The Nottingham City Council Health Scrutiny Committee met on 2 October 2025 to discuss neurodiversity support services and review the committee's work programme. The committee scrutinised the service approaches being taken to support children, young people, and adults with autism¹ and attention deficit hyperactivity disorder (ADHD)². The committee also agreed to change the date of their next meeting from 18 September 2025 to 2 October 2025.

Neurodiversity Support Services

The committee reviewed the service approaches for supporting individuals with autism and ADHD, focusing on both children and adults. The discussion covered challenges in service delivery, improvement plans, referral pathways, and efforts to reduce waiting times.

Key discussion points included:

• Service Demand and Capacity: The Neurodevelopmental Specialist Service (NeSS) is experiencing high demand, receiving over 400 referrals each month, leading to waiting lists of over 3.5 years. The committee heard that the service was originally commissioned for a quarter of this amount.
• Referral Pathways: The Neurodevelopmental Pathway & Support Team (NPST) serves as the initial point of contact for children and young people with potential autism or ADHD, triaging referrals and gathering information to inform clinical assessments.
• Waiting Times: For children referred between the ages of 6 and 17 years and 10 months, the maximum waiting time from referral to review is 77 weeks, with an average of 40 weeks. For those aged 5 and under, the maximum wait is 57 weeks, with an average of 21 weeks. Average waiting times from referral to first intervention are now at 8 weeks, reduced from 39 weeks in April 2025.
• Support During Waiting Periods: NeSS aims to provide support and transparency regarding waiting times, offering information and resources through its website, including links to support groups and mental health services.
• Medication Shortages: A national shortage of ADHD medications that began in December 2023 has led to a backlog of patients waiting for treatment.
• Right to Choose: The increase in alternative providers due to patient choice legislation³ presents challenges regarding the quality of assessments and GP confidence in shared care arrangements.
• Integrated Care System (ICS): An established ICS reporting structure exists for learning disability and autism, with emerging engagement from a wider workforce to support autistic people.
• Adult Mental Health: The Autism Joint Strategic Needs Assessment (JSNA) highlights inequalities associated with mental health, including higher rates of co-occurring conditions and suicide.
• Service Improvements: Actions to improve services include streamlining diagnostic processes, training more clinicians in autism assessment, and offering training and consultation to colleagues outside NeSS.
• Waiting Well Initiatives: NPST has implemented several initiatives to support families while they wait for assessments, such as a new referral form, ADHD-specific parenting programmes, and increased information sharing.
• Internal Service Improvements: Changes to internal referral allocation and management have reduced internal waiting times. A higher priority waiting list has been implemented for certain referrals.
• Service Pressures: The service is experiencing increased referrals, more complex cases, and a lack of trauma/attachment services, leading to referrals to the neurodevelopmental pathway due to similarities in observed behaviours.

The committee was provided with a report titled All-Age ADHD/Autism Provision, and appendices titled Impacts on children in school waiting for an ADHD/autism diagnosis and Under-14s Community Paediatric evaluation for ADHD/autism.

The report noted that:

Autism is a lifelong neurodevelopmental condition that affects how people perceive, communicate and interact with others, although it is important to recognise that not all autistic people see themselves as disabled.

The report also noted the recommendations of the ADHD Taskforce, which stated that:

demand is likely to rise, the Taskforce recommended early prevention in the form of needs led services uncoupled from diagnosis, and that ADHD services need to be digitised, and data improved.

Work Programme

The committee reviewed its work programme for the 2025/26 municipal year, considering issues identified by members and any further suggestions arising from the meeting. The committee agreed to change the date of their next meeting from 18 September 2025 to 2 October 2025.