Attention Deficit Hyperactivity Disorder: Diagnosis

Maria Caulfield Excerpts

Wednesday 1st February 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I thank my right hon. Friend the Member for Tatton (Esther McVey) for securing this important debate. I believe there are two more debates on this issue next week in this Chamber, so she is leading the way in securing this debate, as a starter for that further consideration.

This is a really important issue. We know that people with ADHD have positive traits, strengths and abilities, such as creativity, resilience and the ability to hyper-focus. My right hon. Friend referred to her constituent Tanya Bardsley, who has shown that people with ADHD can be extremely successful, but there are also challenges, as she clearly set out, in living with ADHD and in getting a diagnosis, which is often necessary for people to get the support they need. I am not going to pretend that there is not a problem with accessing assessments at the moment. Many of my constituents also come to see me about that, and many have to go private to get a diagnosis. I fully acknowledge that that is not acceptable.

NICE, which provides the evidence-based guidance, says that commissioners and providers should have due regard for the evidence base when designing and commissioning services. However, my right hon. Friend highlighted a number of key issues that hamper how patients and their families access services. NICE does not actually recommend a maximum waiting time for a diagnosis, so there is no benchmark or gold standard to measure services against. That means that services sometimes struggle to meet what we would consider an acceptable waiting time for assessment. NICE sets out considerations about who should make a diagnosis and the criteria for diagnosis, but the long waits are due to the fact that there is no benchmark for the maximum waiting time.

The second issue that my right hon. Friend highlighted is a national dataset for ADHD assessment waiting times. There is no national collection of data and I note that she said that charities have gone to each ICB for data. In a way, it is encouraging that that data is there, but we need to pull it together nationally so that we have oversight and, as she put it, a waiting list dashboard that we can see. That would be useful not only to see what is happening in terms of best practice but to identify any gaps in certain parts of the country that may have longer waiting times than others.

I am certainly happy to pledge to my right hon. Friend that I will look at that. We are doing so much work in this area at the moment. For decades, mental health services, including neurodiversity services, have been the Cinderella service in health, with physical health much more predominant. We are making the change now to achieve parity of esteem between the two services, but there is a lot of work to do to catch up, and having the data to be able to measure waiting times and standards is a key part of that.

As my right hon. Friend set out, diagnosing ADHD is challenging, because there is no definitive test for it. There are a number of indicators that could suggest an assessment is needed, but someone needs to be seen for that to happen. ADHD often exists in conjunction with other conditions, whose symptoms can overlap and mask those of ADHD. The NICE guidelines aim to improve the diagnosis of ADHD, as well as the quality of care and support that people with ADHD receive.

The NICE guidelines also recognise that ADHD is under-diagnosed in women and girls, and that the indicators are very different. In my work in mental health, we see the consequences of that in young women and girls being admitted to mental health in-patient facilities and having a higher rate of suicide. My right hon. Friend is absolutely correct in what she says.

There are a number of ways in which we are trying to improve access to assessment and diagnosis. Many children and young people seek diagnosis through child and adolescent mental health services, but there are pressures on those services too. We are providing funding to increase access; in the last financial year, £79 million was allocated, which allowed 22,500 more children and young people to access mental health services. As my right hon. Friend eloquently said, it is vital that a person gets a diagnosis as early as possible in their life, so that they get support as soon as possible.

We know that children with ADHD and other neurodiverse conditions such as autism can thrive in and out of school if they get the support they need. We have a trial under way in Bradford looking at an early diagnosis tool to help teachers, parents and others to identify the needs of those with neurodiverse conditions. If successful, that could be expanded across the country. I will update Members as soon as we have the results of the pilot, because we are keen to see improvements in attendance, behaviour and educational outcomes in schools, as well as in the quality of life experienced by children and their parents. The tool is not intended to replace clinical diagnosis, but it should enable support to be made available earlier to children and their parents while they wait for an assessment and a diagnosis.

We also have the special educational needs and disabilities Green Paper, which sets out proposals to improve the outcomes of children and young people with SEND, including those with ADHD, and we will publish a full response to the Green Paper in an improvement plan imminently. Hopefully, my right hon. Friend will feel that that addresses some of the issues that she has raised today.

One of the best forms of practical support that I have seen is the mental health support teams that are now being placed in schools. There are currently 287, which support 4,700 schools, or around 26% of pupils. That figure will increase to 35% of pupils in April. The teams support teachers to identify children who may have ADHD, other neurodiverse conditions or mental health issues, and get them signposted and into the system much quicker. The service is making a real difference on the ground, and we are keen to expand it as quickly as possible. As my right hon. Friend said, children and young people with ADHD suffer higher rates of anxiety—nearly 50% higher than the general population—which is why we need to get that support in as quickly and easily as possible.

I acknowledge that we are not where we want to be with support for ADHD, whether on diagnosis, support or access to assessments. When we respond to the Green Paper, we will hopefully show that we are serious about changing that and making support more easily available. The Bradford pilot will hopefully improve access to services, but the key is getting the data. I commit today to look at the data on waiting times and at a dashboard, because we cannot plan services if we do not know how many people are waiting for an assessment and an ADHD diagnosis. I completely acknowledge that point.

I am happy to meet my right hon. Friend’s constituent Tanya Bardsley. She sounds like an amazing woman—experts by experience are very valuable indeed. I know that there is more to do to improve access to ADHD assessments, but I hope that I have reassured my right hon. Friend that we take the issue seriously.

Question put and agreed to.