Consultation on the implementation of the recommendations, principles and actions set out in the Freedom to Speak Up review

Closed 4 Jun 2015

Opened 12 Mar 2015


This Government wants to ensure that the NHS is the safest and most transparent healthcare system in the world. To achieve this, individuals must feel safe to speak out and raise concerns. In addition, action must be taken when concerns are raised.

The tragic and inexcusable failings at Mid Staffordshire NHS Foundation Trust highlighted the need for a change in culture to encourage staff to raise concerns. In other parts of the NHS, it was clear that in some wards and in some weaker institutions there were also worrying cultures allowing a failure to face up to problems and deal with them, letting down patients and staff alike.

In response to concerns about the reporting culture in the NHS, the Secretary of State for Health commissioned Sir Robert Francis QC to carry out an independent policy review, "Freedom to Speak Up".

The review was asked to identify measures to help to foster a culture in the NHS in England where staff can feel safe to speak out about patient safety, as well as learning lessons from the existing culture in the NHS by listening to those who have experiences to share, both positive and negative.

The report of the review was published on 11 February 2015, with two high-level recommendations:

1. All organisations which provide NHS healthcare and regulators should implement the principles and actions set out in the report in line with the good practice described in the report.

2. The Secretary of State for Health should review at least annually, the progress made in the implementation of these Principles and Actions, and the performance of the NHS in handling concerns and the treatment of those who raise them and report to Parliament. The Secretary of State has agreed to this recommendation.

The Secretary of State has accepted the recommendations in principle. This consultation seeks views on a package of measures to implement the recommendations.

Why We Are Consulting

We are now undertaking this public consultation to ensure that we honour the spirit of what Sir Robert has recommended but also avoid unnecessary layers of bureaucracy or financial burden. We expect that national regulators and oversight bodies and local NHS healthcare providers will need to consider and review how best to implement the principles and actions contained in the report in an effective, proportionate and affordable way, consulting with stakeholders themselves as appropriate.

There are many of the principles and actions that we expect can be taken forward immediately, building on what is already in place locally. We would encourage both local and national NHS organisations to move ahead with such actions without further delay.




  • Voluntary groups
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  • GPs
  • Nurses
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  • Clinicians
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  • Orthotists
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  • Diagnostic radiographers
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  • Speech and language therapists
  • Childcare providers
  • Allied Health Professionals
  • Care-Givers
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  • Responsible Officers
  • Foundation Trusts
  • NHS Commissioning Board
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  • Employer representatives
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  • Directors of PH
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  • Complaints