Services for individuals with autism and ADHD are “under significant pressure”, with patients “falling through the gaps”, a watchdog has warned.
A new review published by the Parliamentary and Health Service Ombudsman (PHSO) shows that demand is severely outstripping capacity.
Consequently, both children and adults with attention deficit hyperactivity disorder (ADHD) and autism endure “long waiting times, variations in access and fragmented care”.
Ombudsman Paula Sussex stated that patients “should not have to fight their way through a confusing system” to secure care in England.
She added that far too many people now feel forced to pay for private treatment, which is “not what good public services should look like”.
The PHSO review highlights a “growing tension” between the national ambitions and local delivery of services for ADHD and autism.
The review warned that a “postcode lottery of care” has developed and highlighted how complaints to the Ombudsman have risen from 410 in 2021/22 to 1,257 in 2025/26.
It comes ahead of a Government-commissioned review into ADHD, autism and mental health services, which is expected to be published imminently.
The PHSO review saw experts analyse 3,000 complaints about ADHD and autism over the last six years.
The common themes identified by the review team include:
- Patients not being given clear, accessible information about their right to choose – a legal right to pick an alternative provider.
- Long assessment waits.
- “Significant” delays when accessing ongoing care and support.
- “Inconsistent” recognition of diagnoses by the NHS following assessments from other providers.
- Difficulties accessing medication.
- Poor communication and “disjointed co-ordination” across service providers.
open image in galleryThe PHSO has called on the Government to publish national guidance to improve access to care and clarify patients’ right to choose a provider.
It also called for a “regulatory gap” to be closed, highlighting how providers offering NHS-funded assessments may not be inspected or monitored by the Care Quality Commission.
Ms Sussex said: “ADHD and autism services are under significant pressure, with demand outstripping capacity.
“Right now, the system is too complex and inconsistent, leaving too many patients falling through the gaps.”
She added: “People should not have to fight their way through a confusing system to get ADHD and autism care.
“We have seen clear evidence that this has created a postcode lottery, with too many people’s access to care depending on where they live.
“The way services are organised has real consequences for people. Patients are navigating confusing pathways, facing long waits, unclear decisions about their right to choose and inconsistent access depending on where they live.
“Too many are left feeling they have no option but to pay privately. That is not what good public services should look like.”
Henry Shelford, chief executive of ADHD UK, said, “Every day we see a wild difference in care across the country: whether you are seen in months or left waiting for years depends almost entirely on where you live.
“That is not an accident of demand — it is the direct product of wide variance in how ADHD services are commissioned.
“Behind every one of these 3,000 complaints is a person whose life is on hold. ADHD is not a trivial condition. Unsupported – it often costs people their education, their jobs, their health and sometimes their lives.
“When someone finally asks for help, the answer should not be a multi-year wait, a refusal of their legal right to choose or a referral to a service that has not even opened.
“The Ombudsman has diagnosed the system correctly and we urge government to follow the Ombudsman’s recommendations.”
A government spokesperson said: “Last December, we asked clinical psychologist Professor Peter Fonagy to lead an independent review, examining the prevalence of – and support for – ADHD, autism, and mental health conditions.
“Professor Fonagy’s final report will be published later this summer, and will inform our new national approach in this area.”