Maladministration, Misconduct, Negligence or Serious Mismanagement: Who is failing how?

I did not spend years of my life investigating this so that everybody involved could eventually move on, collect another senior title and continue exercising power while what happened disappears into institutional memory.

That is one of the main reasons this website exists.

I started as one woman asking for permanent contraception.

What followed became an investigation into how NHS policy is made, what evidence gets considered, how women’s decisions about their own bodies are treated, how unequal healthcare pathways are justified, what happens when senior executives give assurances that later collapse under independent scrutiny, and what happens when you ask the most uncomfortable question of all:

If you look at The Timeline, you can now see the whole pattern in one place.

1. A restrictive policy.
2. A complaint.
3. Assurances from the Chief Executive.
4. An Ombudsman investigation.
5. Formal findings of maladministration.
6. A replacement policy that again restricts women’s choices.
7. No leadership review.
8. A Freedom of Information request asking for the evidence.
9. A statutory deadline missed.
10. An Internal Review admitting the failure.
11. No meaningful internal investigation into who was accountable.
12. Another complaints route closed.
13. A second transparency battle over male vasectomy commissioning.
14. And repeated external escalation because the organisation would not meaningfully scrutinise itself.

At some point, “things went wrong” is no longer enough.

What does maladministration actually mean?

Maladministration is primarily an administrative-accountability concept rather than a criminal offence.

It describes public administration that falls below the standards expected of a public body.

That can include:

• failing to follow proper procedures;
• failing to consider relevant evidence;
• failing to properly explain a decision;
• poor or incomplete record-keeping;
• unreasonable delay;
• inconsistent treatment;
• failure to act fairly or proportionately;
• failure to correct mistakes;
• and failure to learn from complaints.

The Parliamentary and Health Service Ombudsman’s own principles expect public bodies to make decisions properly, keep adequate records, explain themselves, act fairly and put mistakes right.

Its remedy principles also recognise that maladministration can result in injustice or hardship, and that where this happens a public body should consider remedies not only for the complainant but, where appropriate, for other people affected by the same failure.

In this case, maladministration is not simply my description.

The Ombudsman independently found it.

You can read more in What the Ombudsman Found — and What It Could Not Do.

What is the difference between maladministration and misconduct?

This distinction is important.

Maladministration describes what went wrong in administration.

Misconduct describes the behaviour of a person.

An organisation can administer something badly without proving that one particular employee committed misconduct.

But individual conduct becomes relevant when somebody fails to meet the standards reasonably expected of their role.

For senior NHS leaders, the Fit and Proper Person Test framework is especially important because NHS England explicitly identifies behaviours that may be relevant to serious misconduct or serious mismanagement.

Those include:

• dishonest conduct;
• discrimination;
• disregard for appropriate standards of governance;
• resistance to accountability and undermining due process;
• failure to report significant issues;
• repeated or ongoing tolerance of poor practice;
• and continued failures in managing important business, financial or clinical functions.

NHS England also says context matters: whether behaviour was deliberate or reckless, whether dishonesty was involved, whether problems were repeated or continued over time, what role the person played and what impact the conduct had on public confidence.

That framework becomes very relevant when we stop looking at each event in isolation.

What does serious mismanagement mean?

Mismanagement is not necessarily one spectacular act.

It can be repeated failure to properly manage systems, risk, people, compliance and organisational responsibility.

At Board level, that matters because senior leaders are not only responsible for what they personally type into an email.

They are responsible for creating and maintaining systems that work.

If statutory processes repeatedly fail, if governance safeguards fail, if bad policies survive, if complaints do not create learning, if accountability disappears between departments and if leadership is notified without meaningful correction, then the question becomes bigger than one administrative error.

It becomes:

What does negligence mean?

Negligence is different again.

A legal negligence claim ordinarily requires a chain something like:

1. a duty of care;
2. a breach of that duty;
3. causation;
4. and identifiable harm or damage.

So not every bad policy is automatically negligent.

Not every example of maladministration creates a successful negligence claim.

Not every failure of governance causes a legally recoverable injury.

But that does not mean the harm caused by policy is irrelevant.

Quite the opposite.

The real question is whether the NHS created or maintained a healthcare pathway capable of causing foreseeable harm, and whether that foreseeable harm was properly considered.

Can a commissioning policy actually harm a patient?

Of course it can.

A healthcare policy determines what happens to real people and real bodies.

If a woman asks for permanent contraception and the NHS makes that treatment unavailable, exceptional, delayed or conditional on trying another contraceptive first, the policy changes the healthcare she receives.

The chain can look like this:

That is not theoretical.

The NHS itself recognises that hormonal contraception can involve side effects and risks.

Commonly reported effects include headaches, nausea, mood changes, changes to bleeding, sore breasts, acne and weight changes, although the NHS also notes that evidence does not establish that every reported symptom is necessarily caused by hormonal contraception.

Some hormonal methods also carry small increased risks such as blood clots and breast cancer.

That does not make hormonal contraception “bad”.

For millions of women it is an excellent choice.

The issue is whether it is their choice.

A treatment somebody freely chooses after weighing its advantages and disadvantages is not ethically equivalent to a treatment somebody is pressured or channelled toward because the healthcare system has restricted the option they actually want.

Why does NICE make this harm argument stronger?

NICE’s contraception quality standard says women asking for contraception should receive information about, and be offered a choice of, all contraceptive methods.

That explicitly includes permanent methods.

Female sterilisation is one of them.

NICE says healthcare practitioners should help women choose the method that suits them best, and commissioners should ensure services work together so women can receive their preferred method.

So when an ICB creates a policy that effectively says:

You may want permanent contraception, but before we respect that choice you need to try or prove the unsuitability of another method,

there is an obvious question about whether the local policy is facilitating contraceptive choice or overriding it.

This matters even more because the documents I eventually obtained showed that clinicians themselves had raised concerns about LARC being treated as a condition rather than an option, and supporting material referred to patient choice as something that should be paramount. 

Does the Supreme Court Case Montgomery v Lanarkshire Health Board make bodily autonomy part of the negligence question?

Yes.

The Supreme Court decision in Montgomery v Lanarkshire Health Board is foundational because it rejected the older paternalistic idea that doctors get to decide what information or choices a competent adult needs.

The Court made clear that an adult of sound mind is entitled to decide which available treatment, if any, to undergo.

A doctor must take reasonable care to make sure the patient knows about material risks of the recommended treatment and reasonable alternatives.

The whole point is meaningful participation in decisions about your own body.

That creates an important question in this case:

Montgomery applies most directly to the clinical encounter between professional and patient.

My case sits partly upstream of that encounter, because the commissioning policy itself can determine what the clinician is allowed to offer.

That does not automatically make the policy unlawful under Montgomery.

But it does make the conflict with informed choice and bodily autonomy impossible to ignore.

Is loss of bodily autonomy itself a form of harm?

Yes, in my view it plainly is.

The law does not only care about whether somebody developed a measurable physical injury.

Bodily integrity, private life and reproductive autonomy are themselves serious legal and ethical interests.

Healthcare decisions involve what happens to somebody’s body.

Being denied meaningful control over those decisions can therefore be harmful even before we ask whether there was a blood clot, depressive episode, painful side effect or unintended pregnancy.

The relevant harms can include:

• physical side effects from an unwanted alternative treatment;
• psychological distress;
• loss of reproductive autonomy;
• repeated invasive appointments or procedures;
• delay in receiving preferred care;
• prolonged fear of unintended pregnancy;
• and the humiliation or distress of repeatedly having a competent adult decision questioned.

