Two Vasectomy Pathways FOIs Later: Will NHS Thames Valley ICB Finally Show the Evidence?

Why am I asking about NHS-funded vasectomy again?

This follows directly from my previous investigation into the difference between access to male and female permanent contraception.

I discovered that NHS-funded vasectomy services can be delivered through private or independent providers and that direct-access or self-referral arrangements have existed or been developed for men.

At the same time, women seeking permanent contraception have faced a very different history of restrictions, approval requirements and contraceptive gatekeeping.

I wanted to know how that difference had been commissioned, governed and equality-assessed.

You can read the full background here:

What happened to the first vasectomy FOI?

My first request, TV-2607-192, was deliberately broad because I wanted to understand the commissioning history, providers, referral pathways, safeguards and equality assessment surrounding NHS-funded vasectomy.

NHS Thames Valley ICB refused it under Section 12 of the Freedom of Information Act, saying the work required would exceed the statutory cost limit.

I then asked the ICB to fulfil its duty under Section 16 and help me formulate a narrower request that it could answer.

I dramatically reduced what I was asking for.

The ICB nevertheless said it could identify no meaningful refinement.

So I did the refining myself.

How narrow is the second FOI?

On 3 September 2026, I submitted a completely new Freedom of Information request.

I expressly removed:

• historic and expired vasectomy arrangements;
• previous providers;
• historical pathway versions;
• procurement history;
• historic correspondence;
• the original search back to 2017;
• and any request for the ICB to create a new analysis.

I am now asking for only two categories of existing records.

First: the current documents showing how patients presently access NHS-funded vasectomy under relevant former BOB ICB arrangements that remain operative, and any genuinely new Thames Valley-wide arrangements.

Second: the current or most recent recorded evidence showing how equality duties were considered when those arrangements were commissioned, continued or adopted.

That includes NHS-funded services delivered through private or independent providers.

If no equality evidence exists, I have simply asked the ICB to say so.

Why does the equality evidence matter?

Because this is not just a question about where men book a vasectomy.

The underlying question is whether NHS Thames Valley ICB has properly considered the difference between how men and women access permanent contraception.

If men can receive NHS-funded permanent contraception through comparatively straightforward private-provider pathways while women have historically been subjected to substantially more gatekeeping, then I want to see the evidence showing how that difference was assessed.

Not another reassurance.

The records.

Even the acknowledgement had to be chased

The new request was submitted on 3 September 2026.

Seven days later, on 10 September 2026, I still had no acknowledgement and no reference number.

So I chased it.

On 12 September 2026, NHS Thames Valley ICB finally confirmed that the request had been logged and gave it the reference:

The late acknowledgement does not restart the statutory clock.

The request was submitted on 3 September.

When does NHS Thames Valley ICB have to respond?

Under the Freedom of Information Act, public authorities ordinarily have to respond promptly and no later than the twentieth working day following receipt of a valid request.

For this request, that gives NHS Thames Valley ICB a statutory deadline of:

So what am I waiting to see?

At this point, the test is very simple.

I want to see whether NHS Thames Valley ICB will:

1. meet the statutory deadline;
2. provide the current vasectomy pathway documents;
3. provide the equality evidence it holds;
4. clearly confirm if particular records do not exist;
5. and provide a substantive response rather than creating another transparency battle.

The original request was broad.

This one is not.

I have reduced it to the records that should be closest to hand if NHS Thames Valley ICB is currently commissioning, funding or administering these services.

So this time, I am leaving the question here publicly before the deadline passes.

What happens next?

I am not going to keep expanding this post every time another email arrives.

This is simply a marker of where the investigation stands now.

When NHS Thames Valley ICB responds — or if the statutory deadline passes without a lawful response — I will publish the next part separately.

That way, there is a clear public record of what I asked, when I asked it and what the ICB was required to do next.

You can follow the wider chronology on The Timeline, and the underlying correspondence is available through my Evidence Folder.

Men Can Self-Refer. Why Can’t Women? And cheers to another failed FOI Request, and the mystery continues!

A note about my conclusions: I believe the difference between the male and female pathways raises a serious equality problem, and I believe the ICB has repeatedly obstructed transparency around how those differences are justified. This is my opinion. Please review the evidence yourself and make your own.

Why did the vasectomy pathway immediately raise an equality question for me?

By spring 2026, I was already challenging NHS Thames Valley ICB about the way women seeking permanent contraception were still being treated.

The latest female sterilisation policy continued to impose conditions on women’s access.

