The office of the National Guardian was set up following the recommendation of Robert Francis in his seminal review work. The National Guardian and the office covers England and is hosted within the Care Quality Commission. It has/continues to develop processes and cultural improvement to support people speak up about care and quality in healthcare organisations. There are over 1000 guardians country wide with nearly every type of organisation possessing a NHS contract having a guardian in their fold or access to joint guardian arrangements.

Feedback from people who have spoken up or who would have wanted to is that there is fear; concern about individual detriment and a sense of futility - what will actually change and therefor what is the point?

A role of the National Guardian is to speak truth to power and shine a light in areas where staff and data say there are problems - such as the recent report into the culture in ambulance providers.

Looking forward Jayne is eager that culture within organisations is viewed as important as finance or performance dynamics. As more sectors embrace the Guardian approach (police/fire) there is an opportunity to embed this speaking up culture throughout the public sector and ensure we avoid the silences that incur in far too many places.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.