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
| Measure | Value |
|---|---|
| Total cases raised | 8,418 |
| Patient safety concerns | 1,508 |
| Bullying / harassment | 1,411 |
| Average cases per trust | 46.5 |
National trend
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| Quarter | Cases | Patient safety | Bullying / harassment |
|---|---|---|---|
| Q1 2024/2025 | 7464 | — | — |
| Q2 2024/2025 | 7860 | — | — |
| Q3 2024/2025 | 8471 | — | — |
| Q4 2024/2025 | 8615 | — | — |
| Q1 2025/2026 | 7410 | 1165 | 1260 |
| Q2 2025/2026 | 8203 | 1423 | 1413 |
| Q3 2025/2026 | 8775 | 1574 | 1425 |
| Q4 2025/2026 | 8418 | 1508 | 1411 |
Total cases
Patient safety
Bullying / harassment
Trust comparison · Q4 2025/2026
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| Trust | Cases | Patient safety | Bullying / 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 |
| Nottingham University Hospitals NHS Trust | 101 | 14 | 8 |
| York and Scarborough Teaching Hospitals NHS Foundation Trust | 101 | 35 | 28 |
| University Hospitals of North Midlands NHS Trust | 98 | 34 | 39 |
| Norfolk and Suffolk NHS Foundation Trust | 94 | 7 | 6 |
| Chesterfield Royal Hospital NHS Foundation Trust | 94 | 14 | 24 |
Trusts
| Trust | Cases | Patient safety | Bullying | Trend | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Lancashire Teaching Hospitals NHS Foundation Trust
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54 | 24 | 21 | |||||||||||||||||||
Dorset Healthcare University NHS Foundation Trust
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53 | 1 | 4 | |||||||||||||||||||
Greater Manchester Mental Health NHS Foundation Trust
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53 | 10 | 18 | |||||||||||||||||||
Barking, Havering and Redbridge University Hospitals NHS Trust
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53 | 18 | 10 | |||||||||||||||||||
Shrewsbury and Telford NHS Trust
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51 | 10 | 3 | |||||||||||||||||||
Homerton Healthcare NHS Foundation Trust
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51 | 25 | 1 | |||||||||||||||||||
Herefordshire and Worcestershire Health and Care NHS Trust
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50 | 8 | 5 | |||||||||||||||||||
London Ambulance Service NHS Trust
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50 | 1 | 2 | |||||||||||||||||||
Salisbury NHS Foundation Trust
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49 | 20 | 7 | |||||||||||||||||||
Leeds and York Partnership NHS Foundation Trust
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49 | 4 | 21 | |||||||||||||||||||
Cornwall Partnership Foundation Trust
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49 | 10 | 1 | |||||||||||||||||||
Royal United Hospitals Bath NHS Foundation Trust
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48 | 3 | 23 | |||||||||||||||||||
Liverpool University Hospitals NHS Foundation Trust
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48 | 11 | 2 | |||||||||||||||||||
Northamptonshire Healthcare NHS Trust
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48 | 9 | 4 | |||||||||||||||||||
Wye Valley NHS Trust
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47 | 6 | 0 | |||||||||||||||||||
St George's University Hospitals NHS Foundation Trust
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47 | 6 | 6 | |||||||||||||||||||
East Sussex Healthcare NHS Trust
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47 | 11 | 3 | |||||||||||||||||||
Birmingham Women's and Children's NHS Foundation Trust
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46 | 10 | 11 | |||||||||||||||||||
Barts Health NHS Trust
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45 | 1 | 8 | |||||||||||||||||||
Tees, Esk and Wear Valleys NHS Foundation Trust
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45 | 11 | 6 | |||||||||||||||||||
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
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45 | 9 | 4 | |||||||||||||||||||
West Suffolk NHS Foundation Trust
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43 | 12 | 2 | |||||||||||||||||||
South Warwickshire University NHS Foundation Trust
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43 | 11 | 8 | |||||||||||||||||||
University College London Hospitals NHS Foundation Trust
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43 | 3 | 8 | |||||||||||||||||||
Royal Papworth Hospital NHS Foundation Trust
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43 | 1 | 4 | |||||||||||||||||||
Kingston and Richmond NHS Foundation Trust
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43 | 1 | 13 | |||||||||||||||||||
University Hospitals Coventry and Warwickshire NHS Trust
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42 | 7 | 3 | |||||||||||||||||||
West Midlands Ambulance Service University NHS Foundation Trust
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42 | 7 | 2 | |||||||||||||||||||
Great Ormond Street Hospital NHS Trust
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41 | 7 | 12 | |||||||||||||||||||
NORTHAMPTON GENERAL HOSPITAL NHS TRUST
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40 | 7 | 4 | |||||||||||||||||||
The Royal Marsden NHS Foundation Trust
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40 | 5 | 1 | |||||||||||||||||||
East Kent Hospitals University NHS Foundation Trust
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40 | 12 | 4 | |||||||||||||||||||
East Suffolk and North Essex NHS Foundation Trust
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40 | 23 | 14 | |||||||||||||||||||
Bedfordshire Hospitals NHS Foundation Trust
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40 | 2 | 7 | |||||||||||||||||||
Royal Devon University Healthcare Foundation Trust
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39 | 6 | 16 | |||||||||||||||||||
MID Yorkshire Teaching NHS Trust
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39 | 5 | 0 | |||||||||||||||||||
Central and North West London NHS Foundation Trust
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39 | 3 | 1 | |||||||||||||||||||
Hertfordshire Partnership University NHS Foundation Trust
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39 | 9 | 16 | |||||||||||||||||||
Sussex Partnership NHS Trust
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39 | 11 | 1 | |||||||||||||||||||
MID Cheshire Hospitals NHS Foundation Trust
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38 | 15 | 10 | |||||||||||||||||||
North London NHS Foundation Trust
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38 | 5 | 9 | |||||||||||||||||||
North Bristol NHS Trust
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38 | 8 | 2 | |||||||||||||||||||
Calderdale and Huddersfield NHS Foundation Trust
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38 | 6 | 5 | |||||||||||||||||||
Lewisham and Greenwich NHS Trust
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38 | 5 | 3 | |||||||||||||||||||
NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST
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37 | 5 | 16 | |||||||||||||||||||
Derbyshire Community Health Services
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37 | 8 | 4 | |||||||||||||||||||
Epsom and St Helier University Hospitals NHS Trust
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37 | 4 | 14 | |||||||||||||||||||
Leicestershire Partnership NHS Trust
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37 | 3 | 0 | |||||||||||||||||||
Rotherham Doncaster and South Humber NHS Foundation Trust
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36 | 20 | 2 | |||||||||||||||||||
The Princess Alexandra Hospital NHS Trust
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36 | 1 | 3 | |||||||||||||||||||
| Source: National Guardian's Office. Higher case volumes may reflect stronger speaking-up cultures, not necessarily more problems. | ||||||||||||||||||||||
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.