Women were still navigating NHS pathways where clinicians, referral criteria, contraceptive alternatives and organisational policy all sat between the woman and the permanent contraception she had chosen.

Then I found the male pathway.

The screenshot I took from Thames Valley Vasectomy Services showed an NHS-funded vasectomy service delivered by a private provider.

The page said patients registered with GP practices in both Frimley ICB and BOB ICB areas were eligible for NHS-funded vasectomy.

It also said:

For Frimley patients, the page stated that men could refer themselves directly.

For BOB patients, it said the provider was working with the ICB to expand self-referral access.

That got my attention immediately.

If men can bypass the GP, why are women still being gatekept?

This is the question at the heart of the whole issue for me.

Men seeking permanent contraception appeared to have access to something women did not:

• a private provider;
• NHS funding;
• direct-access pathways;
• and, in some areas, self-referral without a GP.

I have not found an equivalent private, NHS-funded, self-referral route for women seeking sterilisation.

And that is the problem.

I am not claiming that vasectomy and female sterilisation are clinically identical.

They are not.

But equality does not require pretending two procedures are medically identical.

It requires asking whether the difference in access is necessary, proportionate and actually justified by evidence.

That is what I wanted the ICB to show me.

Why did I ask Chair Dr Priya Singh to explain the male vasectomy pathway?

During my correspondence with Dr Priya Singh in June 2026, I raised the growing disparity directly.

I challenged the fact that women seeking sterilisation were still being subjected to restrictive pathways while NHS-funded vasectomy services appeared to be expanding access through private provision and self-referral.

I wanted to know how the ICB justified that difference.

Was there an Equality Impact Assessment?

Had the male and female pathways actually been compared?

Had anyone examined whether making vasectomy easier to access while female sterilisation remained harder created or worsened sex-based inequality?

Had anyone considered extending comparable access to women?

I did not get a substantive answer.

So, once again, I moved from asking for explanations to asking for the records.

What exactly did I ask for in FOI TV-2607-192?

On 24 July 2026, I submitted a Freedom of Information request titled:

Commissioning, Procurement and Equality Assessment of NHS-Funded Vasectomy Services.

The request covered NHS-funded vasectomy services across the current NHS Thames Valley ICB area and predecessor organisations from 1 January 2017 onward. It expressly included private and independent providers and direct-access or self-referral pathways.

I asked for four main categories of evidence.

• Who was commissioned — NHS providers, private clinics and independent providers, contract dates, areas covered and service specifications.
• How men accessed the service — GP referral, direct booking, self-referral, eligibility, consent, counselling, refusal criteria and prior approval.
• What equality work had been done — Equality Impact Assessments, PSED assessments and any recorded comparison between vasectomy and female sterilisation.
• Whether equivalent access for women had ever been considered — including self-referral, NHS-funded private provision and allowing the treating clinician’s consent and capacity assessment to determine access without another ICB approval layer.

I also specifically asked how the ICB assured itself that men self-referring into private clinics were being properly assessed for eligibility, capacity and informed consent.  

That is important.

If men can self-refer into private clinics, what safeguards actually apply?

At the moment, I still do not know.

That was one of the reasons for the FOI.

I wanted to see the clinical-governance, safeguarding, audit and monitoring requirements attached to these privately delivered NHS services.

• What does the assessment look like?
• Who checks capacity?
• Who discusses permanence and regret?
• What information does the man receive?
• What are the refusal criteria?
• Does anybody require him to try another contraceptive method first?
• Does anybody ask whether he has children?
• Does anybody ask whether his future partner may want children?
• Does the ICB itself approve anything?

Or is the system basically:

That latter model would actually make sense to me.

What does not make sense is offering that kind of autonomy to men while treating women as though permanent contraception requires institutional permission.

And because the ICB refused to disclose the records, I still cannot tell you exactly where the safeguards sit.

For all I know from the information disclosed so far, men may be receiving appropriate counselling and robust clinical assessment.

Or the private provider may be doing little more than checking eligibility, giving information and proceeding.

I do not know — because the ICB has not shown me the records.

And that uncertainty is precisely why transparency matters.

Why does private NHS-funded access matter so much in the equality comparison?

Because private provision changes the patient experience.

Private clinics are often structured around speed, direct booking and convenience.

The screenshot itself advertises vasectomy access with “minimum fuss”.

That is a very different message from the one women receive.

