Raising concerns and Freedom to Speak Up

Following a review of the Trust’s Freedom to Speak Up (FTSU) process conducted by NHS England and NHS Improvement’s advocacy and learning team, a Raising Concerns: Freedom to Speak Up (FTSU) Policy, Strategy and associated action plan was adopted by the Trust in November 2021. The policy focuses on providing staff with the assurance that they can speak up in confidence and that they will be genuinely thanked and listened to. It also provides clear responsibilities for all staff to speak up and for managers to listen and respond to their concerns without judgement or bias, with an easy-to-follow flow chart for all staff. The action plan details the six key areas to support the development and embedding of FTSU to all aspects of the Trust over the next 2 years: 

  • Full Executive support and backing of FTSU 
  • Increase Guardian capacity and resource via FTSU ambassadors 
  • Full utilisation of the Raising Concerns Forum and development of Board reporting 
  • FTSU communication and engagement plan to reach all staff 
  • Management training in FTSU 
  • Create future FTSU Vision and Strategy 

The initial focus was to increase the capacity of the team to effectively respond to staff concerns. Due to the rising level of contacts, the Trust employed an experienced part time FTSU Guardian for the year to support the substantive post. A full time permanent FTSU advisor was also recruited to support with the administration, communication, and the recruitment of the FTSU Ambassadors, of which we now have ten from the initial recruitment round. 


Concerns data, themes and patterns 

This year has seen the Freedom to Speak up team actively supporting staff to raise their concerns. 359 staff raised a concern with the Freedom to Speak Up (FTSU) team from April 2021 to March 2022 -an increase of over 72%, from the previous year. This provides assurance that staff are more aware of the FTSU team, how to raise a concern and the Trusts commitment to embedding a culture of trust openness and transparency. 


The average number of new concerns/cases raised each month in this financial year was 30, in comparison to 17 for the same period the previous year with peaks and troughs in numbers correlating with heightened FTSU engagement visits to stations and offices and for October, National Freedom to Speak up month, which was promoted by the team. 

Staff have been confident to raise a variety of concerns via the FTSU team, the main theme of which was the application of some of the Trust’s systems and processes. These cases include elements of policies and processes which may not be consistently followed, regular examples include recruitment processes, policy timeframes, local decision making, staffing levels and pay and re-deployment. 

The second highest theme of concerns raised was for bullying and harassment and the associated behaviours which is consistent with feedback from the variety of staff surveys which are completed both nationally and locally. We have continued to see a high demand in the FTSU service, particularly with the reported behaviours of peers and managers as we continue to experience a higher demand for our services. 

There has been a noticeable increase throughout the year of concerns which staff raise regarding a senior or middle manager and again is seen as a positive increase, in that staff are feeling more empowered to speak up about issues they would not previously have dared raise. This year has also seen a rise in the number of managers raising concerns which is a positive reflection of the engagement undertaken and supports the view that speaking up is becoming normal practice at all levels of within the Trust. 

There has been a proportionate rise in the concerns raised by staffing level. Although non managers remain the most common reporters, this year has seen a rise in the number of managers raising concerns which is a positive reflection of the engagement undertaken and supports the view that speaking up is becoming normal practice at all levels of within the Trust. 

It is always anticipated that concerns will predominantly come from frontline operational staff however within this year there has been a significant rise in concerns raised from staff within the corporate and administrative areas of the Trust, again acknowledging that the speak up, speak out message is being heard and understood. 

The station and base engagement sessions undertaken focus on every staffing group at the location, providing the opportunity to listen to all staff, provide general but anonymised feedback to service areas and further embed the principles of speaking up being everyone’s responsibility. 

Empowering staff to speak up in a safe and confidential environment is the primary aspiration of the FTSU programme and publication of data is undertaken in an unidentifiable way to protect individual staff members and teams within the Trust.



Partnership working

The FTSU team has also undertaken extensive work with other departments within the year including, bi-weekly meeting with HR Managers to support expedition of FTSU cases with staff consent., co-presenting of the Early intervention Conversations Training with Mediation, providing a staff perspective in ER case reviews, development and engagement with the staff diversity networks to encourage and support staff from marginalised groups to speak up and extensive engagement and development work with teams to identify staff issues, with the aim of supporting early resolutions. 

Next steps:

This important piece of work is ongoing and a number of priorities are in place for 2022/23 including; 

  • A review of the FTSU Strategy and Policy in line with the National Guardian’s Office (NGO) policy publication and any subsequent service inspections. 
  • Evidence learning and progression using case studies, lived experiences documented and feedback from staff. 
  • Complete training and embedding of FTSU ambassadors collaboratively with champions and ambassador leads across the Trust. 
  • Increase the number of opportunities for staff to engage with FTSU via planned engagement visits and ambassador led engagement and involvement. 
  • Continue to ensure the themes, patterns and gaps identified via FTSU cases is addressed through the Raising Concerns Forum and subsequent forums which address the culture within the organisation. 
  • Reviewing and embedding the inclusion of speaking up in all Trust inductions. 
  • • The embedding of the National Guardians Office and e-Learning for Healthcare (e-LfH) online training offer: Follow up for the Trust Board and senior leaders, Listen Up for all Managers and Speak Up for all staff. 
  • Targeted engagement, recruitment of ambassadors and relationship building targeted to service areas based on data from the National Staff survey, internal pulse surveys and the sexual harassment and bullying survey. 
  • Completion of the NGO Board self-assessment on FTSU as part of the Board FTSU Development session. 

Freedom to Speak Up - breaking down cultural barriers. Supporting and empowering staff to speak up in a safe and confidential environment.


Next Page: Results from the NHS Staff Survey question

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