That is why I reject the idea that this case is simply about “funding criteria”.

Can unequal access create unequal health outcomes?

Absolutely.

The NHS Constitution recognises a right not to be unlawfully discriminated against and gives patients rights around informed choice and involvement in decisions.

ICBs also operate under statutory responsibilities relating to reducing inequalities in access to healthcare and in outcomes.

That means equality cannot be reduced to:

“Men and women both technically have some kind of sterilisation pathway.”

The actual pathway matters.

If men may receive:

• NHS-funded vasectomy;
• private-provider access;
• direct referral;
• or self-referral;

while women face:

• GP referral;
• specialist assessment;
• discussion of alternatives;
• LARC gatekeeping;
• approval criteria;
• and potentially much longer surgical waiting pathways;

then the difference creates a different health burden.

Women may spend longer using contraception they did not want.

They may experience additional side effects.

They may need more appointments.

They may remain at risk of unintended pregnancy for longer.

They may simply abandon their request because the pathway becomes exhausting.

Unequal access can therefore create unequal health burdens.

This is why my investigation into male vasectomy commissioning matters so much. You can read that story in The Gender Gap in Healthcare: The Vasectomy Pathway NHS Thames Valley Would Not Explain.

What evidence did the ICB show that it had considered these harms?

This is exactly what I have been trying to establish.

My Freedom of Information request asked for evidence around:

• the final approval process;
• equality analysis;
• clinical evidence;
• legal and ethical reasoning;
• comparison with male vasectomy;
• bodily autonomy;
• informed choice;
• and whether the post-Ombudsman reforms had actually been followed.

The disclosure I eventually received answered some things, but it also exposed major gaps.

The ICB expressly acknowledged that the detailed comparison I had requested between female sterilisation and the male vasectomy pathway had not been conducted in the earlier supporting work.  

The equality assessment disclosed to me was pre-Ombudsman, recorded no specific patient engagement, and there was still a question over whether later equality work described in the approval papers had ever been completed and disclosed.  

The ICB’s own material also referred to later post-Ombudsman work — including a refreshed report, a 14-item action tracker and further comments raising “significant concerns” — yet those were among the records I was still chasing.  

So one of my central concerns remains:

Does all of this automatically prove legal negligence?

No.

And that distinction matters.

A successful negligence claim normally needs a particular claimant to show a duty of care, breach, causation and damage.

For example, a woman who was inadequately informed about her options, was directed into a treatment she would otherwise have refused, and suffered injury because of it might raise a much more conventional negligence issue.

At commissioning level, the legal routes can be different.

They may include:

• public law and judicial review;
• the Equality Act and Public Sector Equality Duty;
• statutory NHS duties around healthcare inequalities;
• Article 8 and bodily autonomy;
• informed-consent law;
• the NHS Constitution;
• and maladministration resulting in injustice or hardship.

So I would not claim that every failure documented here is clinical negligence.

I would say something more precise:

Whether a particular woman could establish legal negligence would depend on what happened to her personally.

But the possibility of harm should have been part of the policy-making process before any woman ever needed to sue.

Does the failure to learn after the Ombudsman make later harm more serious?

In my view, absolutely.

The first time an organisation gets something wrong, it may say it failed to understand the problem.

That argument becomes much weaker after an independent Ombudsman has already identified the underlying failures.

The Ombudsman’s remedy principles expressly say public bodies should learn from complaints, change policies and systems where necessary and avoid repeating maladministration.

That makes the February 2026 replacement policy especially important.

The ICB had already been told that its earlier work around female sterilisation involved serious failures.

Yet the new policy still contained a requirement that women undergo, or demonstrate the unsuitability of, a LARC trial before sterilisation.

I challenged that restriction directly in my correspondence with the Chair of the ICB - Dr Priya Singh. 

Within months, the LARC requirement itself was being reconsidered.

So the question becomes:

For me, that makes the later events more serious than the original mistake.

What does Dr Nick Broughton’s role raise?

Dr Nick Broughton, Chief Executive and Accountable Officer of NHS Thames Valley ICB, sits at several major points in this history.

He issued the final Chief Executive response to my original complaint.

That response gave me false reassurance about how robustly the policy had been developed and reviewed. The Ombudsman subsequently found important shortcomings in the evidence, reasoning, equality comparison, consultation and complaint handling.

You can examine those contradictions in The Gaps Between Dr Nick Broughton’s Claims and the Ombudsman Findings.

After the Ombudsman report, I asked whether those findings had triggered any consideration of his Fit and Proper Person status.

They had not.

Chair Dr Priya Singh confirmed in writing that:

• the Board, its committees and associated groups had not considered leadership accountability following the PHSO findings;
• and Dr Broughton’s FPPT status had not been reviewed, reassessed or discussed because of them.

That is documented in her response.  

Then came the FOI failure.

As Chief Executive and Accountable Officer, Dr Broughton sat at the top of an organisation that missed a statutory information deadline. What's worse is that the Information Officer at the ICB invented a new deadline, giving themselves TWO MONTHS beyond the statutory deadline, and declined and avoided to give me Legal reasons and justifications for it. 

I directly copied the CEO and Accountable Officer Nick Broughton into later correspondence challenging the continuing breach.

I saw no visible intervention from him that resulted in immediate compliance.

To me, that raises questions about:

• leadership competence;
• oversight;
• tolerance of poor practice;
• governance;
• and fitness for senior office.

Those categories matter because NHS England’s FPPT framework itself treats disregard for governance, resistance to accountability and repeated tolerance of poor practice as potentially relevant to serious misconduct or serious mismanagement.

Why does Dr Nick Broughton’s national role make these questions even more important?

Dr Broughton is not only Chief Executive and Accountable Officer of NHS Thames Valley ICB.

In 2026 he was also appointed in ans so holds the NHS England role of National Priority Programme Director for Mental Health, Learning Disability and Neurodevelopmental Conditions.

That role involves national leadership affecting people with severe mental illness, learning disabilities and neurodevelopmental conditions.

Many of those patients may face far greater barriers than I do when challenging authority, understanding complaints systems, navigating policy and making institutions answer difficult questions.

I find that deeply relevant.

I am persistent.

I understand research.

I keep records.

I challenge language.

I use FOI law.

I escalate.

I publish.

A vulnerable patient with a learning disability may not be able to do any of those things.

I will examine Dr Broughton’s career, progression and current national responsibilities separately.

What does Dr Priya Singh’s conduct raise?

Dr Priya Singh, Chair of NHS Thames Valley ICB, has a central governance role.

I approached her because the Ombudsman findings raised obvious questions about the assurances previously given by her Chief Executive.

Her response established that there had been no leadership-accountability consideration and no FPPT review connected to those findings.  

I then separately challenged her over the February 2026 female sterilisation policy.

I asked whether it complied with equality law, informed consent, bodily autonomy, clinical guidance and the Ombudsman findings.

Instead of a straightforward answer, the correspondence stretched across repeated chasers and explanations while the policy itself was being reconsidered.

Eventually, correspondence was closed - by her - without answering my questions and challenges about the new policy and the gender gap inequality of permanent contraception and just giving me empty promises of updates - that never materialised to this day (16 September 2026)

You can read that history in Why NHS Chair Dr Priya Singh Couldn’t Defend the February 2026 Female Sterilisation Policy.

