Raise a Concern

Speaking up about any concern you have at work is very important. In fact, it is vital, as it helps us to keep improving our services for all patients and the working environment for our colleagues. You can raise a concern about any risk, malpractice or wrongdoing that you believe is harming the service we deliver.

Please be prepared to explain, as fully as possible, the information and circumstances that gave rise to your concern. Do not wait for proof. We would like you to raise the matter while it is still a concern. It does not matter if you later turn out to be mistaken, as long as you are genuinely troubled.

An asterisk ( ) indicates that a certain field is mandatory/required.

Your Personal Details

How would you like to raise your concern?

Confidentially

You are willing to give your name and contact details to the Guardian, but you do not want your identity to be disclosed to anyone else without your consent.

Anonymously

You do not wish to give your name to the Guardian. This may make it more difficult to investigate your concern thoroughly or to provide you with feedback on the outcome.

Name

Job Title

Preferred Email Address

You will receive an email confirmation when you submit the form. You will also receive an email after the guardian has made contact and again when the concern is closed, with the option to provide feedback.

Best Method of Contact

Why are we asking you these questions?

Locala is committed to promoting equity and inclusion, building, and supporting an engaged workplace for all colleagues is important to us. Locala’s strategic ambitions aim to promote and build diversity and inclusion in our ever-growing workforce, and collecting this data offers the opportunity to understand trends and patterns that will help us achieve this ambition.

We understand that some of this information is personal and sensitive, and if you choose not to, you can choose the 'Prefer Not to Say' option. We ask these questions as we would like to keep track of who is speaking up to us. It offers the opportunity to help us understand who is using this service, and what trends can be seen in particular groups of staff experiencing barriers to speaking up.

To assure you further, this monitoring information will only be used for identifying trends and will never be reported in a way that could be linked back to you. For example, we might say that 80% of colleagues who contact us are female, or that 20% are from ethnic minority backgrounds.

If you would like any further information about how this data is stored or used, please contact Locala’s Freedom to Speak Up Guardian.

Professional/Worker Group

Ethnicity

Age

Gender

Religion or belief

Sexual Orientation

Do you consider yourself to have a disability? This is defined as any physical or mental health conditions or illnesses lasting, or expected to last, 12 months or more.

Yes

Prefer Not To Say

Concern Details

Main Issue of Concern

Select the directorate the concern relates to

Have you or someone else already raised this concern through another system?

Yes

I Don't Know

Nature of Concern

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