Which ICBs are rationing ADHD and autism assessments? September 2026

Summary

• 15 of England's 36 ICBs are capping, pausing or slowing Right to Choose ADHD or autism assessments, on their published statements and provider notices. Ten say so themselves, or in a message published on their behalf. Five are reported by providers.
• Four ICBs have a published minimum wait: West Yorkshire, North East and North Cumbria, Somerset and Devon.
• In most of these areas the GP can still refer, and the person joins their chosen provider's waiting list. What stops is the assessment, once the provider has used the number of assessments the ICB has agreed to fund for the year.
• The legal right to choose a provider has not been removed.

The 15 ICBs

Merseyside. We found no ICB statement that assessments in Cheshire and Merseyside are stopped until 2027 or indefinitely. The ICB says it is buying fewer and people will wait longer. The "before April 2027" wording is Kent and Medway's.

Published minimum waits

• West Yorkshire: "currently two years from the date of referral", for independent providers.
• North East and North Cumbria: "an approximately 78-week minimum waiting time for an initial assessment", for the providers it funds in 2026/27.
• Somerset: "a minimum wait of 52 weeks for new Adult ADHD and Autism Assessments", in a message published by ADHD 360. ADHD 360's own table, updated 11 September 2026, lists "Minimum waiting time 67 weeks". The matching message for children gives no timeframe.
• Devon: a patient "will have to wait a minimum of 14 weeks to be seen, with a potential maximum waiting time of 52 weeks" (NHS Devon referral guidance).

Only West Yorkshire's is longer than 18 months. North East and North Cumbria's approximately 78 weeks is about 18 months.

What this means for someone who needs a new referral

The legal right has not been removed. For a mental health referral, including ADHD and autism, a patient can choose any clinically appropriate provider that holds an NHS contract with any ICB or NHS England for that service. That is regulation 39 of the NHS Standing Rules Regulations, SI 2012/2996. We found nothing in the choice regulations that lets an ICB suspend it. In a written answer on 28 April 2026 about Hampshire and Isle of Wight, the government said: "We are absolutely clear that use of these must not restrict patients' choice of provider."

In practice, many people now face a wait of a year or more with no date. The same answer says: "Providers are not asked to close referrals or prevent access to the pathway but, where required, once planned activity levels have been met, they are asked to manage new referrals on a waiting list until they have capacity within their contracted activity envelope."

Other routes:

• The ICB's own local NHS service. The NHS website says waits can be "several months or years".
• A private assessment. NHS England's 2026/27 payment guidance says diagnostic reports from independent providers "should be accepted by NHS commissioned titration services, unless there is a clear clinical reason not to".
• A GP is not obliged to take on shared care prescribing afterwards. Black Country ICB says "Guidance issued by the General Medical Council states the GP is not obliged to enter into a shared care arrangement with any provider".

A rarely used duty: under regulations 47 and 48, if a patient tells the provider or the ICB that they will not start treatment within 18 weeks of referral, and the ICB is satisfied of that, the ICB must, subject to some exceptions, take all reasonable steps to offer an earlier appointment with a different provider (regulation 48). For ADHD and autism this applies only where the referral is to a consultant or a consultant's team, and the regulations do not make clear whether a diagnostic assessment on its own counts. This is our reading of the regulations, not legal advice.

Hampshire's prioritisation

Hampshire and Isle of Wight has not published its criteria. Its FAQ says: "No formal, standardised prioritisation criteria are held centrally by the Integrated Care Board" and "Prioritisation criteria for Right to Choose referrals are set by individual providers and may vary." Its guidance for GPs says providers "are expected to identify and prioritise higher-risk patients".

Its September update says new referrals will be assessed if they "meet clear clinical prioritisation criteria", but it does not publish those criteria or say who applies them. It says Right to Choose patients are "around 27% of all people currently waiting for an assessment" and "have typically waited considerably less time than those waiting for local services".

In a freedom of information response about its 2025/26 activity plans, stated to be accurate as of 10 December 2025, the ICB said there was "no legal advice sought or received".

By contrast, Greater Manchester says "Decisions about priority are made by clinical professionals", and West and North London says prioritisation "will be clinician-led within the provider".

What NHS England has said

ICBs are using NHS Standard Contract provisions, highlighted in NHS England advice, that let them set an "Indicative Activity Plan" with each provider. The same advice says "Clinicians should undertake waiting list reviews, but non-clinical staff can assist with related administration", and "Forms of stratification or clinical triage that are untested or lack an evidence base are likely to present risks, including potential harm to patients."

NHS England's contract guidance says an activity management plan "must not in any way restrict patient choice of provider". Its 2026/27 NHS Standard Contract technical guidance says that during 2025/26, 98 providers used its escalation process over indicative activity plans, across all services. Around half of those escalations were found in the provider's favour, and in nearly 90% of those cases the commissioners were "only found either not to have considered the equality or quality impacts of their plan, or, more often, not to have discussed their considerations with the provider". NHS England stood that escalation process down for 2026/27 and made following its guidance a mandatory obligation under the contract.

How this relates to our register

Our ICB Right to Choose register applies a stricter test: a documented cap or pause on the activity a commissioner will fund. On that test, at our last full check on 1 August, as corrected on 8 September, adult ADHD Right to Choose was capped or paused in 14 of England's 42 pre-merger ICB areas, home to about 19.3 million adults, 42% of adults in England (ONS mid-2024 estimates). North East and North Cumbria is not in that figure: we corrected it on 8 September to no status held, because a long wait on its own is not a cap. It has since published its approximately 78-week minimum wait, listed above. Register: https://finallyseen.org.uk/right-to-choose/icb-status

Method and limits

On 23 September 2026 we checked the published pages of the ICBs listed here and of the other ICBs named in provider notices. Where we found no ICB statement, we used notices from Right to Choose providers, and we mark those entries. "Capping, pausing or slowing" means an ICB statement or provider notice that assessments are capped, paused, delayed, or limited to the most urgent. This is not a census. An ICB not listed may have limits we have not found, and statements change without notice. England has had 36 ICBs since 1 April 2026.

How to cite

Source: Finally Seen, Right to Choose rationing briefing, September 2026, https://finallyseen.org.uk/right-to-choose/rationing-2026-09