To me, the questions are about:

• adequacy of Chair oversight;
• FPPT governance;
• willingness to scrutinise the Chief Executive;
• openness;
• and resistance to accountability.

I am not saying a disciplinary body has found Dr Singh guilty of serious misconduct.

I am saying I believe the evidence warrants scrutiny of whether she fulfilled the accountability responsibilities of her role.

What does Mark Gittins’s Internal Review tell us?

Mark Gittins, Information Governance Consultant, conducted the Internal Review of FOI-TV-2606-105.

His review accepted that my request had not been handled within the statutory timeframe.

That was important.

But I challenged the review because I believed it did not properly establish:

• where the ICB’s own escalation controls failed;
• who was responsible at each stage;
• what executive oversight occurred;
• how disputed redactions had appeared;
• and what governance consequences followed from the admitted breach.

When I kept challenging those questions, Mr Gittins eventually said the ICB would provide no further response on the Internal Review.  

That does not automatically prove misconduct by him.

But it does raise a serious question about whether an internal review mechanism that can acknowledge a statutory failure without meaningfully establishing accountability is functioning as an accountability mechanism at all.

To me, Mark Gittins’s role raises more than a question about whether the Internal Review was technically adequate.

He was the person tasked with reviewing an admitted statutory failure. His own review accepted that NHS Thames Valley ICB had missed the legal FOI deadline, yet when I asked the obvious follow-up questions — where did the controls fail, who was responsible, why had the ICB’s own escalation safeguards not worked, what happened with the disputed redactions, and what accountability followed — those questions were never properly resolved.

That starts to look, in my opinion, like poor governance and potentially mismanagement of the review process itself. An Internal Review should not simply acknowledge that something went wrong; it should help establish how it went wrong, whether the organisation’s safeguards worked, what needs correcting and who is responsible for making sure it does not happen again.

What concerns me even more is that, after I continued pressing those unresolved questions, Mr Gittins told me that the ICB would not provide further responses on the Internal Review. To me, that can reasonably be viewed as resistance to accountability: the review admitted the breach but then stopped engaging when scrutiny moved from “was the deadline missed?” to “who is accountable for allowing this to happen?”

I am not saying that this proves serious misconduct by Mark Gittins. But I do think it raises legitimate questions about professional judgement, adequacy of internal governance, willingness to investigate organisational failure, and whether the Internal Review function was being used to identify and correct problems or simply to administratively close them.

What does Hannah Iqbal’s position raise?

Hannah Iqbal, Chief Strategy and Commissioning Officer, appears in this story because of her senior organisational role and because she was included in later escalation around commissioning and FOI failures.

I have not seen evidence proving that she personally caused the original statutory breach. I would therefore not label her conduct misconduct on the evidence I currently have.

The question is more basic:

That remains an accountability question I think deserves an answer, because through this whole process and that many failures - she's been totally incognito and never showed up even once in correspondence. So that begs the questions: what is she paid to do, and what is she responsible for and failing at?

Hannah Iqbal’s position raises a different kind of question because I do not currently have evidence showing that she personally caused the original FOI failure.

But she is Chief Strategy and Commissioning Officer, a very senior executive role, and she was directly included in later correspondence about commissioning, transparency and the continuing failures. At that point the issue was no longer simply that one FOI had been delayed. The organisation had already admitted statutory non-compliance, serious questions had been raised about internal controls, and I was also challenging how current commissioning decisions — including vasectomy provision and equality between male and female permanent contraception — were being governed.

For me, the accountability question is therefore not only, “Did Hannah Iqbal cause the problem?” It is also: once a senior executive responsible for strategy and commissioning becomes aware of an admitted legal failure and serious concerns about the transparency and equality of commissioning decisions, what duty does she have to intervene, investigate or ensure that somebody does?

If a senior executive is notified of significant governance concerns within her area of responsibility and no meaningful corrective action follows, that can, in my view, raise questions of management failure, inadequate oversight and tolerance of poor practice. Those are exactly the kinds of issues that become relevant when assessing whether senior leadership systems are functioning properly.

I am not claiming that the current evidence establishes serious misconduct by Hannah Iqbal. It does not. But I do think her apparent lack of visible intervention deserves scrutiny. 

Senior leadership accountability includes what people fail to do after they know that something has gone wrong.

What does Lorri Josey’s refusal to investigate add?

Lorri Josey, Complaints Manager in the Public & Patient Experience Team, became involved after the FOI Internal Review.

I asked PPET to investigate something distinct from my information-law rights.

I asked them to investigate:

• staff conduct;
• failed internal controls;
• management response;
• executive oversight;
• and governance accountability for the admitted FOI failure.

Ms Josey repeatedly directed me toward the Information Commissioner’s Office instead. Her correspondence identifies her role as Complaints Manager in PPET. 

I repeatedly explained that the ICO can investigate information-law compliance but is not NHS Thames Valley ICB’s HR department, disciplinary process, management function or executive-governance mechanism.

No alternative internal investigator was identified.

Lorri Josey’s role raises a more direct accountability question because she was not simply a senior manager copied into correspondence. She was the Complaints Manager in NHS Thames Valley ICB’s Public & Patient Experience Team, and I specifically asked her team to investigate the organisational conduct and governance failures that had emerged from the admitted FOI breach.

I repeatedly explained that I was not asking PPET to conduct another Freedom of Information Internal Review. That process had already happened. I was asking who within NHS Thames Valley ICB would investigate the things the ICO could not investigate for the organisation: failed internal controls, staff conduct, management response, senior leadership intervention, accountability and whether remedial, governance or disciplinary action was required.

Initially, I was told that these matters could be dealt with through the FOI Internal Review. Once that review had concluded without resolving them, I returned to PPET and asked again for a corporate complaint to be opened.

Lorri Josey then maintained that the appropriate route was the Information Commissioner’s Office.

Eventually, PPET relied on Regulation 8(1)(g) of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which excludes certain complaints concerning matters subject to Freedom of Information legislation from the NHS complaints procedure.

But that did not answer the question I was actually asking.

I specifically asked PPET to address Regulation 8(3) and explain what happened to the separate concerns about staff conduct, failed governance, management response and executive accountability. I also asked that, if PPET itself was not sufficiently independent or did not have jurisdiction, the concerns be escalated to another appropriate route — for example a senior independent director, Freedom to Speak Up function, NHS England regional governance route or another body capable of examining the conduct and governance issues.

I was not given a substantive explanation of why those separate issues could not be investigated internally. Nor was I given a policy or legal analysis explaining why no alternative internal or external governance route should be engaged. Instead, the matter was ultimately declared closed.

That is significant to me because a complaints function is not only there to tell people which matters it will not investigate. Part of effective complaint handling is identifying the substance of a concern, making sure it reaches the correct part of the organisation and ensuring serious issues are not simply lost because they cross departmental boundaries.

If a Complaints Manager is directly presented with allegations of failed internal controls, staff conduct concerns, admitted statutory non-compliance and possible senior leadership failures, and the response is effectively to redirect the complainant elsewhere without ensuring that anybody inside the organisation examines those matters, I think that can reasonably raise questions about poor complaint management, inadequate escalation, failure of organisational learning and potentially mismanagement of the complaints function itself.

It also raises a question about resistance to accountability. I had made the distinction between the FOIA dispute and the wider governance complaint repeatedly. The issue was not merely whether information should have been disclosed. The issue was what the organisation was going to do about the people, systems and leadership that had allowed the admitted failure to occur and continue.

