Some people referred for ADHD or autism assessments in England are being told they must wait at least two years before they can be assessed, under policies introduced by four NHS integrated care boards (ICBs).
The boards said the measures were adopted because they could not afford the cost of meeting the number of assessment requests. In total, 15 ICBs covering about 19 million people have introduced some form of restriction, including annual limits on funded assessments and criteria designed to prioritise patients according to clinical need.
How the waiting rules vary
West Yorkshire ICB has introduced a two-year minimum wait from referral for anyone seeking an ADHD or autism assessment with an independent provider. The policy applies to the 2.4 million people whose care it commissions and pays for across Leeds, Bradford, Kirklees, Calderdale and Wakefield.
The ICB said its bill for these assessments increased from £7 million in 2023–24 to £21 million the following year.
Other areas have set different minimum waits. Private providers funded by North East and North Cumbria ICB are working to an approximately 78-week minimum wait for an initial assessment. Somerset’s minimum wait is 52 weeks, while Devon’s is 14 weeks. Kent and Medway has also introduced a minimum wait.
In Hampshire and the Isle of Wight, assessments have instead been restricted to patients who meet the ICB’s priority criteria.
These “minimum waits” apply after a GP referral and prevent people in affected areas from seeking an assessment from a private-sector provider through NHS funding during the specified period. Private clinics currently undertake half of NHS-funded ADHD assessments and one-third of NHS-funded autism assessments.
Demand and NHS capacity
The reported scale of demand is substantial: 960,000 people in England are waiting for an ADHD assessment and 295,000 are waiting for an autism assessment.
A government-commissioned review led by Prof Peter Fonagy is examining rising diagnoses of mental illness, ADHD and autism, as well as pressure on NHS assessment, diagnosis and care services. The 700-page review was due to be published on Thursday but was postponed until early the following month.
Sources familiar with the unpublished review said it describes rising demand, greater reliance on private providers and concerns about the consistency and quality of private assessments. They also said it examines financial incentives connected with assessment activity. These details had not been confirmed by publication of the review at the time covered by the report.
The review highlights large increases in recorded neurodiversity among boys since 2000. Among boys aged seven to 18, the percentage with autism rose from 0.2% in 2000 to 4.7% in 2025, while the percentage diagnosed with ADHD rose from 0.4% to 5.1%. For boys aged six to 11, the corresponding figures rose from 0.4% to 6.3% for autism and from 0.7% to 3.8% for ADHD.
These figures describe changes in recorded prevalence. The fact sheet does not establish what proportion of the increase reflects changes in diagnosis, awareness, access to assessment or other factors.
Concerns about access and fairness
Advocacy groups have criticised the restrictions. ADHD UK chief executive Henry Shelford called a two-year minimum wait “heartless and dangerous” and said it denied people needed care.
Finally Seen described the policy as “a locked door with a date on it”, arguing that people’s ability to choose an assessment was being rationed by the calendar. The National Autistic Society said restricting autism assessments could deny people support and contribute to lost school years, crisis and more urgent needs.
The Independent Healthcare Providers Network urged the NHS to allow private clinics to offer as many available appointments as possible. The NHS Alliance’s mental health network said some local leaders had introduced minimum waits or closed waiting lists because of budget pressures and rising demand, describing the position as unsustainable.
More broadly, the British Medical Journal reported that 17 of England’s 36 ICBs had introduced 12- to 16-week minimum waits before patients could receive a new hip or knee or undergo cataract surgery. The comparison points to wider pressure on NHS-funded services, although the policies concern different types of care.
What the policy means for patients
- Waiting rules differ between ICB areas, so the process depends on where a person receives NHS-funded care.
- Some boards use a fixed minimum wait, while others limit assessments to people who meet priority criteria.
- The reported restrictions concern access to assessment; they do not by themselves establish whether an individual has ADHD or autism.
- Warnings that delays could harm education, wellbeing or safety are concerns raised by patient and professional groups, not outcomes established across every affected area.
The central issue is the gap between rising demand and the funding available for assessments. Until the government-commissioned review is published, the full detail of its findings and recommendations remains unclear.
AI tools were used to assist with the preparation of this article.
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