Is There Evidence That Thames Valley ICB Followed the Recommendations of the Ombudsman after the Female Sterilisation Policy Investigation?

NHS Female Sterilisation Policy: The FOI Disclosure Says the February 2026 Policy Was Based on 2024 Work — So Where Is the Evidence of Reform?

A note about my conclusions: this article distinguishes carefully between “there is no evidence this happened” and “the ICB did not disclose evidence that it happened.” Where records have not been supplied, I do not automatically claim they never existed. I am asking a more basic accountability question: if senior NHS leadership says these actions were completed and the records exist, why were those records not produced in an FOI specifically asking for evidence of compliance?

What did I actually ask NHS Thames Valley ICB for?

My Freedom of Information request was deliberately titled:

I was not asking for another assurance that the NHS had learned lessons. They pulled the wool over people's eyes in the media attention that exploded after the Ombudsman's report.

But I wanted the paper trail.

I asked for the final decision and approval material, equality assessment, clinical and legal rationale, evidence relating to the NHS Constitution and relevant guidance, consideration of bodily autonomy and informed choice, comparison with vasectomy, and — crucially — evidence that the revised policy-development processes introduced after the Ombudsman investigation had actually been applied.

I also deliberately asked that, if those improved processes had not been completed before the February 2026 policy was approved, the ICB provide the recorded justification, timetable and plans for completing them.

That last part matters enormously now.

What does the ICB's own FOI response admit about the February 2026 policy?

This is, in my view, the most important part of the entire disclosure.

The evidence they disclosed clearly states:

the February 2026 policy “was based on a recommendation from SERPC in December 2024” and “does not reflect process changes adopted since February 2026.”

The response also says that SERPC-04 v1.0 was recommended in December 2024 and therefore would not reflect the findings or recommendations of the PHSO report - with provisional views which they received in August 2025, and the final report published in December 2025.

That changes the question completely.

The February 2026 policy was introduced after the Ombudsman investigation had already exposed serious problems in the previous decision-making process.

But the ICB's own response now confirms that the policy adopted in February was still based on the December 2024 SERPC work.

The January 2026 Quality Oversight Group paper says the commissioning position had undergone its “full evidence review” at SERPC in December 2024. The supporting documents listed for adoption were likewise the December 2024 report, the old SERPC Equality Impact Assessment and the related supporting information.

What post-Ombudsman evidence is not in the disclosure?

I do not see disclosed:

• a new post-PHSO evidence review;
• a new post-PHSO equality assessment;
• a post-PHSO comparison of the male and female sterilisation pathways;
• a post-PHSO legal analysis;
• a post-PHSO NHS Constitution analysis;
• a post-PHSO autonomy/informed-consent analysis;
• a new consultation exercise;
• the documented SERPC feedback on the PHSO findings;
• the 10 February 2026 SERPC record showing how those findings were considered before ratification;
• the 11 February 2026 SERGG record;
• a revised decision rationale showing why the therapeutic LARC trial remained justified after the Ombudsman's findings;
• or the actual completed decision/ratification record showing what QOG members decided and on what evidence.

And their response actually admits one especially important absence: the requested female-versus-vasectomy comparison was not conducted in the 2024 supporting material.

That is significant because one of the Ombudsman's findings concerned the failure to consider female sterilisation fairly and consistently alongside male sterilisation.

So what did CEO Nick Broughton say had been done?

This is where the story becomes much more difficult for the ICB.

The claims made by CEO Dr Nick Broughton in his letters to me and to the Ombudsman after the PHSO investigation about work said to have been completed were not supported by the documents supplied in my explicit FOI request seeking to establish evidence of compliance with the revised policy-development processes.

Some things are corroborated. Some were explicitly still “in progress”. But for a striking number of actions described as completed, documented or formally agreed, the documents that should evidence those claims were not supplied in my FOI disclosure.

