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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
Mersey and West Lancashire Teaching Hospitals NHS Trust
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Mersey and West Lancashire Teaching Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202524.0
Q2 2024/202521.0
Q3 2024/202546.0
Q4 2024/202541.0
Q1 2025/202656.0
Q2 2025/202635.0
Q3 2025/202653.0
Q4 2025/202636.0
36 9 2
Gloucestershire Hospitals NHS Foundation Trust
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Gloucestershire Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202551.0
Q2 2024/202567.0
Q3 2024/202549.0
Q4 2024/202562.0
Q1 2025/202642.0
Q2 2025/202629.0
Q3 2025/202643.0
Q4 2025/202636.0
36 14 2
Portsmouth Hospitals NHS Trust
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Portsmouth Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202518.0
Q2 2024/202535.0
Q3 2024/202517.0
Q4 2024/202513.0
Q1 2025/202623.0
Q2 2025/202631.0
Q3 2025/202641.0
Q4 2025/202635.0
35 4 12
Gloucestershire Health and Care NHS Foundation Trust
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Gloucestershire Health and Care NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202520.0
Q2 2024/202521.0
Q3 2024/202526.0
Q4 2024/202537.0
Q1 2025/202620.0
Q2 2025/202625.0
Q3 2025/202626.0
Q4 2025/202635.0
35 6 8
Harrogate and District NHS Foundation Trust
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Harrogate and District NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202510.0
Q2 2024/202516.0
Q3 2024/202518.0
Q4 2024/20254.0
Q1 2025/20267.0
Q2 2025/20267.0
Q3 2025/202640.0
Q4 2025/202635.0
35 4 5
East Lancashire Hospitals NHS Trust
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East Lancashire Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202540.0
Q2 2024/202561.0
Q3 2024/2025115.0
Q4 2024/202597.0
Q1 2025/202676.0
Q2 2025/202664.0
Q3 2025/202660.0
Q4 2025/202635.0
35 3 7
Chester Hospital NHS Trust
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Chester Hospital NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202527.0
Q2 2024/202535.0
Q3 2024/202534.0
Q4 2024/202541.0
Q1 2025/202621.0
Q2 2025/202623.0
Q3 2025/202640.0
Q4 2025/202635.0
35 11 11
Lancashire and South Cumbria NHS Foundation Trust
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Lancashire and South Cumbria NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202539.0
Q2 2024/202530.0
Q3 2024/202530.0
Q4 2024/202523.0
Q1 2025/202643.0
Q2 2025/202630.0
Q3 2025/202629.0
Q4 2025/202634.0
34 6 2
Worcestershire Acute Hospitals NHS Trust
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Worcestershire Acute Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202539.0
Q2 2024/202539.0
Q3 2024/202525.0
Q4 2024/202531.0
Q1 2025/202622.0
Q2 2025/202637.0
Q3 2025/202632.0
Q4 2025/202633.0
33 6 13
Buckinghamshire Healthcare NHS Trust
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Buckinghamshire Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202532.0
Q2 2024/202529.0
Q3 2024/202557.0
Q4 2024/202547.0
Q1 2025/202639.0
Q2 2025/202634.0
Q3 2025/202638.0
Q4 2025/202633.0
33 12 5
Bradford Teaching Hospitals NHS Foundation Trust
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Bradford Teaching Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202522.0
Q2 2024/202536.0
Q3 2024/202527.0
Q4 2024/202537.0
Q1 2025/202625.0
Q2 2025/202626.0
Q3 2025/202651.0
Q4 2025/202632.0
32 2 5
Bolton NHS Trust
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Bolton NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202545.0
Q2 2024/202538.0
Q3 2024/202539.0
Q4 2024/202549.0
Q1 2025/202632.0
Q2 2025/202695.0
Q3 2025/202639.0
Q4 2025/202632.0
32 7 3
Royal Berkshire NHS Foundation Trust
