Ombudsman finds women were not given the same opportunity by Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board to make an informed decision about sterilisation.
Leah Spasova, a psychologist from Oxfordshire, complained to the Parliamentary and Health Service Ombudsman after her request for sterilisation was denied.
At the time, the Integrated Care Board (ICB) did not routinely fund female sterilisation and cited the risk of regret as a reason for refusing women the procedure. However, it routinely funded vasectomies for eligible male patients and did not use regret as a reason for rejection.
The ombudsman concluded the board’s approach was unfair, inconsistent and based on subjective reasoning.
Clinical guidance says sterilisation should be available for women and that counselling should address the issue of regret. The board failed to explain why it did not follow such guidance.
Male sterilisation was also recommended for funding by the board without updated cost information, while sterilisation for women was turned down due to a lack of recent evidence, despite older studies showing it can be more cost-effective over time.
“The issue highlighted in Leah’s case about the commissioning and managing of services by ICBs is not an isolated one,” said Paula Sussex, parliamentary and health service ombudsman.
“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,” she continued.
Equality issues
In 2024, an advisory committee was formed to make policy recommendations for six ICBs across the South East, including Buckinghamshire, Oxfordshire and Berkshire West. Four of those six ICBs already funded female sterilisation.
Following Spasova’s complaint, the committee reviewed the policy recommendations and recognised the equality issues, going on to advise that female sterilisation should be funded. Regret or the option of a more cost-effective alternative is no longer used as grounds for refusal.
The board has agreed to write to Spasova to acknowledge its failings and apologise, as well as outline plans for how it will improve complaint handling.
“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. It did not follow the widely recognised principle that clinicians provide advice, but patients ultimately make decisions about their own bodies,” said Spasova.
“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.”
