Over the past year, many families have noticed a growing number of providers offering ADHD and autism assessments through the NHS Right to Choose (RTC) pathway. At first glance, this can feel like a positive step forward, more choice, more availability and potentially shorter waiting times.
However, alongside this expansion, an important change has been happening behind the scenes in how services are planned and funded. This change centres around something called Indicative Activity Plans and it may shape what access to assessments actually looks like in practice.
What are Indicative Activity Plans?
Indicative Activity Plans are introduced and managed by local NHS organisations known as Integrated Care Boards (ICBs).
In simple terms, these plans set out:
- How many assessments a provider is expected and funded to deliver each year
- How NHS budgets are allocated across different services
- The overall level of activity the NHS can support within a financial year
For ADHD and autism services, this often means that each RTC provider is given a fixed number of assessment spaces for the year.
Once those spaces are filled, the provider may:
- Close or pause referrals
- Introduce waiting lists for the next financial year
- Redirect patients to alternative providers
Why is the NHS introducing these plans?
To understand this shift, it helps to look at what has happened in recent years.
Demand for ADHD and autism assessments has increased significantly. This reflects:
- Greater awareness and understanding
- Reduced stigma
- More people seeking clarity and support
In response, some RTC providers accepted very high numbers of referrals. While this increased access initially, it also led to:
- Extremely long waiting lists
- Backlogs stretching over several years
- Increasing pressure on NHS budgets
Indicative Activity Plans appear to be part of a new approach designed to:
- Create more predictable waiting times
- Prevent providers from becoming overwhelmed
- Manage NHS spending more closely
- Distribute demand across multiple providers rather than relying on a few large organisations
Why are there more RTC providers now?
You may have seen new providers becoming available through RTC, many offering remote (online) assessments across England.
This is part of a wider shift where ICBs are:
- Contracting with a larger number of smaller providers
- Expanding geographical flexibility through remote services
- Offering more apparent “choice” within the system
On the surface, this looks like a significant expansion in capacity.
However, Indicative Activity Plans suggest something more nuanced is happening.
Is capacity actually increasing?
This is one of the key questions for families.
While there are more providers available, each one may only be funded to carry out a limited number of assessments per year.
This means:
- The total number of NHS-funded assessments may not increase significantly
- Instead, the same (or similar) level of funding is being spread across more providers
In other words, the system may be shifting from:
A few large providers with very long waiting lists
to:
Many smaller providers with limited, capped availability
What does this mean in practice?
For families navigating the RTC pathway, this can lead to a mixed experience.
1. More choice but limited availability
There may be more providers to choose from, but each one may only have a set number of spaces available.
2. Faster access if you secure a place early
If you are able to access a provider before their allocation fills, waiting times may be shorter.
3. Services filling quickly
Because spaces are limited, some providers may reach capacity within weeks or months.
4. Ongoing uncertainty
Families may need to:
- Check multiple providers
- Move between options
- Reconsider pathways if availability changes
What should parents and carers keep in mind?
- Timing matters – availability can change quickly once referrals open
- Different providers operate differently – waiting times and processes vary
- Flexibility can help – considering multiple providers may increase your chances of access
- Support is still valid and important – seeking an assessment is a positive and appropriate step
A neuroaffirming perspective
It’s important to recognise that rising demand for ADHD and autism assessments is not a problem to be “managed away”.
It reflects:
- People better understanding themselves and their children
- Families advocating for appropriate support
- A shift towards more inclusive and informed approaches to neurodiversity
Needing an assessment is not about “adding pressure” to the system, it is about seeking clarity, validation and access to the right support.
System changes like Indicative Activity Plans are about how services are organised and funded. They do not change the validity of each individual’s experience or need.
Considering a private assessment?
If you are finding that NHS or RTC options are limited, unavailable or not progressing within a timeframe that works for your family, you may be considering a private assessment.
This can feel like a big decision and it’s important to have clear, supportive information.
If you are exploring this route, we are here to help.
We can:
- Talk through your options
- Answer any questions you may have
- Support you in making a decision that feels right for you and your child
Please feel free to get in touch with our team to find out more.