not take action as a direct result of receiving that information. However, the information you share will be recorded and used to inform our ongoing understanding of and any future decisions relating to the organisation concerned.

Personal concerns about your employment

If the matter you are raising is a personal employment-related complaint that only affects you, NHS England is not able to intervene. This is because such matters are generally private issues between you and your employer.

However, some cases may be more complex and involve some aspects listed in section 2

We will consider all the information we receive and decide whether any action is required in line with our remit.

Where possible, we will use information on staff experience to share thematic learning from any such reports we have received with relevant teams within NHS England to inform future policy and guidance for the NHS.

Responsible body

In some cases, NHS England may not be the appropriate or responsible body to consider the matters you are raising. Where another organisation would be better placed to do so, we will where possible explain who that is and share their contact details with you. It will then be for you to decide whether you wish to pursue your concerns with them.

In some circumstances, we may decide to share the information you have provided with a more appropriate body, for example, where we are required to do so by law or where there are strong public interest reasons such as harm to patients or criminal activity. Where possible, we will seek your consent before sharing information.

3. Who can speak up?

This policy is for all NHS workers. Anyone who works in NHS healthcare (including general practice, pharmacy, optometry and dentistry) or works for an independent sector provider of NHS services.

This encompasses any healthcare professionals, non-clinical workers, administrative workers, directors, managers, contractors, volunteers, students, trainees, resident doctors, locum, bank and agency workers and former workers.

We also know some groups in the NHS workforce feel they are seldom heard or find it difficult to speak up. We also know that workers with disabilities, or those who are from a minority ethnic background or the LGBTQIA+ community, do not always feel able to speak up.

We hope this policy will encourage all NHS colleagues to speak up.

4. How to speak up

The national speak up policy allows you to raise a broader range of concerns within your organisation than this policy. Therefore, in most circumstances, the best way to resolve matters is to raise them within your organisation. The organisation where you work should have details of how you can speak up.

Typically, these may be on your intranet, in your organisation’s Freedom to Speak Up policy, in your staff handbook or your line or practice manager should have details.

Alternatively, where you have access to a Freedom to Speak Up guardian, you can approach them. We hope that doing this will give you confidence that the matters will be, or have been, looked into properly.

We recognise there may be times when you wish to raise concerns outside your organisation – for example, where you do not feel they have been effectively addressed, or where you remain concerned after raising them internally. We also understand that not everyone will feel able to speak up within their own organisation.

Where concerns are raised with NHS England, they will need to meet the criteria set out in section 2 for us to take action and NHS England will consider each case on that basis.

Contact details

You can email NHS England’s national Freedom to Speak Up team directly. Please include the information below as this will ensure we can more quickly progress the matters you are raising.

You can also contact our customer contact centre via telephone or in writing to provide details of the matters you are raising.

Colleagues in our customer contact centre will listen to your concerns confidentially and direct you to the correct team. You can speak up:

by email: england.speakup1@nhs.net
by phone: 0300 311 22 33
in writing to:

NHS England
PO Box 16738
Redditch
B97 9PT

Whichever route you choose, please be ready to explain as fully as you can the information and circumstances that gave rise to your speaking up.

It is helpful to know the following:

some details of the matters concerning you and where possible please outline how you think they relate to our remit (section 2)
who is already aware of the matters you are raising
how long the issues have been going on for
where the issues are occurring and who is involved
if you have any supporting documentation or evidence; this can help us to make a decision

If you require additional support to contact us, please let us know at any stage and we will do our best to make alternative suitable arrangements.

5. Feel safe to speak up

Speaking up provides a valuable source of intelligence for NHS England in its regulatory and oversight role, and we want to ensure you feel safe to speak up to us.

If information we receive suggests you may be experiencing disadvantage as a result of speaking to us, we will carefully consider whether this points to a wider issue in how the organisation is being run.

Confidentiality

The most important aspect of your speaking up is the information you can provide, not your identity.

You have a choice about how you speak up:

Openly: you are happy that we know your identity and we can share this with anyone else involved in responding. In these cases, we will still do all we can to keep your identity confidential.
Confidentially: you are happy for your identity to be known to us, but you do not want this to be shared with anyone else.
Anonymously: you do not want to reveal your identity to anyone. This may make it difficult for us to ask you for further information about the matters and may make it more complicated for us to act to resolve the issues. It also means we might not be able to advise on further support you can access, and we may be limited in our ability to provide feedback.

If we decide to contact your organisation about your concerns, we will discuss that with you to mitigate the risk that, depending on the circumstances, it may be possible for your employer to work out who notified us, particularly if you have already raised the matter with them.

However you choose to speak up we will take your concerns seriously.

When you speak up to us, unless you tell us otherwise, we will assume you are giving consent for us to share your concerns with a minimum number of relevant colleagues within NHS England, where this is necessary to consider the issues raised.

NHS England will consider whether concerns raised with us are more appropriately considered by another organisation. Where this is the case, we will determine what information, if any, needs to be shared based on the nature of the concerns, and will seek your consent where the information would otherwise be subject to a duty of confidence.

