By Alison Williams, Assistant Director

A Turning Point for Adult ADHD

Professor Peter Fonagy’s independent review of mental health (MH) conditions, ADHD and autism marks a significant moment for ADHD in England. Moving beyond debates about diagnosis rates, the review challenges systems to rethink how they support people with ADHD to live healthy, productive and fulfilling lives. Its core message is clear: demand is rising, waiting times are unacceptable, and diagnosis alone is not enough. It outlines how future services must provide personalised, needs-led support across the life course.

Moving Beyond Diagnosis

Historically, ADHD pathways have focused on assessment, diagnosis and treatment. Yet many people continue to experience long waits, fragmented care, inconsistent access to medication and limited psychological support.

The review signals a shift towards a needs-led model, where individuals can access advice, interventions and psychosocial support while awaiting assessment. Future pathways are likely to be more personalised, preventative and responsive, ensuring support is available when it is needed most.

ADHD as a Population Health Priority

Perhaps the most significant shift is the move towards viewing ADHD through a population health lens. Future systems will need a deeper understanding of population need, inequalities in access and outcomes, co-occurring conditions, and the impact of ADHD on education, employment, relationships and wellbeing.

This aligns closely with Integrated Care Board (ICB) ambitions to strengthen prevention, early intervention and proactive support through neighbourhood-based models of care.

Integrated, Outcomes-Focused Care

The data shows that ADHD rarely exists in isolation. Many people experience co-occurring MH, neurodevelopmental and physical health conditions, requiring more integrated models of care.

Future pathways are likely to be delivered through multidisciplinary teams spanning primary care, MH, pharmacy, social care, employment support and the voluntary sector. Aligned to neighbourhood health models, the aim is to provide coordinated care organised around the individual rather than organisational boundaries. This means that success will also be measured differently.

Increasingly, systems will focus on outcomes such as health, wellbeing, employment and quality of life, supported by population analytics, demand modelling and real-time performance insights.

A Digitally Enabled Future

Technology will play a critical role in improving access, experience and scalability. Digital triage, virtual consultations, remote monitoring and online psychoeducation offer significant opportunities to enhance care while supporting workforce sustainability.

Looking Ahead

By 2030, adult ADHD services and support could look fundamentally different, with earlier intervention, shorter waiting times, greater integration and a stronger focus on the outcomes that matter most to people, improving health and wellbeing across the life course. If they are done well, systems can move beyond simply managing demand towards delivering timely, personalised support that enables people with ADHD, and those awaiting assessment or diagnosis, to thrive and reach their full potential.

How TPHC Is Supporting the Future of Adult ADHD Services and Support

Many of the recommendations outlined in the Fonagy Review are already being progressed across London. Over the past year, TPHC has worked with NHSE, ICBs and provider organisations to support the redesign of adult ADHD services and wider system transformation.

1) Supporting End-to-End Improvement of London’s Adult ADHD Pathway

Working with 100+ stakeholders across national, regional and local systems, we have supported end-to-end improvement of the adult ADHD pathway across London. By bringing together clinical evidence, operational insight, best practice and local expertise, we have collaborated with clinicians, commissioners, contract leads and operational leaders to help shape more consistent, integrated and sustainable models of care.

Key outcomes have included:

• Strengthened system-wide collaboration through engagement with 100+ stakeholders across national, regional and local organisations.

• Reduced variation and improved quality across ADHD services through the development of a shared service specification framework and recommendations for ICBs.
• Enhanced primary care capability to support assessment, treatment, shared care and ongoing management.
• Improved consistency and equity of access through the design of a pan-London optimal adult ADHD pathway.
• Developed a practical implementation blueprint, aligned with policy, evidence and best practice, to support sustainable system transformation.

Importantly, this programme has helped shift the focus from waiting list management to whole-system redesign, closely reflecting the direction of travel set out in the Fonagy Review.

You can read more about our pan-London work by reading our ADHD Transformation case study.

2) Driving Digital Transformation

Alongside this work, TPHC is leading discovery for the London MH Online Programme, including the ADHD Virtual Pathway, exploring how digital innovation can support earlier intervention, improve access and deliver more personalised care.

The programme aims to create parity between digital access to mental and physical healthcare by establishing a true digital front door to London’s MH system. Rather than simply signposting users or digitising existing processes, it seeks to remove barriers to access, simplify navigation and help people receive the right support at the earliest appropriate point, in a way that works for them.

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What our clients say

”TPHC’s support in advancing the NHSE London ADHD programme has been great so far. Their expertise in strategic transformation and service improvement will enable meaningful, sustained improvements across the pathway—ensuring people receive the right interventions and care to help them thrive in every aspect of life.” 

Maria O’Brien, Chief Executive of West London NHS Trust and Senior Responsible Officer for the NHSE London ADHD Programme

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