What I Believe Needs to Change

Going through this process has made one thing very clear:

The system, as it stands, is not fit for purpose.

Here’s what I believe needs to change:

1. National Consistency in Healthcare Policy

Healthcare decisions — especially those grounded in clinical evidence — should not be fragmented across regions.

• Policies should be based on national clinical guidance
• They should be consistent across the UK
• Access to care should not depend on postcode

2. Guaranteed Referral Pathways

If a service is not available locally:

• there should be a clear, automatic referral process
• patients should be directed to another provider
• access should be protected — not blocked

Imagine if this applied to cancer treatment.

• No one would accept being told:
• “We don’t provide this here — and that’s the end of it.”

And yet, that is exactly what happens in areas like reproductive healthcare.

3. Stronger Accountability Mechanisms

The Ombudsman does important work — but it is limited.

I believe:

• there should be stronger enforcement powers
• systemic failures should be escalated beyond recommendations
• there should be clear consequences for repeated failures in governance and decision-making

4. Smarter, Centralised Decision-Making

Right now, multiple ICBs are:

• running parallel processes
• reviewing the same evidence
• holding separate meetings
• making separate decisions

This is inefficient, costly, and inconsistent.

• Most of the meetings I reviewed in this process had on average 20 professionals in attendance, in person and online. Some meetings had a list of over 53 medical professionals - in 3 groups:
• 1) In Attendance 2) Topic Specialists in Attendance for Agenda Items and 3) Apologies (as in they couldn't make it, but have been invited)

Now, consider how much a single meeting that lasts only 1h costs the NHS, considering medical professionals' hourly wages - especially those highly trained and high-earning experts.

Now, on top of that consider how much this costs per NHS Trust, across the country with those meetings beeing held all the time, for hundreds (maybe thousands of reviews and policies).

• Let's be factual: An average NHS policy meeting, especially those involving senior clinical or management staff (Agenda for Change Band 8+), can cost between £500 and over £1,000 per hour in staff time, based on hourly rate calculations of attendees.
• Staff Seniority: High-level policy meetings involving consultants or senior managers (Bands 8a-9) can exceed £100 per person per hour.
• Attendees & Duration: A one-hour meeting with 10 senior managers easily exceeds £1,000 based on average salary-to-hourly calculations.

Other countries operate with:

• centralised health policy decisions
• unified standards
• local delivery — but not fragmented governance

There is a more efficient way to do this.

And it already exists elsewhere. So why isn't the UK making solid financial, economy-sound and ethical governing decisions on a national level?

The Hard Truth About This Process

This is something I think people need to understand before they even begin a journey like this:

You can:

• spend years researching
• build a fully evidenced case
• prove systemic failures
• have those failures independently confirmed

…and still walk away without actual change.

That is incredibly disheartening.

Because what it means in practice is that accountability still sits with the same system that failed in the first place — under the same leadership, the same structures, and often the same people.

Even now, after the investigation, I am not seeing the level of correction I would expect.

• I am seeing process. I am seeing movement. But I am not seeing the core issue being resolved.

Final Reflection

I don’t think I fully understood what this would take when I started.

It’s very easy to say “just file a complaint” or “just take it further,” but what that actually looks like in practice is something else entirely . This has taken hundreds, if not thousands, of hours of my life — reading, writing, analysing, chasing, waiting, following up, going back over the same points again and again because no one was actually engaging with them properly. And beyond the time, it’s taken a toll on my nervous system in a way that I didn’t expect. There were points where I would genuinely feel nauseous when a deadline was approaching and I knew I hadn’t heard anything. That familiar feeling of “I’m going to have to chase this again,” knowing that it would likely go nowhere, but also knowing that if I didn’t do it, nothing would happen at all.

That’s the part people don’t see. This kind of process isn’t just slow — it wears you down. And I can completely understand why most people would stop long before getting anywhere near this point. Not because they don’t care, but because they have lives to live, work to do, families, responsibilities, and they don’t have the capacity to keep pushing against something that feels like it’s designed not to move.

There were plenty of moments where I could have let it go. It would have been the easier option. But once I started digging and actually seeing what was underneath — the lack of evidence, the contradictions, the way decisions were made and then defended — I couldn’t unsee it. And at that point it stopped being about me trying to access a procedure and became something much bigger.

And there's a deeper motivational layer to my persistence. Because this isn’t just something I’ve experienced personally — it’s something I see in my work all the time.

I’m a psychologist specialising in sex and relationships. I work with individuals and couples who are dealing with the consequences of decisions that are often made far away from them, in systems that don’t fully consider the real-life impact on people’s bodies, their relationships, and their lives. And one of the most common issues I see in couples, again and again, is loss of libido. Read the negative side-effects of the contraceptive pill and you'd see it right there - loss of libido. This i s one of the biggest things that disrupts intimacy. It creates distance, frustration, disconnection. It leads to resentment, to cheating, to heartbreak, to relationships slowly falling apart without people even fully understanding why.

