Review management of ADHD assessments and increase funding

The Government should commission a review of how Attention Deficit and Hyperactivity Disorder (ADHD) assessments are managed by the NHS, including through Shared Care Agreements, and increase funding to reduce waiting times.

In July 2020, a Freedom of Information request made by the BBC found that over 21,000 people were waiting for ADHD assessment on the NHS. Some people have spent up to 5 years on the waiting list.

NHS Constitution states it should be no more than 18 weeks from referral to seeing a consultant for non-urgent, consultant-led treatments. ADHD is a chronic mental health issue.

The Department acknowledges that some people are experiencing long waits for an assessment of ADHD. We recognise that it is vital that people receive a timely assessment and diagnosis of ADHD, as this is important in enabling people to access the care and support they need to live fulfilled lives.

The National Institute for Health and Care Excellence (NICE) is the organisation that provides guidelines for assessing ADHD and we are guided by NICE’s evidence-based recommendations in these guidelines. We expect all Clinical Commissioning Groups (CCGs) and NHS trusts to follow NICE’s ADHD guideline ‘Attention deficit hyperactivity disorder: diagnosis and management’ to improve the assessment and diagnosis of ADHD in adults and children, and the quality of care and support that people receive. Making a diagnosis can be complex because there is no physical test for ADHD (such as a blood test). The NICE guideline therefore does not recommend a maximum waiting time between referral and an assessment for ADHD. The NICE guideline was last updated in September 2019 and in particular recognises the underdiagnosis and misdiagnosis of ADHD in girls and women and the importance of people being able to access support to manage their symptoms and live well with ADHD.

We have no current plans to review how ADHD assessments are managed by the NHS, as it is for CCGs to commission and provide these services based on the needs of their local population. In addition, under the Health and Social Care Act (2012), it is for commissioners to decide how services are funded in their area.

The Handbook to the NHS Constitution (https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england) sets out that patients should start consultant-led treatment within a maximum of 18 weeks from referral, with certain exceptions including services that are not consultant-led and services provided or commissioned by local authorities. ADHD assessments do not fall within this guidance and decisions about ADHD services and treatment are made locally by CCGs.

We and NHS England and Improvement (NHSE/I) do not define ADHD as a mental health condition, but a group of behavioural symptoms that often exist in conjunction with many other conditions whose symptoms can overlap and mask those of ADHD e.g. autism, language disorder, dyspraxia, obsessive-compulsive disorder, and mental health conditions.

Assessments, diagnosis and the provision of support for people with ADHD are carried out in various care settings. Data on the number of people waiting for an ADHD diagnosis and how long they have been waiting is not collected nationally but may be held locally by some CCGs. NHS Digital are working to improve the quality of relevant datasets, such as the Mental Health Services dataset and the Community Services dataset. Improving data on ADHD will be an important first step in determining where further action may need to be taken to support people.

To support earlier identification of ADHD, as part of the NHS Long Term Plan NHSE/I are working with local authority children’s social care and education services as well as expert charities to support neurodivergent children, including children with ADHD and their families, throughout the diagnostic process.

I hope this reply is helpful and provides some reassurance of the expectations on CCGs to provide ADHD assessments, diagnosis and support, as well as our work to improve early identification through the NHS Long Term Plan.

Department of Health and Social Care