Summary

From 1 July 2026, following a recommendation in July 2025 by the Dash review of patient safety across health and care, NHS England will deliver some activities previously undertaken by the National Guardian’s Office (NGO). Trusts, primary care organisations, integrated care boards (ICBs) and independent providers will be taking on greater responsibility and accountability for embedding effective Freedom to Speak Up arrangements. 

Context

In July 2025, Dr Penny Dash’s Review of patient safety across the health and care landscape recommended that the responsibilities of the National Guardian’s Office (NGO) should be taken up by providers, with related national activities delivered alongside other staff voice functions in NHS England.

The review also made clear that the Care Quality Commission (CQC) should assess whether commissioners and providers have effective Freedom to Speak Up arrangements in place, with the right skills, training and support to allow their guardians to deliver their role effectively. The 10 Year Health Plan confirmed this approach and, that the commitment to Freedom to Speak Up remains strong, with guardians continuing to be supported by their organisations and playing a vital role in fostering safe speaking‑up cultures. In January, NHS England published draft proposals setting out the future of Freedom to Speak Up for consultation. The engagement period ended on 20 February 2026 and feedback from a wide range of stakeholders, including guardians, trusts, primary care, ICBs, independent providers, commercial providers of guardian services, trade unions and arm’s length bodies has informed the approach set out here.

The revised Freedom to Speak Up responsibilities

Section 1: Leadership of the Freedom to Speak Up agenda

Supporting local leaders, maintaining national standards and system improvement.

1.1 Guardian registry

Objective

Make sure workers know who their Freedom to Speak Up guardians are, so they can easily access the right guardian and so local accountability is maintained. 

Current NGO role

The NGO registers all guardians who complete foundation training and checks whether they have completed the NGO refresher training modules. The register is published on the NGO’s website. 

What we heard  

There were mixed views from our stakeholders on the value of the current national register. Concerns were raised about the potential for publishing personal contact details on public‑facing websites, with many favouring the use of a generic organisational mailbox accessible only to named guardians as a safer and more practical alternative. 

The revised approach    

Healthcare organisations will be expected to make information about their guardian arrangements available on their websites, to support awareness of and access to their guardians and other speaking up routes. 

Key changes

• All organisations will be required to list their guardian(s) on their website including how to contact them. As a minimum requirement, they will publish the name(s) of their guardian(s) and how they can be contacted.
• The CQC will verify guardian arrangements in NHS trusts through their Well-led inspections. 
• The public-facing national register of guardians will close. 
• NHS England will receive the most current list of all guardians from the NGO before it closes, which will be used for stakeholder engagement and communication purposes only. 

1.2 Policy and guidance  

Objective

Ensure clear, consistent Freedom to Speak Up standards across all healthcare organisations, with the right balance between national consistency and local flexibility. Maintain easy access to guidance, resources, and valuable legacy NGO materials. 

Current NGO role   

The NGO produces national policy and guidance documents, sometimes in conjunction with NHS England. It sets some standards for Freedom to Speak Up implementation and guardian roles and maintains an extensive library of resources and case studies.  

What we heard  

Stakeholders felt that current policy and guidance were broadly sufficient and highlighted the need for national support to embed safe speaking‑up cultures effectively. They also emphasised the importance of ensuring that policy remains relevant and adaptable to different organisational types, sizes, and structures across the system.  

The revised approach   

NHS England’s existing Freedom to Speak Up policy and guidance function will continue. We will develop a programme of engagement for senior leaders to reinforce and clarify expectations and understand support needs in embedding Freedom to Speak Up cultures and arrangements. NHS England will review expectations of primary care providers in 2026/27 and review and rationalise policy and guidance for all other sectors during 2027/28.

Key changes

• NHS England will continue to maintain and update its existing guidance documents.  
• The NGO’s policy development responsibility will cease. 
• All NGO legacy documentation will be preserved through the National Archive site and links to relevant documents will be signposted from NHS England’s Freedom to Speak Up webpages from 1 July 2026. 
• There will be more opportunity to integrate Freedom to Speak Up insights into wider staff experience and patient safety policy development. 
• During 2026/27, the expectations of primary care providers will be reviewed by NHS England. 
• During 2027/28, NHS England will review policy and guidance for all other sectors.

