Implementation of ‘Freedom to Speak Up Guardians’ in NHS acute and mental health trusts in England: the FTSUG mixed-methods study (August 2022)

Summary

This study from Jones et al. identified wide variability in the implementation of the Guardian role and concluded that optimal implementation has six components.

Content

Background

The introduction of ‘Freedom to Speak Up Guardians’ into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England.

The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts.

Results

Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. ‘Freedom to Speak Up Guardian’ is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns; their opportunities to collect, analyse and learn from speaking-up data; and, more generally, the extent to which they developed their role and speak-up culture.

Conclusions

Optimal implementation of the Guardian role has five components:

1. establishing an early, collaborative and coherent strategy congruent with the values of Freedom to Speak Up fosters the
2. implementation of policies and robust, yet supportive, practices
3. informed by frequent and reflexive monitoring of Freedom to Speak Up implementation that is
4. underpinned by sufficient time and resource allocation that leads to
5. a positive implementation climate that is congruent with Freedom to Speak Up values and is well placed to engender positive and sustainable Freedom to Speak Up culture and the well-being of a Guardian.