I am not claiming that Lorri Josey has been formally found guilty of misconduct. She has not. But I do think her handling of my complaint warrants scrutiny because her role placed her at the point where the organisation had an opportunity to investigate itself, escalate the concerns to somebody who could, or identify a credible alternative accountability mechanism. None of those things appears to have happened.

In my view, closing the complaint without answering where those governance and conduct concerns would actually be investigated did not resolve the accountability problem. It became part of it.

Once again - let's remember: at senior level, accountability is not limited to personally causing a failure. It also includes what leaders do — or fail to do — once significant failures are brought directly to their attention.

The matter was eventually closed.

You can read the full story in The Accountability Vacuum Inside NHS Thames Valley ICB.

To me, that is evidence of a structural accountability problem.

What does the vasectomy FOI add to the equality and harm picture?

The male vasectomy investigation matters because it shows what easier access can look like.

I found NHS-funded vasectomy being delivered through private services, with self-referral available in some areas and expansion being discussed.

I then asked the ICB:

• who was commissioned;
• what referral routes existed;
• what safeguards applied;
• what equality assessments had been completed;
• and whether anyone had compared those pathways with women’s access to sterilisation.

The request was refused under Section 12 on cost grounds.

I then substantially narrowed it and asked the ICB to fulfil its Section 16 duty to provide advice and assistance.

I reduced the request to current providers, current access pathways, current equality documentation and the latest comparison with female sterilisation. :contentReference[oaicite:10]{index=10}

The wider question remains:

If the NHS can make permanent contraception convenient, privately delivered and increasingly directly accessible for men, what evidence justifies imposing substantially greater friction on women?

When does repeated maladministration begin to look like systemic mismanagement?

This is perhaps the most important question in the whole article.

One mistake is a mistake.

One missed deadline can be a mistake.

One bad complaint can be a bad complaint.

But NHS England itself says seriousness can be assessed by considering whether issues are frequent or continue over a long period.

Now look at The Timeline.

• A female sterilisation policy was created using a process later found to be maladministrative.
• My complaint about it was itself handled badly.
• The Chief Executive gave assurances I believe were contradicted by the independent findings.
• No leadership-accountability or FPPT review followed those findings.
• A replacement policy introduced another major restriction on women’s choice.
• The Chair repeatedly avoided giving me the direct compliance answer I asked for.
• The ICB then missed a statutory FOI deadline by almost two months.
• Its own Internal Review admitted that failure.
• The wider governance questions were not resolved.
• Senior leadership was directly notified.
• The complaints function would not investigate the organisational consequences.
• The disclosure itself still appeared incomplete.
• A second FOI battle then developed around male vasectomy commissioning and equality.

I think it is entirely reasonable to ask whether this crossed the line from individual instances of maladministration into systemic mismanagement.

Does lack of intention excuse the harm?

No.

This is one of the most dangerous ideas in institutional accountability.

Harm does not require somebody to sit in a boardroom and decide to hurt women.

People can be harmed because:

• bad assumptions go unchallenged;
• evidence is not properly weighed;
• equality is treated as a formality;
• nobody considers the burden of alternative treatments;
• nobody compares unequal pathways;
• poor decisions are not reviewed;
• leaders are not held accountable;
• complaints become something to close rather than learn from;
• and vulnerable people eventually stop fighting.

That is exactly why governance exists.

Why does this matter to women who will never read this website?

Because most women will never spend years doing what I have done.

Most people will assume that if an NHS policy exists, somebody has properly checked it.

Most will trust the first rejection.

Most will not file an FOI.

Most will not know what a Public Sector Equality Duty is.

Most will not challenge an Internal Review.

Most will not email the Chair.

Most will not understand an FPPT framework.

That is why the people who hold public power carry such enormous responsibility.

Why is this connected to the wider NHS crisis?

An NHS can have excellent doctors and nurses and still fail patients through poor governance.

You can put more money into healthcare and still waste it through badly designed policy.

You can publish values about openness and patient-centred care while operating systems where senior accountability is almost impossible to trigger.

When governance fails:

• poor policies survive longer;
• health inequalities survive longer;
• patients experience unnecessary treatment burden;
• warnings are missed;
• money is wasted;
• staff learn that procedures can be ignored;
• and harm can continue because nobody stops the system long enough to examine what it is doing.

That is why governance is not administrative trivia.

In healthcare, governance affects bodies, health and lives.

Does the evidence warrant investigation for serious misconduct or serious mismanagement?

I cannot make the formal finding.

A regulator, employer or authorised governance body has to investigate the individual roles, obtain explanations and reach conclusions.

But I can ask whether the threshold for investigating has been reached.

The NHS’s own framework tells organisations to consider disregard for governance, resistance to accountability, dishonest conduct, repeated tolerance of poor practice and persistent management failures.

Those terms sit far too close to what I have spent years documenting for the answer to simply be:

No review is necessary.

Who appears to carry what accountability?

What am I not claiming?

For clarity:

• I am not saying a court has found Dr Nick Broughton dishonest.
• I am not saying a disciplinary panel has found Dr Priya Singh guilty of misconduct.
• I am not saying Mark Gittins, Hannah Iqbal or Lorri Josey have been formally found guilty of professional misconduct.
• I am not claiming that every woman affected by the policy automatically has a negligence claim.
• I am not claiming that every contraceptive alternative is harmful.

What I am saying is that:

• maladministration has already been independently established;
• foreseeable patient harm should have been part of policy design;
• the evidence disclosed to me does not show that all relevant harms and inequalities were properly weighed;
• further admitted governance failures occurred afterwards;
• and the accumulated pattern now raises serious questions that fit the NHS’s own language around governance, serious mismanagement and misconduct.

What should happen now?

I think external oversight bodies need to stop looking at these events one at a time.

The female sterilisation policy sits in one file.

The Ombudsman report sits in another.

The FPPT question sits somewhere else.

The FOI breach goes to the ICO.

The governance complaint gets redirected.

The vasectomy inequality becomes another commissioning issue.

Each issue can then be treated as small enough to explain away.

The pattern is the evidence.

That is why I created The Timeline.

I believe NHS England, the relevant regional leadership, local health scrutiny and any body responsible for appointing or overseeing senior NHS leaders should examine this history together.

Why I am not going away

I have already lost years to this.

I cannot get those years back.

But I can make sure the evidence does not disappear.

I can make sure decisions stay attached to the people and offices responsible for them.

I can make sure that when somebody is promoted or given a national role, unresolved questions about their previous leadership remain visible.

I can make it harder for the next woman to be told:

“That is simply NHS policy.”

As though policy appeared from nowhere.

Read the full evidence trail

• The Timeline — follow the complete case chronologically
• Evidence Folder — correspondence, FOIs, reports and documentary evidence
• What the Ombudsman Found — and What It Could Not Do
• Dr Nick Broughton’s Claims vs the Ombudsman Findings
• I Challenged the Policy — the CEO Told Me the Governance Was Robust
• When Maladministration Brings No Accountability
• Why Dr Priya Singh Couldn’t Defend the February 2026 Policy
• The Accountability Vacuum Inside NHS Thames Valley ICB
• The Vasectomy Pathway NHS Thames Valley Would Not Explain
• Why I Asked Oxfordshire Health Scrutiny to Investigate

Authoritative sources and frameworks

• NICE — Contraceptive information and methods — women should be informed about and offered a choice of all contraceptive methods, including permanent contraception.
• NHS — Side effects and risks of hormonal contraception — explains recognised side effects and risks relevant to the burden of alternative contraception.
• UK Supreme Court — Montgomery v Lanarkshire Health Board — informed consent, material risks, reasonable alternatives and bodily integrity.
• The NHS Constitution for England — patient choice, involvement, equality and rights within NHS healthcare.
• NHS England — Fit and Proper Person Test Framework for Board Members — serious misconduct, serious mismanagement, governance, accountability and repeated tolerance of poor practice.
• Parliamentary and Health Service Ombudsman — Principles for Remedy — correcting maladministration, remedying injustice or hardship, learning and preventing repetition.

