For many of the people languishing on years-long NHS waiting lists for autism and ADHD assessments, a pathway called Right to Choose (RTC) has been a vital lifeline. Funded by the NHS, RTC permits GPs to refer patients to an independent provider for assessment—and to start patients on treatment, if needed.
This system was designed in response to unacceptable wait times that are causing real harm across many areas of healthcare. It offered many families timely diagnosis, support and treatment for their children who had already been waiting years for help.
“Pausing” assessments
In recent months, as uptake of this process has increased, that lifeline has been quietly fraying. Several independent providers have recently published statements, saying their ADHD and autism RTC services are “paused” for NHS patients in some areas. NHS commissioners in these areas have instructed them to stop booking new Right to Choose assessments, until April 2026 for their patients—creating yet another postcode lottery.
These independent providers are clear: this is not their decision or a limitation in their capacity, but the decision of commissioners, and it’s entirely funding-based.
Less than eight months into the financial year, the number of assessments funded by some Integrated Care Boards (ICBs) has already exceeded budget limits. We may see more ICBs added to that list soon. Patients in these areas will now face an additional wait of at least five months, on top of the existing waiting lists, which can already exceed 12 months. The Right To Choose system, designed to provide timely access to care when NHS services are inaccessible, is now breaking under the strain. Once again, children with SEND are paying the price for another broken system.
What has changed?
The reason for the pause is clearly not a reduction in clinical need, but a change in how these services are planned and managed. This is a little complex, but it’s worth understanding these changes.
Integrated Care Boards (ICBs) are the bodies responsible for commissioning the NHS services needed within their geographical area. They replaced Clinical Commissioning Groups (CCGs). (But just to make things even more complicated, next year, many ICBs themselves will be undergoing reorganisation and merger.)
ICBs can contract private service providers, such as private psychiatry practices, to carry out assessments under the Right To Choose pathway. ICBs are under immense financial pressure after a recent directive to cut their budgets by 50%.
The technical stuff, explained
In 2025, NHS England updated the Standard Contract for “activity-based services”, for example, services that are paid per assessment. This includes Autism and ADHD assessments.
For these services, each ICB must set up an “Indicative Activity Plan” (IAP) with each provider. These plans set out how many assessments the ICB will fund in a financial (April-March) year, and how much this is expected to cost. If a provider and ICB cannot agree on the numbers, the ICB can impose a plan on the provider.
Power to limit services
Crucially, the contract also allows commissioners to set up Activity Management Plans (AMP), which can limit or pause services if the agreed limit is likely to be exceeded. Providers can challenge these decisions, but they must still comply with the limits imposed while disputes are worked through.
In short, ICBs now have stronger contractual levers to cap Right to Choose assessments—and they’re increasingly using them. It’s not entirely clear if ICBs are pausing assessments per individual provider or if they’re looking at the total number of assessments by all their contracted providers, then capping when the overall limit is breached.
No standard system
There also appears to be two different levels of suppression. In some cases, referrals can still be made, and the referral order is maintained—but assessments can’t be booked until the next financial year. In others, it seems some providers are no longer able to accept referrals at all for patients from some ICBs.
Responding to an FOI request about the pause, Greater Manchester ICB admits it has paused all non-urgent RTC referrals, and it’s implementing a new triage system for autism and ADHD assessments. This is to ensure those with the highest need are prioritised on waiting lists. In a Q&A, it states that those who are part of the way through the process, have an assessment booked, or are waiting the start of treatment, are unaffected. South East London ICB is also trialling a triage system for all referrals, according to the Clinical Partners website.
As with many of the services we rely on, the approach is inequitable across the country, with ICBs making individual decisions about how many assessments they will fund each year. It’s unclear how they are determining the agreed numbers for each provider and area. They may be projecting based on previous years, or they may be making those decisions based solely on the available funding. A lack of consistency in costs between providers makes the situation even more complex.
Which ICBs and which providers are affected?
Providers publishing clear statements about pauses or IAP-related restrictions include Psicon, ADHD-360, and Clinical Partners. The information is not always consistent across the providers, but the fact that multiple providers are publishing ICB-specific pauses makes it clear this is a commissioning issue, not an isolated provider problem.
The following ICBs are listed as having restrictions on one or more provider websites:
- Hampshire & Isle of Wight ICB
- Surrey Heartlands ICB
- Frimley ICB
- Black Country ICB
- West Yorkshire ICB
- Greater Manchester ICB
- North Central London ICB
- Coventry and Warwickshire ICB (pausing referrals for over 25s)
This list is drawn from publicly available statements on provider and ICB websites. It is not exhaustive, and other ICBs may have paused activity without publishing notices at this stage. It’s unclear whether the “pause” applies across all RTC providers, effectively suspending access to independent NHS-funded assessments in that area, or whether some providers may still have capacity where others have had to pause.
What this means
While the IAP system is presented as a tool for planning, it’s clearly being used as a blunt rationing instrument if allocations are set too low.
