Following the Paper Trail: What the NHS's Own Records Showed

5. I Reviewed Internal NHS Meeting Notes

Once I had looked at the Constitution, clinical guidelines, and the legal side of things — and could already see that the policy didn’t hold up — I wanted to understand how this decision was made in the first place .

Policies don’t appear out of nowhere. They are discussed, reviewed, and approved through internal committees. So I went to the NHS website for my region — the Oxfordshire NHS Trust / Thames Valley Priorities Committee under what is now BOB ICB (Buckinghamshire, Oxfordshire & Berkshire West Integrated Care Board) — and I started digging.

Every policy is dated. So I went back to the beginning.

I traced it all the way back to 2017 , when the policy was first introduced, and I downloaded and read through the meeting notes that recorded the decision-making process.

Here’s what I found:

• Over multiple meetings, female sterilisation was consistently recognised as a valid and effective form of contraception
• The notes explicitly referenced guidance stating that women should not be pressured into choosing alternatives (such as LARC methods)
• It was acknowledged that both male and female sterilisation are effective and appropriate options
• The committee’s own documentation noted that sterilisation can be cost-effective over the long term
• Male vasectomy was discussed throughout and remained funded without any challenge or change

And then:

• In a later meeting, the decision appears in just a couple of lines
• The policy shifts to: female sterilisation is “not normally funded”
• The justification given: “cost effectiveness” and “levels of regret”
• No supporting evidence is presented for either claim
• There is no reference to research, no data, no updated analysis

On top of that:

• The committee’s own framework states that decisions should involve public consultation and review
• I found no record in the meeting notes that such consultation took place
• There is no documented process showing that these concerns were revisited or properly assessed

What stood out most was the shift.

It went from multiple discussions acknowledging that this is a valid, effective, and legitimate option for women… to a single, unsupported decision to remove funding.

• No new evidence.
• No clear reasoning.
• No visible process of challenge or review.

At that point, it became very difficult to see this as a well-supported or carefully justified policy decision. It looked more like a conclusion that had been reached — without the level of scrutiny, evidence, or accountability you would expect for something that directly affects people’s healthcare choices.

6. I Tested Their Justifications (Cost, Regret, Alternatives)

At that point, I didn’t stop. If those were the reasons being used to justify the policy, I needed to know whether they were actually true.

I’m a researcher at heart, so I kept digging.

The policy relied on three main arguments:

• Cost effectiveness
• Patient regret
• Availability of alternative contraception (LARC methods)

So I tested each one.

On cost effectiveness:

• The NHS’s own discussions acknowledged that sterilisation can be cost-effective over time
• Internal notes referenced modelling showing that sterilisation becomes more cost-effective than long-term contraception after a number of years
• The estimated cost of the procedure itself is around £1,000 within the NHS

I compared that to the average cost of hormonal contraception:

• Roughly £20+ per month , funded over years or decades
• Over 20 years, that exceeds £5,000+ , even before factoring in inflation or additional care

So purely on financial terms, the argument didn’t hold.

On alternatives (hormonal contraception):

• These are not neutral substitutes — they come with well-documented side effects

Including:

• mood changes and depression
• weight gain
• headaches
• reduced libido
• hormonal disruption

And importantly:

• These side effects often lead to further medical support, prescriptions, or therapy
• They can impact relationships, mental health, and overall quality of life
• None of these wider costs — emotional, relational, or medical — appeared to be considered

That’s a problem, because healthcare policy is supposed to consider the full impact on a person’s life , not just the upfront cost of a treatment.

On regret:

• “Regret” was used as a key justification — but no evidence was provided in the decision itself

When I looked into it, I found:

• Relatively low regret rates for sterilisation (particularly in those over 30)
• Research suggesting that regret can be higher in those denied the procedure
• There was no equivalent focus on regret in other reproductive decisions
• And very little discussion or data presented on male regret following vasectomy

What became clear is that these arguments were not being applied consistently or rigorously.

The data that existed didn’t clearly support the conclusions being drawn.

• The wider impacts weren’t being accounted for.
• And some claims — particularly around regret — were presented without evidence at all.
• At that point, it stopped looking like a balanced evaluation…
• and started looking like a decision that had been justified after the fact.

7. I Looked for Evidence of Proper Decision-Making

Let's be honest, I saw this level of injustice going on and I turn into a Pit Bull. My teeth are sunken in and I'm decided that I'll study their negligence and malpractice like my life depends on it. So, yes, I wanted to go one step further and check whether the NHS had actually followed its own decision-making process.

Because there is a process.

The NHS has internal governance and ethical frameworks that are supposed to guide how policies are created, reviewed, and approved. These include requirements around:

• following the NHS Constitution
• ensuring fairness and equality
• using evidence-based decision-making
• conducting appropriate consultation when making significant changes

So I looked for evidence that this process had been followed.

The most revealing piece of information came not from the policy itself, but from the final response I received from the CEO of the Buckinghamshire, Oxfordshire & Berkshire West Integrated Care Board (BOB ICB), Dr Nick Broughton .

In his letter, he set out — very clearly and confidently — what the policy approval process is supposed to involve.

According to that response, policies should:

• Be developed through a formal committee process
• Be based on clinical evidence and effectiveness
• Include consideration of cost-effectiveness
• Be reviewed in line with ethical frameworks and equality duties
• Be subject to appropriate governance, scrutiny, and approval stages

On paper, that sounds robust. It suggests a system that is structured, evidence-led, and accountable.

But when I compared that description to what I had actually found in the meeting notes and documentation, the gap was hard to ignore.

• I could not find clear evidence supporting the claims used to justify the decision
• I could not see a consistent application of the clinical guidance that had been discussed
• I found no documented public consultation , despite this being referenced as a requirement
• The final decision appeared in minimal form , without the level of scrutiny or explanation you would expect
• Key concerns around equality and access were not meaningfully addressed

What struck me most was not just the discrepancy itself, but the confidence with which the process was described as having been followed.

At that point, I realised something that I think is important for people to understand:

You can receive a formal response that sounds complete, authoritative, and final…  and still find, when you look beneath it, that the substance doesn’t match the narrative.

This became a critical part of my case.

• Because once you move beyond surface-level explanations and start looking at the actual records, you begin to see whether a decision was truly evidence-based — or whether it was simply presented that way.
• And that’s exactly what the Ombudsman later had to assess.

Fun notes about NHS Trust CEOs:

• Some reports have highlighted that CEOs of certain large or struggling trusts may receive salaries exceeding £200,000.
• Comparison: NHS Trust CEO salaries are typically around 71% above the national average in the UK.

Isn't it lovely to see this!