A record number of cases were reported by NHS workers to Freedom to Speak Up guardians last year.
There was an uptick in concerns about inappropriate behaviour and staff safety, according to a new report from the National Guardian’s Office.
Officials also warned of a “persistent number” of cases in which a worker speaking out fears that they will be ostracised or overlooked for doing so.
The Freedom to Speak Up guardian role was created in 2016 to better support NHS staff to report issues when they feel they are unable to in other ways.
There are now more than 1,200 across the health service.
From April 2023 to March 2024, there were 32,167 cases reported to guardians.
The record figure is a 27.6% increase on the 25,209 cases reported in the previous 12 months.
The most common report included concerns about inappropriate behaviour, accounting for 38.5% of cases, up from 30.2% a year earlier.
Cases included instances of favouritism, as well as staff being belittled, shouted at, and sworn at, the report said.
It added that “cultural issues such as attitudes towards internationally educated nurses and discrimination towards protected characteristics” were also raised with guardians.
One in every three cases – or 32.3% – involved concerns about staff safety and wellbeing, up from 27.6% in the previous 12 months.
The number of cases regarding patient safety fell to 18.7% from 19.4%, while cases with elements of harassment or bullying also fell by 2% to 19.8%.
Dr Jayne Chidgey-Clark, national guardian for the NHS, said: “More and more people are coming to their Freedom to Speak Up guardians.
“This is credit to the efforts made by guardians to foster trust and break down barriers to speaking up within their organisations.
“Culture is a patient safety issue. Every interaction – whether patient, family member, colleague or consultant – makes a difference to lives and outcomes.”
While 80% of people who spoke up and later gave feedback said they would do so again, the report warned there “remains a persistent number of cases where guardians indicate that the person speaking up to them may be experiencing detriment for speaking up”.
This was present in 4% of cases in 2023, or 1,285.
Examples of detriment in the report included staff being ostracised, given unfavourable shifts, being overlooked for promotion, or moved from a team after speaking up.
Some guardians gave examples such as staff being intimidated for raising safety issues.
Dr Chidgey-Clark added: “We know it can take courage to speak up.
“These case numbers represent 30,000 opportunities for learning and improvement for the benefit of patients and colleagues, yet too many voices still go unheard.
“Our strategic vision is to move the dial on Freedom to Speak Up. Of course workers should be safe to speak up – safety is the bare minimum – what we are aiming to achieve over the next few years is confidence.
“This comes when workers feel not only encouraged to raise matters, but that actions will be taken when they do.”
In terms of worker groups, nurses and midwives made up the greatest proportion of staff who raised issues to Freedom to Speak Up guardians at 28.3%.
Administration and clerical staff were the second largest at 21.3%.
In total, more than 133,000 cases have now been reported to guardians since the role was established eight years ago.