In some circumstances, even where consent is not given, we may still share information where we are required to do so by law or where there are strong public interest reasons, such as to prevent harm to patients or potential criminal activity.

6. What we will do next

What we will do with your information

Our Freedom to Speak Up team is responsible for co-ordinating and overseeing all speaking up cases received by NHS England and will create a report of your concerns.

Your details, if you choose to provide them, are held on a secure database that is only accessed by the Freedom to Speak Up team.

Making a decision

We will gather any relevant information we hold on the organisation.

Each speaking up concern is assessed on a case-by-case basis to determine whether the matters fall within NHS England’s regulatory and oversight role. Where they do not, we will consider whether another body may be better placed to consider the issues raised.

Where matters fall within our remit, we will assess the seriousness and the potential risk of harm. Information provided is also retained as intelligence and may be reviewed alongside any future concerns raised.

Where we determine that action is required, NHS England will decide how to proceed. While you will not be involved in determining the action taken, we will explain our decision to you.

What happens next?

There are a range of actions we may take. We may:

Decide we do not need to take any action

On occasion, even where matters reach our usual threshold for action, we may decide not to take any action if the issues raised are covered by 1 or more of the following scenarios:

the issue is already known to and action is being taken by NHS England (for example, covered as part of an existing regulatory issue)
the concerns provide no new information about a known issue

Where we decide not to pursue the matters further, we will explain why.

For example, if we decide the issues are relevant to its role. Where possible we will seek your consent before we do this.

Decide we need to make enquiries to the organisation

Making enquiries by approaching the relevant organisation for further information enables us to decide what action, if any, is needed to address any issues raised.

Decide the issues need further investigation

Examples of how we do this include (but are not limited to):

asking the relevant integrated care board to investigate
asking the organisation which is the focus of the speaking up concerns to investigate the issues, often with our input
sending the matters for review to the ‘responsible officer’ who manages performance concerns (for concerns relating to individual GPs (general practitioners), dentists or optometrists)
approaching the relevant regional team responsible for overseeing the planning and delivery of education and training for healthcare workers for further information or asking them to investigate

In exceptional circumstances, we may investigate the issue(s) ourselves. We will take the following factors into account:

the potential impact of the issues raised on patient safety
whether the matters have already been looked at, or investigated, by another appropriate organisation (for example, the integrated care board has already reviewed the concerns under the delegation agreement) and how effective the response has been
our confidence in the ability of the organisation’s senior leadership to respond and investigate effectively
the potential learning available to the wider system from an investigation
how long ago the events in question occurred

Communicating with you

We will treat you with respect and will thank you for speaking up.

Where it is appropriate for us to look into the issues further, we will tell you whether we will be making enquiries to the organisation or whether there will be an investigation. It can be difficult to give specific timescales due to the complexity of the issues we receive but where we have relevant updates we will share those with you.

In all cases, we will tell you how we plan to use the information you have given us.

Feedback

Wherever possible we will share feedback with you. It’s important to understand, however, that in many cases what we can share with you will be limited due to the confidential or sensitive nature of the information or due to legal restrictions.

Where we decide not to pursue the matter further, we will explain why.

Complaints about our decision

If you are unhappy with the way we have handled the matters you have raised, NHS England’s complaints process (NHS England’s complaints policy) will consider whether your speaking up concerns have been handled in line with this policy. It will not however investigate the speaking up concerns themselves.

7. How we learn from your speaking up

We want speaking up to improve the services the NHS provides and the environments our staff work in. Where speaking up has identified improvements that can be made, we will support organisations to make those improvements.

Learning will be shared either within organisations or more widely across systems or the wider NHS as appropriate.

We will regularly monitor the effectiveness of this policy and our speaking up arrangements, using all feedback as an opportunity to improve.

8. Advice and support

We know that speaking up can be daunting. However, you are not alone and support is available.

You can find out about the local support available to you on your staff intranet, staff handbook, and from your line manager, the practice manager, occupational health department or HR (human resources) team. Where you have them, staff networks can also be a valuable source of support.

You can also access a range of health and wellbeing support via NHS England:

You can also contact the following organisations:

Speak Up provides free, independent, confidential advice on the speaking up process
the charity Protect provides confidential and legal advice on speaking up
the Trades Union Congress provides information on how to join a trade union
the Law Society may be able to point you to other sources of advice and support
the Advisory, Conciliation and Arbitration Service gives advice and assistance, including on early conciliation regarding employment disputes

Policy impact assessment

As part of the development of this policy, its impact on the business has been assessed.

No detrimental issues were identified.

Appendix 1

Making a ‘protected disclosure’

NHS England is a prescribed body to which you can make a ‘protected disclosure’ where the disclosure is relevant to our role.

A protected disclosure is defined in the Employment Rights Act 1996. This legislation allows workers (subject to a few exceptions) to lodge a claim for compensation with an employment tribunal if they are subjected to a detriment because of speaking up. The legislation is complex and to qualify for protection under it, specific criteria must be met in relation to who is speaking up, about what and to whom. To help you consider whether you might meet these criteria, please seek independent advice from Protect or a legal representative.

There is a defined list of other ‘prescribed persons’ to whom you may also make a protected disclosure.

Publication reference: PRN02307

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