And you'd understand my cynicism now - but while we laugh off the ''Picture or it didn't happen''  when people make selfies in important life moments - I ask for EVIDENCE - or it didn't happen! Because we have an established and shockingly long record of CEO Nick Broughton making claims he cannot support with Evidence. 

So - here's the breakdown of what he has claimed in his letters to myself and the Ombudsman, and what we've actually got documentary evidence for in the disclosure.

 

Date: Nick Broughton's Letters	What he said had happened or was happening	Documentary evidence actually supplied in FOI-TV-2606-105?	My assessment
13 January 2026	PHSO report had been sent to the Third Committee chair/admins on 2 January, who were preparing it for dissemination to the committee.	No underlying email, circulation record, acknowledgement or dissemination record supplied.	❌ Claim only in Broughton’s letter.
13 January 2026	The ICB would “comply fully” with the PHSO recommendations.	The later disclosure expressly says SERPC-04 v1.0 was based on the December 2024 recommendation and therefore would not reflect the PHSO findings/recommendations.	⚠️ The disclosure materially undermines any suggestion that the February policy itself represented full substantive implementation.
16 February 2026	Revised SERPC-04 had been ratified by BOB ICB.	A 6 January QOG cover paper requesting a virtual decision was disclosed, but I have not seen the resulting decision/email vote/ratification record itself.	🟡 Ratification is asserted and later repeated, but the actual decision record was not supplied.
16 February 2026	Providers would be notified; a GP Bulletin issued; prior-approval form uploaded, with March implementation dates.	No provider notification, GP Bulletin, Blueteq upload record or implementation confirmation supplied.	❌ No documentary proof in the disclosure.
16 February 2026	BOB asked SERPC/SERGG to circulate PHSO findings and obtain feedback on whether SERPC’s process required improvement.	No request/circulation email or feedback request supplied.	❌
16 February 2026	“All feedback received was documented” and discussed at SERPC on 10 February and SERGG on 11 February.	No feedback, 10 February SERPC minutes, 11 February SERGG minutes, agenda papers or action records supplied.	❌ This is one of the strongest missing-record issues because he expressly says the material was documented.
16 February 2026	SERPC agreed a further review of SERPC-04, including patient choice.	The FOI response later confirms that a further review happened and a refreshed report existed.	🟡 Event corroborated, underlying evidence withheld.
16 February 2026	Terms of Reference to Planning Group 24 February; policy review 14 April; draft sign-off 22 April; issue to ICBs 30 April; implementation estimated by end May.	No 24 February ToR/planning record, April agenda/minutes, 22 April circulation or 30 April issue record supplied. The FOI response confirms a refreshed April report existed but excludes it.	⚠️ They supplied the timetable in a letter, but not the records showing the work.
16 April 2026 – overarching claim	Remedial work had been “systematically recorded within an action tracker comprising 14 discrete items.”	The 14-item action tracker itself was not supplied.	❌ Major omission. This is the central record that should evidence the claimed remediation.
Action 1 – Equity considerations	Complete: updated Terms of Reference contained explicit prompt to consider equivalent procedures for both genders; ToR reviewed in March.	No updated ToR, March review record or related template supplied.	❌
Action 2 – Action logging	Complete: actions listed on April SERPC and Policy Development Governance Group agendas; details captured in trackers.	Neither April agenda, Governance Group agenda nor action tracker supplied.	❌ They identify the exact records that supposedly prove it; none were disclosed.
Action 3 – Prioritising reviews	Complete: March SERPC work programme updated to prioritise reviews where equality issues were identified.	No March SERPC work programme or minutes supplied.	❌
