Freedom to Speak Up Guardian and NHS Policy: 2026 Guide

At a glance, as at 27 October 2026

Freedom to Speak Up (FTSU) is how NHS healthcare in England helps workers raise concerns about anything that gets in the way of patient care or affects their working life. Organisations providing NHS healthcare adopt NHS England’s national policy, which tells staff how to speak up and what happens next. Providers under the NHS Standard Contract must also have a Freedom to Speak Up guardian. Since the National Guardian’s Office closed on 30 June 2026, providers do more of the work themselves: they publish how to reach their guardian, train new guardians and arrange their support.

What	Where things stand
Who must have a guardian	Providers working under the NHS Standard Contract. In primary care, CQC’s guidance says a guardian isn’t compulsory, and practices can share one.
The national policy	NHS England’s Freedom to Speak Up policy for the NHS (version 2, June 2022). Organisations providing NHS healthcare adopt it as a minimum and add their local details.
What changed on 1 July 2026	NHS England took on some of the office’s work. Providers publish how to contact their guardian, make sure new guardians finish six foundation modules before any case work, and arrange support for them.
Data	NHS trusts, foundation trusts and integrated care boards (ICBs) report six counts to NHS England every quarter. Primary care and independent providers collect their data locally while their national collection is on hold for 2026/27.
What CQC checks	Speaking up, under well-led, for every provider it registers. In NHS trusts, it also checks guardian arrangements at well-led inspections.
Care homes	Outside the national NHS policy. CQC’s freedom to speak up quality statement applies.
Dates to watch	31 December 2026: the national employee assistance programme for guardians ends. 4 January to 1 February 2027: the next quarterly data window for trusts and ICBs.

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Scope

Who Freedom to Speak Up applies to in England

What you need depends on how you provide NHS care. The national policy covers NHS healthcare in primary and secondary care, and the guardian requirement comes from the NHS Standard Contract.

Who	Guardian	National policy	Data
NHS trusts and foundation trusts	The NHS Standard Contract requires one	Adopt it as a minimum	Every quarter, to NHS England
Independent providers of NHS services, hospices included	The NHS Standard Contract requires one when you work under it	Adopt it as a minimum for your NHS services	Collect and review it locally while NHS England pauses the national collection
GP, dental, pharmacy and optometry providers	Not compulsory, CQC says; you can share one, for example with other practices	Adopt it as a minimum	Collect and review it locally while NHS England pauses the national collection
Care homes and other adult social care	Neither the national policy nor the contract clause requires one; any organisation can appoint one	Outside it	No national collection

Who can speak up. Anyone who works in NHS healthcare, including pharmacy, optometry and dentistry. The national policy names clinical and non-clinical staff, receptionists, directors, managers, contractors, volunteers, students, trainees, junior doctors, locum, bank and agency workers, and former workers.

What’s still under review. NHS England is reviewing what it expects of primary care providers during 2026/27, and policy and guidance for every other sector during 2027/28.

What changed in 2026

What changed when the National Guardian’s Office closed

The office closed on 30 June 2026. Dr Penny Dash’s July 2025 review of patient safety recommended that providers take on its responsibilities, with NHS England running the national activities alongside its other work on staff voice. Since 1 July, the work has split three ways:

Who	What they do from 1 July 2026
NHS England	Supports guardians and their networks through its contact centre and its Freedom to Speak Up team, hosts the free foundation training, collects data from trusts and ICBs, and reviews policy and guidance, starting with primary care.
Providers and commissioners	Publish how to contact their guardian, make sure every new guardian completes the foundation training before starting, support their guardians’ development and arrange psychological support for them. Trusts and ICBs also submit data every quarter.
CQC	Checks guardian arrangements in NHS trusts at well-led inspections, including how well leaders make sure guardians get the right training, and holds the personal data in the office’s records.

What stopped. NHS England said the public national register of guardians would close. The office’s speak-up reviews ended, and its own data collection finished with the 2025/26 return.

Where the guidance doesn’t match

Guardian names. The 2026/27 NHS Standard Contract requires providers to show the guardian’s name and job title on their website. NHS England’s April 2026 guidance asks every organisation to publish how to contact its guardian, and says this doesn’t need to include names. If you hold the contract, follow its wording until it changes.
The closing date. The contract’s definitions describe the office as working until 31 March 2026. It closed on 30 June 2026.
Older pages. CQC’s April 2024 well-led guidance for NHS trusts still says the office trains and supports guardians. NHS England does that work now.

