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

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

What did I actually ask NHS Thames Valley ICB for?

My Freedom of Information request was deliberately titled:

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

But I wanted the paper trail.

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

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

That last part matters enormously now.

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

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

The evidence they disclosed clearly states:

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

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

That changes the question completely.

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

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

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

What post-Ombudsman evidence is not in the disclosure?

I do not see disclosed:

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

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

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

So what did CEO Nick Broughton say had been done?

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

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

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

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

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

 

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

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

Why is the January 2026 approval paper so important?

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

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

It then lists the supporting documents used for adoption:

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

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

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

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

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

Where is the actual decision approving the policy?

There is another basic problem.

The January document supplied to me says:

“Virtual decision by email requested.”

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

That is evidence of a request for approval.

It is not, by itself, the resulting decision.

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

That was not in the disclosure I received.

What happened to the equality work?

The supplied SERPC Equality Impact Assessment dates from December 2024.

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

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

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

So where is that EQIA?

Where is the panel record?

Where is the signed final equality analysis?

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

Did the ICB actually compare female sterilisation with vasectomy?

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

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

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

So the question remains:

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

I have not been shown it.

Why does the later April review matter so much?

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

A refreshed report was presented in April 2026.

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

The recommendation was therefore not issued at that point.

It went back for further consideration in June.

A later revised recommendation was then produced.

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

So another obvious question follows:

Why am I challenging the redactions too?

The disclosure problem is not limited to missing documents.

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

I am not seeking private addresses or personal contact details.

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

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

Why are the cost redactions particularly relevant?

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

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

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

The disclosure is also internally inconsistent.

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

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

What about the pages marked “out of scope”?

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

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

These may ultimately prove unrelated to female sterilisation.

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

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

If they are unrelated, the documents will show that.

Why am I now asking for metadata?

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

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

The ICB answered:

“The ICB can confirm this.”

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

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

Why is this more than an FOI technicality?

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

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

The ICB then repeatedly said that lessons had been learned.

Dr Nick Broughton said feedback had been documented.

He described a further review timetable.

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

He said equality prompts had been added.

He said decision rationale would be properly recorded.

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

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

He described future consultation reforms.

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

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

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

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

How long did the FOI disclosure take?

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

The statutory deadline was 6 July 2026.

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

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

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

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

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

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

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

What happens next?

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

This is not a new statutory deadline.

The statutory deadline expired on 6 July 2026.

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

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

Where can I read the evidence?

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

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

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

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.

What the Ombudsman Found

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

What they found was extensive.

🔴 Failures in Decision-Making

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

⚖️ Equality & Fairness Failures

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

📊 Cost & Evidence Failures

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

They did not properly consider indirect costs , including:

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

🧠 Regret Argument Failures

• The policy relied heavily on “regret”

But:

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

🩺 Clinical & Risk Assessment Failures

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

It failed to:

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

🗣️ Consultation & Process Failures

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

📩 Complaints Handling Failures

They:

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

What This Actually Means

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

But they did say — very clearly — that:

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

And that matters.

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

The Outcome — And The Reality Of It

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

That means they formally confirmed that:

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

The NHS acknowledged this. In writing.

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

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

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

They can:

• investigate
• document failures
• make recommendations

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

The Hard Truth About This Process

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

You can:

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

…and still walk away without actual change.

That is incredibly disheartening.

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

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

What This Leaves Me & Other Women With

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

Taking the NHS to court.

But that comes with its own reality:

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

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

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

Why I’m Still Pushing This Forward

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

Most of those women will never:

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

And that’s exactly why these systems continue.

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

With this, I want it to:

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

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