Women seeking sterilisation are asked to navigate clinical pathways, contraceptive alternatives, referrals and eligibility criteria in a system where access itself has repeatedly been questioned.

Even where a woman is eventually approved, the actual operation is still likely to sit within an NHS surgical pathway, with the waiting times and capacity pressures that come with that.

So there are potentially two layers of inequality here:

Where is the equivalent provision for women?

I have not found it.

Why did I have to chase even the acknowledgement of the vasectomy FOI?

The request was submitted on 24 July 2026.

By 30 July 2026, I still had not received a proper acknowledgement, reference number or confirmation that the request had been registered.

So I chased.

I specifically asked for:

• confirmation that the request had been received;
• the assigned reference number;
• and the name, position and department of the person or team responsible for it.

The reply told me the reference was TV-2607-192, but also said:

That answer bothers me more than it may bother other people.

Because throughout this entire case - all the way back to my original complaint to today, I have repeatedly had to ask:

• Who am I actually dealing with?
• Who made this decision?
• Who approved it?
• Who is accountable for it?

And again and again, correspondence arrives from generic teams and generic job labels.

That makes accountability incredibly easy to lose.

Why does refusing to identify officials make accountability harder?

Large organisations already diffuse responsibility naturally.

A request moves between teams.

A policy moves through committees.

An email is drafted by one person and authorised by another.

A decision is described as “the ICB’s position”.

Then, months later, when you ask who actually did what, nobody seems to own it.

This is exactly why I think public officials exercising power should be identifiable in their official roles.

I am not asking for private phone numbers, home addresses or personal information.

I am asking:

Who acted on behalf of a public organisation?

If nobody can tell me that, then accountability becomes almost impossible.

Why did I warn the ICB before the deadline that I did not want another last-minute failure?

The statutory deadline for TV-2607-192 was 21 August 2026.

After what had already happened with my previous FOI request, I was not prepared to simply wait until the deadline and discover that nothing had been done.

So on 17 August 2026, I contacted the FOI team proactively.

I asked whether the request was on track.

I asked whether all relevant teams had been contacted.

I asked whether any issue existed that might prevent a complete response by 21 August 2026.

I explicitly said I did not want to discover after the deadline that the request had again not been progressed appropriately. 

Then came the final response.

Why did NHS Thames Valley ICB refuse the entire vasectomy FOI?

At the very end of the statutory period, the ICB refused the request under Section 12 of the Freedom of Information Act.

Section 12 allows a public authority to refuse a request where it reasonably estimates that the cost of locating, retrieving and extracting the information would exceed the statutory limit.

The ICB said it had carried out an initial scoping exercise taking 10 hours.

It identified relevant records across:

• seven business functions;
• six directorates;
• multiple predecessor organisations;
• historical commissioning records;
• procurement;
• contracts;
• finance;
• quality;
• corporate governance;
• and equality functions.

The ICB therefore said the full request would exceed the 18-hour cost limit and refused it in its entirety.

I can understand why a nine-year, 25-part request might exceed the cost limit.

That is not actually the part that bothers me most.

The next part does.

If the ICB had already mapped the records, why couldn’t it help me narrow the request?

The response said the ICB had considered whether the request could be narrowed by:

• reducing the time period;
• limiting it to current commissioning arrangements;
• restricting it to a particular category of records;
• restricting it to a particular provider or contract;
• or excluding predecessor organisations.

Then it concluded that it could identify no meaningful refinement that would bring the work under the cost limit.  

I did not accept that.

Because by its own account, the ICB had already spent 10 hours working out:

where the information was, which departments held it, what kinds of records existed and which organisations were involved.

That put the ICB in a vastly better position than me to say:

If you ask only for X, Y and Z, we can answer it.

So I asked them to do exactly that.

What does Section 16 actually require public bodies to do?

Section 16 of the Freedom of Information Act creates a legal duty to provide reasonable advice and assistance.

The Information Commissioner’s guidance says that where Section 12 applies, a public authority should first consider whether there is information it can provide within the cost limit.

It should then consider whether it can help the applicant refine or refocus the request.

The ICO specifically says that simply telling somebody to “narrow” a request without indicating what could actually be provided may just lead to another failed request.

The Upper Tribunal has described Section 16 as requiring an authority to suggest obvious alternative formulations capable of providing the core information within the cost limit. 

That is exactly what I asked NHS Thames Valley ICB to do.

How much further did I narrow the request myself?

On 21 August 2026, I wrote back and stripped the request down dramatically.