And then I look at what the system is doing.

I see long-term hormonal contraception being pushed as the default, without proper consideration of what it does to people over time. Not just physically, but psychologically and relationally. I see people dealing with side effects like weight gain, acne, mood instability, anxiety, depression — and then needing more interventions to manage those effects. I see people losing their sense of self, their confidence, their connection to their own bodies, and to their partners.

And the part that’s hardest to sit with is how invisible it all is.

Most people don’t connect the dots. They don’t realise that what they’re experiencing — the drop in libido, the emotional distance, the shift in attraction — might be linked to something that was presented to them as a simple, harmless solution.

There’s also a deeper layer to this that very few people are told about. Hormones influence attraction in ways that are not obvious at the time. Women who meet their partners while on hormonal contraception can later find that their attraction shifts when they come off it. That’s not imagined — it’s biological. Your body is operating under a different hormonal state, and that affects how it responds to another person. I’ve worked with couples who have gone through exactly that — they build a life together, they are ready to have children, stop the contraception and suddenly, something changes, the attraction is gone, and neither of them understands why.

And what you end up with is not just a medical issue — it’s an intimate, relational one. It affects connection, sexuality, identity, family stability. It ripples outward in ways that are never captured in a policy document or a cost-benefit analysis.

So when I saw a system that removes access to a non-hormonal, permanent option — and at the same time continues to rely heavily on methods that I see, firsthand, causing real issues in people’s lives — I couldn’t just step back from that.

Because this is not abstract for me.

I see the damage. I sit with people in it. I am the person who has to tell them what medical professionals and whole systems have omitted.

My list of reasons is long, but aside of the ''it's not fair'' and ''this is not following Clinical Guidelines'' - I see the impact systems have on people's lives and I can't idle when I've unearthed a mountain of maladministration, medical negligence and discrimination.

This is a rotten system that is shaping people’s lives, relationships, and wellbeing in ways that are not being fully acknowledged — and not being challenged enough.

And if you see that clearly, it becomes very difficult to stay quiet.

Would I Do It Again If I Knew What It Would Take?

Yes.

Not because it was easy, and not because I would ever recommend this lightly, but because of how I make decisions in my life.

At every fork, you’re choosing between paths you will later have to live with. And for me, the only way I know how to choose is this: I pick the option I can stand behind, even when it’s hard. Walking away from this, after seeing the level of inconsistency, the lack of evidence, the maladministration, the lies, the resistance to improving and the impact it has on people — that wasn’t something I could live with. Not knowing what I know.

Because the reality is, 99.9% of people will never go this deep. They won’t read the policies, they won’t analyse the notes, they won’t spend the time or energy to challenge something like this — and that’s completely understandable. But it also means that unless someone does, these decisions just sit there, unchallenged, shaping people’s lives quietly in the background. And I couldn’t ignore that once I saw it clearly.

So I made the decision that I could live with. Even if this only leads to a small shift, even if it helps a handful of people, even if it simply makes the issue more visible — that is something I can stand by. What I couldn’t live with is walking away, and then years later watching more rights eroded, more access restricted, more decisions made on behalf of people without their full agency — and knowing I had seen it coming and chose not to act.

We don’t control the outcome of these things. But we do control how we show up in them. And if there’s anything I would leave you with, it’s this: think about the kind of role you want to play in the world, especially when something is beyond unethical, illegal and damaging. Let's finish on an aspirational and inspirational quote...

“Be the change you wish to see in the world.”

Is this the End of the Story?

No, it isn't.

What's next?

I don't want to reveal my next steps - but I can say - I welcome supporters to the cause to reach out, companies, organisations, charities, lawyers, human rights activists to email me and share what they have in mind, what they're doing, what we can do together.

And I'd love to see women's brands - from healthcare to fashion taking a stance in this too.

The battle continues on every front imaginable.

Where Things Stand Now with BOB ICB 's Policy for Female Sterilisation & also Male Vasectomy as of 28 April 2026

On paper, the policy has changed.

The latest version of the policy (February 2026) moves away from the previous position where female sterilisation was “not normally funded,” and instead introduces what is presented as a criteria-based approach.

At first glance, that sounds like progress.

But when you look closely at how the policy actually works in practice, the reality is far more complicated — and still far less equal.

What Has Changed

• Female sterilisation is no longer outright defunded
• It is now conditionally funded under strict criteria
• The policy references national guidance and ethical frameworks
• It includes language about considering individual needs

On paper, this suggests alignment with clinical standards.

What Has Not Changed

The fundamental problem is still there — access is being controlled.

