NHS integrated care boards across England are implementing policies that delay access to attention deficit hyperactivity disorder and autism assessments to manage escalating expenses. Four ICBs have adopted minimum waiting periods of two years or longer, while 15 ICBs covering 19 million people overall have introduced various rationing measures including annual assessment caps and clinical prioritization criteria that restrict evaluations to those with the most severe presentations of neurodiversity.
The disclosure of these access restrictions precedes the planned release of a major government-commissioned review examining the dramatic increases in mental illness, ADHD, and autism diagnoses in recent years. The 700-page report, led by Prof Peter Fonagy and originally scheduled for publication, has been postponed until early next month. According to sources familiar with the document, the review documents how rising demand for mental health, ADHD, and autism care has left patients struggling to obtain timely NHS services and increasingly turning to private providers. The report raises concerns about private sector quality and consistency, while highlighting significant rises in neurodiversity prevalence among boys, including a shift in autism diagnoses among seven- to 18-year-old boys from 0.2% in 2000 to 4.7% in 2025.
The minimum wait policies prevent patients from exercising their legal right to seek private assessments after GP referral. This approach particularly affects those unable to afford private care, which can cost several thousand pounds. West Yorkshire NHS integrated care board, which serves 2.4 million people, implemented a two-year minimum wait after its assessment costs rose from £7 million in 2023-24 to £21 million in the following year. Other regions have adopted varying waiting periods, ranging from 14 weeks in Devon to approximately 78 weeks in the North East and North Cumbria.
Patient advocacy groups have criticized these policies as harmful and restrictive. ADHD UK characterized the approach as “heartless and dangerous,” warning that extended delays may compromise children’s educational outcomes, prevent individuals from accessing necessary support, and increase suicide risk. Currently, 960,000 people in England are awaiting ADHD assessments while another 295,000 await autism evaluations.
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