Skip to main content


Issue date:

September 2023.






Speaking up safely framework, NHS Wales.

Date of expiry/review:

September 2024.

For action by:

Chief executives, NHS Wales health boards / trusts / special health authorities.

Action required by:

30 October 2023, see paragraph 4.


Judith Paget, Chief Executive NHS Wales and Director General Health and Social Services Group, Welsh Government.

HSSG Welsh Government contact(s):

Sara Whittam, Health and Social Services, NHS Workforce and Operations

Speaking up safely framework, NHS Wales

To: Chief executives, NHS Wales health boards / trusts / special health authorities.

Dear Colleague, 

I am writing to you following my letter on 25 August 2023 to all NHS Wales Chief Executives about quality and safety systems in light of the Letby verdict.

In the email I shared an important pillar of these systems, the Framework for Speaking up Safely in NHS Wales. The framework has been developed, scrutinised and approved in social partnership to provide an all-Wales consistency of cultural expectation, approach and escalation process whilst also strengthening local initiatives.   

It is essential to enable NHS Wales staff to speak up about issues with confidence knowing their concerns will be taken seriously, heard fairly and that that they will not face personal repercussions for raising concerns.  

The Framework has now been published on the Welsh Government website

The Welsh Government has already set out the expectation in the communication on 25 August for all NHS boards, trusts and special health authorities to undertake a self-assessment against the organisational requirements detailed in section 6 of the framework and develop an action plan to address any gaps between current practice and the expectations of the framework. 

The expectations of all staff and board members are clearly outlined in the framework, and these expectations extend to the development of this implementation action plan. It will also be crucial to maintain discussions with local trade union colleagues, with whom we have worked in social partnership to develop this framework. This plan is due by 30 October 2023. 

We are committed to supporting all NHS Wales organisations to learn, improve and develop their speaking up culture and provide assurance that no individual will suffer victimisation or detrimental treatment as a result of speaking up. 

Confidence to report poor behaviours or unfair treatment is key to our quality and safety systems supporting the statutory Duty of Quality and Duty of Candour for delivery of services to patients. It is also critical to the retention and wellbeing of our workforce and underpins our equality and inclusion work. 

There are practical toolkits, developed in partnership with our employer and trade union colleagues included in the Framework document, and in due course, resources will be published on the Health Education and Improvement Wales Gwella platform. 

Yours sincerely

Judith Paget signature.

Judith Paget CBE