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Royal Berkshire NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202530.0
Q2 2024/202525.0
Q3 2024/202535.0
Q4 2024/202525.0
Q1 2025/202644.0
Q2 2025/202635.0
Q3 2025/202638.0
Q4 2025/202631.0
31 5 2
South London and Maudsley NHS Foundation Trust
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South London and Maudsley NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202519.0
Q2 2024/202529.0
Q3 2024/202522.0
Q4 2024/202529.0
Q1 2025/202632.0
Q2 2025/202626.0
Q3 2025/202620.0
Q4 2025/202631.0
31 7 11
South Tees Hospitals NHS Foundation Trust
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South Tees Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202533.0
Q2 2024/202539.0
Q3 2024/202535.0
Q4 2024/202544.0
Q1 2025/202643.0
Q2 2025/202648.0
Q3 2025/202648.0
Q4 2025/202631.0
31 6 3
Milton Keynes University Hospital NHS Foundation Trust
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Milton Keynes University Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202514.0
Q2 2024/202550.0
Q3 2024/202544.0
Q4 2024/202522.0
Q1 2025/202610.0
Q2 2025/202616.0
Q3 2025/202628.0
Q4 2025/202631.0
31 2 3
Sussex Community NHS Foundation Trust
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Sussex Community NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202542.0
Q2 2024/202545.0
Q3 2024/202529.0
Q4 2024/202527.0
Q1 2025/202621.0
Q2 2025/202621.0
Q3 2025/202626.0
Q4 2025/202630.0
30 1 0
Surrey and Borders Partnership NHS Foundation Trust
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Surrey and Borders Partnership NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202550.0
Q2 2024/202557.0
Q3 2024/202568.0
Q4 2024/202538.0
Q1 2025/202632.0
Q2 2025/202617.0
Q3 2025/202623.0
Q4 2025/202630.0
30 3 7
Midlands Partnership University NHS Foundation Trust
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Midlands Partnership University NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202520.0
Q2 2024/202524.0
Q3 2024/202534.0
Q4 2024/202536.0
Q1 2025/202632.0
Q2 2025/202634.0
Q3 2025/202629.0
Q4 2025/202630.0
30 8 8
Devon Partnership NHS Trust
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Devon Partnership NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202553.0
Q2 2024/202531.0
Q3 2024/202551.0
Q4 2024/202550.0
Q1 2025/202644.0
Q2 2025/202631.0
Q3 2025/202640.0
Q4 2025/202629.0
29 3 1
Kent and Medway NHS and Social Care Partnership Trust
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Kent and Medway NHS and Social Care Partnership Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202524.0
Q2 2024/202537.0
Q3 2024/202528.0
Q4 2024/202522.0
Q1 2025/202630.0
Q2 2025/202644.0
Q3 2025/202625.0
Q4 2025/202629.0
29 5 5
James Paget University Hospitals NHS Foundation Trust
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James Paget University Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202531.0
Q2 2024/202548.0
Q3 2024/202525.0
Q4 2024/202514.0
Q1 2025/202637.0
Q2 2025/202622.0
Q3 2025/202624.0
Q4 2025/202629.0
29 7 2
Medway NHS Foundation Trust
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Medway NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202510.0
Q2 2024/202537.0
Q3 2024/202535.0
Q4 2024/202538.0
Q3 2025/202624.0
Q4 2025/202629.0
29 8 6
Yorkshire Ambulance Service NHS Trust
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Yorkshire Ambulance Service NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202514.0
Q2 2024/202536.0
Q3 2024/202523.0
Q4 2024/20259.0
Q1 2025/202613.0
Q2 2025/202631.0
Q3 2025/202642.0
Q4 2025/202628.0
28 5 3
Sheffield Teaching Hospitals NHS Foundation Trust
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Sheffield Teaching Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202515.0
Q2 2024/202529.0
Q3 2024/202538.0
Q4 2024/202533.0
Q1 2025/202620.0
Q2 2025/202621.0
