What is this document about?

This is a report about ADHD (attention deficit hyperactivity disorder) services in England and how to improve them. It was written by an independent group of experts asked by NHS England to look at the problems and suggest solutions.

Main problems identified

Long waiting times

• some people wait more than 2 years for an ADHD assessment
• in some areas, waiting times have grown to 10-15 years
• carry high risks for people with These include worsening of mental health, suicide, going into the criminal justice system and substance misuse

Not enough people getting diagnosed

• best research suggests about 5% of children and 2-3% of adults have ADHD
• but far less than this have an ADHD diagnosis and are getting help
• women and girls are much less likely to have a diagnosis

Not enough treatment

• only 25% of children and 15% of adults with ADHD get medication
• this is far too low – research shows 70-90% of people benefit from medication
• access to other types of support is also limited

High costs of not treating ADHD

When ADHD isn’t treated, it costs the UK about £17 billion per year.

This is because people with untreated ADHD are more likely to:

• struggle at school and drop out
• be unemployed long term
• develop mental health problems
• misuse substances
• end up in the criminal justice system

What the report recommends

Start support early

• help families with young children through parenting programmes
• support children in schools before they need a formal diagnosis
• don’t make children wait for a diagnosis to get help

Make schools more supportive

• train teachers to understand and support children and young people with ADHD
• expand mental health support teams in schools
• create whole-school approaches that help all neurodivergent children

Change how services work

• let GPs and nurses do more ADHD care (not just hospital specialists)
• use technology to speed up assessments
• create ‘one-stop-shop’ services for young people (ages 11-24) that deal with all their needs together

Improve quality and fairness

• set clear standards for what good ADHD assessment and treatment looks like
• make sure all service providers (NHS and private) meet these standards
• reduce unfair differences in who can access services

Better support while waiting

• provide clear information about waiting times
• offer help and support to people who are on waiting lists
• connect people with peer support groups

Medication

• ADHD medication works well for people with ADHD but is not used enough in England
• it should be offered when needed (but not as the only support option)
• make it easier for GPs to prescribe ADHD medication

Key messages

• ADHD support shouldn’t only come from the health service – schools, employers, and the justice system all need to help
• don’t wait for a diagnosis to offer support – if someone is struggling, help them based on their needs
• treat ADHD like other common long-term conditions (like diabetes) – with ongoing care mostly from GPs, not just specialists
• prevention is better than crisis management – early support saves money and improves lives
• quality matters – all ADHD services need to meet proper standards and be properly regulated

Conclusion

The report says ADHD has been neglected for too long. With proper support, people with ADHD can thrive. The current system isn’t working well enough, waiting times are too long, and changes are needed across health, education, work, and criminal justice to help people with ADHD live to their full potential.

Our 15 recommendations

For the changes to happen it will need:

• cross-government working and policy changes
• incentives for different sectors and organisations to work together on transformation for ADHD at a national, regional and local systems level
• a combination of preventative, early support strategies
• increase in the capacity and efficiency of NHS services that provide ADHD assessment, care and support
• improved regulation and quality of ADHD services

NHS service providers can’t currently meet demand for ADHD assessment.

We made 12 recommendations in part 1 of the ADHD Taskforce report. We now make 15 extra recommendations, some of which build on our part 1 recommendations.

The part 2 recommendations need to be read alongside part 1 of the ADHD Taskforce report.

Early years support

1. Grow early years support via early years hubs. Support should be prioritised for people from the poorest households/areas and minority groups and children with behavioural challenges or where children or parents have ADHD features.

2. Department for Education, NHS England and the Department for Health and Social Care should continue to use and increase school programmes to include ADHD/neurodivergence (mental health support teams, whole school approach, and Partnerships for Inclusion of Neurodiversity in Schools (PINS).

They should make sure school and education training and policies improve inclusion and reduce the negative impacts of ADHD.

3. Government (across all departments) should think about starting, testing and assessing integrated youth services (youth wellness hubs) in England.

Increasing skills of the workforce and support for people of all ages with ADHD

4. The Royal Colleges of Psychiatrists, of GPs and of Paediatrics and Child Health, NHS England and Department for Health and Social Care (DHSC) as well as other bodies should quickly build skills and training in how to spot if someone has ADHD and how to support them.

DHSC should pay for training programmes across health including primary care.

5. Government departments need to think about how training is delivered on ADHD and neurodivergence to services who work with people with ADHD.

6. The Department for Health and Social Care should support GP practices to take on some parts of ADHD care. The GP contract should include funding for training and support after a diagnosis.

Regulate and make sure of quality ADHD services

NHS England and the Department for Health and Social Care should:

7. With The National Institute for Health and Care Excellence (NICE) work together to set out what is an ADHD qualified healthcare professional and what qualifications are needed for different areas of ADHD care.

• Work with professional groups to find important data needed for improving quality and research, and either produce or recommend already published quality standards.

8. Make sure there is good regulation and accountability of all ADHD commissioning and ADHD providers across England. This will need a quality standards framework for ADHD.

The Care Quality Commission should have oversight of all ADHD service providers.

9. Make sure people with ADHD don’t wait any longer for an assessment than they would for other health Check data on ADHD wait times, rates of ADHD diagnosis and treatment across England.

Commissioners and providers need to provide data on ADHD assessment wait times, how many people are diagnosed with ADHD and what medication is given.

Expand service capacity

10. The National Institute for Health and Care Research and other research funders need to think about an evaluation of how best to support, triage and prioritise people on ADHD waiting lists and how best to deliver services safely given the lack of evidence on optimum approaches.

Meantime, integrated care boards, ADHD commissioners and providers should improve wait times straight away and look at strategies used through quality improvement programmes. This should not rely just on questionnaires but have an experienced team member to collect extra data.

NHS England and Department for Health and Social Care and ADHD service commissioners:

11. Need to support and encourage ADHD service providers to co-develop with people with lived experience and offer a range of different support.

12. ADHD services and clinicians need to work with the ADHD community, to find good ways of working.

This will help increase the amount of people with ADHD that can be seen and supported by:

• sharing tasks
• expanding skills of the current workforce
• training extra new staff

Education, work, the criminal justice system

13. NHS England, the Department for Health and Social Care, the Department for Education (DfE) and the Department for Work and Pensions (DWP) need to work together:

• to carry out the recommendations of the ADHD Taskforce, DfE Neurodivergence Task and Finish Group and DWP Expert Panel to transform systems
• to lower the inequalities people with ADHD face when accessing support with Ministry of Justice (MoJ) and Ministry of Housing, Community and Local Government so that this works across all systems

14. The Ministry of Justice needs to build its own taskforce to help people with ADHD in the prison system.

There is a striking lack of access to support and treatment for people with ADHD in the criminal justice system.

There is not much research on people with ADHD in the criminal justice system and not enough understanding of how unrecognised and unsupported/untreated ADHD increases vulnerability to crimes such as child sexual exploitation and sexual violence.

15. Legacy of taskforce: we recommend that NHS England and Department for Health and Social Care find a way to oversee, monitor and review so that the recommendations of the ADHD Taskforce are carried out.