[2] Francis outlined twenty principles and associated actions, then concluded by making just two recommendations:[3] The twenty principles to allow a consistent approach to raising concerns, while still allowing some flexibility, included: There are now over 800 Freedom to Speak Up Guardians in over 500 organisations in the NHS and independent sector organisations, national bodies and elsewhere in England.
[4] An observational and interviewed-based study of more than 80 Guardians found that a lack of resources, especially time, reduced their ability to respond to concerns, and to analyse and learn from data.
Guardians struggled to develop their role, and create a more positive culture in which staff felt free to voice concerns.
[8][2] The National Guardian's Office is an independent, non-statutory body with the remit to lead culture change in the NHS, so that speaking up becomes "business as usual".
[9] In January 2016 Eileen Sills was appointed as the first Freedom to Speak Up National Guardian for the NHS.