We each have a voice that counts

We want everyone to feel safe and confident when expressing their views. If something concerns us, we should feel confident to speak up, knowing we will be listened to and supported. Our teams need to have safe spaces where they can work through issues that are worrying them.  If there is a better way of doing something, we share it. We will use our voices to shape our roles, workplaces, the NHS, and our communities, to improve the health and care of the nation.

It is important that we all take the time to really listen – beyond the words – to understand the hopes and fears that lie beneath them. We want our people to help one another through challenges, during times of change, and to make the most of new opportunities.

NHS England and NHS Improvement have recently launched the NHS People Pulse for all NHS and provider organisations, to understand our NHS people’s varied experience through COVID-19 and recovery. To build on this, we will now:

  • adapt the 2020 NHS Staff Survey to reflect the current context
  • explore options to implement a yearly survey in primary care in the autumn
  • launch a new quarterly staff survey to track people’s morale in the first quarter of 2021/22, following the results of the 2020/21 National Staff Survey.

Networks and digital spaces are also important ways to convey staff experiences. Making sure we are all empowered to speak up.  We must all make sure our people feel valued, and confident that their insights are being used to shape learning and improvement.

Also you might be interested in The power of allyship – we belong, we stay, we thrive.

Having a voice that counts success stories

You may find these useful when thinking about how to improve practices in your workplace.

More information




  • Megan Reitz and John Higgins – Speak Up: say what needs to be said and hear what needs to be heard
  • Amy Edmondson – The fearless organisation: creating Psychological Safety in the Workplace for Learning, Innovation and Growth
  • Sidney Dekker – Just Culture: Restoring Trust and Accountability in your Organisation
  • Kate Kenny, Wim Vandekerckhove, Marianna Fotaki – The Whistleblowing Guide: Speak Up Arrangements, Challenges and Best Practices
  • Margaret Heffernan – Wilful blindness: why we ignore the obvious
  • Mary C Gentile – Giving Voice to values: how to speak your mind when you know what’s right
  • Mathew Syed – Black Box thinking

Documents and websites

  • Board members of NHS trusts and foundation trusts have specific responsibilities for supporting workers to speak up, which are outlined in the guidance for boards published in July 2019 by NHS Improvement and the National Guardian’s Office. It includes a self-review tool and supplementary information
  • The National Guardian’s office has resources to support leaders and managers to foster a listening, speaking up culture
  • The National Guardian Speak Up index is a key metric for organisations to monitor their speaking up culture. The NHS Annual Staff Survey can help to give some indication as to whether Freedom to Speak Up is embedded within Trusts detailing whether staff feel knowledgeable, encouraged and supported to raise concerns and if they agree they would be treated fairly if involved in an error, near miss or incident.
  • National FTSU raising concerns policy
  • Institute of Business ethics speak up resources

Events and training

What initiatives can I take forward now?

Mersey Care’s work to embrace a Just and Learning Culture has centred on the desire to create an environment where staff feel supported and empowered to learn when things do not go as expected, rather than feeling blamed. This is a culture that instinctively asks in the case of an adverse event: “what was responsible, not who is responsible”. It is not finger-pointing and not blame-seeking. But it is not the same as an uncritically tolerant culture where anything goes. They want to ensure every one of their 8,000 colleagues, along with their service users, understand and feel a true part of their Just and Learning principles. Alongside their Freedom to Speak Up Guardians, their HR team, their Just and Learning Ambassadors and their staff side, patient safety and Centre for Perfect Care colleagues, they  are now developing plans to introduce a ‘pause’ process for colleagues who feel things in work are not going as they had hoped.

Amanda Oates, Executive Director of Workforce at Mersey Care NHS Foundation Trust, talks about their ‘Just and Learning’ culture below:

  • Action: Think about how you could put similar support systems in place for your people, and what you would need in order to do it.
  • Action: We promote and encourage you as employers to complete the free online Restorative Just and Learning Culture training and accredited learning packages to help you become fair, open and learning organisations where colleagues feel they can speak up.

Help us to help you

Do you have a success story or resource to share? Please contact us and let us know so that we can make it available for everyone.