Classification: Official
Publication reference: PRN01370
To:
- Integrated care board chairs
cc.
- Integrated care board chief executive officers
Dear colleagues,
Adoption of the national Freedom to Speak Up policy and access to a guardian for primary care workers
NHS England wrote to you last year setting out our expectations of integrated care boards (ICBs) regarding Freedom to Speak Up (FTSU). A few months later, we wrote to all NHS chairs and chief executives reiterating the expectations for adoption of the national FTSU policy in all NHS organisations (including ICBs), by the end of January 2024.
In addition, and in the same timeframe, trusts and ICBs were expected to use the updated FTSU guide for leaders and self-reflection tool, to ensure the effectiveness of local arrangements.
Freedom to Speak Up in ICBs and NHS trusts
Thank you to those ICBs who have already reviewed and refreshed FTSU arrangements and adopted the national policy for your own staff. For those who have not, we ask that you please prioritise this over October.
Given the importance of ensuring effective arrangements across the NHS (as set out in the FTSU guide for leaders), regional teams will be seeking assurance in October that:
- ICBs have adopted the national policy and applied the FTSU guide for leaders in their own organisation
- all NHS trusts have done the same (and depending on local arrangements, regions may ask ICBs to support them with getting that assurance)
Freedom to Speak Up in primary care
Building on the progress so far, we are now asking ICBs to ensure that FTSU arrangements are in place for system partners in primary care.
We know that reporting through FTSU in primary care settings is improving, but substantial gaps remain, with relatively low reported numbers overall. Routes to escalate concerns are more limited than in secondary care, with risks to individual confidentiality due to the size of some providers.
With this in mind, we are asking ICBs to take the following actions:
1. Ensure that primary care workers are aware of and have access to speaking up routes.
Staff should know how to reach a FTSU guardian who is trained, registered with the National Guardian’s Office, and named in the local FTSU policy. This will support workers with speaking up where needed.
ICBs may wish to prioritise certain contractor groups in improving access/awareness and scale up as their models develop. This will support the primary care patient safety strategy.
2. Generally, raise the profile of FTSU in primary care across your health system by identifying and sharing good practice examples which will already exist within many of your integrated care systems.
This will stimulate awareness and take-up
3. Ensure you have appointed an executive lead to oversee this work, and identified who will work with ICBs to support it.
Regions will be checking on progress as part of 2024/25 arrangements, and we expect that by 2026, ensuring access to FTSU guardians in primary care will form a new part of the delegation arrangements.
To support you with this important work, there are resources available:
National Guardian’s Office:
- Research on possible models for FTSU in primary care
- Access to a primary care FTSU guardian’s ‘network’ to connect and support guardians in their role
- ICB Guardian Network to be established and hosted by the National Guardian’s Office
Thank you for all your continued work on this important agenda, creating the right cultures that enable our people to feel safe to raise concerns, which is invaluable to our efforts to continually improve services and make the NHS a safer place.
If your staff have questions about how NHS England works with ICBs on FTSU cases received by NHS England, please speak to your regional teams, who will be able to help you.
If you have enquiries about this letter, please send them to england.ftsu-enquiries@nhs.net where they will be collated and themed to work out what more support is needed. You can also use the ICB Guardian network which is being set up by the National Guardian’s Office to discuss issues.
Yours sincerely,
Sir Andrew Morris, Deputy Chair, NHS England