Written evidence submitted by ADHD 360 (NWT0011)
About ADHD 360
Summary
The health service is not working adequately for those receiving autism and ADHD assessments. The adult ADHD waiting list has reached up to eight years in some parts of the UK, alluding both to a failure in earlier life intervention and an inability for the public sector to tackle this issue alone. In addition, some ICBs and Trusts have ‘closed’ their service completely for this therapy area, leaving patients stranded without access to the care they deserve.
There is a suite of policy measures that the government should consider, which ADHD 360 have broken down into shorter term and longer-term measures, to better improve access to care for those with neurodiversity.
Short term measures include:
Long term measures include:
Evidence
Around 2.6 million people in the UK are estimated to have ADHD, yet only 350,000-500,000 people have received a formal diagnosis. This leaves a concerning figure of up to 2.25 million people undiagnosed, and therefore not accessing the treatment or care that they deserve to enable them to reach their full potential. In addition, the backlog for ADHD assessments has been increasing post-pandemic, reaching up to eight years to clear in some areas across the UK. Driving the increase in waiting times in part has been the rise in demand for ADHD assessments, with referrals having nearly quadrupled since 2019.
Denying ADHD patients timely access to assessments, diagnosis and treatment has serious consequences not just on the health service, but on the education, labour market, and justice system too. Those with untreated ADHD are more inclined to high-risk behaviour such as drug-taking and criminality, poorer performance in schools, lack of stable employment, and have lower health outcomes, particularly regarding mental health. The status quo is evidently not working for those with ADHD, and will not be improved unless the government consider modern and innovative approaches to reduce the backlog and provide better support and treatment at an earlier stage.
There is a significant financial consequence on the economy of untreated ADHD which must be considered. Independent research reveals that the average annual cost on the health service per individual is £13,552. By contrast, ADHD 360’s three-year assessment, diagnostic and treatment plan amounts to £7,800. When comparing the three-year health and social care cost of £40,656 per individual with the £7,800 cost of ADHD intervention, the return on investment is extensive; for every £1 spent on ADHD diagnosis and management, savings of between £4.21 and £16.37 could be obtained over a 10-year period.
Embracing innovative and digital solutions developed using expertise in the industry should be at the heart of the NHS’s strategy to bring down waiting times. Clinics, such as ADHD 360’s, can facilitate this reduction by operating at a more efficient pace than the NHS. For ADHD 360, the process of referral to assessment takes up to eight months, as opposed to the potential of eight years in NHS clinics. For the individual, this allows their condition to be better and more quickly managed, giving them a greater chance to reach their full potential.
There are several measures, both in the short term and longer term, that should be considered in order to reduce waiting lists for ADHD assessments. Short-term measures draw on immediate actions that can relieve the backlog such as funding and tweaks to existing policy. Conversely, longer-term solutions explore the implementation of a more joined-up system approach to ADHD provision, which would alleviate waiting lists through earlier intervention coupled with faster referral processes.
Shorter-term measures for waiting list reduction
In order to streamline NHS efficiencies in delivering elective care, including ADHD provision, there should be immediate release of additional funding specifically to tackle ADHD assessments.
This funding should be targeted to providers that have the capacity to efficiently reduce this backlog, enabling patients to receive timely care.
It is clear that the system at present is not sufficiently resourced to provide adequate services to patients with ADHD, which restricts them from managing the condition and receiving the appropriate and necessary treatment. Unlocking further funding will help speed up the delivery of care to these patients, provided it is allocated to assessment and diagnostic clinics who are capable to do so.
While the backlog prevails, the predominant pathway for many people seeking ADHD assessments is through utilising their legal Right to Choose (RTC). This allows many people who would otherwise not be able to access assessments on the NHS to receive the care they deserve. There are far too many unlawful interpretations of this legislation, and many ICBs and GPs are acting unlawfully, whether deliberately or accidentally. This is ultimately to the detriment of the patient, who’s treatment is interrupted or withheld.
To immediately and productively tackle the backlog of assessments, GPs should be mandated to accept RTC referrals. This would include signposting patients to assessment providers, in turn improving their chances of receiving care.
At present, many patient referrals access assessments through the R2C pathway, which grants individuals a legal right to choose their mental healthcare provider. In the past five years, 60,000 individuals have selected this option, enabling them to receive the assessment, diagnosis, and treatment that they are entitled to.
The Department of Health and Social Care (DHSC) should explore the expansion of additional neurodiversity assessment centres, using RTC or any qualified provider contracts in high-demand areas.
To end the inconsistency in ADHD care provision across the UK, a standardised quality framework should be drawn up. The current NICE guidelines are dated and inadequate. This would promote equality of access to patients, and provide clearer guidelines to expedite the accreditation process for RTC providers.
Longer-term measures for waiting list reduction
There is a severe lack of a joined-up approach when considering neurodiversity and how it intersects across all segments of life – whether that be interaction with the health service, social services, education, labour market and justice system.
The government should identify opportunities to create a more joined-up approach to ADHD and neurodiversity provision. A more integrated system would better early identify symptoms and allow for a timelier diagnosis and treatment plan.
Keeping a record of the number of those with ADHD will better inform long-term policymaking, and illustrate potential causes for spikes or drop-offs in diagnosis. The establishment of a national register will also enable monitoring of patient outcomes with a view to identifying best practice.
An improved data capture and knowledge sharing regime should include waiting times, diagnosis rates and treatment outcomes. This will ensure that any areas of improvement are managed swiftly, and potential causes of concern can be mitigated against.
While medical professionals are well-placed to identify and accurately diagnose ADHD, there remains many points of access where individuals can fall through the cracks in the system, thereby delaying their chances of treatment. ADHD 360 believe this can better be prevented, if training is expanded across other social professions.
GPs, teachers, social workers and criminal justice professionals should be trained on early recognition of ADHD and referral pathways. This would allow more timely access to ADHD assessment, diagnostics and treatment, precluding individuals from falling through the cracks in the system.
Including ADHD awareness within professional development ensures that training is applied consistently and taken seriously. It also ensures that professionals are continuously up to date on the latest ADHD interventions and best practices.
The government should incentivise and embrace technological advancements in health technology and how this can enhance ADHD services. For example, investment in digital health tools, such as AI-driven screening methods and remote monitoring applications can drive greater efficiency and alleviate pressures on waiting lists.
With new technology being developed and tested at a rapid pace in the UK, an opportunity is presented for the health service to harness this and support its expansion to meet a key government objective on waiting list reduction. ADHD is among the worst offenders for waiting lists, and thus is should be considered a critical component of strategies relevant to elective care.
The current backlog points to a serious failure of the public sector to provide for those with neurodiversity. It is evident that the NHS is not adequately resourced to handle the influx of people with ADHD, and the individual consequences of under-provision is severe for the person lacking treatment. Operating at scale, the private sector could clear the backlog of assessments in a maximum of 18 months.
To drive better value for money, ADHD provision should be granted to the most efficient providers in the private sector. They should have national responsibility, and accountability, for delivery of efficient care to those with ADHD. Doing so would alleviate the pressure on the NHS and make best use of private sector innovation.
April 2025