Executive summary

This paper provides the annual report on internal Freedom to Speak Up (FTSU). It recognises the vital work of our FTSU Guardians who support our staff to speak up, and sets out the key themes from the cases raised by our staff this year.

Action required

To thank our Guardians for their hard work, discuss the paper, agree future corporate reporting and note the next steps. 

Background

1. The Executive Group and People & Remuneration Committee received a mid-year update in November 2024, which shared information on casework themes and developments in commencing a single FTSU service. It also updated on progress against our FTSU Strategy. 

2. The outgoing SRO for FTSU is Professor Sir Stephen Powis, and the incoming SRO is Fiona Edwards, Regional Director for the North East & Yorkshire. Non-executive board oversight remains with Sir Andrew Morris. The internal FTSU Team, which supports our 38 volunteer Guardians (from across all of NHS England), is hosted in the Deputy Chief Executive Directorate.   

Assessment of issues, including themes and trends

Summary of developments in 2024/25

3. Following completion of the new NHS England programme (which brought together NHS England, Health Education England and NHS Digital), a unified FTSU service was launched on 11 June 2024. The service aligns with our FTSU Strategy, which has a vision that:

People trust that they can speak up when they have concerns as part of normal, everyday practice, confident that learning will occur, and improvement will follow.

It has five pillars:

• Improving awareness and understanding of FTSU.
• Providing effective support for our Guardians.
• All staff have a good experience of our FTSU service.
• Improving leaders’ engagement in FTSU in a way that can be seen and felt (we want all executive directors to commit to their part in making FTSU effective).
• Systematic and open approach to learning and improvement

4. The unified service features provision for completely anonymous reporting, thematic and performance data, more information on the intranet about what FTSU is and how it works, including how the role of Guardians is different to that of HR. 

Themes and trends

Cases received in 2024/25

5. We received almost 60% more concerns compared to the 201 cases in 2023/24. It would be too simplistic to assume that staff have more concerns than last year, but it is positive that more staff have felt able to speak up about them, and anonymous concerns represent about a quarter of the total cases. However, there are challenges with anonymous concerns that do not provide sufficiently detailed information to action on an individual basis and/or where those who raise concerns anonymously choose not to communicate further (via the anonymous chat function). We also have 32 cases that are over 12 months old, which reflects some of the challenges experienced with an evident improvement resulting from concerns being raised, and some of those are connected to long-running grievance cases which HR colleagues and senior managers are working hard to conclude. 

6. Indeed, NHS England’s 2023 staff survey results made clear that they experience barriers to speaking up: only 53% of staff felt safe to speak up about anything that concerns them (national average across NHS is 62%); and, if they did speak up, only 36% thought that NHS England would do something about it (national average across the NHS is 50%). As the survey was not done by NHS England in 2024, we are not able to say whether this has changed, but we fully recognise that staff continue to experience barriers to speaking up.

7. The strongest themes from concerns raised in 2024/25 are:

• bullying and harassment, by line managers, senior leaders and within teams
• Cultural Leadership, including lack of empowerment and lack of collaboration
• adherence to HR Policies
• Recruitment Practices

8. Two years ago, we said it was critical to address these (largely recurrent) themes (and the root causes of them) as we built the new NHS England. Therefore, while the relatively recent leadership development programme for our staff has been welcome, FTSU data indicates that there has been no substantive shift in improving the experiences of staff over a number of years. That may also be linked to the fact that there has been no corporate induction featuring FTSU. It feels vital that, as our functions and many of our staff are integrated into DHSC, speaking up informs any new corporate induction, line manager development and organisational development work more broadly. Particularly since the culture of the new DHSC will inevitably be heavily influenced by that of NHS England.

9. An effective and appropriately resourced HR & OD function is critical to the above. A persistent theme of FTSU concerns has related to reportedly poor experiences of the grievance process that is not person-centred. The importance of a much greater emphasis on early resolution by managers is, therefore, essential. It is good to see that steps are being taken to address much of this poor experience, with greater accountability for managers. The promotion of a suitably independent mediation service needs to be part of this.

10. Connected to the poor management of disputes and relationships in teams is the unusually high number of staff who appear to be ‘stranded’ without a suitable substantive role either following the ‘New NHS England’ programme or, more pertinently, following the raising of concerns through one of our formal or informal processes and/or the breakdown of relationships. Clearly, senior leaders and management bear significant responsibility for this, but it is also clear that our HR & OD function has not always been able to support them effectively. The recent change programme for HR & OD, therefore, is welcome, but the fact that the integration with DHSC means that the function now needs to pivot yet again means that its fragility should be recognised and support for it prioritised.

11. Regular liaison between FTSU and senior leaders in HR has been ongoing to provide for escalation of our most complex and/or long-running cases. Greater focus and accountability for managers will hopefully reduce the need for this, and move to FTSU engagement with executive directors and their senior teams.