Legal FOI Request Deadlines Ignored, Internal Procedural Failures Excused, Investigating Their Staff Rejected- Here's Evidence on The Accountability Vacuum Inside NHS Thames Valley ICB  Under CEO Nick Broughton's Leadership

What is PPET — and why did I expect it to investigate?

PPET stands for Public & Patient Experience Team.

Within NHS Thames Valley ICB, this is the function dealing with complaints and patient experience. The person corresponding with me was Lorri Josey, Complaints Manager, Public & Patient Experience Team, NHS Thames Valley ICB.

This distinction matters because I was not simply sending another email to the Freedom of Information team.

I deliberately went to the complaints function because what had happened was no longer only a question of whether my information request had been answered within the Freedom of Information Act.

The ICB's own Internal Review had already admitted that the statutory deadline had been breached.

The problems I wanted investigated were now organisational:

• why the statutory process had failed;
• why the ICB's own internal escalation safeguards had apparently failed;
• why the failure continued after it became known;
• how staff had handled the matter;
• how the Internal Review itself had been conducted;
• why disputed redactions had appeared in responsive records;
• why senior executives did not appear to intervene despite being directly notified;
• and who, if anyone, would be held accountable.

Those are not simply questions about whether section 10 of FOIA was breached.

They are questions about people, management, governance and organisational culture.

Why did I involve PPET before the FOI Internal Review had even finished?

On 23 July 2026, after the FOI team had repeatedly failed to respond properly to me, I requested a formal Internal Review.

But I copied PPET into the correspondence as well.

I explicitly separated the two issues.

The Information Governance team needed to examine the handling of my statutory FOI request.

PPET, I argued, should separately look at the repeated non-response, failure to remedy an acknowledged breach, lack of identifiable accountability and wider administrative and governance failures.

I was already seeing two different questions:

The first belongs to information-law processes and ultimately the ICO.

The second, in my view, belongs squarely inside the organisation's own governance and accountability systems.

Why did Lorri Josey initially say an Internal Review made a separate complaint unnecessary?

On 27 July 2026, Lorri Josey responded.

She told me PPET had checked with NHS Thames Valley ICB colleagues and had been advised that the concerns fell within the FOIA Internal Review process rather than the NHS complaints process.

Importantly, she explained that the ICB complaints process was intended for issues including:

but said that my concerns could instead:

That was the basis on which PPET declined to investigate separately.

Fine.

So I waited for the Internal Review.

Then the Internal Review happened - and I've already written about the Internal Review in this website.

And the premise of that refusal fell apart.

What happened when the Internal Review did not actually resolve the governance failures?

By 17 August 2026, the Internal Review had concluded.

It had admitted the statutory failure.

But it had not answered many of the organisational questions I had raised.

The FOI disclosure was still outstanding.

Questions remained about the ICB's failed escalation procedures.

Questions remained about disputed redactions.

Questions remained about who was responsible.

Questions remained about executive oversight.

And Mark Gittins had now told me that he would provide no further response to my substantive challenges.

So I went back to PPET.

This time I made the distinction impossible to miss.

I told Lorri Josey:

What exactly did I ask NHS Thames Valley ICB to investigate?

My formal corporate complaint on 17 August 2026 was structured around seven areas.

• Failure of the ICB's statutory and internal FOI controls.
• Adequacy and conduct of the Internal Review.
• The continuing statutory breach without an identified legal justification.
• Handling and unexplained redaction of responsive records.
• The conduct of the Internal Reviewer after I challenged him.
• Executive accountability and failure to intervene.
• The persistent absence of accountability across the organisation.

I asked PPET to register a formal corporate complaint and allocate it to a sufficiently senior and independent investigator.

I wanted the investigation to examine the people and systems involved, including Information Governance and Mark Gittins.

I also specifically asked it to establish what action had been taken by:

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

All three had been directly notified about the continuing failures.

I wanted to know what they actually did.

That is a governance investigation.

It is not an FOI appeal.

Why did Lorri Josey send me back to the ICO anyway?

On 19 August 2026, Lorri Josey replied.

She said she had "double-checked" her previous advice and received confirmation that it was correct.

The correct escalation route, she said, was the Information Commissioner's Office.

But she did not initially tell me what legislation, regulation, ICB policy or formal complaints rule she was relying upon.

I found that unacceptable.

"I have double-checked and been told I am correct" is not a transparent reason for denying somebody access to an accountability process.

Who checked?

Against what?

What provision applies?

Why?

If a public body is refusing to investigate a formal complaint, it should be able to explain the basis for doing so.

Why did I challenge the ICB's reliance on Regulation 8?

On 19 August 2026, I wrote back.

I recognised that Lorri Josey appeared to be relying on Regulation 8(1)(g) of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.

That provision is relevant where a complaint relates to a person's right of access to information under the Freedom of Information Act.

I was not disputing the basic point that the ICO should deal with my statutory information-rights dispute.

I had already sent that part to the ICO.

My challenge was that the ICB was treating everything connected with the FOI failure as though it automatically became an information-law question.

I specifically asked the ICB to address Regulation 8(3) and explain why the separate organisational and conduct issues I had identified should also be excluded rather than dealt with through an appropriate internal process.

I did not receive a substantive answer to that point.

Why couldn't the ICO simply investigate the people and governance failures for them?

Because the ICO is not NHS Thames Valley ICB's HR department.

It is not its disciplinary function.

It is not its executive-governance function.

It is not responsible for deciding whether Dr Nick Broughton exercised appropriate leadership after being notified of a continuing statutory failure.

It is not responsible for asking why managers failed to operate the ICB's internal escalation controls.

It is not responsible for determining whether staff complied with their internal organisational duties.

It is not responsible for deciding what management action, disciplinary action, governance action or FPPT consideration should follow.

I told Lorri Josey this directly.

If the ICB's systems failed, somebody inside the NHS still has to ask why.

If PPET was not the right team, why didn't it send the complaint to whoever was?

This was perhaps the simplest question I asked.

I told Lorri Josey:

If PPET cannot investigate this, tell me who can.

Refer it.

Escalate it.

Identify the appropriate internal governance mechanism.

If the concerns involve senior executives and that creates an independence problem, send them somewhere with sufficient independence to investigate.

I identified possible routes myself, including senior independent oversight and NHS England regional governance structures.

What I would not accept was an accountability vacuum in which:

That makes no sense to me.

What do the NHS's own Complaint Standards say should happen when things go wrong?

The Parliamentary and Health Service Ombudsman's NHS Complaint Standards are supposed to create an NHS complaints culture that is open, honest and accountable.

They describe effective complaint handling as thorough and fair.

They expect organisations to give accountable responses, identify mistakes, learn from them and take action to prevent recurrence.

Guidance for senior NHS leaders says they should ensure appropriate structures exist for fair and robust complaint investigations and that learning from complaints is used to improve services.

That is the opposite of what I felt I was experiencing.

I was not seeing curiosity about how the organisation had failed.

