Complaints have risen by almost 206%
The Parliamentary and Health Service Ombudsman reviewed evidence from 3,000 complaints about ADHD and autism services. It reported that complaint volumes had risen from 410 to 1,257 over five years, an increase of almost 206%. The recurring themes included uncertain referral rights, lengthy waits, fragmented care and diagnoses not being recognised consistently across NHS and independent providers.
In one investigated case, a 48-year-old man asked to be referred to an NHS-funded provider for ADHD treatment. His Integrated Care Board refused and directed him to a local service that had not yet opened. The Ombudsman found that the decision was wrong, that NHS treatment was delayed by five months and that he spent almost £4,000 on private care.
What the Ombudsman wants to change
- Clear national guidance explaining access to ADHD and autism services and the patient's right to choose a provider.
- More support for Integrated Care Boards so that commissioning decisions are consistent and lawful.
- Better coordination between assessment, diagnosis, medication titration and continuing care.
- Care Quality Commission registration for NHS-funded providers that deliver assessments but not ongoing care.
- A system in which location does not determine whether a person can understand or obtain the care available to them.
What Right to Choose actually means
For a qualifying elective mental-health referral in England, a patient can choose a clinically appropriate provider that holds a qualifying NHS Standard Contract for the required service. The right can include the first outpatient appointment and subsequent treatment required as a result of that referral. A local commissioner does not have to hold its own contract with the chosen provider if the provider already holds a qualifying contract with another ICB or NHS England.
Assessment and treatment are not always the same service
A provider may offer an NHS-funded assessment without providing medication titration, prescribing or long-term follow-up. Before choosing, ask what happens after diagnosis, whether ongoing treatment is included, how shared-care requests are handled and what happens if the GP will not accept a shared-care arrangement.
The reasons given for refusal matter
Test the explanation you receive
| What you are told | What to ask | Why it matters |
|---|---|---|
| We do not contract with that provider | Does the provider hold a qualifying NHS Standard Contract with any ICB or NHS England for this service? | A local contract is not always required for a qualifying patient-choice referral. |
| You must use the local pathway | Which rule or clinical reason prevents the requested referral? | A referral-management pathway should not obstruct an applicable legal right. |
| The provider is private | Is the requested service being offered under an NHS Standard Contract rather than as a private purchase? | The same organisation may provide both NHS-funded and private services. |
| It is not clinically appropriate | Who made that assessment, what information was considered and what alternative is clinically appropriate? | Clinical judgment can be relevant, but the reasoning should be clear and individual. |
| The waiting list is closed | Is the provider refusing referrals, or is the local body refusing to send one? | Those are different decisions made by different organisations. |
| Your GP will not prescribe afterwards | Does this concern the referral itself, future shared care or both? | A future prescribing issue should not be disguised as an unexplained refusal at the referral stage. |
What to do if your choice is refused
Build a decision that can be challenged
Ask for the refusal in writing. Record the requested provider, service, date and person or body making the decision.
Ask whether the refusal is clinical, contractual, administrative or based on a local commissioning policy.
Confirm that the provider offers the required service under a qualifying NHS Standard Contract and can accept the referral.
Ask the referrer to reconsider the request against NHS England's patient-choice guidance, not only the local pathway.
If the decision came from an ICB or referral-management service, request its written reasons and the applicable policy.
Use the NHS complaints process against the organisation responsible for the refusal. Identify the decision, rule, evidence and outcome you want.
If local resolution does not correct the problem, consider the Parliamentary and Health Service Ombudsman after receiving a final response.
A focused request for reconsideration
I asked to be referred to [provider] for [service] under my NHS right to choose. Please confirm in writing who decided not to make that referral, the precise clinical or legal basis for the refusal, whether the provider's qualifying NHS Standard Contract was checked, and what evidence was considered. Please reconsider the decision against NHS England's current patient-choice guidance and explain the complaint route if the refusal is maintained.
Why the regulatory gap matters
The Ombudsman has also highlighted a gap affecting some NHS-funded providers that conduct ADHD or autism assessments without providing ongoing care. It says these assessment-only providers are not currently registered with, inspected or monitored by the Care Quality Commission in the same way, and has recommended that this should change.
For patients, the practical consequence is that an NHS-funded pathway can still involve several organisations with different responsibilities. A complaint should therefore identify which part failed: referral, assessment, acceptance of diagnosis, treatment, medication monitoring, shared care or continuing support.
Why this matters to ConsumerWise readers
This story demonstrates why a confident refusal is not necessarily a correct one. Patients can be told that a local pathway is the only route, that a provider is unavailable or that no choice exists, yet the underlying rule may say something different. The most effective challenge separates the legal entitlement from the clinical judgment and asks the decision-maker to evidence both.
The bottom line
The Ombudsman's findings do not mean every requested referral must be accepted. They show that patients are encountering preventable complexity, inconsistent decisions and, in some cases, incorrect refusals. A proper decision should identify the responsible body, the applicable choice rule, the clinical reasoning and the route for challenge.
Official sources
- PHSO: National guidance needed to improve ADHD and autism careThe 25 August 2026 report announcement, complaint figures, case examples and recommendations.
- NHS England: Patient choice guidanceOperational guidance for commissioners, providers and primary-care referrers on legal patient-choice rights.
- GOV.UK: NHS Choice FrameworkThe government's explanation of choices available to NHS patients in England and what to do when choice is not offered.
- PHSO: How to complainThe Ombudsman route after the relevant NHS organisation has had an opportunity to respond.