For families, this means deferred referrals will roll over into the next financial year, starting April 2026, immediately consuming a significant proportion of the following year’s capacity. This repeats the cycle we see throughout SEND and other public services: underfunded commissioning, backlogs, and outsourcing, which increases costs, reducing system funds and capacity. When systemic insufficiencies are not addressed, outsourced services become overwhelmed and more costly, which impacts services for all.
Do pauses affect people already on waiting lists?
It seems that patients who have been referred but not yet offered an appointment are most likely to be affected. Psicon states that patients in paused areas “will not be able to progress to assessment until new activity plans are issued in April 2026”. Clinical Partners say anyone referred to them before 1st June 2025 should be unaffected. The general message is that those who have an assessment booked, are mid-way through the assessment process, or are waiting for medication titration sessions should not be affected, but it’s worth reaching out to your provider to double-check if you live in one of the affected areas.
Why this matters for children and families
These delays are not simply an inconvenience. For some children, they are potentially catastrophic. Without timely assessment, children’s education, mental health, and development can suffer severe, long-term harm.
While SEN support in school, EHCPs, and Disability Living Allowance are based on needs rather than diagnosis, an up-to-date assessment report is valuable evidence of needs for those processes, and some specialist schools have diagnosis-related entry requirements.
For some children with ADHD, timely diagnosis and treatment can mean the difference between staying in school and falling behind or exclusion. The cost of a private assessment and medication titration is nothing compared to the long-term cost of school placement breakdown, lost years of education, alternative provision, and unmet potential.
When children are unable to attend school or are on reduced timetables, this also impacts parents’ health and their ability to work, causing further financial issues individually and for the state. However, self-funding an assessment is very expensive and simply out of reach for many people.
A knock on effect for next year
Early exhaustion of available assessment space indicates that Indicative Activity Plans are being set far below the level of need in some areas. Deferred referrals then roll into the next year, creating a repeating cycle of freezes, backlogs, and longer waits.
These pauses highlight a systemic issue: under-resourced services create cascading pressures on outsourced provision, with associated increased costs. Just as local authorities outsource SEND transport or utilise independent specialist schools to fill gaps, NHS-commissioned independent assessments are overwhelmed when the need exceeds what’s planned and agreed. The solution, as with education, is building investment and capacity in the system itself, but that’s extremely difficult to do when your system relies on more expensive outsourced services.
The result of all this has a greater impact on those who are most vulnerable or in need. Children with SEND are frequently the collateral damage of these failings, while simultaneously being blamed for how much their support costs. We see this repeated across education, health and social care after a decade and a half of austerity. It’s yet more evidence that cuts to public services create greater costs down the line—to services and to people.
What affected families should do now
- Don’t wait! If you’ve been considering asking your GP for an RTC referral, don’t delay. Even if your ICB isn’t on this list now, they may be close to their threshold too, and where referrals can still be made, the referral order is being preserved.
- Check the provider’s Right To Choose page if you have already been referred. Many list ICBs with paused bookings. Providers with guidance include Psicon, ADHD-360 and Clinical Partners.
- Check your status: Ask the provider whether the assessment is booked or you’re on a waiting list.
- Escalate urgent cases. If there is an immediate risk to your child’s wellbeing, speak to your GP about referring them for an urgent assessment, particularly in areas running a triage service.
- Keep records and escalate. Contact your local Healthwatch (while they still exist), PALS, your ICB, MPs, or patient advocacy groups if service limits cause harm.
What needs to change
The lack of consistency and regulation in this space is causing inequity across the country.
NHS has published draft ADHD and autism guidance for 2026/7 which sets out national standards for assessment prices, currency models, and definitions to standardise commissioning. This is still under consultation until 16th December, to which you can respond here. However, it’s only guidance as NHS England cannot direct ICBs to do specific things. Whether any consistency will materialise remains to be seen. Even if it does, there is no associated additional funding to cover the shortfall between need and what’s available.
While the Right to Choose still exists, we are seeing the waiting lists for these providers gradually increase, and that will be compounded by these enforced pauses. The limiting of Right To Choose assessments feels like an inevitability in the current climate—these services have been overwhelmed because of obscene delays within NHS services. Unless national funding addresses rising need, families will continue to face long waits from both the NHS and an increasing number of independent providers.
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- SEND reforms and the forgotten children at risk of exclusion
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Since then, Rachel has volunteered supporting local families through the EHCP and appeal process. She is passionate about the legal rights of disabled children and empowering parents to challenge unlawful decision making.
Rachel previously worked in publishing and international events before setting up her own business as an artist and tutor. For the last six years she has worked in co-production, predominantly within maternity and reproductive health, and strongly believes that SEND services should be designed alongside those accessing them.
Rachel founded local campaign group BCP Alliance for Children & Schools (www.BCPACS.uk) bringing together parents, education staff and unions to campaign against funding and service cuts within education. She also started the national Stop Safety Valve campaign
- Focusing on ADHD and autism diagnosis won’t cut costs and wastes money that should be spent on urgent support - December 9, 2025
- ADHD and Autism Right To Choose referrals paused as at least nine NHS areas tell providers to stop booking assessments - November 28, 2025
- Challenging SEND misinformation, one radio interview at a time - November 12, 2025
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