What to do now

For providers and commissioners of NHS care:

Publish how staff can reach your guardian. Put it on your website, in a form that works for staff without regular IT access at work, staff who are off-site or on leave, and people who have left. NHS England wanted this in place by 1 July 2026.
Train any new guardian before their first case. They complete all six foundation modules on NHS England’s Learning Hub and show you the six certificates.
Arrange psychological support for your guardian from 1 January 2027. The national employee assistance programme ends on 31 December 2026. A local employee assistance programme is one option NHS England suggests.
Make sure someone reports your data. Trusts and ICBs: register the people who submit each quarter. Primary care and independent providers: keep collecting it locally and review it at board level or the equivalent.
Update your policy and staff materials. Remove any route that sends people to the National Guardian’s Office.

The guardian

The Freedom to Speak Up guardian: what the role does and who needs one

A Freedom to Speak Up guardian supports workers to speak up when they feel unable to in other ways. Under the national policy, the guardian makes sure the organisation thanks people who speak up, responds to the issues they raise and tells them what it did about them.

NHS England’s guide for leaders describes the reactive and proactive parts of the role:

Responding to cases: the first conversation with each worker, then recording the case, following it up and feeding back.
Improving the culture: finding and reducing barriers to speaking up, making sure training on speaking up happens, and supporting and challenging senior leaders, including through regular reports to the senior team or board.

Who needs one

Providers working under the NHS Standard Contract must appoint at least one guardian and always have one in place (general condition 5.10). In primary care, CQC’s guidance for GP practices says a guardian isn’t compulsory, and a practice can share one with other practices, its primary care network or its ICB. Any organisation can appoint one, the same guidance says.

Independence

The guardian should be independent of the line management chain, or of the partnership in a GP practice, and impartial. NHS England’s guide expects the role to operate with a high degree of independence. For a smaller organisation, it weighs up a guardian of your own against a shared or external one:

A guardian inside the organisation knows its people and culture. Confidentiality and conflicts of interest can be harder for them to manage.
A guardian from outside can look more independent. Their distance can make them less visible and leave them less time to work on the culture.

Recruitment and time

Appoint guardians through fair, open and inclusive competition, paid or voluntary, using NHS England’s guardian recruitment framework. Give them ringfenced time. The guide for leaders sizes it by the number of workers, the number of organisations the guardian supports, the number of sites, and how much your equality indicators show needs to improve. CQC’s 2026 draft frameworks for hospitals, mental health, and primary care and community services say that, where a guardian is in place, they have dedicated time for the role and up-to-date training. Those frameworks are still drafts.

The senior lead, the non-executive director and champions

The national policy also names a senior lead responsible for Freedom to Speak Up, who supports the guardian and reviews how well your arrangements work. In organisations with boards, a non-executive director gives the guardian independent support and helps escalate issues.

Champions promote speaking up and help build trust with people who find it hard to speak up. Only guardians handle cases. NHS England’s guide says champion networks work well in organisations spread across many sites, or where one guardian covers several organisations.

Plan for when the guardian can’t work: tell staff about the interim arrangements, keep supporting workers, and protect what people told the guardian in confidence.

Training and support

Freedom to Speak Up guardian training and support

NHS England requires every new guardian to complete its foundation training before taking on any case work, and to show the person who leads on speaking up all six certificates. It offers the six modules free on its Learning Hub, to independent providers too:

What is speaking up
The freedom to speak up guardian role
Freedom to speak up values
Systems and processes
Support
Equity, diversity, inclusion and belonging

After the foundation training, NHS England can put new guardians in touch with a network chair and a mentor. It is reviewing the office’s refresher modules, and any it keeps will be optional. From then on, the organisation supports each guardian’s continuing professional development.

Training for everyone else. The national policy asks every worker to complete Speak Up, managers to complete Listen Up and senior leaders to complete Follow Up, all on NHS England’s Learning Hub.

Support for guardians

Psychological support. Guardians can use the national employee assistance programme, which CQC provides, until 31 December 2026. After that, each organisation provides independent, confidential psychological support for its guardian, for example through its own employee assistance programme.
Advice. NHS England’s contact centre takes general questions, and its Freedom to Speak Up team gives guardians specialist one-to-one support.
Networks. NHS England now supports the national and regional guardian networks and is reviewing what they do. Attendance is optional, and leaders give guardians protected time to attend.
Escalation. A guardian who needs to take a concern further, outside the organisation, can use NHS England’s external Freedom to Speak Up policy or go to CQC.