I was seeing a hunt for the next reason why somebody else should deal with it.

Why did the ICB close the complaint instead of identifying an accountability route?

On 28 August 2026, PPET sent its next response.

This time it explicitly cited Regulation 8(1)(g).

The ICB said my outstanding concerns arose from the handling of my FOI request and therefore would not be investigated through its complaints process.

Again, my Regulation 8(3) challenge was not substantively addressed.

No alternative internal investigator was identified.

No HR route was identified.

No governance route was identified.

No independent executive route was identified.

No one was named as responsible for examining the conduct issues.

Instead, I was told:

And I was warned that if I sent further correspondence about the FOI complaint, it might be read but not responded to.

There it was again.

The same ending.

Why did this start looking like a pattern rather than coincidence?

On 29 August 2026, I wrote back and laid out the history.

This was no longer the first time I had encountered this behaviour.

Years earlier, I had challenged the original female sterilisation policy through the ICB's complaints process.

The substantive questions about evidence, equality, clinical guidance, bodily autonomy, consultation and decision-making were not properly answered.

Dr Nick Broughton, Chief Executive, eventually issued his final response and closed the internal complaint route.

I went to the Ombudsman.

The Ombudsman subsequently found that the ICB had indeed failed to properly understand and engage with key aspects of my complaint.

Then I challenged Dr Priya Singh, Chair of NHS Thames Valley ICB, about the replacement female sterilisation policy and leadership accountability.

Again, I did not get direct answers to central questions.

Eventually, she declared further correspondence closed.

Then came FOI-TV-2606-105.

The statutory deadline was missed.

I challenged the Internal Review.

Mark Gittins eventually told me that further correspondence on those questions would receive no response.

Then I went to PPET.

Lorri Josey eventually told me the matter was closed, and future emails might not be answered.

The sequence had become painfully familiar:

Once might be poor complaint handling.

Twice starts to concern me.

When I see the same behaviour through the Chief Executive, the Chair, Information Governance, an Internal Reviewer and the complaints function, I start asking whether this is how the organisation itself operates.

What happened when I gave PPET one final opportunity to identify an investigator?

On 29 August 2026, I gave the ICB one final opportunity.

I asked PPET to address Regulation 8(3) and answer one simple question:

If nobody would investigate them, I asked the ICB to say so clearly and identify the legal, regulatory or policy basis for that position.

I gave a deadline of 31 August 2026.

That date passed without the substantive answer I had requested.

Why was "in due course" no longer good enough?

On 2 September 2026, Lorri Josey wrote again.

She said she would share my email with ICB colleagues, seek further confirmation and respond:

"in due course."

At another stage of this battle, perhaps I would have waited.

By September 2026, I was done.

I had already spent years chasing this organisation.

I had repeatedly been given vague timeframes.

I had watched legal deadlines expire.

I had watched people promise answers and then fail to provide them.

I had watched correspondence get closed while substantive questions remained unresolved.

"In due course" is not a timeframe.

And I was no longer prepared to keep my life permanently open-ended around whenever NHS Thames Valley ICB might eventually decide to answer questions about its own accountability.

Why did I finally close the correspondence myself?

On 3 September 2026, I wrote to Lorri Josey for the final time.

I told her I was done waiting for NHS Thames Valley ICB to get its own accountability processes in order.

I had asked repeatedly.

I had explained the distinction between the ICO's responsibility and the ICB's responsibility.

I had identified the legislation I believed was relevant.

I had suggested alternative accountability routes.

I had given them a deadline.

I had given them another opportunity.

I had still not been told who inside the organisation would investigate what had happened.

So this time I closed the correspondence.

There is an important difference.

I was not ending scrutiny because I did not want to answer it.

I was ending an internal exchange because I had exhausted reasonable attempts to make the organisation scrutinise itself.

I would pursue the issues externally instead.

What does this repeated behaviour say about NHS Thames Valley ICB's culture?

This is where my concern has moved beyond individual emails.

Organisational culture is not what an institution writes on its website.

It is what people repeatedly do.

NHS organisations can write that they value:

• transparency;
• openness;
• accountability;
• learning;
• patient involvement;
• equality;
• and continuous improvement.

Those words are cheap.

The test comes when somebody turns up with evidence that something may have gone wrong.

Do you investigate?

Do you answer?

Do you identify who was responsible?

Do you look honestly at leadership?

Do you correct the failure?

Or do you redirect, delay, reframe, deflect and eventually stop responding?

From my experience, the behaviour I have seen across NHS Thames Valley ICB tells a very different story from the values written in its policies.

Is this what top-down resistance to accountability looks like?

In my opinion, yes.

When the same behaviour appears at multiple levels of one organisation, I stop believing that every example is an unrelated mistake.

I saw it from the Chief Executive.

I saw it from the Chair.

I saw it through Information Governance.

I saw it through the Internal Review.

I saw it through PPET.

Different people.

Different functions.

Same endpoint.

Scrutiny is tolerated until it becomes uncomfortable. Then communication is shut down.

That is my interpretation of the documentary record.

Please read it and form your own.

What happens when nobody inside an NHS organisation will investigate the NHS organisation?

You create an accountability vacuum.

And that is dangerous.

Because healthcare organisations exercise enormous power.

They decide what treatment gets commissioned.

They decide what pathways patients have to navigate.

They decide what evidence is sufficient.

They decide how equality duties are interpreted.

They decide how complaints are investigated.

They decide whether senior leadership needs scrutiny.

They handle statutory information requests about their own decisions.

If the same organisation can make the decision, investigate the decision, investigate the complaint about the decision, review its own investigation and then decide that nobody needs to investigate the governance failures exposed along the way, that starts looking frighteningly close to institutional self-policing without meaningful accountability.

Why does this matter far beyond one FOI request?

Because healthcare governance is not paperwork.

The quality of governance affects what care people can access, how quickly failures are corrected and whether dangerous decisions are caught before they hurt people.

Weak accountability creates space for poor decisions to survive.

Poor decisions can restrict treatment.

They can create inequality.

They can leave patients without care they need.

And in healthcare, failures that remain unexamined can ultimately contribute to real harm.

This is why I become angry when accountability is treated like an administrative inconvenience.

These organisations are not selling shoes.

They make decisions about people's bodies, health and sometimes their survival.

The standard should be higher, not lower.

Is the NHS good at talking about values but bad at proving them?

That is increasingly my view.

NHS documents are full of commitments.

Openness.

Transparency.

Patient-centred care.

Learning culture.

Equality.

Accountability.

Governance.

But when I ask for evidence showing those principles being applied to an actual failure, I repeatedly find something else.

I find missing records.

I find unanswered questions.

I find delays.

I find people sending responsibility elsewhere.

I find nobody apparently willing to examine the people at the top.

And eventually I find another email telling me that communication is finished.

Values are not what an organisation says about itself. Values are what it repeatedly does when following them becomes inconvenient.

Do I think this organisational culture is rotten?

Yes.

In my opinion, this is rotten.

I am not saying that every person working at NHS Thames Valley ICB is incompetent or acting badly.

I am saying that the accountability structure I have experienced appears rotten.

A healthy organisation should be able to examine itself.

A healthy organisation should not be frightened of evidence.

A healthy organisation should not make a member of the public fight through five different internal functions simply to find somebody willing to ask, "How did we fail and who needs to fix it?"

And a healthy organisation certainly should not keep ending conversations when those questions refuse to go away.

If this can happen here, how widespread is the problem across the NHS?

