National Guardian's Office

The National Guardian's Office is an independent, non-statutory body established to lead cultural change around speaking up in healthcare in England. Its work arose from the recommendations of Sir Robert Francis QC's 2015 Freedom to Speak Up Review, which examined the barriers faced by NHS workers who attempted to raise concerns and the detriment that some experienced as a result. The office's central objective is to make speaking up a normal and routine part of healthcare practice rather than an exceptional act associated only with formal whistleblowing. The organisation deliberately uses the broader expression “speaking up.” This covers concerns about patient safety, quality of care, workplace culture, discrimination, bullying, management practice and other matters that affect staff or the delivery of care. It also includes ideas for improvement. In the office's framing, speaking up concerns anything that interferes with patient care or negatively affects a person's working life. This language is intended to make the process accessible to all healthcare workers and to encourage early intervention before problems become more serious. The office does not operate as a conventional regulator, employer or statutory investigatory authority. Instead, it supports and challenges the healthcare system. Its principal operational role is to train, guide and support Freedom to Speak Up Guardians working within healthcare organisations. These guardians provide an alternative and confidential route through which workers can raise concerns, seek support and identify barriers to speaking up. They are appointed by the organisations they serve, but work within guidance developed by the National Guardian's Office. Guardians are also expected to promote proactive improvements in their own organisations, not merely respond to individual cases. The network extends across NHS provider organisations, independent-sector healthcare organisations, national bodies and other healthcare-related institutions in England. Reference material describes more than 1,200 guardians operating across more than 700 organisations. The office also collects and publishes information about speaking-up activity, shares examples of effective practice, advises healthcare bodies and challenges the system where arrangements are ineffective. Its annual reporting role was linked to recommendations arising from the Gosport Independent Panel, with the intention of making good practice visible and holding government and healthcare institutions to account. The office has been sponsored by the Care Quality Commission, NHS England and NHS Improvement. Its work is therefore situated between workforce support, patient safety and organisational accountability, while remaining distinct from the statutory functions of those bodies. Reported activity increased substantially over time: more than 20,000 cases were raised with Freedom to Speak Up Guardians in 2020–21, while more than 38,000 cases were reported in 2024–25 and over 172,000 cases had been recorded since data collection began in 2017. These figures measure use of the guardian network rather than the number of investigations or substantiated complaints. The National Guardian leadership has changed several times. Eileen Sills became the first National Guardian for the NHS but resigned two months after appointment, citing insufficient time to combine the role with her other responsibilities. Dr Henrietta Hughes OBE succeeded her in July 2016 and left the post in September 2021 after five years. Dr Hughes later became England's first Patient Safety Commissioner. Dr Jayne Chidgey-Clark was announced as the third National Guardian for Freedom to Speak Up in November 2021. In July 2025, it was announced that the National Guardian role would be abolished, while Freedom to Speak Up Guardians would remain in NHS provider organisations. The long-term institutional status of the office consequently requires verification.

The National Guardian's Office developed from the 2015 Freedom to Speak Up Review led by Sir Robert Francis QC. That review investigated why NHS staff in England sometimes struggled to raise concerns and why workers who did speak up could suffer professional or personal detriment. One of its recommendations was the creation of a National Guardian who could provide independent leadership on speaking up and promote a more open culture across the NHS. The office adopted the language of “speaking up” rather than limiting its remit to whistleblowing. This approach encompasses formal concerns, requests for support, suggestions for improvement and observations about anything that may obstruct patient care or damage working life. The objective is preventive as well as responsive: workers should be able to raise issues early, and organisations should learn from concerns rather than treating them solely as challenges to authority. Eileen Sills was the first Freedom to Speak Up National Guardian for the NHS. She left the position two months after appointment, explaining that she did not have sufficient time to combine it with her other work. Dr Henrietta Hughes OBE was appointed in July 2016 and served for five years before stepping down in September 2021. She subsequently became England's first Patient Safety Commissioner. Dr Jayne Chidgey-Clark was announced as the third National Guardian on 11 November 2021. Her resignation was announced on 4 August 2025, following an absence from the post beginning in December 2024. Operationally, the office's most visible contribution has been the development and support of the Freedom to Speak Up Guardian network. Guardians are appointed by individual organisations across the NHS, the independent healthcare sector, national bodies and related institutions. They offer workers an alternative route for raising patient-safety, care-quality and workplace concerns. Their responsibilities also include identifying organisational barriers to speaking up and encouraging leaders to improve local culture. The office provides training, guidance and support, while reviewing how organisations handle concerns and disseminating examples of effective practice. The National Guardian's Office has been sponsored by the Care Quality Commission, NHS England and NHS Improvement. Although independent and non-statutory, it has had an accountability-oriented role within the healthcare system. Following the Gosport Independent Panel's examination of deaths at Gosport War Memorial Hospital, the National Guardian was expected to publish an independent annual report for presentation to Parliament. Such reporting was intended to showcase good practice, identify systemic shortcomings and press government and healthcare institutions to respond. The scale of the network and its recorded activity increased over the office's operating period. More than 1,200 Freedom to Speak Up Guardians were reported across over 700 organisations. In 2020–21, guardians received more than 20,000 cases, including almost 6,000 raised by nurses and midwives. By 2024–25, annual activity exceeded 38,000 cases, and the cumulative total since collection began in 2017 exceeded 172,000. These figures demonstrate the breadth of the reporting channel but do not, by themselves, establish the merits or outcomes of individual cases. In December 2021, the Department of Health and Social Care said it would explore applying the Freedom to Speak Up model to social care. In July 2025, the abolition of the National Guardian role was announced, with the continuation of local Freedom to Speak Up Guardians in NHS provider organisations. This announcement marks a significant change in the national structure and leaves the office's final institutional status and future arrangements subject to confirmation.

