Freedom to speak up - the role of freedom to speak up guardians and the National Guardian's Office in England.

Following the events at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis was commissioned to undertake a public inquiry. During this process, from speaking to NHS workers and from the evidence submitted to the inquiry, he found that staff had tried to speak up about their concerns, but that they had been ignored, or victimised as a result. This experience was not confined to Mid Staffordshire and a further report, Freedom to speak up, was commissioned. Freedom to speak up made two recommendations, which were accepted by all NHS organisations and the Department of Health. The report included principles and actions about the culture and practice in the NHS, the appointment of freedom to speak up guardians in NHS trusts and foundation trusts and a national guardian to lead this network, undertake case reviews and provide support and challenge to the system. In this article, I will describe the work of freedom to speak up guardians and the National Guardian's Office, the impact of these on workers in NHS trusts and other organisations, and the next steps in the journey to make speaking up business as usual. © Royal College of Physicians 2019. All rights reserved.