I cannot prove from my case that every NHS organisation behaves like this.

But I would be deeply surprised if this culture exists nowhere else.

That is exactly why external oversight matters.

NHS England.

The Care Quality Commission.

The Parliamentary and Health Service Ombudsman.

The Information Commissioner's Office.

Health scrutiny committees.

Boards.

Audit and governance functions.

All of them should be asking whether organisations are merely publishing accountability frameworks or actually living by them.

Why am I now pursuing accountability outside NHS Thames Valley ICB?

Because I have tried the internal routes.

I complained.

I challenged the Chief Executive.

I challenged the Chair.

I used Freedom of Information law.

I requested an Internal Review.

I challenged the Internal Review.

I asked PPET to investigate the governance failures.

I explicitly separated those failures from the ICO's information-law role.

I asked for an alternative internal route.

I asked for somebody — anybody — inside the organisation to take ownership of investigating what had happened.

I did not get one.

So I am no longer spending endless weeks trying to convince NHS Thames Valley ICB that it should investigate itself.

I will take the evidence to organisations whose job is to scrutinise it from the outside.

And I will continue publishing the documentary record here.

Where can I read the correspondence with Lorri Josey and PPET?

You can read my correspondence with Lorri Josey, Complaints Manager in the Public & Patient Experience Team at NHS Thames Valley ICB, together with the FOI Internal Review, leadership correspondence and wider evidence trail in my Evidence Folder.

I encourage you to read it rather than simply taking my interpretation at face value.

This is my opinion. Read what I asked. Read what they answered. Read where they stopped answering. Then decide for yourself what kind of accountability culture the evidence shows.

Sources and further reading

• The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009
• Parliamentary and Health Service Ombudsman — NHS Complaint Standards
• PHSO — NHS Complaint Standards at a glance
• PHSO — Guidance for NHS senior leaders on meeting the Complaint Standards

The Questions About the February 2026 Female Sterilisation Policy that Dr Priya Singh Wouldn’t Answer

A note about my conclusions: throughout this website I distinguish between established documentary facts and my interpretation of them. My opinion is that I have repeatedly been misled, stonewalled and faced institutional attempts to close down scrutiny rather than answer it. In places, I believe I have been lied to and that failures have been covered up. That is my opinion. 

Please feel empowered to review the evidence yourself and reach your own.

Why should women have to prove temporary contraception is unsuitable before permanent contraception is respected?

By spring 2026, the history was already extraordinary.

I had originally challenged an Oxfordshire policy that effectively prevented women from routinely accessing NHS-funded sterilisation.

The Parliamentary and Health Service Ombudsman later found serious failures in the evidence, decision-making, equality considerations, consultation and complaint handling surrounding that policy.

The ICB then introduced another Female Sterilisation Policy in February 2026.

On paper, this new policy appeared more permissive because female sterilisation was no longer simply described as “not normally funded”.

But it introduced another form of gatekeeping.

Women seeking permanent contraception were expected to undergo, or demonstrate the unsuitability of, a “therapeutic trial” of Long-Acting Reversible Contraception (LARC) before accessing sterilisation.

That immediately raised the same underlying question I had been asking for years:

Especially when men seeking permanent contraception through vasectomy were not being subjected to an equivalent requirement.

Did NHS Thames Valley ICB actually consider the February 2026 policy compliant?

On 28 April 2026, my correspondence with Dr Priya Singh was primarily about leadership accountability following the Ombudsman investigation.

But I also raised the new February 2026 Female Sterilisation Policy.

I told Dr Singh that I did not believe the underlying problem had actually been resolved.

I specifically challenged the requirement for a “therapeutic trial” of LARC before sterilisation.

My position was straightforward: if a woman is seeking permanent contraception, forcing her through a temporary contraceptive pathway before respecting that choice does not look like patient-centred informed consent to me.

It looks like gatekeeping.

I also pointed to the growing contrast with male sterilisation. NHS-funded vasectomy services were being made more accessible, including routes involving private providers and direct referral arrangements, while women continued to face additional hurdles before accessing permanent contraception.

Why couldn’t the Chair answer a question the Board should already have resolved?

On 1 June 2026, after Dr Singh had answered my separate questions about Dr Nick Broughton and the Fit and Proper Person Test, I turned squarely to the current policy.

I asked her to tell me whether NHS Thames Valley ICB considered the February 2026 Female Sterilisation Policy fully compliant with:

• the Equality Act 2010;
• the Public Sector Equality Duty;
• the NHS Constitution;
• Montgomery v Lanarkshire Health Board [2015];
• relevant NICE guidance;
• relevant WHO guidance;
• the Ombudsman’s findings in case C-2121396;
• and the principles of informed consent, bodily autonomy and patient-centred decision-making.

I deliberately made the question difficult to evade.

I asked her to answer:

YES — the ICB considers the policy compliant.

or

NO — it does not.

If the answer was yes, I asked her to explain how forcing women through a LARC pathway was compatible with bodily autonomy and informed consent.

If the answer was no, I asked the equally obvious question:

Why had the policy been approved and imposed on women in the first place?

On 3 June 2026, I received only an acknowledgement from the Office of the Chair confirming receipt of my email.

There was no answer to the compliance question.

On 6 June 2026, I chased again.

Still no substantive answer.

Why was another committee review needed only months after the policy was introduced?

On 8 June 2026, I wrote again.

I reminded Dr Singh that the February 2026 policy had already been approved, adopted and applied to women for months.

If the Board had approved that policy, surely somebody must already have established the basis on which it was considered lawful, ethical, clinically defensible and compliant.

This should not have required weeks of research after I asked the question.

The reasoning should already have existed.

I asked again for a detailed response.

On 9 June 2026, Dr Singh finally responded — but still did not answer the question.

Instead, she told me that, following further feedback about the application of the policy, female sterilisation was going to be discussed again at the NHS South East Regional Priorities Committee.

She wrote that:

That commitment matters.

I had asked whether the existing February 2026 policy was compliant.

The response was effectively: another committee is looking at it and we will come back to you.

By itself, that told me something important.

The policy I was challenging had only been operating for a few months and was already back under review.

If the February 2026 policy was sound, why was its LARC requirement removed?

On 16 June 2026, Dr Singh wrote to me again.

She explained that the South East Region Priorities Committee had considered sterilisation on 14 April 2026 and again on 9 June 2026.

And this time there was a substantial development.

The Committee had recommended that women should be able to choose sterilisation after being fully informed about alternatives, without first having to undergo a trial of LARC.

In other words, one of the central requirements I had been challenging was now being removed.

Dr Singh told me:

• the recommendation would go to NHS Thames Valley ICB for adoption;
• the process would include Board-level scrutiny;
• it would include Quality Committee approval;
• the process was expected to be prompt;
• a new policy was expected to be implemented in early autumn 2026;
• and I would be informed as soon as the new policy became available.

Those are concrete commitments.

But changing the policy did not answer whether the February 2026 policy should ever have been approved.

The fact that the NHS was now fixing the LARC requirement did not answer whether it had been appropriate to impose that requirement on women in February 2026.

Quite the opposite.

Its removal made the question sharper.

And if the requirement was not defensible, how had it passed the governance process in the first place — especially after the ICB had just been through an Ombudsman investigation into failures involving this exact area of healthcare policy?

Why did I keep having to ask the same compliance question?

On 19 June 2026, I wrote back because Dr Singh still had not answered what I had actually asked.

I told her directly that my patience was running out.

