The short version
- Four NHS integrated care boards in England have instituted minimum waiting periods ranging from 14 weeks to two years for ADHD and autism assessments.
- The policy changes aim to control costs as spending on private providers has tripled in some regions, while over a million people remain on waiting lists.
- A major government-commissioned review highlights a dramatic rise in diagnoses among boys since 2000, raising concerns about assessment quality and financial incentives.
Four integrated care boards across England have implemented new policies requiring patients with suspected attention deficit hyperactivity disorder or autism to wait at least two years before undergoing formal assessments. This strategic shift represents a significant change in how the National Health Service manages access to neurodiversity diagnoses, moving from open referral systems to structured rationing mechanisms. The decision by these health authorities comes as they struggle to balance their budgets against a backdrop of surging demand for diagnostic services that has overwhelmed existing capacity.
The specific waiting periods vary by region, reflecting the distinct financial pressures faced by each board. West Yorkshire NHS integrated care board, which serves 2.4 million people including areas in Leeds and Bradford, has set a two-year minimum wait from the date of general practitioner referral. This measure was introduced after the board’s expenditure on such assessments tripled from £7 million in the 2023-24 fiscal year to £21 million last year. Similarly, the North East and North Cumbria ICB has established an approximate 78-week minimum wait for initial assessments funded by private providers.
Other regions have adopted different timelines based on their local constraints. Somerset ICB has instituted a 52-week minimum wait, while Devon’s equivalent period is significantly shorter at 14 weeks. Kent and Medway ICB has also decided to impose a minimum waiting period, though specific durations were not detailed in the initial reporting. In Hampshire and the Isle of Wight, access to assessments has been restricted entirely to patients who meet strict clinical priority criteria, effectively denying immediate evaluation to those with less severe symptoms.
These policies fundamentally alter the landscape for patients seeking diagnosis by preventing them from utilizing their legal right to choose non-NHS care providers during the waiting period. Previously, many individuals exercised this option because NHS capacity was limited, leading private clinics to perform half of all NHS-funded ADHD assessments and a third of autism evaluations. By enforcing minimum waits, the health boards are effectively blocking access to these faster private pathways for those who cannot afford to pay out-of-pocket, which can cost several thousand pounds.
Patient advocacy groups have reacted strongly to these developments, describing the delays as scandalous and potentially harmful. The charity ADHD UK characterized the minimum wait policies as heartless and dangerous, warning that prolonged delays could damage children’s educational prospects and deny individuals essential support for managing their daily lives. There are also concerns that extended waiting periods may increase the risk of suicide among vulnerable populations who are desperate for answers and care.
The implementation of these rationing measures occurs against a backdrop of staggering statistics regarding neurodiversity diagnoses. A major government-commissioned review, led by Professor Peter Fonagy, reveals that the prevalence of autism in boys aged seven to 18 rose from 0.2 percent in 2000 to 4.7 percent in 2025. For younger boys aged six to 11, the increase was even more pronounced, jumping from 0.4 percent to 6.3 percent over the same period, representing a sixteen-fold increase.
Similar trends are evident for ADHD diagnoses. The percentage of boys aged seven to 18 diagnosed with the condition rose from 0.4 percent in 2000 to 5.1 percent in 2025, an almost thirteen-fold leap. Among six- to 11-year-old boys, the rate increased five-fold from 0.7 percent to 3.8 percent. These figures, provided by the Clinical Practice Research Datalink, highlight the immense scale of the challenge facing the NHS, schools, employers, and families in England.
The Fonagy report, which was unexpectedly postponed until early next month after being due for release on Thursday, raises serious concerns about the consistency and quality of assessments currently being conducted. Sources familiar with the document indicate it paints a detailed picture of how rising demand has left patients increasingly reliant on private providers while struggling to get rapid access to NHS care. The review also highlights financial incentives associated with assessment activity, suggesting that economic factors may be driving some of the diagnostic surge.
Currently, there are 960,000 people in England waiting for an ADHD assessment and another 295,000 awaiting one for autism. In total, fifteen integrated care boards covering 19 million people have introduced various forms of rationing to manage their finances. These measures include limiting the number of assessments paid for annually and using clinical prioritization criteria to restrict evaluations to those with the most serious signs of neurodiversity. The situation underscores a systemic crisis in mental health and neurodevelopmental care provision.
The disclosure of these widespread efforts to delay and deny access to assessments comes just before the publication of the full Fonagy review, which was ordered by former Health Secretary Wes Streeting amid concerns that the weight of requests was overwhelming the health service. As the government prepares to release its findings, the tension between fiscal responsibility and patient need remains unresolved. The coming months will likely see further scrutiny of how these minimum wait policies impact public health outcomes and whether they constitute a sustainable solution or merely a temporary patch on a deeper structural failure.
Sources behind this briefing
Go to the original reporting
- The Guardian World↗NHS bodies in England impose two-year minimum wait for ADHD and autism assessments
