NHS body used risk of regret to deny women sterilisation, ombudsman finds

An NHS body denied women funding for sterilisation in case they regretted the procedure, an investigation has found.

However, the same integrated care board (ICB) routinely funded vasectomies for eligible men, according to the Parliamentary and Health Service Ombudsman (PHSO).

Leah Spasova filed the complaint against the Buckinghamshire, Oxfordshire and Berkshire West ICB after her request for sterilisation was rejected.

According to the ombudsman, the ICB did not routinely fund female sterilisation at the time, citing the risk of regret as a reason for refusal.

Its policy for male sterilisation routinely funded vasectomy and did not use regret as a reason for rejection.

The PHSO found that this approach was unfair and inconsistent, and said the ICB failed to explain why it did not follow clinical guidance.

While guidance is not mandatory, it says sterilisation should be available for women and counselling should address the risk of regret.

The PHSO also found that the ICB used cost-effectiveness arguments inconsistently, with male sterilisation recommended for funding without updated cost data.

Ms Spasova, a psychologist from Oxfordshire, described the policy as “absolutely discriminatory”.

She said she had been enquiring about sterilisation for a decade and was passed back and forth between services.

“Then the ICB turned down my request for funding,” Ms Spasova said. “One of the most important lessons from my case is the systemic problems and the lengthy process that patients must go through to challenge NHS decisions.

“Before approaching the ombudsman, I conducted my own research and found that the policy in place at the time appeared inconsistent with key principles of NHS care, did not respect the NHS constitution, and did not align with Nice guidance around contraceptive choice.

“These concerns about autonomy and fairness prompted me to seek further accountability.

“Rejecting my application for sterilisation on the basis of regret means they were taking on liability for my feelings. The ICB says sterilisation is funded under exceptional circumstances, but nowhere do they list what those criteria are, so it is impossible to know if you will be accepted or not.

“Someone else is making decisions about your body based on criteria you can’t even see.

“Policies like this are damaging for women’s healthcare and women’s access to health services – it’s absolutely discriminatory.

“There is continuing widespread inequality in how permanent contraception is accessed, with concerns about fairness and respect for women’s bodily autonomy remain unresolved.”

A committee that took responsibility for making policy recommendations for six ICBs across the South East in 2024, including Buckinghamshire, Oxfordshire and Berkshire West, reviewed the female sterilisation policy following Ms Spasova’s complaint.

It has recommended that the procedure should be funded, and that regret or the availability of other contraception is no longer used as grounds for refusal.

The ombudsman has recommended that the ICB write to Ms Spasova to acknowledge its failings, and also said there “may be similar wider problems” in multiple areas of the NHS.

Paula Sussex, of the PHSO, said: “The issue highlighted in Leah’s case about the commissioning and managing of services by ICBs is not an isolated one.

“We are concerned that there may be similar wider problems affecting multiple areas of healthcare, and we have concerns that the system is not consistently meeting people’s needs and is letting patients down.

“Our data has highlighted that there are often unclear explanations of treatment or diagnosis within the NHS, confusing pathways, a lack of updates while patients wait for care, and poorly communicated changes to provision.

“This case shows the power of the patient voice. Leah complained about her experience and the ICB is now reviewing its sterilisation policy.

“This could benefit and empower many more women to make informed decisions about their health.”

In April, Buckinghamshire, Oxfordshire, and Berkshire West ICB merged with Frimley ICB to become Thames Valley ICB.