Action 4 – Recording decision rationale	Complete: documentation updated and in use from April; decisions to record evidence/guidance departures and equality impact.	No updated template/documentation supplied. No April deliberation record supplied. The FOI response says the refreshed April report existed, but withholds it.	⚠️ Potential evidence exists by their own admission, but it was not disclosed.
Action 5 – Ethical Framework	Complete: Ethical Framework circulated with April agenda; slides added to committee template; ongoing.	No April agenda, circulated framework, updated template or slides supplied. The only ethical material disclosed relates to the older 2024 process.	❌
Action 6 – Comparison between treatments	Complete: report templates now prompt comparative prices and offset costs.	No revised report template supplied. The FOI response also confirms that the female-vs-vasectomy comparison requested was not conducted in the 2024 material.	❌ No proof of the claimed process change; especially important because the substantive equality comparison was still missing from the February policy evidence.
Action 7 – Equity of previous decisions	In progress: previous SERPC decisions where application differed between men and women to be reviewed for equity.	No review, work paper, list of decisions or interim output supplied.	❌ No evidence supplied of progress.
Action 8 – Publication of rationale	In progress: agreement being sought from ICB representatives.	No correspondence, proposed publication framework or decision supplied.	❌
Action 9 – Context for SERPC decisions	In progress: align SERPC work programme with ICB commissioning responsibilities and budgets.	No supporting record supplied.	❌
Action 10 – Committee training	In progress: information sessions planned covering cost-effectiveness, evidence bias, NICE obligations and ethics.	No training materials, invitations, agenda or attendance record supplied.	❌
Action 11 – Patient autonomy / experience	In progress: ethical framework review scheduled for June.	No revised ethical framework or June Governance Group record supplied.	❌
Action 12 – EIA template	In progress: current Equality Impact Assessment template to be reviewed, scheduled for June.	No revised template, review paper or June decision supplied.	❌
Action 13 – Information sharing	In progress: review other regional Terms of Reference and ethical frameworks for shared learning.	No comparative review or related record supplied.	❌
Action 14 – Public consultation	To be progressed: expert advice/communications support to create a lawful, robust consultation process.	No consultation framework or completed process supplied. On 6 May, Broughton expressly acknowledged that the work had not yet been completed and that “there is no formal public consultation programme currently underway.”	🔴 Not merely absent from disclosure: Broughton subsequently confirmed it remained undone.
6 May 2026	Governance Group had discussed public engagement in February and agreed a clearer consultation approach.	No February Governance Group minutes or decision record supplied.	❌
6 May 2026	Further expert advice was being sought on consultation duties.	No advice request, advice received, legal/engagement assessment or resulting record supplied.	❌
6 May 2026	Two consultation principles had been agreed: early stakeholder engagement and early flagging of formal consultation requirements.	No policy, template or process document containing those agreed principles supplied.	❌
6 May 2026	Thames Valley would give me a meaningful opportunity to participate, with this documented in the policy governance record.	No consultation invitation or governance record demonstrating that opportunity supplied.	❌
Post-PHSO review itself	A refreshed report reflecting the PHSO findings was considered in April; comments from the SERPC legal adviser, Thames Valley ICB and SCW then raised “significant concerns”; further work happened in June and Draft v2.2 emerged.	None of the refreshed report, April deliberations, “significant concerns” comments, June deliberations or Draft v2.2 were disclosed. Instead, the ICB labelled the refreshed material “outside scope”.	🔴 The ICB itself confirms that the strongest post-PHSO evidence exists, and nevertheless did not supply it.

