Freedom to Speak Up

Quarterly data from the National Guardian's Office showing how many speaking up cases each NHS trust receives. Covers patient safety concerns, bullying and harassment, and other workplace issues raised by staff through Freedom to Speak Up Guardians.

8,615
Cases raised (Q4 2024/2025)
197
NHS trusts reporting
43.7
Avg per trust
0.0%
Patient safety

Key figures — Q4 2024/2025

8,615
Total cases raised
0
Patient safety
0
Bullying / harassment
43.7
Avg cases per trust

Source: National Guardian's Office. Higher case numbers may indicate a healthier speaking up culture, not necessarily more problems.

National Trend

Total cases raised across all NHS trusts by quarter

Total cases raised Patient safety concerns Bullying / harassment

Trusts with most cases — Q4 2024/2025

Top 15 trusts by total FTSU cases. Higher numbers may reflect stronger speaking up cultures.

197 trusts — Q4 2024/2025

Most cases Patient safety Bullying A–Z
University Hospitals Plymouth NHS Trust
190 cases
190
cases
Nottingham University Hospitals NHS Trust
159 cases
159
cases
Nottinghamshire Healthcare NHS Foundation Trust
143 cases
143
cases
Northern Lincolnshire and Goole NHS Foundation Trust
128 cases
128
cases
Walsall Healthcare NHS Trust
127 cases
127
cases
Somerset NHS Foundation Trust
126 cases
126
cases
University Hospitals of Derby and Burton NHS Foundation Trust
119 cases
119
cases
University Hospitals Dorset NHS Foundation Trust
119 cases
119
cases
United Lincolnshire Hospitals NHS Trust
115 cases
115
cases
Dorset County Hospital NHS Foundation Trust
115 cases
115
cases
University Hospitals of Leicester NHS Trust
110 cases
110
cases
Hampshire and Isle of Wight Healthcare
108 cases
108
cases
Guy's and St Thomas' NHS Foundation Trust
106 cases
106
cases
Leeds Teaching Hospitals NHS Trust
103 cases
103
cases
East Lancashire Hospitals NHS Trust
97 cases
97
cases
Birmingham and Solihull Mental Health NHS Foundation Trust
94 cases
94
cases
NORTH WEST ANGLIA NHS FOUNDATION TRUST
94 cases
94
cases
Manchester University NHS Foundation Trust
93 cases
93
cases
Mersey Care NHS Foundation Trust
89 cases
89
cases
Oxford University Hospitals NHS Foundation Trust
89 cases
89
cases
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
88 cases
88
cases
Birmingham Women's and Children's NHS Foundation Trust
87 cases
87
cases
Norfolk and Suffolk NHS Foundation Trust
82 cases
82
cases
Derbyshire Healthcare NHS Trust
81 cases
81
cases
Cambridge University Hospitals NHS Foundation Trust
78 cases
78
cases
University Hospitals Birmingham NHS Foundation Trust
76 cases
76
cases
Hull University Teaching Hospitals NHS Trust
76 cases
76
cases
East of England Ambulance Service NHS Trust
76 cases
76
cases
East Suffolk and North Essex NHS Foundation Trust
74 cases
74
cases
Homerton Healthcare NHS Foundation Trust
74 cases
74
cases
Blackpool Teaching Hospitals NHS Foundation Trust
73 cases
73
cases
Tees, Esk and Wear Valleys NHS Foundation Trust
70 cases
70
cases
Chesterfield Royal Hospital NHS Foundation Trust
70 cases
70
cases
Royal Wolverhampton NHS Trust
68 cases
68
cases
Oxford Health NHS Foundation Trust
67 cases
67
cases
Herefordshire and Worcestershire Health and Care NHS Trust
66 cases
66
cases
Liverpool University Hospitals NHS Foundation Trust
64 cases
64
cases
University Hospitals Sussex NHS Foundation Trust
63 cases
63
cases
York and Scarborough Teaching Hospitals NHS Foundation Trust
63 cases
63
cases
Essex Partnership University NHS Foundation Trust
63 cases
63
cases
Gloucestershire NHS Trust
62 cases
62
cases
Cambridgeshire and Peterborough NHS Foundation Trust
61 cases
61
cases
Birmingham Community Healthcare NHS Foundation Trust
61 cases
61
cases
Barnsley Hospital NHS Foundation Trust
59 cases
59
cases
Dorset Healthcare University NHS Foundation Trust
59 cases
59
cases
Mid and South Essex NHS Foundation Trust
59 cases
59
cases
South Western Ambulance Service NHS Foundation Trust
59 cases
59
cases
Greater Manchester Mental Health NHS Foundation Trust
58 cases
58
cases
University Hospitals of North Midlands NHS Trust
58 cases
58
cases
Bedfordshire Hospitals NHS Foundation Trust
55 cases
55
cases
Data from the National Guardian's Office. Freedom to Speak Up was established following Sir Robert Francis QC's 2015 review into creating an open and honest reporting culture in the NHS. Every NHS trust in England has a Freedom to Speak Up Guardian.