The national policy

The Freedom to Speak Up policy for the NHS: who it covers and how staff speak up

NHS England’s Freedom to Speak Up policy for the NHS (version 2, June 2022) sets the minimum standard for local policies. It covers whistleblowing too: its appendix explains protected disclosures. All NHS organisations, and others providing NHS healthcare in primary and secondary care in England, adopt it and add their local details, such as names, contacts and routes. NHS England asked organisations to have the updated policy in place by 31 January 2024. Under the NHS Standard Contract, providers also keep a policy and procedures in line with it, and make sure their sub-contractors do the same (general condition 5.10.4).

What the policy tells staff:

What they can speak up about: anything that gets in the way of patient care or affects their working life, such as a process that people aren’t following, feeling discriminated against, or behaviour that affects their wellbeing or that of colleagues or patients.
Who they can speak up to: their line manager or supervisor, a senior manager, partner or director responsible for the subject, the patient safety or clinical governance team, HR, the guardian, the local counter fraud team, the senior lead for Freedom to Speak Up and, in organisations with boards, the non-executive director for it. Smaller organisations offer fewer of these routes.
Who they can go to outside: CQC for quality and safety concerns about the services it regulates; NHS England for concerns about GP surgeries, dental practices, optometrists and pharmacies, and the running of NHS trusts; the NHS Counter Fraud Authority for fraud; and a professional regulator, such as the GMC or NMC, about a colleague’s conduct.
How: in person, by phone or in writing, and openly, confidentially or anonymously.
What happens next: the organisation thanks them, discusses the issue, tells them how long any investigation will take and agrees how to keep them updated. Someone suitably independent and trained investigates, and the organisation shares the outcome and the lessons where it can.
Escalation: if they aren’t satisfied, they can go to the senior lead or the non-executive director for speaking up, or to an outside body such as CQC or NHS England.
Oversight: the most senior leaders receive a report at least once a year, with an overview of the themes staff raise with the guardian.

Openly, confidentially or anonymously

Openly: the person they speak to knows who they are and can share it with others involved in the response.
Confidentially: the person they speak to knows who they are and won’t share it without their consent.
Anonymously: nobody knows who they are. The policy warns that this can make it hard to ask them for more information or act on the concern, and that they may not get extra support or feedback on the outcome.

Contracts and settlement agreements

Under the NHS Standard Contract, nothing in an employment contract, a contract for services or a settlement agreement may stop staff speaking up about the quality or safety of care, or making a protected disclosure. Every settlement agreement, and any other agreement when someone leaves, must include the contract’s set wording that says so (general conditions 5.10.6 and 5.10.7).

Speaking up and whistleblowing

In NHS England’s guide for leaders, speaking up covers raising concerns, suggesting improvements, whistleblowing and protected disclosures. Whistleblowing law protects workers who make a protected disclosure whatever a policy says, and our UK whistleblowing policy guide covers that law.

Most speaking up happens in conversations with supervisors and line managers, the policy says. Other routes matter when the concern is about the manager. In small practices, CQC says, some staff fear for their jobs when the concern is about the person who employs them.

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Inspection

What CQC checks on speaking up

The regulator looks at speaking up under well-led for every provider it registers, care homes included. Its quality statement, “Freedom to speak up”, reads: “We foster a positive culture where people feel that they can speak up and that their voice will be heard.” It expects:

staff and leaders who act with openness, honesty and transparency
leaders who encourage staff to raise concerns, and staff who trust that leaders will hear them
support for people who speak up, external whistleblowers included, without fear of detriment
leaders who investigate concerns sensitively and confidentially, then share the lessons and act on them
a sincere and timely apology when something goes wrong, and an explanation of what the service is doing to stop it happening again

The statement covers four subtopics: speaking up culture, the Freedom to Speak Up guardian, whistleblowing and closed cultures. It links to regulations 10, 12 and 17, with regulation 9 to consider. Our CQC well-led guide covers the evidence to keep and how the regulator scores it.

NHS trusts

NHS England says CQC verifies guardian arrangements in NHS trusts through its well-led inspections, including how well trust leaders make sure guardians get the right training.

GP practices

No regulation deals with a practice’s speaking-up arrangements on their own, CQC’s GP guidance says. If you can’t show evidence when the inspector asks, you risk breaching the regulations that do apply: it looks at speaking up under regulations 12, 13, 16, 17 and 20. Where it has concerns about speaking up, it may check:

how you build a culture where people feel they can speak up and know you’ll listen
how you make staff aware of your policies, encourage them to speak up and respond to their feedback and concerns
how you listen to, evaluate, escalate and respond to the concerns and trends your guardian reports
how what staff and the guardian raise drives learning and improvement
how you evaluate and monitor your arrangements to find barriers

In CQC’s draft frameworks

In the sector drafts of 24 March 2026, speaking up moves into a topic on workforce equity and culture, under well-led. The hospital, mental health, and primary care and community drafts say that, where in place, guardians have dedicated time for the role and up-to-date training, and work with leaders to remove barriers to speaking up. They are drafts, and the regulator has set no date for them.

