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Source · NHS speaking-up culture

Freedom to Speak Up

8,418 cases (Q4 2025/2026) 181 NHS trusts reporting 46.5 avg per trust 17.9% patient safety

Quarterly data from the National Guardian's Office showing how many speaking-up cases each NHS trust receives — patient safety concerns, bullying and harassment, and other workplace issues raised by staff through Freedom to Speak Up Guardians. Higher case numbers may indicate a healthier speaking-up culture, not necessarily more problems.

Key figures — Q4 2025/2026

National Guardian's Office
Measure Value
Total cases raised8,418
Patient safety concerns1,508
Bullying / harassment1,411
Average cases per trust46.5

National trend

Total cases raised across all NHS trusts by quarter
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National speaking-up cases by quarter
QuarterCasesPatient safetyBullying / harassment
Q1 2024/20257464——
Q2 2024/20257860——
Q3 2024/20258471——
Q4 2024/20258615——
Q1 2025/2026741011651260
Q2 2025/2026820314231413
Q3 2025/2026877515741425
Q4 2025/2026841815081411
Total cases Patient safety Bullying / 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 below. Cases, patient safety and bullying concerns are separate series; higher counts can reflect stronger reporting.

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TrustCasesPatient safetyBullying / harassment
Leeds Teaching Hospitals NHS Trust2603440
University Hospitals Birmingham NHS Foundation Trust1722475
Mersey Care NHS Foundation Trust143912
University Hospitals Plymouth NHS Trust1387539
NORTH WEST ANGLIA NHS FOUNDATION TRUST1291419
University Hospitals Dorset NHS Foundation Trust121104
Dorset County Hospital NHS Foundation Trust120165
Nottinghamshire Healthcare NHS Foundation Trust1191122
University Hospitals of Leicester NHS Trust1161514
Manchester University NHS Foundation Trust1111333
Nottingham University Hospitals NHS Trust101148
York and Scarborough Teaching Hospitals NHS Foundation Trust1013528
University Hospitals of North Midlands NHS Trust983439
Norfolk and Suffolk NHS Foundation Trust9476
Chesterfield Royal Hospital NHS Foundation Trust941424
Most cases Patient safety Bullying A–Z

Trusts

181 trusts · Q4 2025/2026

Trust sparklines show cases raised across all available recorded periods, regardless of the selected quarter. Periods without a recorded value are omitted.