I told them I was prepared to drop:

• expired historical contracts;
• the wider nine-year historical search;
• most predecessor organisations;
• historic pathway versions;
• historic procurement exercises;
• and most of the original 25 questions.

I reduced my core priorities to four things:

1. Who currently provides NHS-funded vasectomy?
2. What is the current access and referral pathway?
3. What is the current or latest equality assessment?
4. What is the current or latest recorded comparison with female sterilisation?

I even asked them:

If all four are still too much, tell me which ones you can provide.

And if even that was too broad, tell me what obvious further refinement would work.

I was trying to cooperate with them. 

Why did I have to chase the Section 16 help too?

Because they did not answer.

On 28 August 2026, seven days later, I chased again.

I reminded them that I was not asking them to reconsider the original FOI.

I was asking for the advice needed to formulate a new request that would actually succeed.

I again asked them to tell me what current information, or combination of categories, they could reasonably provide.

Then, on 2 September 2026, I finally received their answer.

It was basically:

That is the point where, in my view, the ICB stopped merely relying on Section 12 and started failing its Section 16 responsibility.

The ICO may ultimately decide whether that amounted to a legal breach.

I think it did.

How can there be no workable refinement when I was asking for current providers and one current pathway?

This is what I still cannot understand.

We are talking about a service the ICB is currently commissioning.

Surely somebody knows:

• who is currently being paid to deliver it;
• what service specification applies;
• how patients are referred;
• what current eligibility criteria apply;
• and whether an equality assessment exists.

If NHS Thames Valley ICB genuinely cannot retrieve even that basic current information within 18 hours, then to me that raises an entirely different governance problem.

How do you oversee a commissioned service if you cannot efficiently identify its current provider, pathway or equality documentation?

Why did I escalate the Section 16 refusal to Dr Nick Broughton and Dr Priya Singh?

On 3 September 2026, I stopped debating the point with the anonymous Information Governance Officer.

I copied in:

• Dr Nick Broughton, Chief Executive and Accountable Officer;
• Dr Priya Singh, Chair;
• and Hannah Iqbal, Chief Strategy and Commissioning Officer.

I told them directly that I regarded the refusal to provide meaningful Section 16 assistance as another organisational failure.

I also made clear that I was copying senior leadership deliberately. Not because I expected a miracle. But because I wanted there to be no later suggestion that they did not know what was happening.  

I heard nothing from Dr Singh.

I heard nothing from Dr Broughton.

Once again - breaches in FOI guidelines and I saw no evidence of senior intervention.

Why does Dr Nick Broughton’s role as Accountable Officer matter again?

Why am I so bothered that the FOI team refuses to give names?

Because this entire case has taught me how easily responsibility disappears inside a large institution.

The vasectomy FOI response did not come from a named officer.

It came from:

“Information Governance Officer.”

When I asked for the name and position of the person handling the request, I was told the ICB does not give names because requests may be handled by multiple people. 

I think that is a terrible approach to public accountability.

• Who drafted the refusal?
• Who approved the Section 12 estimate?
• Who decided there was no meaningful Section 16 refinement?
• Who checked that decision?
• Who was responsible for escalating it?
• Who signed it off?

If nobody is named, how does anybody later reconstruct what actually happened?

And if nobody can reconstruct what happened, how does anyone get held accountable?

Does easier male access automatically prove unlawful inequality?

No.

There may be legitimate clinical reasons why vasectomy and female sterilisation are commissioned differently.

Vasectomy is generally simpler, less invasive and cheaper.

But those facts do not answer every equality question.

They do not automatically explain:

• why men may self-refer while women cannot;
• why private NHS-funded provision is apparently available to men but not women;
• why women have historically faced prior-approval and exceptional-funding hurdles;
• why women may be pushed towards reversible contraception before permanent contraception;
• or whether anybody actually performed a proper equality assessment before expanding male access.

That is exactly why I asked for the records.

What does equal healthcare actually require here?

Equal healthcare does not mean giving men and women identical operations.

It means that where the NHS creates easier access for one sex to permanent contraception, it should be able to explain why comparable access cannot or should not be offered to the other.

It should be able to show:

• the clinical evidence;
• the commissioning rationale;
• the equality assessment;
• the safeguards;
• the patient experience;
• and the proportionality of the different pathways.

So far, I have not been shown that analysis.

Instead, when I asked for it, I got a refusal based on cost.

Then, when I asked them to help me narrow the request, I got told there was no meaningful way to do so.