Care homes

Speaking up in care homes

The national Freedom to Speak Up policy and the guardian clause in the NHS Standard Contract cover NHS healthcare, so they don’t apply to a care home’s social care. If you hold an NHS contract for some of your services, check what it says about speaking up.

CQC’s freedom to speak up quality statement applies to every care home it registers, and it looks at speaking up under well-led. Its draft framework for adult social care (March 2026, still a draft) rates a service as requires improvement where “arrangements for staff to raise concerns or contribute ideas are not effective”, including how well the service communicates the process and how accessible it is to staff.

Staff in a care home need at least one way to raise a concern that doesn’t go through the home’s manager, such as a named person at group level or an independent route. They can also go straight to CQC, a prescribed person for whistleblowing about health and social care in England. Any organisation can appoint a Freedom to Speak Up guardian, care homes included. Our UK whistleblowing policy guide covers what a care home’s policy needs and the law that protects staff who blow the whistle.

Data and reporting

Recording Freedom to Speak Up cases and reporting to the board

Since April 2026, NHS England has collected the data every quarter from NHS trusts, foundation trusts and ICBs. Each organisation nominates one to three people to submit it through the national data portal, and guardians don’t need their own accounts. The six counts:

Cases raised anonymously
Cases with an element of patient safety or quality of care
Cases with an element of worker safety or wellbeing
Cases with an element of bullying or harassment
Cases with an element of other inappropriate attitudes or behaviours
Cases where the person indicates disadvantageous or demeaning treatment because they spoke up (detriment)

One case can count under several of these. NHS England’s data guide adds rules for recording them:

A case someone raises anonymously stays anonymous in your data, even if they later give their name.
A confidential case is one where the person tells the guardian who they are and asks them not to pass it on.
Bad treatment someone reports months after speaking up counts as a new case, in the quarter they raise it.

Quarter of 2026/27	Submission window for trusts and ICBs
Quarter 1	23 July to 31 August 2026
Quarter 2	5 October to 2 November 2026
Quarter 3	4 January to 1 February 2027
Quarter 4	5 April to 3 May 2027

NHS England doesn’t publish the data centrally. Anyone with a Model Health System login can see it.

Primary care and independent providers. NHS England has paused your national collection for 2026/27 and will review it. Keep collecting your data locally, review it at board level or the equivalent, and work with your guardian on what to improve.

For reference. Guardians recorded 37,770 cases in 2025/26, the last year of national figures from the National Guardian’s Office: 12.4% anonymous and 2.9% indicating detriment, and 76% of the people who gave feedback said they would speak up again.

Reporting to the board

The national policy promises staff that the most senior leaders receive a report at least once a year, with an overview of the themes they raise with the guardian. NHS England’s guide for leaders asks for more: a report from the guardian at least twice a year. The guardian writes and presents it, in three parts:

An assessment of cases: whether the organisation evaluates, escalates and responds to concerns quickly, and whether anything changed as a result.
The action taken: the barriers to speaking up and the plan to remove them, the level of detriment for speaking up, and how the arrangements keep improving.
Recommendations.

The guide says the report should explain what the figures mean, the “so what?”, alongside the data and themes.

The reflection and planning tool

NHS England’s free reflection and planning tool asks your senior team to review your arrangements against the eight principles in its guide for leaders. You score statements from 1 to 5, summarise your actions for the next 6 to 24 months, and note how you’ll share your strengths. The senior lead for Freedom to Speak Up should complete it at least every two years. CQC’s well-led guidance for NHS trusts says providers had to adopt the national policy and complete the tool by 31 January 2024.

Where software helps

The quarterly counts and the board report come from the same records, so keep them in one case log. CalmER takes concerns through any channel, confidential if the person chooses, gives each case a clear owner from the start, shows trends across teams, sites and case types, and drafts a board pack from your live data for a person to sign off. See CalmER.

FAQs

Common questions

What is Freedom to Speak Up?

