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Protect – Speak up stop harm
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Free, confidential whistleblowing advice
Call us on 020 3117 2520 or email us

What’s next for whistleblowing in the NHS 

by
doctors in scrubs in an operating theatre

So farewell National Guardian’s Office – the home of Freedom to Speak Up guardians (FTSU) and the champion for openness and transparency within the NHS. After just over 9 years since it was created following the recommendations from Sir Robert Francis KC’s “Freedom to Speak Up” review, the NHS agency is being closed and enveloped into the work of NHS England. 

"We want to thank our dedicated staff, the thousands of guardians we have trained, the many managers who listen to workers, and the leaders who have championed Freedom to Speak Up. Over the past nine years, the National Guardian's Office has supported the healthcare system to improve workplace cultures, ensuring workers are confident to speak up. We have done this by providing expert support, guidance, and challenge. The closure of the National Guardian's Office marks the end of a vital chapter in the ongoing effort to ensure every voice is heard, respected, and protected in the health service. All the staff at the National Guardian's Office, past and present, remain immensely proud of the impact made and are grateful to the community of individuals whose commitment to speaking up has carried this work forward. We will remain focused on the values of courage, impartiality, empathy and learning as we support the transition of functions to NHS England so that the voice of workers continues to be a voice that counts."
statement from the National Guardian's Office

The government’s new 10 Year Health Plan for England “Fit for the Future” promises to build on the National Guardian’s work and align it “with other national staff voice functions, such as the existing freedom to speak up case management function – meaning the distinct role of the guardian will no longer be required”. How this will work in practice is yet unknown – but what is clear is that any new system needs to  ensure the NHS Speak Up system is working, staff have confidence in it and issues get addressed, before they reach scandal status. 

In our evidence to the Thirlwall Inquiry in December 2024 – we presented key evidence relating to the FTSU guardians system. Drawing on the data from our whistleblowing Advice Line we shared that although FTSU guardians provide to some a really precious and valuable source of help, many of our callers tell us that the FTSU guardian they had contacted failed to provide any meaningful support. There often seems to be confusion about the role of the FTSU guardians: is it to provide support to the whistleblower or is it to escalate the concern and/or hold the trust to account when the concern is not properly addressed? We know that many guardians are under-resourced and have to balance a caseload of grievances alongside serious whistleblowing concerns without the ability to prioritise the latter. We also know that there is a wide variability in how NHS Trusts implement the role. 

The “Fit for the Future” policy paper suggests the government is keen to ensure that concerns raised by staff will be acted on more quickly: 

“Many of the NHS’ worst scandals happened – or lasted longer – because staff were ignored, or did not feel able to speak up. We will act more quickly on staff concerns. The National Guardian for Freedom to Speak Up in the NHS trains and supports a network of 1,300 freedom to speak up guardians across England, offering guidance to encourage employees to share concerns about patient safety. Now that these guardians have been established, we will do more to integrate their role.” 

We are pleased to see the “Fit for the Future” policy paper address holding senior leaders to account. We have been calling for measures to increase managers’ and leaders’ accountability and ensure they respond to whistleblowers effectively for many years. Protect supports calls for senior managers and directors to be held to professional standards, subjected to a fit and proper persons test and banned from holding senior managerial positions where it has been shown they have ignored or victimised a whistleblower. A consultation in 2024 presented proposals to regulate NHS managers and this new 10 year Health Plan for England sets out new measures for this area:  

“For senior leaders who let their profession and colleagues down – whether through dishonest behaviour, by silencing whistle-blowers or covering up unsafe practice – we will legislate to establish a new system to disbar them from ever taking leadership roles in the NHS again. We know from our engagement that both the public and staff want failure to have consequences, and for us to bring an end to trend of people ‘failing upwards’ in the NHS.”

As the National Guardian Office’s team transition into NHS England and ways of working are established, we believe there are further areas that need to be addressed: 

Board Oversight 

All NHS Boards should designate someone with responsibility for overseeing the effectiveness of whistleblowing arrangements in their organisation.  At present, Boards receive reports on “speaking up” via their FTSU guardians but this is not the only way that individuals can blow the whistle inside the NHS. Many whistleblowers will raise concerns with their line managers, or to a director without any FTSU involvement and it is unclear how this data is captured, or what experience they have.  A Board non-exec role as “the Whistleblowers’ Champion” could ensure that the right questions are asked at Board level about all the whistleblowing channels and whether processes are working effectively.  

Speak up oversight from the Care Quality Commission (CQC) 

We welcome the commitment to widen the CQC’s inspection remit to include freedom to speak up functions.  

“As part of its wider inspection responsibilities, a core function of CQC will be to assess whether every provider (and in time, ICB [Integrated Care Boards]) has effective freedom to speak up functions, and the right skills and training in place.”

In the NHS in England and Wales there is a complex matrix of regulators and none seems to act directly on whistleblowers’ reports that have been ignored or victimised. Whistleblowers do not have a clear path outside of their Trusts to highlight failures of the Trust’s whistleblowing arrangements and to put pressure on their Trust to improve. We would like to see the CQC to adopt a similar model to the Independent National Whistleblowing Officer (INWO) in Scotland, where clear whistleblowing or speak up standards are legally set for Scotland NHS health organisations. This is supported by investigations if these standards are not meet, holding both the organisations and senior leaders to account for any breaches.  

Fully Reform the Freedom to Speak Up System 

The Freedom to Speak Up guardian system was an innovation when it was first created, and we continue to support the idea of an individual in each Trust supporting whistleblowers to speak up. However, research has shown that the role is often too large and under-resourced to work effectively. We suggest that FTSU guardians focus on their role of supporting individual whistleblowers and that the role of changing the culture – to one in which whistleblowing is valued and encouraged – sits squarely with senior leadership including the Board. 

This refocus of the FTSU guardians should be backed up with a widening of the CQC remit to oversee a set of clear standards on speak up arrangements that they can regulate including holding senior leaders to account when these standards are not met. 

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