Securing a London Mental Health Board mandate for London’s first pan-system approach to adult ADHD transformation
| Outcomes at a glance |
|---|
| • Eight recommendations across three themes received a mandate for adoption from the London Mental Health Board in March 2026, with next steps agreed for adoption across London ICBs through their relevant governance structures |
| • Consolidated London-wide response coordinated to the NHS Payment Scheme consultation on ADHD guide prices for 2026/27, supporting a more consistent and equitable service offering across the capital |
| • London-wide adult ADHD service specification development now underway, built on TPHC’s robust baseline and mechanisms |
The challenge
NICE estimates that approximately 3.5% of UK adults have ADHD, equating to around 1.6 million people in England. When accounting for people with suspected but undiagnosed ADHD, the overall number affected is likely much higher. In London, just 16% of that population currently receive treatment, rising to 23% for those with moderate or severe ADHD. Waiting times are increasing and can reach up to eight years for adults. Behind those numbers is a system under significant and growing strain.
Fragmented pathways, inconsistent commissioning arrangements, and the absence of a clear national strategic steer have left each of London’s integrated care boards developing local responses in isolation, resulting in significant variation in how adults access assessment, diagnosis, and treatment. ICBs are at different stages of developing service specifications, accreditation approaches, and activity controls. For the adults navigating this system, the experience is often one of delay, inconsistency, and having to repeat their story across services.
The challenge is compounded for groups who are historically under-recognised. Girls and women with ADHD are frequently misdiagnosed or missed entirely. The Independent ADHD Taskforce has concluded that sustained improvement requires coordinated action at national, regional, and local levels. Lord Darzi’s 2024 review of the NHS underscored the same point: rising demand for ADHD assessment and treatment is overwhelming services and contributing to poor health outcomes. Despite this, only around 2% of mental health budgets are allocated to direct ADHD care.
The urgency for more responsive, equitable and innovative care pathways is reflected in the 10-year London Mental Health Strategy, which commits to exploring opportunities to strengthen assessment and treatment pathways through collaboration with ICBs, providers, primary care, and voluntary and community sector organisations.
At the same time, there is a clear appetite across the London system to work together. Aligning and standardising aspects of local service offers, and exploring Once for London opportunities for shared infrastructure and innovation, is possible. The work needed was a structured, evidence-based programme to build that shared understanding and translate it into actionable recommendations.
Our approach
TPHC partnered with NHS England London to develop a clear, evidence-based approach to transforming the adult ADHD pathway across the capital. Delivery was structured around an expert Clinical Reference Group comprising clinical, operational, and commissioning leads, supported by two subgroups focused on primary care and commissioning.
We engaged more than 75 stakeholders across London, including national, regional, ICB, and provider representatives. Through structured in-depth interviews with clinicians, commissioners, and operational leads, we surfaced the key challenges: long waiting times, fragmented pathways, and variation in diagnostic approaches. We also identified opportunities for innovation, including digital triage, shared care models, and workforce capability development.
Alongside stakeholder engagement, we carried out horizon scanning of UK and international best practice, and mapped both the current and idealised adult ADHD care pathway for London, including commissioning arrangements, service specifications, and shared definitions of care. This produced a clearer picture of where pressures are most acute and where improvement efforts would deliver the greatest system benefit.
We coordinated a consolidated London-wide response to the NHS Payment Scheme consultation on proposed non-mandatory guide prices for ADHD services in 2026/27, submitted on behalf of all London ICBs. We then developed an agreed set of recommendations for adoption across London, with a phased set of priorities for immediate and longer-term action, presented to the London Mental Health Board, which granted a mandate for adoption in March 2026.
The impact
This work gave NHS England London, ICBs, and providers a clearer shared understanding of adult ADHD services across the capital, surfacing major variation alongside a strong appetite for pan-London collaboration. That shared baseline, built through engagement with over 75 stakeholders, is itself a significant outcome in a system where no such common picture previously existed.
Eight recommendations across three themes received a mandate for adoption from the London Mental Health Board in March 2026: strengthening primary care capability for ADHD management; improving consistency in service standards, tariffs, and market management; and improving transitions of care. Next steps involve adoption across London ICBs through their relevant governance structures, as ICBs are the responsible commissioners for ADHD services. Implementation will support a London-wide ADHD capability framework, consistent training for primary care, shared service standards, and smoother transitions of care, laying the foundation for a ‘Once for London’ service specification with more seamless pathways and reduced health inequalities.
For patients, the programme directly addresses inequalities in access and experience. Clearer eligibility criteria and pathways will bring mental health care for ADHD closer to parity with the treatment of physical health conditions, and will specifically improve access for groups who are under-recognised, including girls and women.
The robust baseline and mechanisms established will support the development of a London-wide adult ADHD service specification. The programme is now moving into its next phase, with scoping underway for continued consulting support to accelerate progress, including a dedicated focus on Children and Young People engagement and pathway mapping, and a workstream on transitions of care.
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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