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Trust adopts new methods of empowering staff by giving them the freedom to speak up, enabling an immediate escalation of incidents and enhancing the safety culture


    • Create a speaking up culture in the organisation, thereby improving patient and staff experience
    • Support equality, diversity and inclusion amongst staff; promoting quality improvement, learning and development
    • Encourage staff to raise any safety concerns by granting access via other mediums of reporting


    • Formed a cultural team, headed by the Freedom to Speak Up Guardian (FTSUG) to support vulnerable staff/patients
    • Escalated concerns within hours of receipt to ensure rapid action and risk triangulation
    • Established direct reporting systems and introduced the anonymous ‘speak-up’ button on trust website
    • Established networks for Black, Asian, minority, ethnic and other underprivileged groups, empowering them to speak up


    • Improved the CQC rating from ‘Requires Improvement’ to ‘Good’
    • Enhanced patient safety culture, and enabled systemic improvements across organisational boundaries
    • Received positive staff feedback and improved patients’ quality of care


At RDaSH we have approached the adoption of Freedom to Speak Up (FTSU) in ways that are inclusive and not only focussed on developing our organisational culture but assisting development of partner agencies. In taking this broader approach to FTSU we have both improved our patient safety culture, and enabled systemic improvements across organisational boundaries. This type of joint working is essential to meet the vision of the National Guardian and the NHS 10 Year plan.

Our internal FTSU team consists of a Guardian, Deputy Guardian, a Director for FTSU, CEO, Non Executive Director (NED) for FTSU and 15 passionate FTSU advocates who work together to promote a speaking up culture.

We encourage any staff who have a patient/staff safety concern to raise this. We work with internal leads to ensure that staff to feel able ‘speak up’ to their manager or clinical lead in the first instance, however if this is not possible to ensure staff to know that they have other routes to access via; the FTSU Team; learning team; staff-side representatives; safeguarding team; spiritual care team; well-being support and the health and safety teams. This collective approach to FTSU is focussed upon easing access, early detection and consistency.


We appointed our FTSU Guardian in May 2016, who has also held the chair role for Yorkshire and Humber regional Network since Autumn 2016. What this has meant is that from FTSU commencement, we have fulfilled an ambition to develop our local culture in parallel with the development of joint-work with our regional partners. This, we believe, supports patient safety and staff wellbeing in a ‘place-based’ and integrated way.

To ensure that our ambitions have become a reality we have required to coproduce our journey with all staff, and also restructured our teams to ensure FTSU concerns enable change. The reason for this is that we have learned from barriers that have arisen in our/other Trusts if FTSU roles are isolated, have insufficient time allocated or an inadequate infrastructure around them.

We have achieved our ambition through the formation of our Cultural Improvement and Development Team which is led by our FTSU Guardian. This team supports the collective function of FTSU; Equality, Diversity and Inclusion; Quality Improvement and Learning and Development. This targeted integration enables a wider spread of FTSU, but also joint working that supports our most vulnerable staff and patients, and a route for improvement and learning which is sustained.


Three years into our FTSU Journey we can demonstrate how ‘speaking up’ has become integral to our culture, examples include:

  • We have clear escalation systems centred upon ‘no surprises’, meaning that FTSU concerns are appropriately shared within hours of receipt to ensure rapid action and risk triangulation with other patient and staff safety measures.
  • We have reporting systems which enable us to focus upon cultural change, concerns raised, staff experience and care quality, these are reported through direct care teams, operational learning meetings, Trust Quality and Audit Committees and also through the Public Board Meetings (An example paper is attached).
  • We have a FTSU policy, provided in easy-read and spoken-word form to ensure accessibility.
  • Our Board of Directors have worked with Trust leads to coproduce our FTSU strategy, and this has also affected a review of other related HR, and patient safety policies.
  • Our ‘speak up’ reporting system has been refined and developed aimed at continuous service improvement.
  • An example of an individual case outcome is provided in the attached anonymised case study.

Our focus upon FTSU and improving organisational culture has yielded positive outcomes in terms of our patient care, staff feedback and has contributed to our CQC re-rating moving from ‘Requires Improvement’ to ‘Good’, of which we are proud.


There are a number of ways we have enabled cultural spread, examples include:

  • The development of FTSU advocate roles which are deliberately diverse in terms of skill mix, role, seniority and geographical locality, to increase accessibility. Advocates receive training and bimonthly supervision.
  • We ensure all new starters receive FTSU information. This induction session is led by our CEO. Additional targeted induction sessions are led by the Deputy FTSU Guardian for staff groups who may be more vulnerable (i.e. junior doctors, student nurses, bank workers and volunteers).
  • We have introduced digital ways to ‘speak up’, including an anonymous ‘speak up’ button on the trust website, and Improvement-Hub ‘speak up’ challenges. These add to existing ways staff can ‘speak up’; via phone, text, email, face-to-face meetings and social media.
  • We have worked with neighbouring providers who have challenges different from our own (i.e highlighted by ‘inadequate’ CQC ratings). In connecting with other Trust leads about FTSU we have shared processes and established systems to communicate and collectively address concerns that have occurred in collocated departments. This has helped spread good practice beyond our organisational boundaries and enabled others to develop more positive FTSU approaches which is beneficial for patients accessing our whole system.


We measure the value of our FTSU approaches in a number of ways, here are four examples:

  • We gather feedback from all who have spoken up and use the statistical and narrative feedback in our review of FTSU processes as well as in promotional material to help others to ‘speak up’.
  • We have hosted targeted events within the Trust linking FTSU with other core business. One example is FTSU training provided to over 200 clinical staff demonstrating how FTSU is an essential safeguarding measure in the Trust. Another example is World Mental Health Day, linking FTSU to workplace well-being:
  • In all of their assurance site visits our NEDs support FTSU, they check that FTSU contact details are advertised and in they discuss FTSU in terms of health and safety. In addition, the NED responsible for FTSU conducts case audits randomly to gain assurance and provides feedback through the Board of Directors Meetings.
  • To further the spread of FTSU we have formed the ‘I-CAN’ Network. I-CAN stands for ‘Improvement Culture Ambassadors Network’ and focusses upon what people CAN do to help support improvement. After ‘speaking up’ people are offered people to become an ‘ICAN’. This means they are then utilised in future change and resolution activity, spreading the message that value can be gained from raising concerns.


The examples listed show local, regional and national involvement which supports RDaSH FTSU culture:

  • Regular face-to-face ‘big conversations’, open to all staff, focussed upon enabling staff to express what needs to change and involving them in designing change.
  • Establishment of BAME, LGBT+, Disability and Faith diversity networks, enabling people who may feel disempowered to ‘speak up’ and involving people to make meaningful change after concerns have been raised.
  • FTSU presentations at patient and public ‘listen to learn’ networks. This enables communication about FTSU learning, and also seeks to involve patients and carers in coproducing change.
  • Our FTSU Guardian has regularly presented at the Regional Social Care Partnership upon the value of ‘speaking up’. Additionally, the Guardian supports the Leadership Academy by presenting to all new regional Graduate Management Trainees discussing their FTSU obligations as our ‘NHS leaders of the future’.
  • Our Trust conference each year has focussed on FTSU culture, involving national speakers. In 2017, Ruth May presented concerning patient safety, in 2018, Dame Jackie Daniels and Yvonne Coghill provided keynote speech’s focused upon safe and transparent cultures linked with diversity. This summer our keynote speaker was Prof Michael West who is working with us to develop compassionate FTSU leadership. We provide free conference places to all regional FTSU Guardians, to share learning, and enable CPD at this financially pressured time, this is the video link: