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 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
West London NHS Trust
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20 | 4 | 15 | |||||||||||||||||||
South West Yorkshire Partnership NHS Foundation Trust
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20 | 3 | 3 | |||||||||||||||||||
University Hospitals Bristol and Weston NHS Foundation Trust
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19 | 0 | 0 | |||||||||||||||||||
North East London NHS Foundation Trust
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19 | 6 | 6 | |||||||||||||||||||
The Christie NHS Foundation Trust
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19 | 2 | 2 | |||||||||||||||||||
Bridgewater Community Healthcare NHS Trust
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19 | 0 | 6 | |||||||||||||||||||
Lincolnshire Community Health Service NHS Trust
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19 | 2 | 2 | |||||||||||||||||||
Croydon Health Services NHS Trust
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18 | 1 | 1 | |||||||||||||||||||
Birmingham Community Healthcare NHS Foundation Trust
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18 | 0 | 0 | |||||||||||||||||||
The Hillingdon Hospitals NHS Foundation Trust
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18 | 0 | 5 | |||||||||||||||||||
Royal Orthopaedic Hospital NHS Foundation Trust
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18 | 0 | 3 | |||||||||||||||||||
Kettering General Hospital NHS Foundation Trust
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17 | 7 | 1 | |||||||||||||||||||
Liverpool Heart and Chest Hospital NHS Foundation Trust
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16 | 4 | 3 | |||||||||||||||||||
Warrington and Halton Teaching Hospitals NHS Foundation Trust
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16 | 5 | 2 | |||||||||||||||||||
Rotherham NHS Foundation Trust
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15 | 5 | 3 | |||||||||||||||||||
Tavistock and Portman NHS Foundation Trust
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15 | 4 | 4 | |||||||||||||||||||
North Staffordshire Combined Healthcare NHS Trust
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14 | 0 | 0 | |||||||||||||||||||
Humber Teaching NHS Foundation Trust
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13 | 12 | 0 | |||||||||||||||||||
University Hospitals of Morecambe Bay NHS Foundation Trust
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12 | 5 | 2 | |||||||||||||||||||
Royal National Orthopaedic Hospital NHS Trust
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12 | 0 | 4 | |||||||||||||||||||
Dartford and Gravesham NHS Trust
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12 | 5 | 2 | |||||||||||||||||||
Kent Community Health NHS Foundation Trust
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11 | 0 | 0 | |||||||||||||||||||
North East Ambulance Service NHS Foundation Trust
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11 | 3 | 0 | |||||||||||||||||||
Queen Victoria NHS Trust
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11 | 0 | 1 | |||||||||||||||||||
Great Western Hospitals NHS Foundation Trust
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11 | 2 | 2 | |||||||||||||||||||
Shropshire Community Health NHS Trust
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11 | 1 | 4 | |||||||||||||||||||
Liverpool Women's NHS Foundation Trust
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11 | 2 | 4 | |||||||||||||||||||
South West London and St George's Mental Health NHS Trust
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10 | 0 | 0 | |||||||||||||||||||
Hertfordshire Community NHS Trust
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6 | 2 | 0 | |||||||||||||||||||
Cambridgeshire Community Services NHS Trust
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4 | 1 | 1 | |||||||||||||||||||
London North West University Healthcare NHS Trust
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4 | 0 | 2 | |||||||||||||||||||
| 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.