Q3 2025/202626.0
Q4 2025/202628.0
28 2 6
Cambridgeshire and Peterborough NHS Foundation Trust
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Cambridgeshire and Peterborough NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202546.0
Q2 2024/202549.0
Q3 2024/202538.0
Q4 2024/202561.0
Q1 2025/202628.0
Q2 2025/202647.0
Q3 2025/202639.0
Q4 2025/202628.0
28 3 1
Oxleas NHS Foundation Trust
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Oxleas NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202520.0
Q2 2024/202524.0
Q3 2024/202519.0
Q4 2024/202529.0
Q1 2025/202639.0
Q2 2025/202629.0
Q3 2025/202638.0
Q4 2025/202627.0
27 2 7
Northern Care Alliance NHS Foundation Trust
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Northern Care Alliance NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202517.0
Q2 2024/202515.0
Q3 2024/202514.0
Q4 2024/202522.0
Q1 2025/202619.0
Q2 2025/202617.0
Q3 2025/202634.0
Q4 2025/202627.0
27 12 6
Berkshire Healthcare NHS Foundation Trust
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Berkshire Healthcare NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202513.0
Q2 2024/202519.0
Q3 2024/202515.0
Q4 2024/202514.0
Q1 2025/202631.0
Q2 2025/202621.0
Q3 2025/202632.0
Q4 2025/202627.0
27 0 10
Sherwood Forest Hospitals NHS Foundation Trust
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Sherwood Forest Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202542.0
Q2 2024/202547.0
Q3 2024/202575.0
Q4 2024/202542.0
Q1 2025/202641.0
Q2 2025/202636.0
Q3 2025/202630.0
Q4 2025/202627.0
27 2 3
Surrey and Sussex Healthcare NHS Trust
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Surrey and Sussex Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q2 2024/20253.0
Q3 2024/20258.0
Q4 2024/202537.0
Q1 2025/202615.0
Q2 2025/202628.0
Q3 2025/202645.0
Q4 2025/202627.0
27 6 2
Chelsea and Westminster Hospital NHS Foundation Trust
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Chelsea and Westminster Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202518.0
Q2 2024/202521.0
Q3 2024/202520.0
Q4 2024/20259.0
Q2 2025/202614.0
Q3 2025/202623.0
Q4 2025/202627.0
27 3 5
Lincolnshire Partnership NHS Foundation Trust
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Lincolnshire Partnership NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202525.0
Q2 2024/202525.0
Q3 2024/202529.0
Q4 2024/202533.0
Q1 2025/202634.0
Q2 2025/202632.0
Q3 2025/202634.0
Q4 2025/202627.0
27 4 2
Sheffield Children's NHS Foundation Trust
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Sheffield Children's NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202540.0
Q2 2024/202520.0
Q3 2024/202525.0
Q4 2024/202515.0
Q1 2025/202638.0
Q2 2025/202625.0
Q3 2025/202625.0
Q4 2025/202626.0
26 8 2
University Hospital Southampton NHS Foundation Trust
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University Hospital Southampton NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202536.0
Q2 2024/202518.0
Q3 2024/202519.0
Q4 2024/202517.0
Q1 2025/202617.0
Q2 2025/202624.0
Q4 2025/202626.0
26 2 6
George Eliot Hospital
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George Eliot Hospital · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202519.0
Q2 2024/202516.0
Q3 2024/202515.0
Q4 2024/202518.0
Q2 2025/202627.0
Q3 2025/202621.0
Q4 2025/202626.0
26 3 2
Central London Community Healthcare NHS Trust
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Central London Community Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202541.0
Q2 2024/202532.0
Q3 2024/202535.0
Q4 2024/202524.0
Q1 2025/202624.0
Q2 2025/202636.0
Q3 2025/202625.0
Q4 2025/202626.0
26 7 2
Barnsley Hospital NHS Foundation Trust
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Barnsley Hospital NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202515.0