Under the current policy:

• Women are expected to undergo a “therapeutic trial” of Long Acting Reversible Contraception (LARC)
• Only if LARC is deemed unsuitable, ineffective, or inappropriate can sterilisation be considered
• The burden remains on the individual to prove that alternatives have failed

And this is where the logic completely falls apart.

If someone has made a clear, informed decision that they do not want children and they want a permanent contraceptive solution — what exactly is the purpose of forcing them into a “trial” of something they have already decided they do not want?

A therapeutic trial is supposed to treat something.

What is being treated here?

There is no medical condition being treated. There is a decision.

And forcing someone into a pathway of temporary contraception when they are explicitly seeking a permanent solution is not clinical care — it is gatekeeping.

• It’s the equivalent of saying:
• “You’ve decided on a permanent solution, but first you need to go through a series of temporary ones to prove that you really mean it.”

There is no rational clinical basis for that.

If the option is approved, safe, and recognised — the question should be whether the person has capacity and has made an informed decision. Not whether they have complied with a prescribed sequence of alternatives.

The Ongoing Inequality — And This Is Where It Gets Worse

At the same time that women are being put through this conditional, restrictive pathway, something very different is happening on the other side.

BOB ICB is actively working with private providers to expand access to NHS-funded vasectomy services.

As per current service information:

• Men in the region can access NHS-funded vasectomies through private providers
• In some cases, they can self-refer directly — without even going through their GP
• These services are being actively expanded and streamlined

So let’s be very clear about what this means in practice:

• Men can access permanent contraception directly, quickly, and with minimal barriers
• Women are required to go through clinical gatekeeping, trials of alternative methods, and justification processes

This is not a subtle difference.

This is a structural imbalance in how access is designed.

What This Means in Practice

What This Means in Practice

The policy has not created equal access.

It has created two completely different pathways:

• One that is patient-led, accessible, and streamlined
• One that is restricted, conditional, and controlled

And that difference matters.

Because it directly affects:

• how quickly someone can access care
• how much control they have over their own body
• and whether their decision is treated as valid from the outset

The Bottom Line

This is not a resolved issue.

It is a reframed one.

Female sterilisation remains a controlled option, dependent on compliance with a pathway that many people do not want and should not be required to go through.

Meanwhile, male sterilisation is being made increasingly accessible — even to the point of removing the need for GP involvement altogether.

That is not equality.

And it is not consistent with the principles the system claims to uphold.

So I asked NHS Thames Valley ICB Chair Dr Priya Singh to justify the new restriction

For me, identifying that the policy had changed was not enough.

The previous female sterilisation policy had already been investigated by the Parliamentary and Health Service Ombudsman. Serious failures had been identified in how the ICB had considered the evidence, patient choice, informed consent and the difference between access to female sterilisation and male vasectomy.

Yet in February 2026, women were once again being presented with another restriction: a requirement for a “therapeutic trial” of Long-Acting Reversible Contraception (LARC) before permanent sterilisation.

So I wanted to know something very simple:

I took those questions directly to Dr Priya Singh, Chair of NHS Thames Valley ICB.

I asked her whether the February 2026 policy complied with the Equality Act 2010 and Public Sector Equality Duty, the NHS Constitution, the principles established by Montgomery v Lanarkshire Health Board, NICE guidance, informed consent and bodily autonomy. I also asked how the ICB could justify continuing to place additional barriers in front of women seeking permanent contraception while access to male vasectomy remained fundamentally different.

I repeatedly asked for a clear answer and for the evidence supporting the policy.

What followed became another important chapter in this story. The correspondence continued for weeks. The policy was being reconsidered while I was challenging it. Dr Singh ultimately declined to give me the straightforward compliance answer I had requested and later closed the correspondence.

To me, that raised an even bigger question: if the Chair of the organisation could not clearly defend the restriction when directly challenged on its legal, clinical, equality and autonomy implications, why had women been subjected to it in the first place?

What the Ombudsman Found

The Ombudsman’s role is not to decide whether a policy is “right” or “wrong” in principle — but whether it was created and implemented properly, fairly, and in line with standards .

What they found was extensive.

🔴 Failures in Decision-Making

• The NHS did not properly balance the evidence when making the policy decision
• It failed to fully explore relevant evidence that was available to it
• It did not justify why it departed from clinical guidance (NICE, WHO, etc.)
• The reasoning behind the decision was not clearly documented or explained

⚖️ Equality & Fairness Failures

• The policy did not treat women and men in a fair and consistent way
• Male sterilisation remained funded, while female sterilisation was restricted
• Similar risks (such as regret) were handled differently depending on gender

📊 Cost & Evidence Failures

• The NHS failed to demonstrate that alternatives were more cost-effective
• Evidence actually suggested sterilisation can be more cost-effective long-term

They did not properly consider indirect costs , including:

