NHS integrated care boards across England are implementing extended waiting periods and rationing measures for attention deficit hyperactivity disorder and autism assessments as they grapple with unprecedented demand for diagnoses. Four ICBs have adopted minimum two-year waiting periods from referral, while 15 ICBs covering 19 million people have introduced various restrictions including annual assessment caps and clinical prioritization criteria that limit evaluations to cases deemed most severe. These policies are generating considerable concern among patient advocacy groups, who argue the delays risk harming children’s educational outcomes and increasing suicide risk among those awaiting care.
The prevalence of these conditions has risen dramatically in recent years. According to figures from the Clinical Practice Research Datalink, the percentage of boys aged seven to 18 with autism increased from 0.2% in 2000 to 4.7% in 2025. Among younger boys aged six to 11, autism diagnoses rose from 0.4% to 6.3% over the same period. ADHD diagnoses among boys aged seven to 18 climbed from 0.4% to 5.1% between 2000 and 2025, while diagnoses among boys aged six to 11 increased from 0.7% to 3.8%. These trends have created substantial pressure on NHS capacity, with 960,000 people in England currently waiting for ADHD assessments and 295,000 awaiting autism assessments.
The cost pressures driving these restrictions are significant. West Yorkshire’s costs for private assessments surged from £7m in 2023-24 to £21m in the following year, prompting its two-year minimum wait policy affecting 2.4 million residents. Other regions have adopted varying approaches, with North East and North Cumbria implementing approximately 78-week minimum waits, Somerset establishing 52-week minimums, and Devon operating at 14 weeks. The restrictions effectively bar patients from exercising their legal right to choose private providers, potentially forcing those who can afford assessments to pay several thousand pounds out of pocket.
Advocacy organizations have condemned these policies. ADHD UK’s chief executive characterized the two-year minimum waits as “heartless and dangerous” and “institutionalized cruelty,” emphasizing that people are being denied available care. The restrictions come ahead of publication of a major government-commissioned review examining surging diagnoses of mental illness, ADHD, and autism. The Fonagy report is expected to address the systemic challenges these rising diagnoses pose for the health service, schools, employers, and families.
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