Freedom to Speak Up development and support

From 1 July 2026, following a recommendation 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 (FTSU) arrangements.

More information is available in The future of Freedom to Speak Up publication.

Our commitment to FTSU in the NHS remains strong, with guardians continuing to play a vital role in supporting speaking up culture and ensuring leaders understand expectations of their role in FTSU and receive the support they need to fulfil these responsibilities.

 

Creating a safe speaking up environment: the role and responsibilities of healthcare leaders and commissioners

Healthcare leaders play a critical role in developing and sustaining a safe, inclusive speaking up culture. They are responsible for ensuring environments where staff feel confident and supported to raise concerns, knowing they will be listened to and treated fairly.

To support this, healthcare leaders are responsible for embedding the fundamental principles below within their organisations to provide safe and effective speaking up arrangements.

Fundamental principles of FTSU healthcare leadership:

  • Value speaking up.
  • Role-model speaking up and set a healthy FTSU
  • Make sure workers know how to speak up and feel safe and encouraged to do so.
  • When someone speaks up, thank them, listen up and follow up.
  • Use speaking up as an opportunity to learn and improve.
  • Support FTSU guardians to fulfil their role in a way that meets workers’ needs
  • Identify and tackle barriers to speaking up.
  • Know the strengths and weaknesses of the organisation’s speaking-up culture and act to continually improve

More information is available in the Freedom to Speak Up: A guide for leaders in the NHS and organisations delivering NHS services, which offers practical guidance to help leaders embed and strengthen these principles and enable effective speaking up arrangements.

Additional resources to support healthcare leaders with their FTSU arrangements are available on the Freedom to Speak Up pages of the NHS England website.

Following the closure of the National Guardian Office, healthcare leaders and commissioners of NHS services should continue to fulfil their existing FTSU responsibilities and in addition:

  • ensure information about how to contact their guardian is publicly available
  • routinely submit their organisations FTSU data to NHS England’s via the data collection system
  • ensure all guardians they appoint complete the mandatory guardian foundation training and support guardians continuing professional development
  • ensure appropriate psychological support is available for their guardians

Further information about the revised responsibilities can be found within The future of Freedom to Speak Up publication.

 

Information for healthcare leaders to support their FTSU responsibilities

Please note, many resources linked to in this section are based on the National Guardian’s Office legacy materials, which remain valid.

Submitting FTSU data to NHS England 

NHS England will collect quantitative data from trusts and ICBs through the national data collection process.

  • a data collection guide will be published soon
  • data can be reviewed via the Model Health System

All organisations, including primary care and independent healthcare providers, should continue to:

  • collect data locally
  • review it at board level (or equivalent)
  • work with their FTSU guardian to identify improvement opportunities from their data

Ensuring access to a guardian

All workers (and those who previously worked for the organisation) must be able to easily contact their FTSU guardian, and publicly available information about how to contact the guardian should be in place by the 1 July 2026.

This is to ensure information is accessible to workers without regular workplace IT access and to support staff who are off-site, on leave, or have left the organisation.

Recruiting a FTSU guardian

Healthcare leaders should appoint guardians using the guardian recruitment framework

This framework supports organisations to:

  • clarify expectations of the role
  • standardise recruitment
  • ensure guardians are properly supported

Training for newly appointed guardians

Leaders must ensure that all newly appointed guardians complete foundation training before undertaking any case work.

Training is available on the NHS England e-learning.

Leaders must ensure completion of the following 6 training modules

  • Module 1: What is speaking up
  • Module 2: The freedom to speak up guardian role
  • Module 3: Freedom to speak up values
  • Module 4: Systems and processes
  • Module 5: Support
  • Module 6: Equity, diversity, inclusion and belonging

Leaders are required to seek verification through their guardian, who must submit all 6 certificates issued by the Learning Hub.

Guardian development

Healthcare leaders are responsible for supporting the continuing professional development (CPD) of their guardians as part of ensuring the ongoing effectiveness of their FTSU arrangements.

We encourage use of the guardian development guide to support ongoing learning and development conversations with their line manager.

Supporting your FTSU guardian

Leadership support

Strong and visible leadership support is essential for supporting your guardian. Leaders are expected to:

  • actively promote the guardian role
  • empower guardians to act independently
  • reinforce the importance of speaking up

More resources are available on the NHS England Learning Hub, including practical guidance to support guardians 

Psychological support

Organisations are responsible for providing access to independent, confidential psychological support for their guardian.