Freedom to Speak Up (FTSU) is how NHS healthcare in England encourages workers to raise concerns about anything that gets in the way of patient care or affects their working life, and makes sure someone listens and acts. Its principles come from an independent review by Sir Robert Francis. Organisations providing NHS healthcare adopt NHS England's national policy, and providers under the NHS Standard Contract must have a Freedom to Speak Up guardian.

What does FTSU stand for?

FTSU stands for Freedom to Speak Up. A guardian is the person workers in NHS healthcare can go to when they feel unable to raise a concern in other ways.

What does a Freedom to Speak Up guardian do?

A guardian supports workers to speak up when they feel unable to in other ways. They make sure the organisation thanks people who speak up, responds to what they raise and tells them what it did. They also look for barriers to speaking up, make sure training on speaking up happens, and report to senior leaders or the board.

Who needs a Freedom to Speak Up guardian?

Providers working under the NHS Standard Contract must appoint at least one guardian and always have one in place (general condition 5.10 in the 2026/27 contract). In primary care, CQC's guidance for GP practices (December 2022) says a guardian isn't compulsory, and practices can share one with other practices, their primary care network or their integrated care board. Any organisation can appoint a guardian.

Do care homes need a Freedom to Speak Up guardian?

The national policy and the guardian clause in the NHS Standard Contract cover NHS healthcare, so they don't apply to care homes as social care providers. Check any NHS contract you hold. CQC looks at speaking up in every care home under well-led, and any organisation can appoint a guardian.

What happened to the National Guardian's Office?

It closed on 30 June 2026, after Dr Penny Dash's July 2025 review of patient safety recommended that providers take on its responsibilities. From 1 July, NHS England took on some of its work: supporting guardians and their networks, hosting the foundation training, collecting data and reviewing policy. Providers now publish how to contact their guardian, train new guardians and arrange their support. CQC holds the personal data in the office's records.

What training does a Freedom to Speak Up guardian need?

NHS England requires every new guardian to complete its foundation training, six modules on its Learning Hub, before taking on any case work, and to show the organisation all six certificates. The modules cover what speaking up is, the guardian role, values, systems and processes, support, and equity, diversity, inclusion and belonging. After that, the organisation supports the guardian's continuing professional development.

What is the NHS whistleblowing policy?

NHS England's Freedom to Speak Up policy for the NHS (version 2, June 2022) is the national policy for speaking up, whistleblowing included. Organisations providing NHS healthcare in England adopt it as a minimum and add their local details. Its appendix explains protected disclosures under whistleblowing law.

Can NHS staff speak up anonymously?

Yes. The national policy lets staff speak up openly, confidentially or anonymously. Anonymous means nobody knows who they are, and the policy warns that this can make it harder to ask them for more information, act on the concern and give them feedback on the outcome. Confidential means the person they speak to knows who they are and won't share it without their consent.

What are examples of Freedom to Speak Up concerns?

The national policy gives examples: a way of working or a process that people aren't following, feeling discriminated against, or other people's behaviour affecting your wellbeing or that of colleagues or patients. NHS England's data guide adds lone working at night, too little protective equipment, stress at work, incivility and microaggressions, and bad treatment after speaking up, such as unfavourable shifts or a move to another team.

What is a Freedom to Speak Up champion?

A champion promotes speaking up and helps build trust with people who find it hard to speak up. Only guardians handle cases. NHS England's guide for leaders says champion networks work well in organisations spread across many sites, or where one guardian covers several organisations.

When is Freedom to Speak Up Month?

October. The National Guardian's Office held Speak Up Month every October with guardians, leaders, managers and workers across healthcare, to raise awareness of speaking up. The office closed on 30 June 2026, so check with NHS England or your guardian network for this year's plans.

Do we have to publish our Freedom to Speak Up guardian's name?

The 2026/27 NHS Standard Contract requires providers to show the guardian's name and job title on their website. NHS England's April 2026 guidance asks every organisation to publish how to contact its guardian, and says this doesn't need to include names. If you hold the contract, follow its wording until it changes.

What Freedom to Speak Up data do we report to NHS England?

NHS trusts, foundation trusts and integrated care boards submit six counts every quarter: cases raised anonymously, and cases with an element of patient safety or quality of care, worker safety or wellbeing, bullying or harassment, other inappropriate attitudes or behaviours, or detriment for speaking up. Primary care and independent providers collect and review their data locally while NHS England pauses their national collection for 2026/27.

Sources & further reading

References

General information, not legal advice. It reflects our understanding of the law and official guidance as of October 2026, so check the sources above for the current position.

Freedom to Speak Up guardian and NHS policy: what providers in England must do in 2026