Freedom to speak up services

The Healthcare Governance Academy Freedom to Speak Up (FTSU) service provides a safe, independent and trusted route for staff to raise concerns about patient safety, quality, conduct or organisational culture. It plays a vital role in ensuring that issues are identified early, escalated appropriately and addressed before they lead to harm. For NHS trusts, an effective FTSU service is not only a regulatory requirement but a core component of a healthy, open and learning culture.

​

A well-functioning FTSU service helps trusts hear the voices that might otherwise go unheard. By offering confidential, impartial support, the service encourages staff to speak up without fear of detriment, supporting psychological safety and trust across the organisation. Concerns raised through FTSU often provide early warning of risks related to quality, safety, leadership or behaviour, enabling timely intervention and continuous improvement.

​

For NHS trusts, the benefits extend beyond individual cases. An effective FTSU service strengthens governance and assurance by providing boards with insight into cultural and operational risks that may not be visible through formal reporting routes. When concerns are handled consistently, transparently and compassionately, trusts can demonstrate learning, improve staff engagement and strengthen compliance with CQC well-led expectations and NHS People Promise commitments.

​

Ultimately, a strong Freedom to Speak Up service helps NHS trusts create environments where openness is normal, learning is continuous and patient safety is prioritised. By supporting staff to speak up and ensuring concerns lead to meaningful action, trusts can reduce risk, improve outcomes and build a culture that supports both high-quality care and staff wellbeing.