People accessing ADHD and autism services in England are facing a postcode lottery, lengthy waits and confusing pathways, according to a new report from the Parliamentary and Health Service Ombudsman (PHSO).
Its findings highlight how fragmented commissioning and inconsistent access can leave people struggling to get the assessment, treatment and ongoing support they need – with potential consequences for their health, education, employment and wellbeing.
Complaints about ADHD and autism care have more than doubled
The Ombudsman’s report, Improving ADHD and autism services: commissioning with confidence, is based on findings from around 3,000 complaints.
It reveals an almost 206% increase in complaints about ADHD and autism over the past five years, rising from 410 to 1,257.
Recurring problems include:
- lengthy waits for assessment and treatment
- uncertainty over patients’ legal right to choose an NHS-funded provider
- diagnoses not being consistently recognised between NHS and independent providers
- significant regional differences in access to services
- gaps in regulation of some NHS-funded assessment providers.
The Ombudsman argues that although commissioning alone cannot resolve the gap between demand and capacity, the way services are designed and delivered can make these pressures worse.
When navigating care becomes part of the problem
One investigation illustrates the human impact of these systemic issues.
Rich, a 48-year-old student from South London, asked to receive his ADHD treatment from Psychiatry UK under the NHS’s Right to Choose arrangements. Instead, South East London ICB directed him towards a local service that was still being developed and had no opening date.
The Ombudsman found that this delayed his NHS treatment by five months. Rich ultimately paid almost £4,000 for private treatment.
He described navigating the system as “completely overwhelming”, particularly given the difficulties that ADHD itself can create around managing complexity and administration. The experience contributed to anxiety and severe insomnia.
In another case, a woman was removed from an ADHD medication titration waiting list without warning or a valid reason, leaving her without specialist monitoring for around six months.
These cases demonstrate that access to healthcare is not simply a clinical issue. Difficulties navigating fragmented systems can themselves create additional stress and uncertainty for people already seeking support.
A postcode lottery – and a regulatory gap
The Ombudsman is calling on the Government to introduce clear national guidance covering ADHD and autism services, including patients’ right to choose a provider.
It also wants greater support for Integrated Care Boards (ICBs) so they can make more consistent commissioning decisions that reflect local needs.
Another recommendation is for NHS-funded providers carrying out ADHD and autism assessments, but not ongoing care, to be registered with the Care Quality Commission. Currently, these providers are not routinely inspected or monitored, creating what the Ombudsman describes as a regulatory gap.
“People should not have to fight their way through a confusing system to get ADHD and autism care,” said Parliamentary and Health Service Ombudsman Paula Sussex CBE.
Why this matters to employers
For employers, the findings are a reminder that access to neurodiversity support does not end with the workplace.
Employees may be navigating long waits, inconsistent services or significant personal costs while simultaneously trying to manage their health, work and everyday responsibilities. This was a key issue that was raised during our recent Make a Difference Leaders Lunch focused on supporting families and carers through change and uncertainty.
That makes the workplace an important part of the wider support picture. Employers cannot solve problems within NHS commissioning, but they can consider how their own policies, occupational health provision, workplace adjustments and employee support interact with the realities their people are facing.
It also reinforces the importance of moving beyond awareness towards practical, accessible neuro-inclusive support.
For HR and wellbeing leaders, that might mean ensuring managers understand how to respond when an employee is struggling, making workplace adjustment processes straightforward, and providing clear signposting to appropriate sources of support rather than expecting employees to navigate everything alone.
The report is ultimately about more than improving healthcare pathways. It highlights the consequences when systems become too complicated for the people they are designed to support.
For employers seeking to build genuinely inclusive workplaces, understanding those barriers is an important part of the picture.
You can download the report here.
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