Why does this feel like transparency is being obstructed around male commissioning?

Because this is not obscure historical trivia.

I am asking how an NHS-funded service for men is currently commissioned.

I am asking how private providers are selected and governed.

I am asking what safeguards exist.

I am asking what equality analysis exists.

I am asking whether women were ever considered for comparable access.

Those are basic public-interest questions.

And instead of getting a clear audit trail, I have had to fight through:

• an unacknowledged request;
• a last-minute Section 12 refusal;
• a refusal to identify the officials handling it;
• a separate request for Section 16 help;
• another delay;
• and then a flat statement that there was no meaningful refinement they could suggest.

To me, that is obstructive.

And because this information directly relates to whether men are receiving easier access to permanent contraception than women, I find the lack of transparency even more concerning.

Why does the difference in patient experience matter as much as the formal policy?

Because healthcare inequality is not only about whether two services technically exist.

It is also about how difficult they are to access.

A man who can self-refer to a private NHS-funded clinic may experience:

• direct booking;
• shorter administrative routes;
• private-provider efficiency;
• fewer gatekeepers;
• and quicker progression to treatment.

A woman seeking sterilisation may experience:

• GP referral;
• specialist referral;
• discussion of alternative contraception;
• policy criteria;
• possible approval hurdles;
• and then an NHS surgical waiting list.

Even before we compare the operations themselves, the pathway can create a huge difference in practical access.

That is healthcare inequality in real life.

Why do I describe the current system as favouring men’s reproductive choices?

Because from what I can currently see, a man can say:

I do not want children. I want permanent contraception.

And the system appears capable of building convenient NHS-funded access around that decision.

For women, the system has spent years asking whether we might regret it, whether we should try something else first, whether our circumstances are exceptional enough, and whether the NHS should fund the decision at all.

That is not a small difference.

It sends a cultural message too:

I think that is deeply unequal.

What did I do after NHS Thames Valley ICB refused to help me narrow the request?

I stopped arguing with them.

On 3 September 2026, I told the ICB that I would submit a new and substantially narrower request.

The ICO guidance is clear that a refined request is treated as a new request, with a fresh statutory response period, and the costs of the original request cannot simply be aggregated with it. 

So I stripped the scope right down.

The new request is deliberately minuscule compared with the original one.

I have removed the broad historical search.

I have removed the 25-part structure.

I have narrowed it to the core current information I actually need.

And even then, the first thing that happened was familiar.

I did not receive a prompt acknowledgement and case reference.

So I had to chase again.

What does even the failure to acknowledge a tiny new FOI tell me?

On its own, not much.

Inside this history, quite a lot.

Because this is now a recurring environment.

I submit a request.

I wait.

I chase acknowledgment.

I ask for a reference.

I ask who is handling it.

I get a generic team response.

I wait until the deadline.

I challenge the result.

I ask senior leadership to intervene.

Nothing changes.

At some point, repeated process failure stops feeling accidental. It starts looking like how the system works under its current Leadership of CEO Nick Broughton.

What am I trying to establish with the new narrowed vasectomy FOI?

The new request is designed to strip away every excuse.

I want the core evidence necessary to answer a few basic questions:

• Who is currently commissioned to provide NHS-funded vasectomy?
• What is the current approved access and referral pathway?
• What current equality assessment applies?
• And has anyone actually compared that pathway with female sterilisation?

If NHS Thames Valley ICB cannot answer even that without another refusal, delay or transparency battle, then that in itself will tell us something important about the state of its commissioning records and accountability systems.

Why am I going to keep comparing vasectomy with female sterilisation?

Because this comparison goes to the heart of everything I have been challenging since 2022.

Permanent contraception should be about informed adult choice.

If the NHS believes men can make that choice through a straightforward, even privately delivered, NHS-funded pathway, then it needs to explain why women cannot be given something comparably respectful of their autonomy.

Not identical surgery.

Not identical clinical pathways.

Comparable respect for the decision.

That is what I have been asking for all along.

Where can I read the vasectomy FOI evidence?

You can read the original vasectomy FOI, the Section 12 refusal, my Section 16 request for help narrowing it, the ICB’s refusal to provide further assistance, and the later correspondence with senior leadership in my Evidence Folder.

Sources and further reading

• Information Commissioner’s Office — Section 16: Advice and Assistance
• Information Commissioner’s Office — Section 12: Requests Exceeding the Cost Limit
• Information Commissioner’s Office — Refusing a Request and the Section 16 Duty