Blog Post Case Study: Anonymous concern reporting for the NHS

Find out how UHCW NHS Trust created SpeakUp – a tool that gives NHS staff the chance to raise concerns quickly, easily and in confidence – using App Rail.

Staff Users
Concerns Reported
Build Time
3 months
HTN Winner

The Problem

Freedom to Speak Up Guardians provide an important route to NHS workers to speak up about patient safety issues or workplace matters. There are over 700 Freedom to Speak Up Guardians in over 400 organisations in the NHS and independent sector organisations, national bodies and elsewhere in England.

Most guardians process concerns via phone or email, but can also recieve written letters. Concerns must be recorded and statistics are reported to internal boards and the National Guardian's Office (NGO). It can be challenging to process anonymous feedback, so most guardian's prefer being able to remain in contact with staff who raised a concern.

University Hospital Coventry & Warwickshire NHS Trust (UHCW) is one such organisation. The Freedom to Speak Up Guardian, Lorna Shaw speaks about their existing process:

I wanted a more efficient process than writing an email or making a phone call. It is a step-by-step process, collecting the minimum detail in order to have a concern raised.

Most NHS organisations have an incident reporting system, such as RLDatix, which was used by UHCW. But it wasn’t a popular system with staff and the Trust believed that developing an app would be more effective.

The Trust has been using App Rail since 2021, and they realised they could leverage the platform to prototype and build their App.

Creating the App

The UHCW Innovation team built the SpeakUp app with minimal technical assistance from App Rail. By running a series of focused workshops and ideation sessions they were able to gather feedback on their ideas. They then took on the task of developing the prototype and incorporating the team’s ideas into different iterations. The Freedom to Speak Up Guardian, Lorna Shaw explains:

The Trust wanted the app to reduce the barriers for raising workplace concerns. It needed to assure confidentiality and offer the option of anonymity, encouraging a culture where everyone feels at ease to speak up.

It also needed to be easy to use and accessible to all, especially the many NHS workers who don’t use computers in their day-to-day jobs.

The app gives staff three options to file a concern: open, in confidence and anonymous. They can select from a number of Freedom to Speak Up Ambassadors, identified by their names and job roles. Lorna says:

The ambassadors only give advice or signpost staff to policies or further appropriate assistance, but they may also refer the enquirer to the Guardian directly.

If staff choose to raise a formal concern, it goes directly to the Guardian. They will thank the worker, share the concern with management and provide feedback regarding progress and outcomes.

When anonymous concerns are made, communication takes place in the same app through anonymous messages, whereas if concerns are raised openly or in confidence, staff provide their email address and telephone number as a method of communication.


The SpeakUp app was initially used in a pilot project with 300 staff and it has recently been rolled out to all 11,000 employees at UHCW. In September 2022 the App won an Award for Excellence in Communication from Health Tech News.

Lorna is a big fan:

The app has been welcomed by staff, especially those who don’t traditionally use computers in their day-to-day jobs and wouldn’t email the Guardian or ambassadors.

She also says that there has been an increase in contacts and telephone calls, providing evidence that the role of the Guardian is being further known across the organisation.

SpeakUp assists in embedding a more open and honest culture where staff feel safe to raise concerns and know they will be listened to.

UHCW sees much potential in future development and iteration of SpeakUp, for example gathering more data to help understand equality, diversity and inclusion numbers. It is known that certain groups of workers can be more hesitant to speak up, and such data would highlight potential areas of improvement

Learn more about SpeakUp →

NHS Trust? See how App Rail can help.