Complaints Over Autism and ADHD Services in England Have Tripled in Five Years
Complaints about autism and ADHD services in England rose from 410 in 2021-22 to 1,257 in 2025-26, an increase of more than 200% over five years, according to data published by the Parliamentary and Health Service Ombudsman on August 26, 2026. The figures, drawn from analysis of 3,000 complaints, form the evidence base for a new report by Ombudsman Paula Sussex titled "Improving ADHD and Autism Services: Commissioning With Confidence."
The report identifies three recurring systemic failures. First, patients face persistent confusion about their right to choose a provider under NHS arrangements (the "right to choose" lets patients pick an alternative NHS-funded provider when waiting times are too long). Second, diagnoses are inconsistently recognised across NHS and private providers, creating gaps in continuity of care. Third, waits for assessment and treatment remain lengthy. Open NHS referrals for ADHD and autism assessment and support in England have reached roughly 562,000, with more than 60% of adults and children on those referrals facing waits exceeding a year. Separately, the Ombudsman's office reported in July 2026 that more than 800,000 people in England are waiting for an NHS assessment for ADHD or autism, a figure that covers a broader patient population than the open-referral snapshot.
The sheer volume of complaints has also overwhelmed the Ombudsman's own operations. The office reported a six-month waiting time for processing incoming complaints, driven by the surge in autism and ADHD-related cases.
Individual cases detailed in the report illustrate the operational failures at the commissioning and provider levels. Rich, a 48-year-old patient, was wrongly denied a referral to Psychiatry UK by NHS South East London integrated care board (ICB). ICBs are the local bodies responsible for planning and funding NHS services in their area, having replaced clinical commissioning groups in 2022. In Rich's case, the ICB insisted he use a local ADHD service that was not yet operational. The denial delayed his NHS treatment by five months and led him to pay almost £4,000 for private care. In another case, South London and Maudsley NHS foundation trust removed a woman from the ADHD medication titration waiting list without warning or valid reason, leaving her without specialist monitoring support for approximately six months. A further case involved a patient who received an autism assessment lasting just 50 minutes, which failed to follow guidance from the National Institute for Health and Care Excellence (NICE).
In a published case study, the Ombudsman found that it was not appropriate for a young person with autism to wait over 18 months for diagnosis and treatment. The Ombudsman has also previously stated that almost nine in ten people waiting for an autism assessment wait beyond the recommended 13-week threshold.
The report lands amid broader policy movement. In December 2025, the UK government commissioned clinical psychologist Professor Peter Fonagy to lead an independent review examining the prevalence of, and support for, ADHD, autism, and mental health conditions. That review is ongoing.
The trajectory of these complaints, a tripling in five years, tracks alongside a well-documented rise in demand for neurodevelopmental assessments across the NHS. Several intersecting pressures help explain the volume: increased public awareness of autism and ADHD, particularly among adults and women historically underdiagnosed; the expansion of "right to choose" legislation enabling patients to select alternative providers; and commissioning structures that have not kept pace with referral growth. ICBs hold responsibility for local service design, but the Ombudsman's findings suggest significant variation in how those duties are carried out.
The inconsistency in diagnosis recognition across NHS and private providers points to a fragmentation problem. Patients who obtain private diagnoses, sometimes after long NHS waits, frequently encounter ICBs reluctant to accept those diagnoses for medication prescribing or ongoing care. The result is effectively a two-tier system where the ability to pay determines not just speed of assessment but continuity of treatment. Rich's case, in which an ICB directed a patient to a non-operational local service while denying access to an available provider, is a concrete instance of commissioning decisions overriding clinical need.
The broader context here is one of local autonomy outpacing national coordination. The Ombudsman's call for standardised guidance addresses a gap that ICB-level commissioning has not filled. Without national protocols on provider choice, diagnosis recognition, and maximum waiting times, local variation will likely continue to generate complaints at the current rate. The Fonagy review may eventually provide a framework, but its terms are broad, covering prevalence and support across ADHD, autism, and mental health conditions collectively. Whether its recommendations will address the specific commissioning failures the Ombudsman has identified is an open question.
