NHS bodies are forcing people with suspected attention deficit hyperactivity disorder and autism to wait at least two years before they can be assessed as they struggle to meet surging demand for diagnoses of neurodiversity. Four NHS integrated care boards (ICBs) covering large regions of England have adopted the approach because they cannot afford the cost of the number of assessments that people are seeking. Patient groups are warning that the “scandalous” delays such policies involve may damage children’s chances of succeeding at school, deny people the help they need to manage their lives, and increase the risk of suicide.
The charity ADHD UK denounced minimum waits as “heartless and dangerous”. In all, 15 ICBs, which between them cover 19 million people, have brought in various ways of rationing assessments for ADHD and autism to try to balance their books. These include limiting the number of assessments the ICBs will pay for in any given year and using “clinical prioritisation” criteria to restrict assessment to those with the most serious signs of neurodiversity.
Disclosure of the NHS’s widespread efforts to delay and deny access to assessments comes before the publication of a major government-commissioned review of the colossal increases in diagnoses of mental illness, as well as ADHD and autism, in recent years. It was ordered last year by Wes Streeting, the then health secretary, amid concern that the weight of requests for assessment, diagnosis and care was overwhelming the health service’s ability to meet demand. The 700-page report of the review, led by Prof Peter Fonagy, was due to be published on Thursday but was unexpectedly postponed until early next month.
Sources familiar with the document told the Guardian that it painted a detailed picture of how the fast-rising demand for help with mental illness conditions, ADHD and autism has left those affected struggling to get rapid access to NHS care and increasingly reliant on private providers. Fonagy’s report raises serious concerns about the sector, especially about the consistency and quality of the assessments it provides and the fact that there are “financial incentives associated with assessment activity”. It also lays bare the scale of the challenge that the increasing number of diagnoses of mental illness, ADHD and autism pose for the NHS, as well as schools, employers and families, by highlighting up to 24-fold rises in the prevalence of neurodiversity in boys since 2000.
It reveals that the percentage of seven- to 18-year-old boys with autism rose from 0.2% in 2000 to 4.7% in 2025. Prevalence among boys aged six to 11 rose from 0.4% to 6.3% over the same period – a 16-fold jump. Similarly, the percentage of seven to 18-year-old boys diagnosed with ADHD rose from 0.4% to 5.1% between 2000 and 2025 – an almost 13-fold leap – and from 0.7% to 3.8% – up five-fold – among boys aged six to 11, according to figures provided by the Clinical Practice Research Datalink.
That is even though private clinics now undertake half of NHS-funded assessments of ADHD and a third of those for autism, because many patients exercise their legal right to choose non-NHS care, given the NHS’s own limited capacity to do the assessments. Such curbs by the NHS are likely to force those who can afford it to pay a private provider for an assessment for themselves or their child, which can cost several thousand pounds. They are being implemented at a time when there are 960,000 people in England waiting for an ADHD assessment and another 295,000 awaiting one for autism.
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