Every Integrated Care Board (ICB) and NHS trust in England is carrying an ADHD or autism assessment waiting list that is either unacceptable by clinical standards, politically uncomfortable, or both. In many footprints the lists now exceed three years for adult autism and two years for adult ADHD. Children's waits are shorter on paper but longer in practice once the full EHCP pathway is included.
Commissioners have five realistic options. Each has trade-offs. This guide is a straight-talking summary written for the people actually making these decisions. For broader context on how Right to Choose is reshaping the provider market, see The UK Right to Choose ADHD Provider Landscape in 2026.
Option one: do nothing, let the list extend
This is, in practice, the default. Resources stay fixed, demand continues to rise, and the waiting list absorbs the gap. It is the cheapest option in-year. Over two to three years it becomes the most expensive, because untreated ADHD and autism generate downstream costs in education, employment, criminal justice, and secondary mental health. National Audit Office analysis has flagged this pattern repeatedly.
Use this option when: the waiting list is stable or shrinking. Almost never true in 2026.
Option two: expand NHS in-house capacity
The traditional answer. Recruit substantive clinicians, train them up, and scale the service over twelve to twenty four months. Clinically this is the cleanest option because it preserves the full NHS governance chain.
The problem is speed and supply. Substantive recruitment for specialist ADHD and autism clinicians typically takes six to twelve months per post, often longer. Training someone new to ADOS-2 takes a further three to six months before they are reliably independent. For a service trying to clear a two-year waiting list this option is the right long-term answer but contributes almost nothing in the first twelve months.
Use this option when: you have a genuine multi-year workforce plan and the list is not yet politically toxic. Pair it with one of the other options for in-year impact.
Option three: refer more patients into Right to Choose
For adult ADHD, Right to Choose (RTC) is already doing significant heavy lifting. Patients exercise their statutory right under the NHS Constitution to choose a non-NHS provider, the home ICB funds the assessment under tariff, and the waiting time is typically weeks rather than years.
This works. It is also expensive at the ICB level, because tariff is paid per assessment and costs scale linearly with volume. It does not work for children, where RTC does not apply in the same way. And it depends entirely on the RTC provider market having enough assessor capacity to absorb the volume. In 2025 and early 2026 several RTC providers paused new referrals because they ran out of assessors, not money.
Use this option when: you commission adult ADHD and the RTC provider market still has capacity. Validate the capacity question with the provider directly before increasing referral volume.
Option four: commission a private provider to run a backlog clearance programme
A defined-scope block contract with a private neurodiversity provider to assess a specified cohort of patients within a specified timeframe. This is distinct from ongoing RTC referrals because it is a one-off programme with fixed scope and fixed pricing.
This is the fastest way to move the numbers. Well-scoped programmes clear thousands of assessments in weeks. It requires upfront capital and careful patient selection, but the results are unambiguous. The clinical governance question is the one commissioners need to be sharpest on. The best programmes embed peer review, caseload oversight, and safeguarding protocols comparable to NHS standards. The worst treat backlog clearance as a volume exercise and generate quality concerns downstream.
Use this option when: you have a defined backlog, capital to deploy, and a provider with genuine governance capability.
Option five: augment in-house capacity with agency assessor workforce
Instead of commissioning a separate provider to run the programme, the NHS service or ICB brings in agency assessors to work within the existing service. The patients stay on the NHS service's books. The governance chain stays with the substantive clinical leadership. The agency supplies the clinicians and handles compliance, but the service runs the programme.
This is the option most often misunderstood. It is not a locum rota. A well-run agency workforce programme supplies a scoped team of specialist clinicians for a defined duration, typically eight to twelve weeks, with peer review, supervision, and throughput reporting built in. Mobilisation is faster than substantive recruitment, typically weeks rather than months. Cost sits between RTC tariff and substantive staffing, and scales with team size rather than per-assessment.
Critically, this option preserves the service's clinical identity. For services that want to clear a backlog without transferring patients to an external provider, this is usually the right answer.
Use this option when: you want to keep patients on the NHS service, you have clinical leadership capacity to oversee an expanded team, and you need impact measured in weeks rather than years.
The honest combined recommendation
In most ICB footprints in 2026, the right answer is a combination. Use RTC to drain the adult ADHD list. Use an agency workforce programme to clear the autism backlog while keeping patients in-house. Start substantive recruitment in parallel for the twelve-to-twenty-four-month picture. Avoid treating any single option as the whole answer.
Where Vantis sits
Vantis runs the agency workforce option. Our ADOS-2 trained autism assessors, ADHD specialists, and clinical psychologists have delivered backlog clearance programmes at scale, including 3,000 ADHD assessments in eight weeks for an NHS trust in the north west and 600 combined ADHD and autism assessments in two months for a Birmingham private clinic. We scope programmes against clinical governance requirements from day one, not as an afterthought.
If you are weighing these options for your footprint and want a scoped proposal, get in touch and we will come back within one working day.