Case study on freedom to speak up

Freedom to Speak Up Guardian, Hospital, England

What happened

A doctor working within a hospital had raised a number of issues around the themes of patient and staff safety, communication and relationships within the team. Raising concerns through this route had resulted in the doctor feeling isolated and unsure about how to escalate.

The doctor initially raised these issues with their line manager and senior members of staff, who acknowledged verbally that their concerns mattered, but there was limited feedback.

As a result, they approached me as their Freedom to Speak Up Guardian (FSUG) for advice and support on how to manage the concerns. The staff member had the opportunity to discuss, from their perspective, what had happened and how they were feeling. In response to this, I arranged meetings for the staff member to feel supported to Speak Up and discuss the behaviour they had reported to have experienced. Having done so, we triangulated their experiences – and themes arising – and identified a pattern of behaviour, to include racial discrimination. Having received consent from the staff member, information was shared with staff side representatives and the BAME network, which provided early support for the staff member.

Given that the staff member had accessed the Freedom to Speak Up (FTSU) route, reporting that they felt ignored, it was crucial to adhere to the FTSU process in terms of support, advice, and signposting. This is vital to ensuring the effectiveness of raising concerns and in providing staff with the opportunity to be listened to and receive feedback, with follow up.

Supporting staff through the FTSU process has ensured that staff feel comfortable and confident to raise concerns, that they’re listened to effectively, and that actions are taken as a result. This staff member has also been supported by Human Resources, Occupational Health, Learning & Development via coaching sessions, and supported at meetings.


It’s key to note the huge impact that racial discrimination can have on members of staff, both on their wellbeing and – consequently – their ability to work. It can often lead to extended periods of time off work, unsettlement within the team, pressures on other staff, increased workload and further sickness.

Reporting incidents and raising concerns using internal processes should be encouraged as internal colleagues and departments can provide information and knowledge about how these concerns can be managed. If staff feel that appropriate action hasn’t been taken, raising the issue with a FSUG can be an alternative route to speaking up.  It is the role of the FSUG to support staff to speak up where they’ve been unable to do so by other routes.

Individual’s perceptions are important and should be valued. As a FTSU service, we provide everyone with the same opportunity to speak up, to be listened to, with follow up.

Learning, recommendations and feedback

  • Report concerns, including racism, to your Freedom to Speak Up Guardian if you don’t feel able to use other routes. While FSUGs cannot carry out investigations, they can support and ensure a fair process.
  • Raising your concerns with your HR team as soon as possible can allow for appropriate signposting, support and advice. FSUG can support you with accessing this route if required.
  • Staff support networks can be a valuable point of contact and support – if available, consider reaching out to them, it can help to talk, however always be mindful of confidentiality.
  • Consider keeping a journal, which records the behaviour you’ve experienced and witnessed, as well as the impact this has had on your feelings about work and your overall wellbeing.

What the GMC say

  • Doctors may be reluctant to report a concern for several reasons. For example, because you fear that nothing will be done or that raising your concern may cause problems for colleagues; have a negative effect on working relationships; have a negative effect on your career; or result in a complaint about you.  However if you are hesitating about reporting a concern for these reasons, you should bear in mind that you do not need to wait for proof – you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken.

(Raising and acting on concerns, paragraphs 9 and 10c).