As an Integrated Care Board, we recognise the concern that waiting times can cause for individuals and families, particularly children and young people. We have been working hard to reduce large inequalities in waiting times while managing rapidly rising demand and costs.
Over the last few years, we have led a series of detailed engagement activities with our communities across West Yorkshire in relation to neurodiversity. This included two neurodiversity summits, resulting in feedback and a range of recommendations we have been implementing. Some of the action we have taken includes putting in place safeguards for urgent clinical cases, more than £4 million of additional investment this year, and work to develop Neurodiversity Hubs offering earlier, needs-based support.
Why we need to change
Demand for autism and ADHD assessments has risen significantly, including for assessments provided by independent-sector providers through Right to Choose. Right to Choose in the NHS provides patients with a legal right to choose where they have their NHS treatment, offering more options to enable people to make choices that best suit individual circumstances, giving greater control of their care. This has widened differences in waiting times between patients who have been referred to NHS Trusts and those who have chosen Independent Providers, ranging from more than five years to a matter of weeks respectively, and these can vary significantly across West Yorkshire.
The ICB’s spending on neurodiversity services has increased from £3 million in 2022-23 to £25 million in 2025-26. It is vital that we commission health and care services within the financial envelope we have available, whilst at the same time, work to reduce inequity in waiting times. Failure to address increasing costs in this area could have resulted in other services being reduced.
This summer, the ICB introduced a two-year minimum wait for routine referrals to Right to Choose providers for 2026-27.
Investment and responsible financial management
We have identified c.£30 million for neurodevelopmental services in 2026-27; £5 million above 2025-26 expenditure. Alongside this additional investment, activity plans for non-accredited Right to Choose providers who have not been assured through NHS West Yorkshire ICB’s accreditation process have been reduced to support a managed transfer towards accredited provision. Over the last six months, five additional accredited providers are now providing assessment for ADHD and Autism, all of which are based in West Yorkshire. We have reduced our non-accredited provider activity plans by 31% to fund activity with accredited providers. Overall, we are funding more capacity this year than last, spread across more providers, as new accredited providers have come on board.
Quality and oversight
The ICB has accredited nine independent sector providers alongside NHS Trust provision. Accredited providers must meet agreed standards for governance, quality, reporting and clinical practice. A West Yorkshire accreditation panel oversees approval and ongoing monitoring through a fair, transparent and consistent process.
Prioritising people with urgent clinical needs
The two-year minimum wait applies only to routine referrals as a mechanism to ensure equity across West Yorkshire. Expedited assessment remains available, with the aim to start an assessment within 12 weeks, when both of the following conditions are met:
- There are significant safety, physical health, mental health or education risks for which an expedited assessment would have a clear and immediate impact.
- The person is well and stable enough to consent to and meaningfully engage in the assessment process.
The above criteria have been introduced across all providers with a clear intention to address and reduce health inequalities for our communities across West Yorkshire, specifically those groups who face the most significant health inequalities.
People awaiting medication and safe ongoing monitoring are also prioritised over those waiting for assessment. Capacity for assessment of children and young people is also prioritised where possible within activity plans.
Longer-term transformation
Our longer-term transformation programme includes Neurodiversity Hubs, providing a single point of access, structured triage and screening, and needs-based support whether or not someone proceeds to diagnostic assessment. By connecting people with community, education, mental health, social and other support, the hubs will reduce reliance on diagnosis as the sole gateway to help.
Some areas of West Yorkshire are now procuring local hub services. Learning from the early hubs, alongside further clinical work on consistent diagnostic thresholds, will inform West Yorkshire commissioning expectations and public engagement during 2027. The two-year minimum wait will also be reviewed as part of 2027-28 planning to determine whether it can be changed or removed.