Trust Cases Patient safety Bullying Trend
Leeds Teaching Hospitals NHS Trust
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Leeds Teaching Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202534.0
Q2 2024/202568.0
Q3 2024/202555.0
Q4 2024/2025103.0
Q1 2025/202653.0
Q2 2025/202670.0
Q3 2025/202676.0
Q4 2025/2026260.0
260 34 40
University Hospitals Birmingham NHS Foundation Trust
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University Hospitals Birmingham NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202588.0
Q2 2024/202579.0
Q3 2024/202583.0
Q4 2024/202576.0
Q1 2025/202686.0
Q2 2025/2026101.0
Q3 2025/2026148.0
Q4 2025/2026172.0
172 24 75
Mersey Care NHS Foundation Trust
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Mersey Care NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202570.0
Q2 2024/202571.0
Q3 2024/202599.0
Q4 2024/202589.0
Q1 2025/2026114.0
Q2 2025/2026119.0
Q3 2025/2026141.0
Q4 2025/2026143.0
143 9 12
University Hospitals Plymouth NHS Trust
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University Hospitals Plymouth NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/2025128.0
Q2 2024/2025160.0
Q3 2024/2025151.0
Q4 2024/2025190.0
Q1 2025/2026152.0
Q2 2025/2026143.0
Q3 2025/2026154.0
Q4 2025/2026138.0
138 75 39
NORTH WEST ANGLIA NHS FOUNDATION TRUST
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NORTH WEST ANGLIA NHS FOUNDATION TRUST · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202590.0
Q2 2024/202587.0
Q3 2024/2025111.0
Q4 2024/202594.0
Q1 2025/2026109.0
Q2 2025/2026126.0
Q3 2025/2026145.0
Q4 2025/2026129.0
129 14 19
University Hospitals Dorset NHS Foundation Trust
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University Hospitals Dorset NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/2025137.0
Q2 2024/2025152.0
Q3 2024/2025127.0
Q4 2024/2025119.0
Q1 2025/2026107.0
Q2 2025/2026127.0
Q3 2025/2026107.0
Q4 2025/2026121.0
121 10 4
Dorset County Hospital NHS Foundation Trust
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Dorset County Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/2025108.0
Q2 2024/2025148.0
Q3 2024/2025128.0
Q4 2024/2025115.0
Q1 2025/2026119.0
Q2 2025/2026116.0
Q3 2025/2026120.0
Q4 2025/2026120.0
120 16 5
Nottinghamshire Healthcare NHS Foundation Trust
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Nottinghamshire Healthcare NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/2025118.0
Q2 2024/2025168.0
Q3 2024/2025138.0
Q4 2024/2025143.0
Q1 2025/202694.0
Q2 2025/202686.0
Q3 2025/2026140.0
Q4 2025/2026119.0
119 11 22
University Hospitals of Leicester NHS Trust
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University Hospitals of Leicester NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202580.0
Q2 2024/202594.0
Q3 2024/2025133.0
Q4 2024/2025110.0
Q1 2025/202693.0
Q2 2025/202691.0
Q3 2025/2026112.0
Q4 2025/2026116.0
116 15 14
Manchester University NHS Foundation Trust
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Manchester University NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202553.0
Q2 2024/202582.0
Q3 2024/202570.0
Q4 2024/202593.0
Q1 2025/202670.0
Q2 2025/202666.0
Q3 2025/202689.0
Q4 2025/2026111.0
111 13 33
Nottingham University Hospitals NHS Trust
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Nottingham University Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/2025146.0
Q2 2024/202589.0
Q3 2024/2025122.0
Q4 2024/2025159.0
Q1 2025/2026145.0
Q2 2025/2026144.0
Q3 2025/2026110.0
Q4 2025/2026101.0
101 14 8
York and Scarborough Teaching Hospitals NHS Foundation Trust
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York and Scarborough Teaching Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202516.0
Q2 2024/202541.0
Q3 2024/202564.0
Q4 2024/202563.0
Q1 2025/202670.0
Q2 2025/202691.0
Q3 2025/202668.0
Q4 2025/2026101.0
101 35 28
University Hospitals of North Midlands NHS Trust
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University Hospitals of North Midlands NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202566.0
Q2 2024/202587.0
Q3 2024/202562.0
Q4 2024/202558.0
Q1 2025/202679.0
Q2 2025/2026106.0
Q3 2025/2026118.0
Q4 2025/202698.0
98 34 39
Norfolk and Suffolk NHS Foundation Trust
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Norfolk and Suffolk NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202554.0
Q2 2024/202564.0
Q3 2024/202541.0
Q4 2024/202582.0
Q1 2025/202668.0
Q2 2025/2026119.0
Q3 2025/202693.0
Q4 2025/202694.0
94 7 6
Chesterfield Royal Hospital NHS Foundation Trust
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Chesterfield Royal Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202567.0
Q2 2024/2025107.0
Q3 2024/202583.0
Q4 2024/202570.0
Q3 2025/202667.0
Q4 2025/202694.0
94 14 24
Birmingham and Solihull Mental Health NHS Foundation Trust
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Birmingham and Solihull Mental Health NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/2025110.0
Q2 2024/2025101.0
Q3 2024/2025128.0
Q4 2024/202594.0
Q2 2025/2026194.0
Q3 2025/2026104.0
Q4 2025/202692.0
92 23 17
Hampshire and Isle of Wight Healthcare