Guardians can continue to access the national Employee Assistance Programme (provided by the Care Quality Commission) until 31 December 2026.

National and regional networks

Freedom to Speak Up guardian networks are a vital source of support, offering a safe space for guardians to discuss role-specific queries and share learning.

Participation in these networks, while optional, enables guardians to connect regularly with peers, share learning, and access mutual support. They also provide opportunities to establish a ‘guardian buddy’ arrangement for ongoing peer support.

Leaders are responsible for ensuring guardians have protected time and the necessary support to participate in these networks where they choose to attend.

 

Integrated care board and primary care FTSU arrangements

We encourage all leaders to continue to work to the updated national Freedom to Speak Up policy for the NHS, which is applicable to primary care, secondary care and integrated care boards.

During 2026/27, NHS England will review the expectations of primary care providers for FTSU.

 

Support for healthcare leaders, non-executive directors and trustees

Policy and guidance documents to support effective speaking up arrangements are available on the NHS England website.

Healthcare leaders can also make enquiries via email: england.ftsu-enquiries@nhs.net

Speak Up, Listen Up and Follow Up training modules for NHS workers

The existing speak up training modules for NHS workers remain accessible via the NHS England’s Learning Hub. Healthcare leaders are encouraged to continue to share these modules with relevant staff groups in their organisation.

 

Information for FTSU guardians

Support for guardians from NHS England

Following the closure of the National Guardian’s Office, guardians will still be able to access support nationally.

Guardians can contact

  • the NHS England contact centre with general enquiries (telephone: 0300 311 22 33 and email contactus@nhs.net). Specialist queries will be escalated to the national Freedom to Speak Up team
  • NHS England’s Freedom to Speak Up Support and Development team to request specialist 1-to-1 support at ftsu-enquiries@nhs.net

We encourage guardians to seek support and escalation routes locally, with their executive and non-executive lead for FTSU, their Board including the senior independent director or chairperson where possible.

Escalation routes for guardians nationally are via NHS England’s external Freedom To Speak Up policy or via the Care Quality Commission.

Guardian foundation training and resources for existing guardians

All newly appointed guardians are required to complete all 6 modules of the foundation training. Guardians must evidence successful completion of this training by presenting their certificates to their organisation’s healthcare leader responsible for FTSU.

The foundation training for newly appointed guardians is available on NHS England’s Learning Hub, please note all new users will be required to register for an account. All 6 modules (detailed in the ‘Training for newly appointed guardians’ section above)  must be completed before commencing any case work for their organisation.

Newly appointed guardians who have completed foundation training can then request network chair and mentor details via england.ftsu-enquiries@nhs.net

Resources for existing guardians can also be found within the NHS England Learning Hub.

Guardian networks

NHS England will support regional and national guardian networks following the closure of the National Guardian’s Office.

  • networks will be reviewed during 2026/27
  • network chairs will be involved in shaping future arrangements
  • attendance will remain optional 

All guardians can continue to access regional, national and peer networks.

NHS England’s national and regional teams will:

  • support networks during the transition period
  • work with network chairs on future arrangements

Newly appointed guardians will be able to access network chair details via email: england.ftsu-enquiries@nhs.net

 

Information for FTSU stakeholders

Stakeholders can access information about FTSU on the NHS England website. General FTSU enquiries should be directed the NHS England contact centre (telephone: 0300 311 22 33 and email contactus@nhs.net).

Specialist queries will be escalated to the national Freedom to Speak Up team.

 

Information for independent healthcare providers (including hospices)

Data

National data collection is currently paused. However, providers should continue to:

  • collect data locally
  • review and act on findings
  • share themes with their national/regional networks

Networks

Providers should continue to attend regional and national networks.

Guardian foundation training

Foundation training for guardians is also accessible to all independent healthcare providers via NHS England’s Learning Hub.

Policy and guidance

Organisations should review all revised responsibilities locally and use the latest policy and guidance published by NHS England.

 

Accessing the National Guardian’s Office website

Access to the National Guardian’s Office website will be via the national archive site, which will capture the updated website as June 2026.

The link to the archive site will be available soon.

Please note that not all functions will be available on the archive site, and relevant links to documents to support FTSU have been published on this webpage.