Why ICB Decisions Are Driving a Two-Tier ADHD Care Model

Why ICB Decisions Are Driving a Two-Tier ADHD Care Model – an Independent Provider’s Experience

The UK is facing a growing ADHD crisis. A severe lack of understanding, awareness and, crucially, funding has left tens of thousands of people struggling to access the assessments and care they desperately need. Not only does it impact the individual, but also the support network around them. Delayed assessments and treatment result in family dysfunction and stress, school disruption, constant attendance at primary care, and misdiagnosis of other mental health conditions result.

Delays impact far more than individual health, they also carry serious socio-economic consequences, including reduced productivity, greater reliance on social services, and a higher likelihood of involvement with the criminal justice system. The recent BMJ article (BMJ 13 August 2025) clearly demonstrates the many preventative benefits of treating ADHD “ those who took medication had a reduced risk of first occurrence of suicidal behaviour, substance misuse, transport accidents and criminality”.

In the past 6 years ADHD360 has assessed and cared for 51,946 patients. That’s 51,946 lives changed. We see the struggles of patients and families every day and we are alarmed at recent NHS decisions that will exacerbate the unnecessary suffering and introduce new barriers for individuals to live their best lives.

Integrated Care Boards (ICBs), which control funding for local NHS services, have chosen to maintain budgets for traditional services whilst ignoring the evidence as published in the BMJ, the potential savings and the preventative nature of mental health services such as those for ADHD.

Indicative Activity Plans (IAPs) have been introduced for independent providers such as ADHD360, but not inefficient NHS Trusts, to manage budgets and support financial planning. In practice many ICBs are using them to conceal their decisions to reduce ADHD funding and favour other services. IAPs are being applied without transparency or public scrutiny, despite the regulatory requirements in the NHS Payment Scheme. In practice ICBs are now refusing to fund patient choice referrals once internal financial caps are reached. which is effectively blocking access for many patients.

At the core of UK healthcare is evidence-based medicine; unfortunately, it is not supported by evidence-based funding.

ICBs are suggesting that independent providers increase the waiting times for their NHS funded patients to move the costs into following year’s budgets, rather than act transparently and make public their flawed and uninformed decisions available for scrutiny and challenge.

With NHS waiting times now reaching up to eight years in some regions, traditional healthcare services are clearly not equipped to meet the scale of this crisis. As Health Secretary Wes Streeting has acknowledged, the NHS requires the support of the independent sector to cope.

ICBs are ignoring this advice. ADHD care is now largely delivered by independent providers. Reducing funding for ADHD is impacting the ability of independent providers to meet the needs of patients exercising their right of choice.

Moreover, many ICBs are introducing gateways that restrict the ability of patients to freely exercise their right of choice. Interface services and unnecessary access protocols are being introduced; in practice they are creating the health inequalities they are promoted to remove. Patients and families with the skills and experience to navigate the ICB barriers can exercise the right of choice, those experiencing the greatest inequalities are unable to access the care they need.

The practical impact of this is that it creates a two-tier system of care:

• Those who can afford private care are able to access diagnosis and treatment promptly
• Everyone else is trapped in a broken system of unbearably long waiting times, including those under RTC.

Worse still, this effectively defeats the very purpose of Right to Choose, a scheme specifically designed to provide access to all the country’s healthcare resources and utilise the capacity in the independent sector – the very solution Wes Streeting advocates.

To date, only 40% of ICBs have been willing to engage with ADHD360 to discuss these caps. The proposals we have seen so far suggest a 20-30% average budget reduction compared to last year – this coming at a time when demand is increasing revealing a significant 50-60% reduction in the funding for actual referrals. This lack of engagement and transparency is creating a dangerously uneven playing field as patients without financial means are forced to wait years and years for support.

Phil Anderton, CEO at ADHD360 said, “The national system shuts the door. ADHD360 opens it. We were built to run towards the problem – because ignoring it costs lives and money. Every pound invested in ADHD care can return significant NHS savings. Until ADHD is treated as a preventative care priority rather than a cost centre, patients will keep losing out. ADHD360 are constantly working to keep their fees competitive and affordable for those who can find the money for their treatment. It is time for the NHS to support the patients with the greatest need.”

ICBs are exercising their choice of which services to fund, which providers to engage with, and which patient rights to ignore. It is time for ICB commissioners to find the confidence, courage to effectively allocate their budgets to improve the lives of their patients, not simply support traditional healthcare – return the right of choice to patients not the ICB finance team.

It’s clear that things need to change.