• long-term contraception use
• side effects
• wider health and societal impacts

🧠 Regret Argument Failures

• The policy relied heavily on “regret”

But:

• regret was acknowledged as subjective and difficult to measure
• evidence on regret was contradictory
• it was applied inconsistently between men and women
• The NHS failed to consider the role of informed consent , despite legal and ethical requirements

🩺 Clinical & Risk Assessment Failures

• The NHS did not properly weigh the risks of alternative contraception

It failed to:

• fully assess side effects
• consider patients who cannot tolerate alternatives
• follow through on its own plan to review these groups

🗣️ Consultation & Process Failures

• The NHS did not carry out proper consultation , despite stating it would
• It did not follow its own ethical framework and processes
• Key steps in decision-making were not documented or evidenced

📩 Complaints Handling Failures

They:

• did not follow complaint timelines
• did not keep me updated properly
• did not engage with my actual concerns
• Instead, they repeated the policy without addressing the issues raised

What This Actually Means

The Ombudsman did not say the NHS cannot set policies like this.

But they did say — very clearly — that:

• The decision-making process was flawed
• The evidence was not properly handled
• The reasoning was not transparent
• The policy was not applied fairly

And that matters.

Because once the process fails, the policy itself becomes very difficult to defend.

The Outcome — And The Reality Of It

After more than two years of investigation, the Ombudsman partly upheld my complaint .

That means they formally confirmed that:

• the decision-making process was flawed
• the evidence was not properly balanced
• the policy was not applied fairly
• and the complaints process itself failed

The NHS acknowledged this. In writing.

• They apologised.
• They accepted the failures.
• They agreed to review the policy.

And yet — despite all of that — the outcome stops there.

Because the Ombudsman does not have the power to enforce change.

They can:

• investigate
• document failures
• make recommendations

But they cannot compel the NHS to change policy , and they cannot take legal action on your behalf .

The Hard Truth About This Process

This is something I think people need to understand before they even begin a journey like this:

You can:

• spend years researching
• build a fully evidenced case
• prove systemic failures
• have those failures independently confirmed

…and still walk away without actual change.

That is incredibly disheartening.

Because what it means in practice is that accountability still sits with the same system that failed in the first place — under the same leadership, the same structures, and often the same people.

• Even now, after the investigation, I am not seeing the level of correction I would expect.
• I am seeing process. I am seeing movement. But I am not seeing the core issue being resolved.

What This Leaves Me & Other Women With

At this stage, the only path that could create enforceable change is legal action .

Taking the NHS to court.

But that comes with its own reality:

• it is expensive
• it is time-consuming
• it requires legal backing and resources

And in the UK, we do not have a straightforward mechanism for collective legal action in cases like this. There is no easy way for all affected women to come together and challenge this as a group.

Which means that, once again, the burden falls on individuals.

Why I’m Still Pushing This Forward

This policy affects women across the region — and likely reflects wider issues across the UK.

Most of those women will never:

• read policy documents
• analyse meeting notes
• understand their legal position
• or take a complaint this far

And that’s exactly why these systems continue.

So the reason I’m sharing all of this — in this level of detail — is because I want this case to be useful beyond me.

With this, I want it to:

• support organisations that are already working to protect women’s rights
• give legal teams something concrete to work with
• provide evidence that this is not just a personal complaint, but a systemic issue

If you are a legal firm working on a no win, no fee basis , or an organisation focused on healthcare rights, reproductive rights, or equality law — I am open to being contacted. Just email me with your thoughts, ideas, agenda and we can go from there.

How This Unfolded

This whole saga took years. It built over time, through a series of conversations, delays, and decisions that only made sense once I stepped back and looked at the full picture. Here’s what actually happened, step by step:

Timeline: Childfree by Choice Realisations, Investigating Female Sterilisation Process and The Application and Rejection of my Funding Request

• In My Early 20s
• I realised I didn’t want children and started asking about permanent contraception. Over the years that followed, I repeatedly tried to get information from both GPs and sexual health clinics, but I was consistently redirected or told I was too young. There was never a clear answer or pathway.
• October 2022
• I decided to ask again. I spoke to my GP about accessing female sterilisation through the NHS. He told me he didn’t know the process himself but said he would look into it and come back to me.
• Early 2023 (after several months)
• My GP came back to me with information — with a policy. This was the first time I became aware that female sterilisation had been defunded locally, despite being a nationally recognised and funded procedure.
• Spring / Summer 2023
• Following the guidance I was given, my GP submitted an Individual Funding Request (IFR) for the procedure. There were no clear criteria or expectations outlined — it was essentially a case of applying and waiting for a decision.
• Summer 2023
• My funding request was rejected. The response didn’t meaningfully engage with my situation, and when I asked for further clarification, I was referred back to the same policy - despite me pressing for clarity on  their decision making process that led to a rejection.
• 2 July 2023
• I submitted a formal complaint to the BOB ICB. In that complaint, I challenged the policy itself — its legality, its alignment with national guidelines, and the way it restricts access to a legitimate healthcare option.
• July – October 2023
• The complaints process became drawn out and difficult to navigate. I followed up multiple times, but responses were delayed and often did not address the substance of my concerns. The process exceeded its own stated timelines.
• October 2023
• After much pressing and many delays, I received a final response from the CEO of the local NHS Trust. The response largely reiterated the existing policy, reasurringly spoke about the rigorous process Policies are made through and confidently stated the Process has been followed. Yet it did not meaningfully engage with the legal, ethical, and clinical issues I had raised.
• November 2023
• After exhausting the internal complaints process, and with my concerns still unresolved, I escalated the case to the Parliamentary and Health Service Ombudsman. But my Complaint wasn't taken in immediately.