Q2 2024/202513.0
Q3 2024/202541.0
Q4 2024/202559.0
Q1 2025/202667.0
Q2 2025/202648.0
Q3 2025/20269.0
Q4 2025/202626.0
26 3 2
Torbay and South Devon NHS Foundation Trust
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Torbay and South Devon NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202537.0
Q2 2024/202543.0
Q3 2024/202547.0
Q4 2024/202540.0
Q1 2025/202633.0
Q2 2025/202643.0
Q4 2025/202625.0
25 4 8
North Tees and Hartlepool NHS Foundation Trust
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North Tees and Hartlepool NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202515.0
Q2 2024/202516.0
Q3 2024/202521.0
Q4 2024/202513.0
Q1 2025/202620.0
Q3 2025/20263.0
Q4 2025/202624.0
24 2 2
Isle of Wight NHS Trust
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Isle of Wight NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202523.0
Q2 2024/202516.0
Q3 2024/202538.0
Q1 2025/202610.0
Q2 2025/202614.0
Q3 2025/202621.0
Q4 2025/202624.0
24 2 5
Cheshire and Wirral Partnership NHS Foundation Trust
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Cheshire and Wirral Partnership NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/20259.0
Q2 2024/20252.0
Q3 2024/202510.0
Q4 2024/202511.0
Q1 2025/202610.0
Q2 2025/202619.0
Q3 2025/202619.0
Q4 2025/202624.0
24 1 5
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
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Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202539.0
Q2 2024/202524.0
Q3 2024/202519.0
Q4 2024/202529.0
Q1 2025/202622.0
Q2 2025/202625.0
Q3 2025/202649.0
Q4 2025/202622.0
22 5 3
Royal Cornwall Hospitals NHS Trust
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Royal Cornwall Hospitals NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202522.0
Q2 2024/202513.0
Q3 2024/202518.0
Q4 2024/202517.0
Q1 2025/202615.0
Q2 2025/202610.0
Q3 2025/202620.0
Q4 2025/202622.0
22 6 2
South Tyneside and Sunderland NHS Foundation Trust
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South Tyneside and Sunderland NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202526.0
Q2 2024/202526.0
Q3 2024/202524.0
Q4 2024/202534.0
Q1 2025/202615.0
Q2 2025/202625.0
Q3 2025/202617.0
Q4 2025/202622.0
22 5 5
North West Ambulance Service NHS Trust
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North West Ambulance Service NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202540.0
Q2 2024/202526.0
Q3 2024/202528.0
Q4 2024/202529.0
Q1 2025/202631.0
Q2 2025/202619.0
Q3 2025/202626.0
Q4 2025/202622.0
22 8 1
Clatterbridge Cancer Centre
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Clatterbridge Cancer Centre · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202515.0
Q2 2024/202512.0
Q3 2024/202517.0
Q4 2024/202512.0
Q1 2025/202626.0
Q2 2025/202611.0
Q3 2025/202637.0
Q4 2025/202622.0
22 8 5
Airedale NHS Foundation Trust
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Airedale NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202520.0
Q2 2024/202513.0
Q3 2024/202520.0
Q4 2024/202511.0
Q1 2025/202627.0
Q2 2025/202616.0
Q3 2025/202636.0
Q4 2025/202621.0
21 8 1
Imperial College Healthcare NHS Trust
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Imperial College Healthcare NHS Trust · cases raised by reporting period
Reporting periodCases raised
Q2 2024/202516.0
Q3 2024/202520.0
Q4 2024/202523.0
Q1 2025/202613.0
Q2 2025/202625.0
Q3 2025/202630.0
Q4 2025/202621.0
21 1 1
Alder Hey Children's NHS Foundation Trust
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Alder Hey Children's NHS Foundation Trust · cases raised by reporting period
Reporting periodCases raised
Q1 2024/202524.0
Q2 2024/202540.0
Q3 2024/202519.0
Q4 2024/202536.0
Q1 2025/202616.0
Q2 2025/202632.0
Q3 2025/202623.0
Q4 2025/202621.0
21 0 0
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.