We are aware that the rising need for ADHD (attention deficit hyperactivity disorder) services continues to present a significant challenge, with referral volumes far outstripping capacity. This creates risk for patients and systems.

NHS England continues to work with systems to help them better manage demand. The independent ADHD Taskforce published its interim report in June 2025, with the full report expected in the autumn.

Their recommendations have shaped this work and will continue to do so. We urge integrated care boards (ICBs) to implement recommendations, with particular emphasis on integrated and stepped care, ensuring they are embedded at a system level to maximise impact. 

In the meantime, when considering ways to manage demand on local ADHD services, we ask all systems to thoroughly consider the patient experience and safety impact, as well as any local governance, legal and broader system implications.

Managing service provision

Systems should ensure any potential changes to provision are designed to be as neuroinclusive as possible.

Appropriate impact assessment(s) must be completed as part of planning, via locally agreed mechanisms, considering both Public Sector Equality Duty (Equality Act 2010) and Health Inequalities Duty (Health and Social Care Act 2012). These should recognise that the experiences of neurodivergent people differ from that of the broader population.

Systems may wish to consider different approaches as part of their plans to support and manage risk to patients, while managing demand on services. These can include the following options.

Reviewing the waiting list

Systems can undertake a review of the waiting list to:

• ensure patients currently waiting wish to continue, and are assigned to the most appropriate waiting list based on any relevant criteria, for example, age
• enable development of a needs-based waiting list and identification of patients requiring additional or alternative support, with signposting and internal referral to relevant services as appropriate
• ensure patients and families know how to contact the service if the patient’s condition deteriorates

Clinicians should undertake waiting list reviews, but non-clinical staff can assist with related administration, dependent on available resource.

Providing a patient support offer

Systems can also implement a support offer to help patients live well with ADHD. This could include voluntary sector provision, peer support options, and comprehensive patient information and signposting.

Using NHS Standard Contract provisions

The new NHS Standard Contract Activity Management provisions can be used to ensure that each provider delivers the right level of activity.

These provisions allow commissioners to agree or set an Indicative Activity Plan with each provider (whether contracted or non-contract activity) and to manage activity by reference to that plan using the contractual Activity Management process. 

Full details of the provisions can be read in the NHS Standard Contract 2025/26 technical guidance at Section 42. 

Help and advice on the use of these provisions can be obtained by emailing the NHS Standard Contract team at england.contractshelp@nhs.net or contacting your ICB Contracting team.

Assessing risk

Forms of stratification or clinical triage that are untested or lack an evidence base are likely to present risks, including potential harm to patients.

These safety concerns must be explored thoroughly as part of planning, and systems should undertake a robust evaluation of the risks of all options. ICBs may wish to take their own legal advice when considering any changes to processes.

If you wish to discuss your approach, please email england.adhdprojectgroup@nhs.net.

Publication reference: PRN02161