Temporary workers, permanent voices: A Speak Up review (March 2026)

Summary

A review carried out by the National Guardian’s Office has found that temporary workers feel largely excluded from being able to speak up about workplace issues – with almost two-thirds (60.4%) of temporary workers surveyed saying they do not have a voice in the NHS in England.

In the report review, it was found that the biggest barrier to speaking up for temporary workers was the fear of losing shifts.

The review was carried out to enhance the understanding and improvement of a speak up culture among temporary workers in the NHS, working in roles such as nursing, midwifery and health and social care.

The review included surveys, focus groups and interviews to gather diverse perspectives. It spoke to workers, Freedom to Speak Up guardians and other key stakeholders including national representative organisations.

Content

The review heard deeply moving stories from temporary workers, with many recounting experiences of unfair treatment at work, not being supported and feeling like an outsider. In addition, temporary workers reported issues such as a lack of proper staff induction, a lack of advocacy and representation, mistrust in speaking up processes and a lack of support after raising concerns.

The review was carried out following a Health Services Safety Investigations Body (HSSIB) Investigation in 2024 which found widespread discrimination and cultures of fear hindering speaking up among temporary staff.

The review found:

• About two-thirds (64.6%) of participants surveyed said they knew speaking up arrangements in their organisation.
• 5% of workers from NHS Professionals were not aware of Freedom to Speak Up guardians whereas only 18.8% of workers from Trust Bank were not aware of Freedom to Speak Up guardians.
• Seniority had an impact on whether workers knew the arrangements for speaking up. 71% of staff pay bands five-to-eight knew what the speaking up arrangements were, whereas only 59% of bands one-to-four did.

The review report contains six recommendations to help tackle the issues identified, aimed at both the healthcare system and provider organisations and temporary workforce suppliers.

The recommendations include calls for the strengthening of support allowing temporary workers to speak up and the promotion of a culture of inclusion and belonging for temporary workers.

Related reading on the hub:

• Speaking up for patient safety: An interview with Kathy Nabbie
• Speaking up as an agency nurse cost me my career
• My experience as an agency nurse