19 December 2023

• They came back to me saying that I need to have affirmative from the NHS that they have finalised my complaint before I can approach the Ombudsman. This took a few more months to get to. I needed to get the NHS to affirm they're done with their internal investigations into my complaint and I was gonna do it.
• 13 February 2024
• After a lot of emails and pestering, a small yet huge victory came through one day. A letter from the CEO of the BOB ICB NHS Trust -  Dr Nick Broughton FRCPsych came through.

With the NHS CEO's letter in hand, and even more confidence that he had shot himself in the foot with it - I approached the Ombudsman again and filed a Complaint with them.

February 2024 -  September 2024

What I hadn’t fully realised at that point is that escalating to the Ombudsman doesn’t automatically mean your case will be taken forward. Before anything else, they assess whether your complaint falls within their remit and whether it meets the threshold for investigation. In my case, there was a real possibility that it wouldn’t. One of the concerns raised was that I was a single complainant, and the Ombudsman typically prioritises cases that demonstrate wider systemic impact. That was difficult to hear, because from my perspective, the issue was already obviously systemic — it just wasn’t being recognised as such.

I made it very clear that this was not just about me. This policy affects every woman in the region who might want to make the same decision, and many of them will never even get to the point of questioning it. Most people don’t have the time to dig through policies, meeting notes, and guidelines. They don’t know where to look, or that they can challenge decisions like this in the first place. So what appears as a “single complaint” is often just the visible tip of something much bigger. It took several more months of back-and-forth, clarifications, and persistence before the Ombudsman accepted that this warranted investigation.

Eventually, they confirmed they would take the case forward and formally look into the NHS’s actions, but even getting to that point was a process in itself.

But before all the developments on that front, something even crazier happened...

The NHS Doubled Down, Despite Knowing the Ombudsman is Looking to Investigate Them

While the Ombudsman was still deciding whether my complaint was even worth investigating, the NHS didn’t pause, reflect, or reconsider anything. Quite the opposite. During that period of back-and-forth, where I was essentially trying to prove that this issue was bigger than just me, a new version of the policy was published in July 2024. It confirmed, in plain terms, that female sterilisation “is not normally funded,” again citing “levels of regret” and “more cost-effective methods of contraception” as justification. The language hadn’t meaningfully evolved, the reasoning hadn’t been strengthened, and none of the concerns I had raised — about legality, ethics, or alignment with national guidance — appeared to have been addressed. If anything, it felt like a quiet reinforcement of the same position, just formalised again.

What made this particularly difficult to process was the timing. While I was still navigating a long, exhausting process just to get my complaint recognised as valid, the system I was challenging was actively reaffirming itself. There was no indication of review, no acknowledgement of scrutiny, no sense that the issue had even been taken seriously enough to reconsider. It felt less like a process of accountability and more like an institution closing ranks. To see a policy that I had spent months dissecting and challenging simply restated, without engagement or reflection, made it very clear how resistant these systems can be to change — even when serious questions have been raised.

Timeline: The Ombudsman Process

At this point, my complaint had left the NHS system entirely. But what I didn’t expect was just how long the next stage would take.

Here’s how that unfolded:

• 15 November 2023
• I submitted my complaint to the Parliamentary and Health Service Ombudsman.
• February 2024
• The Ombudsman formally acknowledged my complaint and confirmed they would need to assess whether to take it forward.
• April 2024
• My case was allocated to a caseworker for initial review.
• September 2024
• Due to the complexity of the case, it was escalated and reassigned to a Senior Caseworker .
• 5 November 2024
• The Ombudsman formally opened a full investigation and requested evidence from the NHS.
• January 2025
• I received a formal notice that the investigation had already taken 12 months , with further delays due to the volume and complexity of evidence.
• Throughout 2024–2025
• The Ombudsman:
• requested multiple rounds of evidence
• reviewed internal NHS documents
• corresponded with both myself and the ICB
• issued provisional findings and allowed both sides to respond
• 16 December 2025
• The Ombudsman issued their Final Report and Decision .

