'Freedom to speak up' review

Sir Robert Francis QC published an independent review on the creation of an open and honest reporting culture in the NHS. The Freedom to speak up review took evidence from over 600 people and 19,000 online surveys. The review called for:

  • a 'freedom to speak up guardian', to be appointed in every NHS trust to support staff
  • a national independent officer to help guardians if cases were going wrong
  • a new support scheme to help NHS staff who had found themselves out of a job as a result of raising concerns
  • the establishment of processes at all trusts to make sure concerns were heard and investigated properly.

The report revealed serious cases of bullying and discrimination towards staff who had tried to raise concerns over patient care, and Sir Robert suggested that this was fundamentally a patient safety issue.

The report was published almost exactly 2 years after the final report on the Mid Staffordshire scandal, when the government had committed to further action on clarifying the procedure of raising concerns or making complaints.

In his initial response to the report, Secretary of State for Health Jeremy Hunt confirmed that he would accept all 20 of Sir Robert's recommendations in principle and would begin consultations with NHS organisations to implement them. Hunt also pledged to consult on establishing a new independent national whistleblowing guardian within the Care Quality Commission (CQC), to review the treatment of whistleblowers.

'Learning not blaming'

In July 2015, the government published Learning not blaming, which responded to Freedom to speak up and two other reports:

  • Investigating clinical incidents in the NHS, a report by the Public Administration Select Committee
  • Dr Bill Kirkup's independent Morecambe Bay investigation report.

The document contained responses to each report in turn, but also identified key themes running through all three, including the importance of:

  • openness, honesty and candour
  • listening to patients, families and staff
  • finding and facing the truth
  • learning from errors and failures in care
  • people and professionalism.

The Freedom to speak up review in ‘Learning not blaming’

The government outlined the outcome of a consultation on a package of measures to implement the principles and actions recommended in the Freedom to speak up report.

It stated that an Independent National Officer (INO) would be appointed to act as a key leader in 'national renewal and reinvigoration of an open and learning NHS culture'. The INO would be hosted by the Care Quality Commission (CQC) and appointed by December 2015.

The response also said that each trust would appoint a 'Freedom to Speak Up Guardian' and, once in place, the INO would publish guidance on local implementation of the guardian role. Health Education England would produce guidance and a curriculum to help NHS organisations ensure that training around raising concerns was of a sufficiently high standard.


Francis R.
Freedom to speak up.
Freedom to speak up; 2015.

Hunt J.
Francis report; update and response.
Department of Health and Social Care; 2015.

Triggle N.
NHS 'to get whistleblower guardians'.
BBC News; 2015.

Lintern S.
Exclusive interview; Francis insists whistleblowing measures have 'teeth'.
Health Service Journal; 2015.

Department of Health.
Learning not blaming: response to 3 reports on patient safety.
Department of Health; 2015.