The truth about ADHD waiting times and the independent sector

IHPN’s Senior Policy Advisor, Sean Phillips, sheds light on independent sector provision of NHS ADHD services in light of recent media coverage

The latest figures suggest more than 700,000 people in England are currently waiting for an ADHD assessment, with waiting times at some providers many years, and in some cases, over a decade. 

The cost of not addressing this challenge is estimated to be around £17 billion to the UK economy, with individuals with unsupported neurodevelopmental conditions at higher risk of worse educational outcomes; not being in education, employment or training (NEET); more likely to be dependent on welfare; and at greater likelihood of being in contact with the criminal justice system.  

The evidence meanwhile concerning the co-occurrence of neurodevelopmental conditions with mental-ill health demonstrates the wider impact inaction has on the overall health of those seeking access to care. 

The recently published, expert-led and NHS England-commissioned, ADHD Taskforce report is clear that ADHD is “under-recognised, under-diagnosed and under-treated”. There is, in their words, “inadequate service capacity for all ages” across the NHS today. Similar conclusions would also be drawn in the provision of support for Autism Spectrum Disorder (ASD).   

In meeting this challenge, the independent sector already plays a significant role – and will be a key part of solution to meeting demand in this area. Whether that’s boosting access to high-quality services, improving access, reducing waiting times, introducing adaptations and innovation in service delivery, or providing real choice to patients — and all free at the point of use. 

Today, at least 50% of all NHS ADHD assessments and over a 33% of all Autism assessments are conducted by the independent sector – based on analysis from the IHPN.  

Yet, how independent sector services are regulated and how they are contracted with the NHS is often poorly understood – as demonstrated by recent media coverage. 

Independent providers delivering NHS-funded ADHD and Autism services are subject to the same regulatory regime as any other provider.  Where required by law, they are registered with the CQC and regulated when prescribing ADHD medication.

IHPN members have also adopted additional quality frameworks, including the UK Adult ADHD Network (UKAAN) and the ADHD Assessment Quality Assurance Standard (CAAQAS).  In combination, these represent the current gold standard for patient safety and clinical quality.

To describe ‘private providers’ as ‘unregulated’ in this context, therefore, is simply false.

But that is not to say there is real complexity – and some confusion – in the way that ADHD services are overseen.  Under the current regulatory framework, assessment-only services are not within CQC scope. IHPN fully support the ADHD Taskforce’s recent proposals to ensure regulation is more ‘transparent’ and ‘clear’ and welcome work that would ensure NICE guidance is clear on what is meant by an ‘appropriately qualified’ professional in the context of ADHD diagnosis.

There is similar complexity in the contracting and payment of ADHD services.  It has been suggested that current Right to Choose (RTC) regulations “prevent local NHS bodies from requiring that a private company gains prior authorisation before providing care to patients”. This is incorrect.  

In order to achieve a ‘qualifying contract’ with an NHS ICB and to deliver ADHD or Autism assessments under RTC, every provider must achieve accreditation with an ICB, in which they will be required to demonstrate that they meet regulatory standards, as required by the CQC, and demonstrate that services are delivered in accordance with the NHS Standard Contract.  

But in addition, providers must then tailor the service to local specifications which are set by each commissioner. This means there may be tens of different specifications that a provider must meet if they deliver services across England. 

A constructive place for the Government and NHS England to undertake reform- building on the ADHD Taskforce report, with support from the independent sector –  would be in establishing a consistent, high-quality service specification that all NHS commissioners can use. 

Recent reporting in the Guardian has described the recent growth in expenditure on ADHD care as “overspend”.  In reality, expenditure has increased as demand for services has grown, and as NHS waiting times have increased. Without the additional capacity and capability that the independent sector has brought through RTC — there would simply be even greater unmet need and likely, harm. 

What is really required is a public debate about how to effectively resource NHS neurodevelopmental services. The suggested figure of £164m in ‘unplanned expenditure’ for the provision of ADHD services by the independent sector in fact equals just 0.02% of the projected overall spend on NHS mental health services alone in England this financial year (on the basis it is projected to reach £15.6bn).  

The NHS England Medium Term Planning Framework is clear in calling on commissioners to: “optimise existing resources to reduce long waits for autism and ADHD assessments and improve the quality of assessments”.  

This means working constructively with – and maximising the role that the independent sector can play, leaning into the capacity and capability they offer. 

So what should be done? 

• Closer collaboration between the independent sector and the NHS to ensure improved data sharing and reporting, with agreement over the metrics which can show ‘what good looks like’. 

• Using this information to develop a national service framework, with clear standards for ADHD and Autism assessment and diagnosis – to give patients much needed clarity and to inform future commissioning.   

• Supporting ADHD Taskforce recommendations to ensure that regulation is ‘transparent and clear’. 

• Close working between the independent sector and all relevant stakeholders, including NHS England and GP representative groups to ensure shared care is effectively supported between providers through enhanced information sharing, understanding and agreement to minimise the risk of harm.  

• The development of a fair, transparent payment framework – leading to a tariff which supports the delivery of services in a sustainable manner and which supports an innovative, high-quality model of care.  

Reducing ADHD waiting times at scale will only be possible if the NHS and independent sector work together, using all available capacity to deliver safe, high-quality care for patients.