This means the process from submission to final decision took over two years .

And importantly — during this time, the NHS continued to uphold and reinforce the policy , despite it being under investigation.

The Erosion of Women's Rights

At the same time, I’ve been watching a broader shift happening over the years — a steady erosion of access to reproductive choices, particularly when it comes to permanent contraception for women. More restrictions. More gatekeeping. More decisions being made for women, rather than with them.

And no, I'm not speaking about the USA, I'm speaking about the UK following into their footsteps. Right wing undercurrents pushing agendas and pressing with influece. Don't trust me on it - you can Google that.

And it 's sad most people don’t even realise it’s happening.

To me, this is about bodily autonomy. I don't care if you want a vasectomy, female sterilisation or some completely unrelated to reproductive health procedure - it is your body, it is your choice what you want to live with and do.

So, to me i t’s b igger - it's about the right to decide what kind of life you want to live, and to have access to the healthcare options that support that decision — without being blocked, filtered, or dismissed.

That’s why I took this further - because it felt necessary.

Impact on Women

Here's how myself and other women in the region are affected by the defunding of female sterilization services, which can be viewed as a discriminatory policy coupled with negligence:

Impact on Personal Autonomy and Health Choices:

• Personal Experiences: Myself, like many women in your region, have faced significant barriers in accessing a crucial healthcare service. The defunding effectively removes an important option for women who have decided that sterilisation is the right choice for their bodies and futures.
• Broader Impact: This policy restricts the autonomy of women to make informed and independent decisions about their reproductive health, a fundamental aspect of personal liberty and dignity.

Increased Emotional and Psychological Stress:

• Uncertainty and Frustration: Women seeking sterilization are now faced with uncertainty and confusion. The lack of clear communication and the prolonged process you experienced is indicative of a broader systemic issue, leading to increased stress and anxiety.
• Impact of Denied Services: For women who have decided against having children, or for whom additional pregnancies may pose health risks, the inability to access sterilisation can lead to significant emotional distress.

Potential Health Risks and Medical Implications:

• Alternatives May Not Be Suitable: For some women, alternative forms of contraception may not be medically suitable or preferred, making sterilisation the safest or most effective option.
• Risk of Unwanted Pregnancies: Without access to sterilisation, there may be an increased risk of unintended pregnancies, which can have substantial health, economic, and social implications for women.

Economic and Social Consequences:

• Financial Burden: Women might have to seek private treatment for sterilisation, imposing a financial burden that unfairly discriminates against those from lower socio-economic backgrounds.
• Career and Life Planning: The uncertainty and inability to access sterilisation can affect life planning, including career development and personal relationships, as it imposes an additional layer of uncertainty regarding family planning.

Implications of Negligence and Lack of Accountability:

• Erosion of Trust: The way in which this policy change was implemented – without clear communication or apparent consideration of its impact – erodes trust in the healthcare system.
• Lack of Representation and Advocacy: This situation highlights a possible lack of advocacy and representation for women's health issues within the healthcare governance structures, suggesting a gap in understanding or prioritizing women’s healthcare needs.

Discriminatory Nature of the Policy:

• Gender Inequality: The defunding can be perceived as a form of gender inequality, as it specifically affects a service exclusive to women, potentially impacting their rights and freedoms.
• Ignoring Clinical Guidelines: By overlooking NICE guidelines and other healthcare standards, this policy seems to undermine the established consensus on women’s health rights and needs.

Overall, the defunding of female sterilisation services by the NHS Oxfordshire Trust represents not just a removal of a medical procedure but also signifies a broader neglect of women's health rights, autonomy, and well-being in the region.

What I Did Next

After going through all of this — the Constitution, the clinical guidelines, the legal side, the meeting notes, and testing their justifications — I didn’t just sit with it.

I put it all together.

I wrote a formal complaint to the NHS, outlining everything I had found:

• The contradictions with the NHS Constitution
• The misalignment with clinical guidelines (NICE, WHO, GMC)
• The legal concerns around bodily autonomy and informed consent
• The lack of evidence behind their key claims (cost, regret)
• The inconsistencies in their own internal decision-making process

I referenced their own meeting notes. I cited legal precedent. I challenged their reasoning directly.

And I made one thing very clear — if they are restricting access to a legitimate medical option based on “regret,” they are effectively positioning themselves as responsible for people’s future feelings. Which is not how healthcare — or the law — works.

That complaint became a detailed, evidence-based challenge to the policy itself.

The NHS Complaints Process (And What Actually Happened)

What followed was not a meaningful investigation.

It was delay after delay, deflection and nothing more than empty words.

The NHS has a formal complaints process, with stated timelines for responses. I followed that process properly. I waited. I gave them time to respond.

And then I chased.

