Recent discussions with Audit Committee Chairs reveal growing concern over whistleblowing reforms and escalating NHS pressures. The closure of the National Guardian’s Office (NGO) and transfer of responsibilities to NHS England signal a major shift, raising questions about independence, visibility, and trust.

Simultaneously, patient care challenges—from staffing shortages to treatment delays—are straining frontline
services. These changes underscore the urgent need to ensure staff feel safe and supported to speak up.

National Whistleblowing Oversight Reforms

Under the Fit for the Future 10 – Year Health Plan, whistleblowing support is being restructured:

Closure of the NGO

  • Disbanding by 2026; functions absorbed by NHS England – itself to be abolished in 2027
  • Loss of independent advocacy role
  • Oversight integrated into broader staff voice systems

Continuation of FTSU Guardians

  • Role remains mandated in the 2026/27 NHS Standard Contract
  • NHS England to lead guidance, training, and support
  • Over 1,400 Guardians have handled 142,000+ cases

Key Risks

  • Reduced independence may erode trust and visibility
  • Guardians face inconsistent support and unclear escalation routes
  • Staff still fear retaliation and lack of follow-through

Patient Care Pressures
Mounting challenges are impacting safety and experience:

Issue                                Impact on Patient Care
Workforce shortages  –  Reduced continuity; increased errors and burnout
Treatment backlog   –    Delayed diagnoses; poorer long-term outcomes
Emergency strain     –    Long A&E waits; overcrowding; compromised safety
Industrial action     –      Service disruption; morale and retention issues

Strategic Implications for NHS Organisations
A coordinated response is needed across governance, culture, and planning:

Governance & Oversight

  • Embed FTSU into risk and assurance frameworks
  • Boards should receive regular thematic reports

Culture & Leadership

  • Promote psychological safety for speaking up
  • Train managers to respond constructively

Patient Safety

  • Use whistleblowing data for quality improvement
  • Escalate concerns with patient impact swiftly

Strategic Planning
Align with NHS England’s 2025/26 priorities:

  • 4% productivity improvement
  • Reducing elective backlogs
  • Enhancing digital integration and workforce retention

Assurance Prompts
Organisations should seek external assurance in key areas – Please contact TIAA’s Healthcare Sector Lead or Advisory team for more information.

FTSU Effectiveness

  • Independent review within the past 12 months?
  • Assess Guardian visibility, independence, and case handling
  • Benchmark and recommend improvements

Whistleblowing Culture

  • Is there evidence staff feel safe to speak up?
  • Use anonymous surveys, trend analysis, and barrier identification

Patient Safety Linkages

  • Have cases with patient impact been reviewed?
  • Commission thematic reviews and gap analyses

Board Assurance

  • Is FTSU integrated into Board oversight?
  • Validate reporting, align with incident data, and improve scrutiny

Veran Patel, Director of Health & Social Care
veran.patel@tiaa.co.uk