Important: “not disclosed” does not automatically mean “never happened”. But this Freedom of Information request specifically asked for evidence that the revised post-Ombudsman policy-development processes had been applied. Where the ICB itself identifies records which supposedly document or evidence that work, their absence from the disclosure is itself highly relevant.

Why is the January 2026 approval paper so important?

Because it shows what the February policy was actually being approved on.

The January Quality Oversight Group paper states that the female sterilisation commissioning position underwent its “full evidence review” in December 2024.

It then lists the supporting documents used for adoption:

• the draft SERPC-04 policy;
• the December 2024 Female Sterilisation Clinical Commissioning Policy review;
• the SERPC-04 Equality Impact Assessment;
• the supporting information for policy adoption;
• and prior-approval forms.

That is the documentary foundation I was actually shown for the February 2026 decision.

The paper acknowledges that the Ombudsman investigation had concluded and says an action plan was underway.

But acknowledgement that an Ombudsman report exists is not the same thing as redoing the evidence, equality, legal, ethical, consultation and decision-making work in light of its findings before adopting the replacement policy.

Indeed, the same January paper places several further governance steps after the proposed approval, including submission of an EQIA to an EQIA panel and consultation with specialist clinicians.

Where is the actual decision approving the policy?

There is another basic problem.

The January document supplied to me says:

“Virtual decision by email requested.”

It asks Quality Oversight Group members to consider approving the policy.

That is evidence of a request for approval.

It is not, by itself, the resulting decision.

I therefore asked for the actual recorded QOG approval or ratification decision: the vote, email decision, confirmation or equivalent record showing that approval occurred and what the decision-makers relied upon.

That was not in the disclosure I received.

What happened to the equality work?

The supplied SERPC Equality Impact Assessment dates from December 2024.

It says no specific patient engagement took place, identifies no missing information, concludes that no changes were necessary, and contains blank fields for the director or decision-maker and date signed.

The January 2026 QOG paper then says that further implementation work should include:

“lead EQIA submission to and approval by EQIA panel”.

So where is that EQIA?

Where is the panel record?

Where is the signed final equality analysis?

And, particularly importantly, where is the post-Ombudsman analysis comparing male and female access to permanent contraception?

Did the ICB actually compare female sterilisation with vasectomy?

The FOI response gives a surprisingly clear answer regarding the 2024 material:

That is particularly important because the Ombudsman had already identified failures in treating equivalent circumstances involving women and men fairly and consistently.

The later 14-point action list then says a review of previous SERPC decisions where application differs between men and women was still “in progress”.

So the question remains:

Where is the documentary evidence that the substantive male-versus-female equality comparison was completed before the February 2026 policy was put into force?

I have not been shown it.

Why does the later April review matter so much?

The ICB's final FOI response confirms that the genuinely refreshed review reflecting the PHSO findings came later.

A refreshed report was presented in April 2026.

After that meeting, comments from the SERPC legal adviser, NHS Thames Valley ICB and the SCW Clinical Policy Implementation team reportedly raised “significant concerns”.

The recommendation was therefore not issued at that point.

It went back for further consideration in June.

A later revised recommendation was then produced.

That matters because Dr Priya Singh subsequently told me that this later recommendation removed the requirement for women to undergo a LARC trial before sterilisation if they did not wish to consent to LARC.

So another obvious question follows:

Why am I challenging the redactions too?

The disclosure problem is not limited to missing documents.

Names and official roles of people participating in healthcare policy-making were redacted under section 40(2).

I am not seeking private addresses or personal contact details.

I am seeking transparency about who participated in decisions affecting access to NHS healthcare.

I have therefore challenged those redactions and asked the ICB to justify why the identities of officials and professional advisers acting in official capacities should remain hidden.

Why are the cost redactions particularly relevant?

Activity, expenditure and cost figures were also blacked out in parts of the disclosure.

That matters because cost and cost-effectiveness have historically been relied upon as part of the justification for limiting women's access to female sterilisation.

Where financial considerations have been used to justify restrictions on healthcare access, there is a strong public-interest reason for being able to scrutinise the numbers and assumptions relied upon.

The disclosure is also internally inconsistent.

Figures hidden in one attachment appear openly in another, including an estimated annual cost impact of £162,000 for BOB, £47,000 for Frimley, 344 admissions, £640,000 expenditure in 2023/24 and an average cost of £1,870.

I have therefore asked the ICB to disclose the underlying activity and cost information unless it can provide a specific and legally sustainable reason for withholding it.

What about the pages marked “out of scope”?

The December 2024 SERPC minutes also contain whole sections removed as “out of scope”, including:

• Fertility Preservation;
• EBI Recommendations for Urology;
• and Retired EBI Statements.

These may ultimately prove unrelated to female sterilisation.

But I am no longer prepared simply to accept entire blocks of a decision-making meeting being hidden while being told they are irrelevant.