I pointed out the chronology:

• the original female sterilisation policy had been challenged;
• the Ombudsman had found serious failures in how it was developed;
• there had been no leadership accountability consideration;
• a replacement policy had then been introduced in February 2026;
• and only months later that policy was already being rewritten.

I again asked Dr Singh to answer:

Did the ICB consider the February 2026 policy fully compliant — yes or no?

If yes, why was one of its core requirements being removed?

If no, why had it ever been approved and why was it still being applied to women?

Why did acknowledgements keep replacing answers?

On 23 June 2026, Dr Singh acknowledged my email and said:

I wrote again on 23 June 2026 because, once again, I wanted an answer to the question — not another acknowledgement that the question existed.

By 26 June 2026, the promised week was ending.

I emailed again:

Did she intend to answer the question?

Or was another self-imposed deadline going to pass?

This pattern had already become painfully familiar to me.

Why did Dr Priya Singh refuse to give a yes-or-no answer?

On 27 June 2026, Dr Singh finally sent a substantive response.

But she still would not answer yes or no.

She told me it was “not appropriate or accurate” to reduce complex healthcare policy to a binary question.

She then listed principles she said underpinned the February 2026 policy:

• patient-centred care;
• informed consent;
• clinical judgement;
• a least-invasive approach;
• recognition of biological differences;
• and alignment with legislation, national guidance and the Ombudsman findings.

Those statements may sound reassuring.

But once again, they did not answer my question.

I had not asked whether reassuring principles could be written around the policy.

I had asked whether the actual policy — including its LARC requirement — complied with the standards I had identified.

And by this point the regional committee had already recommended removing that requirement.

What did Dr Priya Singh promise would happen next?

Across the correspondence in June 2026, Dr Singh made several specific statements about what would happen next.

I was told that:

• the female sterilisation policy would be reconsidered following the South East Region Priorities Committee recommendation;
• the new recommendation would go before NHS Thames Valley ICB;
• there would be Board-level scrutiny;
• there would be Quality Committee approval;
• the process would be undertaken promptly;
• a revised policy was expected in early autumn 2026;
• I would be told “as soon as the new policy is available”;
• and, even after correspondence was closed, Dr Singh specifically preserved one exception: sending me a link when the policy was approved.

Why was correspondence closed while the central question remained unanswered?

The final part of Dr Singh’s 27 June 2026 response is particularly important.

She told me:

“We do not consider there to be any further substantive issues to address through this correspondence.”

She said this would be the ICB’s final response, apart from one exception:

She then said further correspondence on the same issues would not receive substantive replies unless I raised something materially new.

So the correspondence was formally closed while I still maintained that the central question had never been answered.

Why did I resort to Freedom of Information legislation?

By this point, I had learned not to rely only on promises that somebody would eventually explain the process.

I wanted the records.

So on 8 June 2026, while this correspondence with Dr Singh was still unfolding, I submitted a Freedom of Information request seeking the documentary evidence behind the February 2026 Female Sterilisation Policy.

I asked for material showing its approval, equality assessment, evidence base, legal and ethical rationale, comparison with vasectomy, treatment of autonomy and informed choice, and evidence that the Ombudsman’s recommendations had actually been incorporated into subsequent decision-making.

The statutory deadline was 6 July 2026.

That deadline passed.

And passed.

And passed.

I chased.

I chased.

I chased and filed an Internal Review Request - as per ICO guidelines.

By the time substantive disclosure arrived in September 2026, I had been waiting for roughly three months.

The response arrived more than two months beyond the statutory deadline. NO LEGAL justification was provided - this was an invented deadline by the ICB themselves. So, now they are - in my opinion - cool with breaking the law too. And the kicker - CEO Dr Nick Broughton is the one in charge of FOI requests - as per his title of Accountable Officer. But more on that in the posts tagged with FOI - you can find those in the Chronicles page. 

By 11 September 2026 — 95 calendar days after my original request — the ICB was around 48 working days beyond its statutory deadline.

That delay became a separate transparency battle in its own right.

What did the delayed FOI disclosure still fail to show?

When the documents finally arrived in September 2026, they still did not provide everything I had asked for.

The disclosure did give me useful evidence.

But it also exposed major gaps.

The material supplied showed that much of the documentation underlying the February 2026 policy pre-dated the Ombudsman’s final findings.

The ICB’s own response referred to further post-Ombudsman work carried out in February, April and June 2026.

It referred to:

• documented feedback on the Ombudsman findings;
• further regional committee consideration;
• a refreshed policy report;
• a 14-item action tracker;
• updated decision-making processes;
• and subsequent comments raising what the ICB itself described as “significant concerns”.

Yet key parts of that post-Ombudsman audit trail were not included in the disclosure.

The documents I received also did not show me the complete decision record I had expected to see for adoption of the February 2026 policy.

The Equality Impact Assessment supplied was an older document and the disclosed records indicated further equality work was supposed to occur.

And the ICB expressly confirmed that the detailed comparison I had sought between female sterilisation and vasectomy access had not been conducted in the earlier supporting work.

Why does this look like a wider transparency problem rather than one unanswered email?

Because this is now a pattern running through the entire case.

First I asked the ICB questions directly.

Then I asked its Chief Executive.

Then I asked the Ombudsman.

Then I asked the Chair.

Then I asked through Freedom of Information legislation.

Again and again, obtaining the answer has required another mechanism, another deadline, another chase, another escalation and another documentary search.

And I have now made multiple Freedom of Information requests relating to this case.

One examined leadership accountability and Dr Nick Broughton’s FPPT status.

Another sought the evidence behind the February 2026 Female Sterilisation Policy and its supposed post-Ombudsman governance.

A further strand has examined male vasectomy commissioning and access, including providers, self-referral, criteria, equality assessments and whether the NHS ever properly compared those pathways with the hurdles imposed on women.

Those FOI battles deserve their own articles.

Read the Freedom of Information articles documenting my battle for transparency with NHS Thames Valley ICB.

What am I still waiting for as of 12 September 2026?

As I update this article on 12 September 2026, I am still waiting for clarity on several things that should not require detective work by a patient.

• Where is the final revised Female Sterilisation Policy Dr Singh said I would be sent?
• Did the promised Board-level scrutiny occur?
• Did the promised Quality Committee approval occur?
• What happened to the “early autumn 2026” implementation timetable?
• Where is the complete post-Ombudsman documentary trail showing how the earlier governance failures were corrected?
• Where is the complete equality analysis comparing the female sterilisation pathway with male vasectomy?
• Why did I have to use Freedom of Information legislation to try to establish things the Chair told me would form part of a transparent governance process?

What does this pattern say about transparency at NHS Thames Valley ICB?

I do not think NHS Thames Valley ICB has been transparent with me.

I think I have repeatedly been given partial answers, reassuring language and future promises instead of the documentary accountability I was asking for.

I think some statements made to me during this case have been untrue.

I think serious failures have repeatedly been absorbed into process rather than confronted openly.

And where records capable of proving what happened have been delayed, omitted or extraordinarily difficult to obtain, I believe it is reasonable to ask whether institutional self-protection has crossed into cover-up.

That is my opinion.

Please do not take it on faith.

Read the evidence.

Read the Ombudsman findings.

Read Dr Singh’s emails.

Read the FOI responses.

And form your own view.

Where can I read the evidence?

You can read the correspondence with Dr Priya Singh, Chair of NHS Thames Valley ICB, the relevant Freedom of Information material, the Ombudsman evidence and the wider documentary history in my Evidence Folder.