Physio staff who trained overseas have a chance to air their views about 'speaking up' in the NHS

Three choices available 

You can participate in three ways: survey, focus group or one-to-one interview 

• survey participants face 45 questions - none of which are mandatory - and the survey takes up to 20 minutes to complete. Responses will remain confidential and are only recorded when the ‘done’ button is clicked at the end. You can access the survey by clicking this link
• focus groups will be held from 10 to 19 September. To book a session, contact: intelligenceandlearning@nationalguardianoffice.org.uk
• healthcare workers wishing to speak to the review team but feel uncomfortable doing so in a group setting, should email: intelligenceandlearning@nationalguardianoffice.org.uk to arrange a one-to-one meeting 

The survey closes at the end of the day on 19 September. To read the Participant Information Sheet, click

Freedom to Speak Up Guardian case study: Rochelle Francois

Senior physio Rochelle Francois is a hand therapist at the London clinic, where she has acted as Freedom to Speak Up Guardian lead since 2022. Her case study is one of a number on the NGO website.

Rochelle says: ‘In on some ways, it feels like the hard work in achieving a speak up culture is just beginning.’ She points out that the NGO found a drop in some indicators of ‘positive speak up cultures' in a report [published in 2022].

‘Some healthcare workers continue to experience “detriment”  for speaking up, and speaking up is far from business as usual. This certainly rings alarm bells for healthcare organisations. Why are we seeing this decline?' she asks.

Rochelle points out that Sir Robert Francis QC’s review of the topic – which led to the birth of NGO and to Freedom to Speak Up guardians – was published some years ago [2015].

'Building a community'

Rochelle says that guardians’ power is based on their ‘ability to build community’. ‘At The London Clinic, having gained multiple new members earlier this year, we’re now a dozen-strong grassroots movement spanning all corners of the hospital. Diversity and representation are critical – our colleagues need to feel like they are speaking to someone “like them”.

‘That’s why our guardians are from different roles, clinical and non-clinical. We’ve different levels of experience, we have different backgrounds and faiths. But together, we congregate around one aim – to support our colleagues in speaking up. Many of us have shared experiences of not being listened to or not knowing who to go to in the past – we’ve been there, and we know what it’s like.

A ‘growing presence’

Rochelle continues: ‘For guardians to truly thrive, they need the backing of their organisation and they need to feel fully equipped. As such, we’ve undertaken NGO Foundation and Refresher training, we’re creating a brand-new Freedom to Speak Up policy and we’re working on our visibility as a priority. This has included an updated intranet page with our pictures and bios, different options to contact us, badges, lanyards, posters, a relaunch event in our canteen, and we have weekly walk-arounds to speak to colleagues in situ. Our presence is growing.

‘Meanwhile, my role as the lead guardian is to work with senior leaders so that they understand what’s happening on the ground, they know the discussions that are happening and the key themes that are coming up. Their buy-in is critical.'

A 'pivotal moment'

Rochelle adds: ‘Over the course of this year, as our guardians are growing in confidence and Freedom to Speak Up is reinforced as a priority at our hospital, we can see the improvement. People are coming to us with concerns, honest conversations are being had, and ultimately bridges are being built.

‘The more of us there are, the more matters we address and the more positive stories we achieve, the more we can keep the culture growing. This feels like a pivotal moment, and our grassroots guardian community is showing what it means to take up space.’

Speak up month: October

The NGO is holding a 'Speak Up Month' during October, with a theme 'Listen Up'. It will focus on the power of listening, an attribute that can encourage people to feel confident to speak up. For more details, click 

What is the National Guardian's Office (NGO)?

The NGO and the role of the Freedom to Speak Up Guardian were created in response to recommendations made by Sir Robert Francis in his report 'The Freedom to Speak Up' (2015), the NGO states.

These recommendations were made as Sir Robert found that the NHS culture did not always encourage or support workers to speak up, and that patients and workers suffered as a result.

The NGO leads, trains and supports a network of Freedom to Speak Up Guardians in England and conducts speaking up reviews to identify learning and support improvement of the speaking up culture of the healthcare sector.

The 1,200-plus guardians in the NHS and elsewhere ensure that workers can speak up about any issues impacting on their ability to do their job. The NGO also 'provides challenge and learning' to the healthcare system as a whole, the NGO adds.