• 2025

  National Guardian role scheduled for abolition

  [1]National Guardian's Officeen.wikipedia.org

  The role of National Guardian is announced for abolition, while local Freedom to Speak Up Guardians are expected to remain in NHS provider organisations.

• 2021

  Jayne Chidgey-Clark announced as third National Guardian

  [1]National Guardian's Officeen.wikipedia.org

  Dr Jayne Chidgey-Clark is announced as the third National Guardian for Freedom to Speak Up.

• 2021

  Social care expansion considered

  [1]National Guardian's Officeen.wikipedia.org

  The Department of Health and Social Care announces exploration of Freedom to Speak Up Guardians for social care.

• 2016

  Henrietta Hughes appointed National Guardian

  [1]National Guardian's Officeen.wikipedia.org

  Dr Henrietta Hughes OBE succeeds the first National Guardian and begins a five-year term.

• 2015

  Freedom to Speak Up Review recommends a National Guardian

  [1]National Guardian's Officeen.wikipedia.org

  Sir Robert Francis QC's review of barriers and detriment affecting NHS whistleblowers recommends national leadership for a stronger speaking-up culture.

A system-wide, independent support and culture-change body for safe and effective speaking up in healthcare, positioned between workforce support, patient safety and organisational accountability.

• Healthcare workforce support

  Freedom to Speak Up Guardian network

  A network of guardians appointed by healthcare organisations to provide workers with an alternative route for raising concerns, ideas and patient-safety issues. Guardians support individual workers, identify barriers to speaking up and encourage their organisations to build more open and responsive workplace cultures. The network spans NHS and independent-sector organisations, national bodies and other healthcare institutions in England.

• Professional guidance

  Speaking-up guidance and training

  Guidance, training and practical support for Freedom to Speak Up Guardians and healthcare organisations. The material promotes a broad understanding of speaking up, covering patient care, working conditions, workplace culture and improvement ideas rather than only formal whistleblowing disclosures.

• Healthcare accountability

  Annual reporting and speaking-up data

  National reporting and data collection intended to show the volume and nature of concerns raised through Freedom to Speak Up arrangements, highlight effective practice and identify systemic barriers. The reporting function is also intended to support accountability by informing Parliament, government and healthcare leaders.

• 2025

  Abolish the National Guardian role while retaining local guardiansStrategy

  Background

  The government announced a change to the national structure for Freedom to Speak Up arrangements.

  Action taken

  The National Guardian role was announced for abolition, while Freedom to Speak Up Guardians were to remain in NHS provider organisations.

  Aftermath

  The future institutional arrangements for national leadership and support require further verification.

  Source

• 2021

  Explore extending Freedom to Speak Up into social careStrategy

  Background

  The speaking-up model had been developed primarily for NHS and healthcare organisations, while social care also faced workforce and care-quality concerns.

  Action taken

  The Department of Health and Social Care announced that it would explore options for introducing Freedom to Speak Up Guardians in social care.

  Aftermath

  The reference material does not establish the final outcome of the exploration.

  Source

• 2015

  Adopt a national speaking-up leadership modelStrategy

  Background

  The Freedom to Speak Up Review identified barriers to raising concerns and cases of detriment affecting NHS workers.

  Action taken

  A National Guardian and supporting office were established to lead cultural change and promote safer routes for staff to speak up.

  Aftermath

  The model led to the development of a national Freedom to Speak Up Guardian network across healthcare organisations in England.

  Source

1. 1National Guardian's Officeen.wikipedia.org