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Hampshire and Isle of Wight Healthcare · cases raised by reporting period
Reporting periodCases raised
Q3 2024/202596.0
Q4 2024/2025108.0
Q1 2025/2026110.0
Q2 2025/2026119.0
Q3 2025/2026110.0
Q4 2025/202691.0
91 15 1
Guy's and St Thomas' NHS Foundation Trust
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Guy's and St Thomas' NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202588.0
Q2 2024/202564.0
Q3 2024/2025113.0
Q4 2024/2025106.0
Q1 2025/202686.0
Q2 2025/2026116.0
Q3 2025/202693.0
Q4 2025/202690.0
90 13 22
Somerset NHS Foundation Trust
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Somerset NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202580.0
Q2 2024/2025117.0
Q3 2024/202589.0
Q4 2024/2025126.0
Q1 2025/202695.0
Q2 2025/202690.0
Q3 2025/202678.0
Q4 2025/202688.0
88 15 16
East Midlands Ambulance Service NHS Trust
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East Midlands Ambulance Service NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q2 2024/202533.0
Q3 2024/202551.0
Q4 2024/202549.0
Q2 2025/202656.0
Q3 2025/202657.0
Q4 2025/202687.0
87 25 8
United Lincolnshire Hospitals NHS Trust
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United Lincolnshire Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202591.0
Q2 2024/2025109.0
Q3 2024/2025118.0
Q4 2024/2025115.0
Q1 2025/2026123.0
Q2 2025/2026120.0
Q3 2025/202693.0
Q4 2025/202686.0
86 6 14
East and North Hertfordshire Teaching NHS Trust
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East and North Hertfordshire Teaching NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2025/202688.0
Q2 2025/202672.0
Q3 2025/202682.0
Q4 2025/202684.0
84 3 6
Cambridge University Hospitals NHS Foundation Trust
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Cambridge University Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202572.0
Q2 2024/202567.0
Q3 2024/202579.0
Q4 2024/202578.0
Q1 2025/202658.0
Q2 2025/202673.0
Q3 2025/202689.0
Q4 2025/202682.0
82 19 9
Avon and Wiltshire NHS Trust
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Avon and Wiltshire NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202539.0
Q2 2024/202527.0
Q3 2024/202543.0
Q4 2024/202552.0
Q1 2025/202636.0
Q2 2025/202662.0
Q3 2025/202634.0
Q4 2025/202680.0
80 15 54
Walsall Healthcare NHS Trust
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Walsall Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202576.0
Q2 2024/202582.0
Q3 2024/202578.0
Q4 2024/2025127.0
Q2 2025/202673.0
Q3 2025/2026129.0
Q4 2025/202679.0
79 71 31
Royal Free London NHS Foundation Trust
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Royal Free London NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202517.0
Q2 2024/202521.0
Q3 2024/202523.0
Q4 2024/202514.0
Q1 2025/202613.0
Q2 2025/202612.0
Q4 2025/202678.0
78 2 3
Hull University Teaching Hospitals NHS Trust
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Hull University Teaching Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202562.0
Q2 2024/202554.0
Q3 2024/202579.0
Q4 2024/202576.0
Q1 2025/202668.0
Q2 2025/202682.0
Q3 2025/202682.0
Q4 2025/202675.0
75 8 2
County Durham and Darlington NHS Foundation Trust
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County Durham and Darlington NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202522.0
Q2 2024/202522.0
Q3 2024/202525.0
Q4 2024/202551.0
Q1 2025/202633.0
Q2 2025/202629.0
Q3 2025/202660.0
Q4 2025/202673.0
73 27 15
University Hospitals Sussex NHS Foundation Trust
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University Hospitals Sussex NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202565.0
Q2 2024/202547.0
Q3 2024/202573.0
Q4 2024/202563.0
Q1 2025/202656.0
Q2 2025/202663.0
Q3 2025/202673.0
Q4 2025/202672.0
72 3 11
Sandwell and West Birmingham Hospitals NHS Trust
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Sandwell and West Birmingham Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202549.0
Q2 2024/202571.0
Q3 2024/202536.0
Q4 2024/202527.0
Q1 2025/202697.0
Q2 2025/202667.0
Q3 2025/202653.0
Q4 2025/202671.0
71 7 18
Oxford Health NHS Foundation Trust
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Oxford Health NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202576.0
Q2 2024/202587.0
Q3 2024/202576.0
Q4 2024/202567.0
Q1 2025/202665.0
Q2 2025/202656.0
Q3 2025/2026110.0
Q4 2025/202670.0
70 6 9
Leeds Community Healthcare NHS Trust
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Leeds Community Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202543.0
Q2 2024/202550.0
Q3 2024/202543.0
Q4 2024/202552.0
Q1 2025/202647.0
Q2 2025/202646.0
Q3 2025/202649.0
Q4 2025/202670.0
70 8 0
University Hospitals of Derby and Burton NHS Foundation Trust
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University Hospitals of Derby and Burton NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202585.0
Q2 2024/2025103.0
Q3 2024/202584.0
Q4 2024/2025119.0
Q1 2025/202675.0
Q2 2025/2026108.0
Q3 2025/2026115.0
Q4 2025/202667.0
67 11 10
Oxford University Hospitals NHS Foundation Trust
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Oxford University Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202536.0