1.3 Data collection

Objective

Improve national data collection so it is more consistent and supports system learning and improvement, reduces administrative burden, and integrates more effectively with existing NHS systems to generate meaningful insights.

Current NGO role

The NGO collects quantitative and qualitative Freedom to Speak Up data from all guardians every quarter and publishes the quantitative data.  

What we heard 

Stakeholders strongly supported the need for a more robust, simple and reliable reporting solution, highlighting the importance of clear user guidance and appropriate training. Concerns were raised about the confidentiality of submitted case data and whether the Model Health System is suitable or accessible for all sectors, particularly primary care where reporting varies and guardians often work across multiple organisations. There was also a clear appetite to improve the quality and usefulness of data collected and insights generated.

The revised approach

NHS England will collect quantitative data from NHS trusts and ICBs through the NHS national data collection process from April 2026. Healthcare organisations, rather than guardians, will be responsible and accountable for submitting data. National data collections for primary care and independent health care service providers will be paused for 2026/27 and reviewed.  

Key changes 

• Quarterly quantitative data collections will be through NHS England’s established national data process from April 2026. Initially, this will only cover NHS trusts, NHS foundation trusts and ICBs.
• Organisations will submit anonymised data provided by their guardian(s). Guidance to support data submission will be provided by July 2026.
• Wider access to this data will be through the Model Health System.
• Primary care and independent healthcare organisations should continue to collect and analyse Freedom to Speak Up data locally.
• The national data collection for primary care and independent healthcare organisations will be paused during 2026/27 and reviewed.
• The NGO data collection process will stop after the 2025/26 data return is completed in May/June 2026.

1.4 System learning

Objective

Strengthen system‑wide learning from speaking up by identifying themes, sharing best practice, and acting to address systemic issues.

Current NGO role  

The NGO conducts periodic speak up reviews on specific themes or organisations and publishes reports with recommendations for improvement.

What we heard

Stakeholders voiced support for thematic learning, along with broad support for the principle of thematic learning offered by the NGO’s speak up reviews, though many felt these reviews had not yet delivered their intended impact. Many emphasised the need to maintain a national learning function if these reviews don’t continue, with better integration of speak up insights with staff surveys and patient safety systems. Additional priorities included standardised data, consistent definitions, and more regular national thematic reporting to ensure learning is meaningful and actionable across the system. 

The revised approach

Support a stronger focus on system learning through the Freedom to Speak Up guardian networks, helping organisations use learning and insights to improve practice. This will help inform national oversight approaches and workforce and patient safety policy development.

Key changes

• Learning will be gathered from guardian support interactions, network feedback, data analysis and prescribed body casework functions – and insights will be shared as thematic learning across the system.  
• The standalone NGO speak up reviews will stop.

Section 2: Supporting Freedom to Speak Up guardians

Ensuring guardians have the tools, training and support they need.

2.1 Guardian training

Objective

Make sure consistent, high‑quality and accessible foundation training is available to all guardians and make sure organisations take responsibility for the continued professional development of their guardians. 

Current NGO role

The NGO provides free accredited foundation and refresher training for guardians. It  maintains central training records and regularly monitors compliance. 

What we heard

There were mixed experiences with the current training and strong support for a new platform accessible to all guardians. Stakeholders were divided on optional refresher modules, balancing flexibility with concerns about maintaining training quality. There was also positive feedback about tailored learning and development, although some stakeholders highlighted the risk of reduced access for smaller organisations and the need for protected time to complete training and continuous professional development. 

The revised approach

NHS healthcare providers and commissioners will be solely responsible for ensuring their guardians are appropriately trained, including ensuring all new guardians complete the foundation guardian training, which will be available through the e-Learning for Health platform. As part of trust-level Well-led assessments, the CQC will consider how effectively trust leadership ensures that guardians are appropriately trained.