• Every time a deadline passed, I emailed.
• Every time I was told a response was coming, I followed up when it didn’t arrive.
• Again. And again. And again.

Months went by like this.

At some point, it stopped feeling like a process and started feeling like a wall.

I was corresponding with someone from the complaints team, and despite everything I had put forward — all the evidence, all the questions — nothing moved. No real engagement. No real answers. Just a system that seemed designed to absorb time and energy until you gave up.

And that’s the part I think people need to understand.

This process is exhausting by design.

It takes time. It takes persistence. And if you don’t keep pushing, nothing happens.

What became clear to me, eventually, is that there was no real intention to properly address what I had raised. No meaningful accountability. No willingness to revisit the decision.

That was the moment I realised:

If I wanted this to go anywhere, it wasn’t going to happen inside the NHS.

Seeking Justice Outside the System

That’s what led me to the Ombudsman.

Most people don’t know this, but there are independent bodies in the UK that exist specifically to investigate complaints when systems fail to do so themselves. These are called Ombudsman services, and they exist across different sectors:

• Financial Ombudsman (for banking, insurance, etc.)
• Parliamentary and Health Service Ombudsman (for NHS and public services)
• And others, depending on the area

Their role is to step in after you’ve exhausted the internal complaints process , and to independently assess whether something has gone wrong.

• That’s important — you can’t go to them straight away.
• You have to go through the (exhausting) system first.
• Even if that system fails you.

So after months of chasing, waiting, and getting nowhere, I escalated my complaint to the Parliamentary and Health Service Ombudsman (PHSO) .

Why I Took This Further

T his was no longer just about me.

It would have been easier to walk away. To accept the outcome and move on.

But what I had uncovered made that impossible.

This policy doesn’t just affect one person — it affects every woman in the region who might want to make the same decision . And most of them will never even realise that this is something they can challenge. They won’t have the time, the knowledge, or the energy to go through what I went through.

And that’s exactly how systems like this continue.

There are many, many reasons why I kept going - keep reading and you'd find out.

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!

How I Investigated This Policy (And How You Can Too)

When I discovered that female sterilisation had been defunded in my area, I didn’t just accept the decision at face value. I wanted to understand whether this policy was actually lawful, ethical, and aligned with national healthcare standards.

So I approached it like an investigation.

What I found is that you don’t need to be a lawyer or a policymaker to question decisions like this — but you do need to know where to look.

Here’s exactly what I did.

1. I Started With the Policy Itself

The first step was to read the actual policy in full.

Not just summaries. Not what someone told me. The actual document.

In my case, this was:

NHS's Policies for each Trust are available and accessible online, and if you can't find them - you have the right to request them.

This is where I found the official reason for defunding female sterilisation — including claims about “regret” and “cost effectiveness.”

That’s important because once you understand the reasoning, you can test whether it holds up.

It is important for me to note here,  Cost Effectiveness is easy to investigate - that was going to be an easy and clear deductive verification of their claim.

However, I knew I had a serious case on my hands when I saw ''Regret'' on that policy.

Why?

Because if they are refusing based on ‘’ Regret ’’ they are technically and practically accepting responsibility for people’s feelings - which makes them legally liable for any choices they did or didn’t control and limit or force you into - because people can regret anything and everything.  So realistically, if the NHS was taking it upon themselves to manage your feelings in 5, 10, 30 years by making decisions for you - they take legal responsibility and you can sue them for any medical decision that led to you feeling regret.

It is unacceptable that this reason for defunding and discontinuing female sterilisation has nothing to do with its safety, reliability, or other medical concerns. It was clear as day that the decision to cut funding for women is an example of gender discrimination, patriarchal, unethical and disrespectful treatment of women that undermines women's bodily autonomy.

Consider the following:

If the NHS will argue it takes responsibility to safeguard adult's feelings about their own choices over their own body - and the ICB stands behind this, and state the need to protect people by restricting access to the birth control of their choice, I will challenge the ICB to take it upon themselves and play judge as to who is making a 'safe and unregrettable choice' of becoming a parent and responsible for another human being for life.

As Mertes states in her paper in the Journal of Medical Ethics* (2017) ‘’If physicians consider it to be their duty to Check if patients have given due consideration to possible future regrets in the case of a sterilisation request, they should equally consider it their duty to check if patients who request fertility treatment have given due consideration to the impact of parenthood on their lives.’’

In other words, and a bit of a prickly example - but if the NHS is taking it upon themselves to ensure I as an educated, healthy adult woman don't regret my decision to NOT have children,  isn't it logical for them to take legal responsibility and maybe force abortions on 15-year-olds who may (or may not) regret becoming teen moms if left to choose for themselves?

So, you can now see how their 'Regret' claim is legally and practically bonkers as a Policy statement that limits healthcare options for grown-up adult women.

