Fears proposals could increase ADHD backlog

Waiting times to get an ADHD diagnosis could get even longer if new budget limits are introduced, providers and charities have warned.

NHS England is proposing to set payment limits on its "right to choose" providers, which GPs can refer patients to for an ADHD assessment anywhere in England.

While the government said patients would "continue to have the power to choose", assessment organisations said the proposals were "unworkable" and could lead to delays.

Hartlepool mum Leanne Baister, who was considering using right to choose to assess her seven-year-old son for ADHD, said her family felt "stuck".

The NHS Choice Framework enables GPs to refer patients for specialist treatment, including ADHD or autism assessments, with any appropriate provider.

The costs are covered by the NHS.

Patients sometimes choose providers outside of where they live because they may have shorter waiting times than those available in their own area.

At the moment, NHS Integrated Care Boards (ICBs) can be charged as much as necessary by providers.

"We are proposing to introduce a power for commissioners to limit payments for elective services, and other services reimbursed on an activity basis, above planned levels," a consultation notice from NHS England read.

It would apply to larger organisations, and the payment limit would be calculated based on previous levels of service and expectations for the coming year.

The government confirmed NHS England would continue to consult on the 2025/26 budget proposals, despite plans to eventually scrap the body.

CEO of charity ADHD UK Henry Shelford, which aims to help people affected by the condition, said he expected waiting times to "jump".

"They want to make right to choose like getting an Oasis concert ticket," he said.

"You don't get what you think you're queuing up for, but instead of a wildly different price, it's a wildly different wait time than the one you expected."

Mr Shelford said that when the payment limit was reached, people would be forced to wait until the next year when funding was available again.

"It eradicates patient choice by making patient choice futile," he said.

Many areas of the UK had such long backlogs for adult ADHD assessments that it would take at least eight years to clear them, a BBC investigation found last year.

Mrs Baister said she was considering using right to choose to get a quicker ADHD assessment for her son Toby.

She said the longer the wait, the longer it would take for them to access things like medication.

"This places our family under enormous pressures," Mrs Baister said. "We're kind of stuck."

She works for charity Little SENDsations, which supports families of children with disabilities.

"Parents are burnt out and sick and tired of fighting a system full of brick walls," Mrs Baister said.

Mother-of-two Sarah Jane, from Hartlepool, waited five years for her own ADHD diagnosis.

She used right to choose to get an assessment for one of her own children and the waiting time was eight months.

Ms Jane said being officially diagnosed was "validation".

"If you don't know, and you've got all these feelings of 'something's wrong with me, I'm different', it affects your self-esteem."

She said it would be "devastating" if right to choose provider waiting times got longer.

"A lot of families are at breaking point," Ms Jane said. "[Right to choose] gives people hope."

ADHD assessment providers are also apprehensive.

Psicon managing director Dr Daniel Simmonds acknowledged the need for funding controls but said that current proposals appeared "unworkable".

"There is a risk that the pressures of implementation could unintentionally lead to delays in care, reduced capacity and compromised patient safety," he said.

Co-founder and executive chair of Paloma Health, Darshak Shah, said proposals would risk right to choose being reduced to an "illusion that exists 'in name only' - the right to be referred but not necessarily to be treated".

Meanwhile clinical director at Oakdale Dr Caroline Falcone said: "As we interpret it, these limits could restrict the number of referrals we can accept from areas where we as a provider do not hold a direct contract with a patient's ICB.

"If funding does not align with the growing demand for ADHD assessments, there is a risk that some individuals may struggle to access the services they need."

The Department of Health and Social Care said the consultation did not propose any changes to the right to choose.

"This government inherited a broken NHS with too many patients facing long waits for ADHD assessment," the spokesperson said.

"Through our Plan for Change, this government will get the NHS back on its feet by turning around severe delays and getting people the treatment they need."

It also added that it was working with NHS England's cross-sector ADHD taskforce to tackle the challenges those with ADHD face, including timely access to services and support.

In the proposal document for 2025/26, NHS England said setting payment limits was the "right thing to do".

"The proposal for commissioners to set payment limits is consistent with fixed allocations and the need for the NHS as a whole not to spend more than the resources it has available."

A consultation on the payment proposals closed in February.

NHS England has been contacted for comment.

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