Source · NHS speaking-up culture
Freedom to Speak Up
Quarterly counts, per NHS trust, of cases brought to Freedom to Speak Up Guardians, and of how many carried an element of patient safety or quality, or of bullying or harassment.
8,617 cases brought to Guardians (Q4 2025/2026)
186 NHS trusts reporting
A case can carry more than one element, so the elements do not add up to the total. The National Guardian's Office closed on 30 June 2026 and 2025/26 is its final publication.
Average cases per trust (Q4 2025/2026): 46.3. Share of cases with an element of patient safety or quality: 18.0%.
Trusts 186 trusts, Q4 2025/2026
Trust sparklines show cases brought to Freedom to Speak Up Guardians across all available recorded periods, regardless of the selected quarter. Periods without a recorded value are omitted.
| Trust | Cases | With an element of patient safety/quality | With an element of bullying or harassment | Trend | ||||||||||||||||||||||||||||||||||||||||||||||||||
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Leeds Teaching Hospitals NHS Trust
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260 | 34 | 40 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals Birmingham NHS Foundation Trust
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172 | 24 | 75 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Mersey Care NHS Foundation Trust
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143 | 9 | 12 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals Plymouth NHS Trust
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138 | 75 | 39 | |||||||||||||||||||||||||||||||||||||||||||||||||||
NORTH WEST ANGLIA NHS FOUNDATION TRUST
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129 | 14 | 19 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals Dorset NHS Foundation Trust
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121 | 10 | 4 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Dorset County Hospital NHS Foundation Trust
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120 | 16 | 5 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Nottinghamshire Healthcare NHS Foundation Trust
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119 | 11 | 22 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals of Leicester NHS Trust
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116 | 15 | 14 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Manchester University NHS Foundation Trust
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111 | 13 | 33 | |||||||||||||||||||||||||||||||||||||||||||||||||||
York and Scarborough Teaching Hospitals NHS Foundation Trust
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101 | 35 | 28 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Nottingham University Hospitals NHS Trust
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101 | 14 | 8 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals of North Midlands NHS Trust
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98 | 34 | 39 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Chesterfield Royal Hospital NHS Foundation Trust
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94 | 14 | 24 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Norfolk and Suffolk NHS Foundation Trust
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94 | 7 | 6 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Birmingham and Solihull Mental Health NHS Foundation Trust
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92 | 23 | 17 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Hampshire and Isle of Wight Healthcare
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91 | 15 | 1 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Guy's and St Thomas' NHS Foundation Trust
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90 | 13 | 22 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Somerset NHS Foundation Trust
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88 | 15 | 16 | |||||||||||||||||||||||||||||||||||||||||||||||||||
East Midlands Ambulance Service NHS Trust
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87 | 25 | 8 | |||||||||||||||||||||||||||||||||||||||||||||||||||
United Lincolnshire Hospitals NHS Trust
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86 | 6 | 14 | |||||||||||||||||||||||||||||||||||||||||||||||||||
East and North Hertfordshire Teaching NHS Trust
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84 | 3 | 6 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Cambridge University Hospitals NHS Foundation Trust
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82 | 19 | 9 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Avon and Wiltshire NHS Trust
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80 | 15 | 54 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Walsall Healthcare NHS Trust
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79 | 71 | 31 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Royal Free London NHS Foundation Trust
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78 | 2 | 3 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Hull University Teaching Hospitals NHS Trust
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75 | 8 | 2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
County Durham and Darlington NHS Foundation Trust
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73 | 27 | 15 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals Sussex NHS Foundation Trust
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72 | 3 | 11 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Sandwell and West Birmingham Hospitals NHS Trust
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71 | 7 | 18 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Leeds Community Healthcare NHS Trust
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70 | 8 | 0 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Oxford Health NHS Foundation Trust
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70 | 6 | 9 | |||||||||||||||||||||||||||||||||||||||||||||||||||
University Hospitals of Derby and Burton NHS Foundation Trust
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67 | 11 | 10 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Mid and South Essex NHS Foundation Trust
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66 | 8 | 14 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Royal Wolverhampton NHS Trust
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66 | 7 | 14 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Oxford University Hospitals NHS Foundation Trust
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66 | 4 | 11 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Essex Partnership University NHS Foundation Trust
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65 | 11 | 12 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Northern Lincolnshire and Goole NHS Foundation Trust
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65 | 3 | 2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
King's College Hospital NHS Foundation Trust
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64 | 18 | 16 | |||||||||||||||||||||||||||||||||||||||||||||||||||
South Western Ambulance Service NHS Foundation Trust
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64 | 3 | 6 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Maidstone and Tunbridge Wells NHS Trust
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62 | 15 | 8 | |||||||||||||||||||||||||||||||||||||||||||||||||||
East of England Ambulance Service NHS Trust
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62 | 2 | 4 | |||||||||||||||||||||||||||||||||||||||||||||||||||
South Central Ambulance Service NHS Foundation Trust
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61 | 0 | 17 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Frimley Health NHS Foundation Trust
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61 | 15 | 3 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Moorfields Eye Hospital NHS Foundation Trust
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60 | 3 | 2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Norfolk and Norwich University Hospitals
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58 | 8 | 4 | |||||||||||||||||||||||||||||||||||||||||||||||||||
The Dudley Group NHS Foundation Trust
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56 | 11 | 1 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Derbyshire Healthcare NHS Trust
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55 | 6 | 10 | |||||||||||||||||||||||||||||||||||||||||||||||||||
East London NHS Foundation Trust
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55 | 26 | 15 | |||||||||||||||||||||||||||||||||||||||||||||||||||
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
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54 | 19 | 16 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Source: National Guardian's Office. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
About this source
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. Quarterly returns are collated by the National Guardian's Office.
