Promoting partnership working in the NHS

Freedom to speak up/Freedom to improve - West Suffolk NHS Foundation Trust

The organisation

West Suffolk NHS Foundation Trust serves a predominantly rural geographical area of roughly 600 square miles with a population of around 280,000. The trust provides a range of acute services with associated inpatient and outpatient facilities. With a turnover of £211m, they are one of the largest employers in Suffolk, employing around 2,997 whole time equivalent staff.

The challenge

The trust's 2015 NHS staff survey results showed that staff were reluctant to come forward to report incidents of bullying and harassment. In addition the Care Quality Commission (CQC) highlighted in March 2016 a bullying culture in one of the trust’s clinical departments. This issue had already been jointly identified by the trust and trade unions. 

The process 

To address the problem, management and trade unions developed the Freedom to speak up/Freedom to improve campaign, which was introduced at their trust leadership summit in December 2015. The campaign aims to encourage staff to speak up when they see poor behaviour or safety issues. This includes encouraging staff to speak up when they see bullying or rudeness. To support the campaign the trust made all managers freedom to speak up guardians, encouraging staff to raise issues with their own or any other manager within the trust. The campaign also:

  • provides advice for staff on how to deal with poor behaviour on a one to one level
  • ensures senior managers are visible and approachable
  • embeds the trust's patient first values into the employment life cycle
  • introduced the organisation to the BUILD constructive feedback model (Behaviour, Understand, Impact, Listen, Do differently) and the ABC of appreciation (Action, Benefit, Continue) model. Both produced by April Strategy, and embedded through the trust's leaderships programmes (see related documents)
  • uses exit interviews and monitoring turnover to inform decision making on the working environment for staff
  • further promotes the trust's Care First helpline for staff
  • encourages staff to raise issues with trusted partners or trade union represenatives.

Following the CQC visit the trust put in place a development programme to address management styles in the clinical department identified as having a bullying culture. This included a leadership development day for band 7 staff using the BUILD model. A full time trade union officer from the Royal College of Midwives also ran a workshop for staff looking at behaviours in the workplace and their potential impact on others.

Other actions taken by the trust include a committment to, and payment for mediation where the trust and the individuals involved both agree it could result in an amicable outcome, and high profile senior clinical/managerial dismissals due to bullying. The latter demonstrated support for staff who raise concerns and a committment from the trust to take action.



Following the introduction of the Freedom to speak up/Freedom to improve initiative, the percentage of staff/colleagues at the trust reporting most recent experience of harassment, bullying or abuse in the NHS staff survey (key finding 27) increased from 25 per cent in 2015 to 51 per cent in 2016.


The annual report of the Care First helpline for staff, February 2016 to January 2017, demonstrated a 256 per cent increase in use. This usage represents a 12 per cent annual usage against headcount, demonstrating a great awareness of the helpline across the trust. Work related issues represented 50 contacts and out of those four contacts were regarding bullying and harassment. There were 121 contacts on personal issues.


Top tips


  • Ensure there is an open door relationship between senior managers and TU representatives.
  • Ensure there is a commitment from the employer to follow through concerns raised by staff.
  • Have a communication plan in place to support the freedom to speak up campaign.
  • Encourage managers to peer review and talk to each other so they are aware at an early stage if their behaviour is not in line with the trust values. This enables issues to be tackled informally and can prevent them from escalating.

Further information:

Jan Bloomfield, Executive Director of Workforce and Communications:

Paul Pearson, Trust Convenor & UNISON Branch Secretary: