Attention deficit hyperactivity disorder (ADHD) services: why consistency, oversight and better planning matter now 

Demand for ADHD services has risen sharply in England with up to 18,915 new referrals for possible ADHD in December 2025, a 17.3% increase from December 2024¹, placing significant pressure on commissioners, providers and patients alike. Public discussion of this trend can quickly become polarised, particularly when it drifts into debates about whether demand is “real,” whether too many people are seeking assessment, or whether individual providers are getting it wrong.

But that is not the most helpful lens.

A more practical question could be: how can ADHD services be commissioned, governed and delivered in a way that is consistent, clinically robust and fair for patients, while also ensuring responsible use of public money?

As demand grows, the system is becoming more complex. NHS-funded pathways involve a mix of public and independent providers, often operating with different assessment models, follow-up arrangements and cost structures. In that environment, some variation is inevitable. The challenge is making sure it reflects legitimate differences in patient need or local service design - not unwarranted inconsistency in access, quality or value.

In our view, the central issue is not simply one of capacity, it is one of oversight, consistency and planning.

Where there is rapid growth in demand, more providers entering the market, and a range of local commissioning approaches, it becomes harder for systems to maintain a clear view of how services are working in practice - and how demand is likely to evolve next. Without that visibility, it may be difficult to answer some basic but important questions. Are pathways being applied consistently? Are patients receiving broadly comparable standards of assessment and follow-up? Are commissioners paying similar amounts for similar services? And does local capacity reflect likely future need?

These questions go to the heart of patient confidence, clinical governance and the stewardship of public resources.

We believe a more mature model is needed - one built on clearer service expectations, proportionate oversight and a shared understanding of what good looks like across NHS-funded ADHD pathways.

That starts with acknowledging the importance of unwarranted variation.

Variation in itself is not evidence of poor care. Different populations and local systems will always produce some differences in demand, pathway design and treatment choices. But when variation becomes too wide, or cannot be readily explained, it should prompt closer examination. This might include differences in assessment volumes, waiting times, diagnostic outcome patterns, prescribing patterns, follow-up arrangements, discharge practices, or the overall cost of care per patient.

Looking at these patterns does not mean second-guessing clinical judgment or reopening unhelpful debates about diagnosis. It means giving commissioners and providers a stronger evidence base from which to understand how services are being delivered and where greater consistency may be needed.

This is where data can play a valuable role. Applied consistently across providers, a well-designed dataset can strengthen oversight and help systems move beyond headline demand figures to understand the pathway in more detail.

For example, commissioners may benefit from visibility on referral sources, throughput, time spent in assessment, diagnostic outcome patterns, prescribing patterns, follow-up activity and onward handoff into ongoing care. No single metric can tell the whole story, and data should never be used in isolation. But taken together, these indicators can help identify where further review is warranted and where deeper discussion between commissioners and providers may be needed.

That kind of approach is not about creating a punitive environment. It is about enabling proportionate assurance.

This also has implications for commissioning. If ADHD pathways are to be delivered consistently across a mixed-provider landscape, contracts need to do more than secure capacity alone. They should set clear expectations around clinical accountability, pathway design, follow-up arrangements and the core data needed for oversight, while giving commissioners the ability to pursue targeted audit or additional clinical review where warranted. That would help translate broad principles on quality and consistency into a more practical operating model.

Commissioning also needs to anticipate future pressure, not simply respond to what has already emerged. Predictive demand analysis and capacity modelling could help commissioners better understand where demand is likely to rise, how local need may vary, and what level of assessment and follow-up capacity will be required across the pathway. In a system that has often been forced to respond reactively, that kind of planning capability could support earlier intervention, more equitable access and more sustainable use of resources.

This matters because demand is unlikely to be evenly distributed. Local population characteristics, referral behaviour, service awareness, backlog, and access to specialist support may all shape how pressure emerges across different systems. Better planning can help distinguish between temporary surges and structural demand, and support decisions about where capacity should be expanded and how pathways should be configured.

In this sense, better data should not only help systems understand variation after it appears. It should also help them anticipate pressure before it escalates. That creates an opportunity to move from reactive management to more strategic commissioning; aligning resources more closely to likely need, rather than relying solely on historical activity or visible backlog.

A stronger data and governance framework could also support a more confident relationship between the NHS and independent providers. The use of mixed-provider models is not unique to ADHD, and it is unlikely to disappear. The real opportunity, therefore, is not to frame public and private provision in opposition to one another, but to develop a clearer blueprint for collaboration: one with transparent standards, agreed datasets, explicit quality expectations and a more consistent approach to oversight.

Patients could then have greater confidence that services are being delivered to comparable standards, regardless of provider. Commissioners would be better placed to manage cost, quality and access in the round. Providers would operate within a clearer and fairer framework.

ADHD services are receiving national attention, and there will understandably be calls for more capacity, faster access and clearer policy direction. All of these matter, but alongside them, there also needs to be a stronger focus on the mechanics of commissioning, governance and planning.

Because sustainable improvement will not come from rhetoric alone. It will come from building pathways that are transparent, evidence-led and capable of giving patients, providers and commissioners confidence that care is being delivered consistently, planned intelligently and funded responsibly.

The immediate priority is not to inflame the debate. It is to improve the system around it. And that means better visibility, better oversight, and a clearer understanding not only of what good practice looks like now, but of where need is likely to grow next.