12. During 2024/25, Guardians continued to have the opportunity to raise thematic concerns with (former) Chief Executive, Amanda Pritchard, and with our non-executive directors. Jim Mackey is due to meet the Guardians on 1 July.

Improvements from FTSU cases in 2024/25

13. Delivery of recommendations from a FTSU investigation into events dating back to 2019 have begun to be implemented to address detriment caused to a member of staff for speaking up and also gain assurance that those original concerns were investigated appropriately. This case highlighted the importance of genuinely listening to staff and senior managers getting a second independent opinion on the approach they are taking, as well as consistent HR support.

14. In another case, the trust in FTSU Guardians was essential to multiple staff coming forward with significant concerns about culture and leadership behaviour in a team. The Guardians built trust with those individuals, ultimately providing a bridge to HR for those staff so their concerns could be investigated under the appropriate policy. However, implementation of recommendations, particularly improvements in culture and leadership behaviours are not apparent to those who have spoken up at the time of writing. It is expected that new executive leadership will ensure that is addressed.

15. In another case, where similar themes of concern were raised, the relevant executive director has overseen a programme of cultural development. This underlined the importance of considering the overall perception of leadership behaviours in a team (even where individual ‘complaints’ may not have been fully upheld) and executive directors taking responsibility for ensuring feedback is heard rather than refuted or ‘explained away’, and accountability for improvement was made clear.

16. Where concerns were raised about a major procurement process, the early engagement of the relevant executive director and their willingness to take the concerns seriously and commission an independent review resulted in positive feedback from the person who spoke up, even though their concerns were not substantiated by that review. This underlines the impact of meaningful engagement by senior leaders who genuinely listen and respond substantively. Feedback tells us that this needs to happen more often.

Review of our FTSU Service

17. It was agreed that the effectiveness of the new service would be reviewed at the end of 2024/25. That review has been completed and took account of a range of feedback, including:

• internal Audit
• NHS England’s Reflection & Planning Tool output
• FTSU Guardians
• staff who have used the service (via an anonymous survey)
• staff networks and other groups
• HR Business Partners
• periodic conversations with individual executive directors

18. That collated feedback identified the following common themes (we have included anonymous feedback from service users to highlight some of these):

• new service elements of anonymity and clarity on the role of FTSU was welcome. Even more could be done on the latter.
• the diversity of the Guardian cohort and ability to choose a Guardian are strengths.
• consistency of responsiveness of FTSU service could be improved further.
• frustration with the organisation’s responses to speaking up, despite positive efforts of the FTSU Service, particularly senior leaders not engaging with concerns being raised/experienced, sometimes because of an insistence that concerns are ‘proven’ through formal process.
  • “[After I spoke up…] I felt better, but can’t say I felt totally assured that changes would happen”.
  • “[After I spoke up…] I felt relieved at first but now am sad that my experiences made no difference to the way the programme and organisation operates”.
• greater engagement, listening and action by senior management in responding to speaking up.
  • “Commitment to response times and actions from senior leadership. Again to be clear – the Guardian I spoke to was excellent – but it’s the wider organisation who needs to step up to make this process work”.
• need for even more communications with staff about how FTSU works, including greater efforts to improve the perception of the safety of speaking up.
• improve elements of the case management process to ensure perception of fairness and appropriate and effective escalation.
  • “The guardian was very good in this respect, but I’m not sure the organisation was responding appropriately to the concern she raised on my behalf”.
  • “My concerns are complex and still being worked through. Escalation feels a bit laboured and slow”.
• need to further improve data collection and sharing (while maintaining confidentiality) to enable senior leaders to understand and act on thematic feedback from FTSU.
• much greater articulation of learning and improvement is needed as a result of speaking up.
  • “The organisation has learnt absolutely nothing from my case. I know this because the same issues remain completely unchanged”.

19. Lack of capacity of our Guardians to handle all the cases being received has proven a challenge at times, particularly in the first six months of the new service when case numbers were consistently high and some Guardians were not in a position to take on new cases. This has now been addressed by recruiting more Guardians, but something we will need to monitor given the possibility that some will leave through voluntary redundancy. As well as compliance with National Guardian’s Office training requirements, all Guardians have had the opportunity to receive additional training on skills which are specific to the role, feedback from which has been very positive.

20. This feedback, where not already anticipated and being addressed, has informed the focus of our plans for 2025/26.

Next steps

21. The next six months will be focused on:

• commencing a systematic approach to capturing and sharing learning and improvement that results from speaking up
• consolidated support for Guardians, including enhanced processes for case management.
• embedding an enhanced approach for addressing (and preventing) detriment that is sometimes reported when staff speak up
• communications and engagement campaign focused on the value of listening by managers.
• engagement with executive directors and their senior teams on a regular basis
• engaging with DHSC colleagues to understand their approach to speaking up and share our learning to-date
• confirm future corporate reporting requirements for FTSU

Publication reference: Public Board paper (BM/25/29(Pu))