I have therefore requested the complete text of those sections, subject only to any specific FOIA exemption the ICB can properly justify.

If they are unrelated, the documents will show that.

Why am I now asking for metadata?

Some of the disclosed records are unsigned, undated, described as drafts, or do not make clear when the version supplied was actually created or finalised.

During the prolonged FOI delay, I specifically asked the ICB to confirm that responsive documents had been preserved in their original form, including their metadata, and that nothing had been altered, destroyed, concealed or retrospectively created.

The ICB answered:

“The ICB can confirm this.”

I have therefore asked them to substantiate that assurance by providing the available creator, creation date, modification date, last-modified-by information and version/edit history for the key documents.

After an FOI response delivered two months beyond its legal deadline, I am no longer prepared simply to accept assurances about document provenance where the underlying metadata can establish the chronology objectively.

Why is this more than an FOI technicality?

Because the Ombudsman had already investigated this organisation's handling of female sterilisation policy.

The findings concerned failures involving evidence, clinical guidance, equality, consultation, transparency, decision rationale and complaint handling.

The ICB then repeatedly said that lessons had been learned.

Dr Nick Broughton said feedback had been documented.

He described a further review timetable.

He said corrective actions had been systematically recorded in a 14-item tracker.

He said equality prompts had been added.

He said decision rationale would be properly recorded.

He said the ethical framework had been brought back into committee decision-making.

He said previous decisions affecting men and women differently would be reviewed.

He described future consultation reforms.

Then I filed an FOI specifically asking for the evidence that these new processes had actually been applied.

And many of the records that should prove those claims were not supplied.

I am not saying that every missing record proves that the action never happened.

I am saying that an organisation previously criticised for poor documentation, transparency and decision-making has once again asked the public to rely on assurances while failing, in its FOI disclosure, to produce much of the documentary evidence that should substantiate those assurances.

How long did the FOI disclosure take?

I submitted FOI-TV-2606-105 on 8 June 2026.

The statutory deadline was 6 July 2026.

NHS Thames Valley ICB did not provide the substantive disclosure until 4 September 2026.

The ICB has now expressly accepted that the statutory deadline was seriously missed and that there was no legal authority for the replacement date it had proposed.

By the time I received the documents, I had spent months chasing a disclosure about whether the NHS had actually corrected failures already identified by an Ombudsman investigation.

And once the documents finally arrived, the post-Ombudsman audit trail was still largely missing.

What have I now asked NHS Thames Valley ICB to provide?

I have asked the ICB to complete the disclosure by providing or accounting for the records it has itself described, including:

• the documented February feedback on the PHSO findings;
• the February SERPC and SERGG records;
• the updated Terms of Reference;
• the April refreshed review report;
• the April SERPC minutes;
• the 14-item action tracker;
• records showing completion of the actions marked complete;
• the legal, Thames Valley and SCW comments which reportedly raised “significant concerns”;
• the actual QOG approval or ratification record;
• any completed EQIA and EQIA-panel approval record;
• the challenged redacted information;
• and the preserved metadata for the key policy-development records.

What happens next?

I have given NHS Thames Valley ICB until the end of Tuesday 15 September 2026 to provide the outstanding records and corrected disclosure or explain, item by item, why information is not held, outside scope or legally exempt.

This is not a new statutory deadline.

The statutory deadline expired on 6 July 2026.

It is simply the final practical opportunity I am giving the organisation to complete a disclosure that is already substantially overdue.

If the ICB does not provide the records, I will proceed using the evidence already available through the Information Commissioner's Office, NHS England and the other external accountability and scrutiny routes already underway.

Where can I read the evidence?

You can read the original Freedom of Information request, the delayed disclosure, the ICB's responses, my challenge to the omissions and redactions, the Ombudsman material and the wider documentary history in my Evidence Folder.

I do not expect anyone to take my interpretation on trust.

Read what the NHS said it had done. Read what it actually disclosed. Compare the two. Then make up your own mind.