Q2 2024/202531.0
Q3 2024/202541.0
Q4 2024/202589.0
Q1 2025/202673.0
Q2 2025/202676.0
Q3 2025/202675.0
Q4 2025/202666.0
66 4 11
Royal Wolverhampton NHS Trust
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Royal Wolverhampton NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202555.0
Q2 2024/202562.0
Q3 2024/202562.0
Q4 2024/202568.0
Q1 2025/202656.0
Q2 2025/202664.0
Q3 2025/202661.0
Q4 2025/202666.0
66 7 14
Mid and South Essex NHS Foundation Trust
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Mid and South Essex NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202576.0
Q2 2024/2025116.0
Q4 2024/202559.0
Q1 2025/202657.0
Q2 2025/202659.0
Q3 2025/202667.0
Q4 2025/202666.0
66 8 14
Northern Lincolnshire and Goole NHS Foundation Trust
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Northern Lincolnshire and Goole NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202596.0
Q2 2024/202592.0
Q3 2024/202585.0
Q4 2024/2025128.0
Q1 2025/2026122.0
Q2 2025/202694.0
Q3 2025/2026107.0
Q4 2025/202665.0
65 3 2
Essex Partnership University NHS Foundation Trust
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Essex Partnership University NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202559.0
Q2 2024/202572.0
Q3 2024/202570.0
Q4 2024/202563.0
Q1 2025/202698.0
Q2 2025/202680.0
Q3 2025/202676.0
Q4 2025/202665.0
65 11 12
King's College Hospital NHS Foundation Trust
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King's College Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202592.0
Q2 2024/202581.0
Q3 2024/202588.0
Q4 2024/202555.0
Q1 2025/202684.0
Q2 2025/202669.0
Q3 2025/202644.0
Q4 2025/202664.0
64 18 16
South Western Ambulance Service NHS Foundation Trust
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South Western Ambulance Service NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202538.0
Q2 2024/202553.0
Q3 2024/202562.0
Q4 2024/202559.0
Q1 2025/202652.0
Q2 2025/202653.0
Q3 2025/202657.0
Q4 2025/202664.0
64 3 6
Maidstone and Tunbridge Wells NHS Trust
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Maidstone and Tunbridge Wells NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202547.0
Q2 2024/202561.0
Q3 2024/202544.0
Q4 2024/202545.0
Q1 2025/202663.0
Q2 2025/202659.0
Q3 2025/202676.0
Q4 2025/202662.0
62 15 8
East of England Ambulance Service NHS Trust
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East of England Ambulance Service NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202536.0
Q2 2024/202526.0
Q3 2024/202561.0
Q4 2024/202576.0
Q1 2025/202646.0
Q2 2025/202658.0
Q3 2025/202664.0
Q4 2025/202662.0
62 2 4
South Central Ambulance Service NHS Foundation Trust
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South Central Ambulance Service NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202549.0
Q2 2024/202543.0
Q4 2024/202555.0
Q1 2025/202661.0
Q2 2025/202665.0
Q3 2025/202667.0
Q4 2025/202661.0
61 0 17
Frimley Health NHS Foundation Trust
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Frimley Health NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202538.0
Q2 2024/202551.0
Q3 2024/202554.0
Q4 2024/202551.0
Q1 2025/202642.0
Q2 2025/202649.0
Q3 2025/202663.0
Q4 2025/202661.0
61 15 3
Moorfields Eye Hospital NHS Foundation Trust
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Moorfields Eye Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202553.0
Q2 2024/202553.0
Q3 2024/202538.0
Q4 2024/202542.0
Q1 2025/202646.0
Q2 2025/202622.0
Q3 2025/202633.0
Q4 2025/202660.0
60 3 2
Norfolk and Norwich University Hospitals
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Norfolk and Norwich University Hospitals · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202565.0
Q2 2024/202546.0
Q3 2024/202547.0
Q4 2024/202550.0
Q1 2025/202661.0
Q2 2025/202673.0
Q3 2025/202653.0
Q4 2025/202658.0
58 8 4
The Dudley Group NHS Foundation Trust
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The Dudley Group NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202525.0
Q2 2024/202527.0
Q3 2024/202557.0
Q4 2024/202538.0
Q1 2025/202655.0
Q2 2025/202659.0
Q3 2025/202676.0
Q4 2025/202656.0
56 11 1
Derbyshire Healthcare NHS Trust
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Derbyshire Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202552.0
Q2 2024/202537.0
Q3 2024/202584.0
Q4 2024/202581.0
Q1 2025/202640.0
Q2 2025/202662.0
Q3 2025/2026106.0
Q4 2025/202655.0
55 6 10
East London NHS Foundation Trust
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East London NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202584.0
Q2 2024/202562.0
Q3 2024/202577.0
Q4 2024/202543.0
Q1 2025/202644.0
Q2 2025/202636.0
Q3 2025/202636.0
Q4 2025/202655.0
55 26 15
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
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THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202535.0
Q2 2024/202547.0
Q3 2024/202548.0
Q4 2024/202588.0
Q2 2025/202665.0
Q3 2025/202658.0
Q4 2025/202654.0
54 19 16
Source: National Guardian's Office. Higher case volumes may reflect stronger speaking-up cultures, not necessarily more problems.

About this source

Methodology
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.