Anyhow! This was clear as day from the get-go, but I needed more backing than pure 'Common Sense' because it appeared it was not so common in the NHS team that signed off on this policy.

2. I Looked at Clinical Guidelines (NICE, WHO, GMC)

Next, I checked it against clinical guidelines — the frameworks that healthcare professionals are expected to follow when making decisions about treatment, safety, and patient care.

Most people don’t know what these are, but they’re essential. In simple terms:

• NICE (National Institute for Health and Care Excellence) provides evidence-based guidance on what treatments and procedures are safe, effective, and should be available within the NHS.
• WHO (World Health Organization) sets global standards for health practices, including reproductive rights and access to contraception.
• GMC (General Medical Council) regulates doctors in the UK and sets standards around consent, patient autonomy, and decision-making in medical care.

These bodies don’t make casual suggestions — they set the baseline for what good, ethical, and lawful healthcare looks like.

So I asked: does this policy align with those standards?

Here’s what I found:

• NICE recognises female sterilisation as a valid, safe, and appropriate contraceptive option . It is not considered experimental or exceptional — it is part of standard reproductive healthcare.
• WHO includes sterilisation as a legitimate method of contraception and emphasises the importance of informed choice and access without unnecessary barriers.
• GMC guidance makes it clear that doctors must support patients in making informed decisions about their care , and must not impose their own views or restrict options without clear clinical justification.
• When you look at those together, the expectation is clear:
• Sterilisation is a recognised option, and patients should be able to choose it if they are informed and competent to decide.

What I was seeing locally didn’t match that.

The procedure wasn’t being discussed as one option among others — it was being removed altogether. That means the decision is no longer happening between doctor and patient. It’s being made in advance, at policy level, by restricting access entirely.

And that’s where the conflict lies.

3. I Checked It Against the NHS Constitution

Most people don’t know this, but the NHS has a Constitution — a document that sets out what it is supposed to stand for and how it should treat patients. Once I found the policy, I went straight to it.

Here’s what stood out to me:

• The NHS commits to equal access for all , regardless of gender
• It has a duty to provide a comprehensive service
• It must respect a person’s right to make informed decisions about their care
• It must ensure fairness and non-discrimination in how services are delivered

So I asked a very simple question: if female sterilisation is removed, is the male equivalent — vasectomy — still funded in my local NHS Trust?

I found the policy for Male Vasectomy. It was funded.

That alone raises a serious issue. One option remains accessible, the other is removed. That’s not equal access, and it’s hard to argue that it aligns with fairness or non-discrimination. On top of that, removing a valid, approved option altogether means the choice is gone before a patient can even make an informed decision.

The “Postcode Lottery” Problem

Another thing that became clear very quickly is how the NHS is actually structured.

Services are managed locally by Integrated Care Boards (ICBs) — regional bodies responsible for funding and planning care in specific areas. This means they can make decisions about what is or isn’t available in your region.

In practice, that leads to situations like this:

• A procedure is approved and funded nationally
• But removed locally , depending on where you live
• And there is no automatic referral to another area that provides it

You’re simply blocked.

To me, that’s where the system breaks down. If a procedure is recognised as a legitimate healthcare option across the NHS, access to it shouldn’t depend on your postcode. At the very least, there should be a referral pathway that ensures you can still access it elsewhere.

Otherwise, equality exists on paper — but not in reality.

4. I Looked at the Law - on the Human Right to Bodily Autonomy

If I wasn't a psychologist, I'd have been a lawyer. So, once I had checked the Clinical Guidelines and the NHS Constitution, I wanted to understand whether this would actually hold up legally. Not many people approach it this way, but I care about whether something would stand in court — not just whether it feels unfair.

And that cuts directly into something much more fundamental — bodily autonomy.

So I looked into the legality of Bodily Autonomy from a legal precedent perspective.

A legal precedent is a court ruling that sets a standard for how similar cases should be interpreted in the future. It matters because it shapes how rights are applied in real situations, not just in theory.

Here’s what I found:

• The case Montgomery v Lanarkshire [2015] established that patients have the right to make informed decisions about their treatment
• It confirmed that doctors have a duty to inform — but the decision belongs to the patient
• It reinforced the principle of bodily autonomy as a legal right , not just an ethical idea
• It shifted medical practice away from paternalism (doctor decides) to patient-led decision-making

So I applied that to my situation:

• Female sterilisation is a recognised, approved medical option
• But access to it is being restricted through a funding gatekeeping process
• That process places the decision in the hands of a panel, not the patient
• There are no clear criteria , which makes the decision arbitrary rather than clinical

That’s the conflict. That’s the point where this stopped being just a healthcare issue for me, and started looking like something that may not stand up if properly challenged - even in court.

• This is no longer about being informed and making a decision with a doctor.
• It becomes about whether someone else believes your decision is acceptable.