Key changes 

• The foundation training module will be hosted by NHS England on the e-Learning for Health platform from May 2026. 
• Organisations will need to ensure their guardian completes the foundation training before starting their role. 
• New guardians will be able to access mentors through the NHS England training platform.  
• The NGO refresher training modules will be reviewed to decide whether they can be hosted on the e-Learning for Health platform and, if so, they will be optional.  
• Organisations will be responsible for ensuring their guardian(s) receive appropriate training and continuing professional development after completing the foundation training. 

2.2 Guardian support

Objective

Provide guardians with access to a supportive infrastructure that includes confidential specialist advice and clear escalation routes for complex cases. 

Current NGO role 

The NGO provides confidential one-to-one support by phone and email and access to a national employee assistance programme specifically for guardians (through the CQC). 

What we heard

Feedback showed mixed views on this function moving to NHS England and some welcomed the added authority, while others were concerned it could discourage guardians from approaching a regulator directly. There were also concerns about ending the national employee assistance programme support, with low confidence in the consistency and confidentiality of equivalent local provision. 

The revised approach   

Expert staff in NHS England will provide confidential one-to-one support for guardians, with arrangements in place to ensure this support is suitably separate from NHS England’s prescribed body function. NHS England will further consider how it can support organisations to commission independent psychological support for their guardians.  

Key changes  

• CQC’s national employee assistance programme will remain available to all guardians until 31 December 2026.   
• Organisations should ensure there is independent psychological support available locally to their guardian, potentially through their local employee assistance programme.  
• Guardians can contact NHS England at contactus@nhs.net and requests for confidential one-to-one support can be made to england.ftsu-enquiries@nhs.net. Guardians can continue to access support from their peers through the guardian networks and mentors. 
• Escalation of Freedom to Speak Up concerns nationally should continue through NHS England’s external Freedom to Speak Up policy and CQC. 

2.3 Guardian networks

Objective

Strengthen the guardian networks by supporting effective peer support, shared learning, and consistent coordination, while retaining flexibility to respond to local needs and ensuring inclusive networks are available to all guardians. 

Current NGO role

National and regional guardian networks are coordinated by NGO-appointed chairs. There are regular meetings, which are attended by the NGO. Attendance and engagement varies.

What we heard

Stakeholders raised concerns about the level of support NHS England can realistically provide. People were concerned about the administrative burden that may be placed on volunteer network chairs and about capacity at regional level. There were mixed views about whether network attendance should remain optional, given already inconsistent participation. Many felt the purpose and function of the networks should be revisited to ensure they remain inclusive, sustainable, and accessible to all guardians. 

The revised approach

NHS England’s national team will work with network chairs and regional teams during the first half of 2026/27 to understand each network and agree a way forward that maintains the guardian safe space, with chairs being supported. 

Key changes

• Existing national networks will be supported by NHS England’s Freedom to Speak Up team. 
• Existing regional networks will be supported by NHS England regional teams.  
• The purpose and function of guardian networks will be reviewed, with network chairs involved in the process.
• Network attendance will be optional.

2.4 Guardian enquiries

Objective

Make answers to Freedom to Speak Up‑related queries easily accessible to guardians, with clear online information and appropriate routing of complex queries. 

Current NGO role  

The NGO handles approximately 4,000 enquiries a year by email and phone. Most queries relate to training, guardian contacts, and data submissions and reporting. 

What we heard

There was concern about whether a contact centre could effectively manage calls, about inconsistent responses and about frequently asked questions becoming outdated. Some stakeholders raised questions about what constitutes a complex or specialist query and whether the national Freedom to Speak Up team have the skills and capacity to handle these effectively. 

The revised approach

NHS England’s contact centre will handle general enquiries and escalate specialist queries to the NHS England Freedom to Speak Up team. NHS England will clarify how more complex queries will be handled. 

Key changes  

Information will be available on the NHS England website, which will also signpost to information retained on the National Archive version of the NGO website, available from 1 July 2026.

• Stakeholders will be able to contact the NHS England contact centre with general enquiries (phone 0300 311 22 33 and email contactus@nhs.net). Specialist queries will be escalated to the national Freedom to Speak Up team.
• Guardians can request specialist one-to-one support at ftsu-enquiries@nhs.net

Appendix 1: Timeline

Publication reference: PRN02339