NHS has no hope of meeting autism and ADHD demand, warns report

Demand for autism and ADHD assessments is increasing at such a rate that they have surpassed the ability of the NHS to keep up, the Nuffield Trust has warned.

Rather than doing more of the same, a ‘radical rethink’ is needed of how services are provided to assess for neurodiversity, they concluded.

The increase in referrals is happening at such a scale that it stands out as a ‘serious problem’ even amid the wider challenges affecting health services, the analysis found.

Growing backlogs are a result of increased awareness of neurodivergent conditions and the pandemic alongside workforce pressures and sustained underfunding, the think tank said.

In December there were 172,022 patients with an open referral for suspected autism – the highest number ever reported and a more than five-fold increase since 2019, the analysis found.

Waiting lists are ballooning as the NHS struggles to keep pace with median waits growing from four to nine months over the past four years.

But this figure also hides wide variation in access to assessments nationally with one ICB reporting two and a half years for a first appointment.

While figures are not collected on ADHD waiting lists, there is data which suggests rapid increases in demand including a 51% increase in the number of patients prescribed medication for the condition since 2019.

The impact on children waiting for an assessment in particular should not be underestimated, the Nuffield Trust said.

Without a formal diagnosis, children and young people with suspected autism or ADHD may not be getting the support they need at school, which can significantly affect their life’s trajectory, the analysis noted.

Thea Stein, chief executive of the Nuffield Trust said: ‘The extraordinary, unpredicted and unprecedented rise in demand for autism assessments and ADHD treatments have completely overtaken the NHS’s capacity to meet them.

‘It is frankly impossible to imagine how the system can grow fast enough to fulfil this demand.

‘We shouldn’t underestimate what this means for children in particular: many schools expect an assessment and formal diagnosis to access support – and children and their families suffer whilst they wait.’

The huge rise detailed in the analysis is likely to be down to a combination of changing social attitudes and better awareness, she said but the current health service model was ill-equipped to meet the need.

‘We need to urgently understand the different elements of this complex picture and find a whole system approach across education, society at large and the health service.

‘Pumping more money into the current model certainly isn’t the solution: a radical rethink is required.’

NHS England has said it will launch a new ADHD taskforce to improve care for people living with the condition.  

The taskforce will bring together expertise from health, education, and justice, to better understand the challenges facing those with ADHD.

A Department of Health spokesperson said: ‘We know it’s vital to have a timely diagnosis of autism or ADHD and we are taking action to reduce assessment delays.

‘NHS England has published a national framework to help speed up autism assessments and is establishing a new ADHD taskforce alongside the government, to improve care for people living with the condition.

‘In addition, our £13m partnership with NHS England will help improve specialist support for neurodiverse children in primary schools.’