Key figures, Q4 2025/2026
National Guardian's Office
| Measure | Value |
|---|---|
| Cases brought to Freedom to Speak Up Guardians | 8,617 |
| With an element of patient safety/quality | 1,548 |
| With an element of bullying or harassment | 1,443 |
| Average cases per trust | 46.3 |
National trend
Cases brought to Freedom to Speak Up Guardians across all NHS trusts by quarter. Bullying or harassment starts in 2022/23 and patient safety/quality in 2020/21; earlier quarters are gaps, not zero.
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| Quarter | Cases brought to Guardians | With an element of patient safety/quality | With an element of bullying or harassment |
|---|---|---|---|
| Q1 2020/2021 | 4912 | 927 | Not indexed |
| Q2 2020/2021 | 4612 | 870 | Not indexed |
| Q3 2020/2021 | 4985 | 888 | Not indexed |
| Q4 2020/2021 | 4579 | 778 | Not indexed |
| Q1 2021/2022 | 4495 | 747 | Not indexed |
| Q2 2021/2022 | 4193 | 837 | Not indexed |
| Q3 2021/2022 | 5268 | 1053 | Not indexed |
| Q4 2021/2022 | 4856 | 939 | Not indexed |
| Q1 2022/2023 | 4966 | 1069 | 1125 |
| Q2 2022/2023 | 5536 | 1106 | 1180 |
| Q3 2022/2023 | 6261 | 1284 | 1337 |
| Q4 2022/2023 | 6024 | 1073 | 1311 |
| Q1 2023/2024 | 6131 | 1095 | 1341 |
| Q2 2023/2024 | 6774 | 1308 | 1287 |
| Q3 2023/2024 | 8166 | 1532 | 1634 |
| Q4 2023/2024 | 7703 | 1500 | 1472 |
| Q1 2024/2025 | 7758 | 1339 | 1440 |
| Q2 2024/2025 | 8125 | 1609 | 1613 |
| Q3 2024/2025 | 8778 | 1453 | 1524 |
| Q4 2024/2025 | 8878 | 1599 | 1504 |
| Q1 2025/2026 | 7649 | 1183 | 1304 |
| Q2 2025/2026 | 8383 | 1472 | 1431 |
| Q3 2025/2026 | 8960 | 1605 | 1441 |
| Q4 2025/2026 | 8617 | 1548 | 1443 |
Cases brought to Freedom to Speak Up Guardians
With an element of patient safety/quality
With an element of bullying or harassment
Trust comparison, Q4 2025/2026
Fifteen trusts with the most cases. The chart uses all trusts in the selected quarter and is independent of the search and sort on the Trusts tab. Cases, cases with an element of patient safety/quality and cases with an element of bullying or harassment are separate series that overlap, because one case can carry several elements.
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| Trust | Cases brought to Guardians | With an element of patient safety/quality | With an element of bullying or harassment |
|---|---|---|---|
| Leeds Teaching Hospitals NHS Trust | 260 | 34 | 40 |
| University Hospitals Birmingham NHS Foundation Trust | 172 | 24 | 75 |
| Mersey Care NHS Foundation Trust | 143 | 9 | 12 |
| University Hospitals Plymouth NHS Trust | 138 | 75 | 39 |
| NORTH WEST ANGLIA NHS FOUNDATION TRUST | 129 | 14 | 19 |
| University Hospitals Dorset NHS Foundation Trust | 121 | 10 | 4 |
| Dorset County Hospital NHS Foundation Trust | 120 | 16 | 5 |
| Nottinghamshire Healthcare NHS Foundation Trust | 119 | 11 | 22 |
| University Hospitals of Leicester NHS Trust | 116 | 15 | 14 |
| Manchester University NHS Foundation Trust | 111 | 13 | 33 |
| York and Scarborough Teaching Hospitals NHS Foundation Trust | 101 | 35 | 28 |
| Nottingham University Hospitals NHS Trust | 101 | 14 | 8 |
| University Hospitals of North Midlands NHS Trust | 98 | 34 | 39 |
| Chesterfield Royal Hospital NHS Foundation Trust | 94 | 14 | 24 |
| Norfolk and Suffolk NHS Foundation Trust | 94 | 7 | 6 |