NHS Right to Choose – Stop this Change
NHS England is about to make getting an ADHD Assessment and ADHD support harder.
If you want to stop waiting times rising further and keep your constitutional right to NHS Choice, your Right to Choose, then protest against this change.
Video Updates
Campaign Update
Responding to NHS England’s Statement
Summary
NHS England is in consultation about changes that when will mean the end of Right to Choose as we know it. This change affects people in England only.
Local NHS Areas (Integrated Care Boards / ICBS) are being given the ability to restrict your access to use Right to Choose options. Instead of being seen as soon as your Right to Choose choice can see you – your local Integrated Health Board will through payment levers decide when you are seen. As ICB failure to choose to resource ADHD services adequately, and consequent long wait times, is the reason most need to opt for Right to Choose we expect those same ICBs to restrict access to their patients accessing Right to Choose.
We are protesting this on that both plan and process is not fit for purpose. The use of the technical changes in a backwater consultation of the NHS Payment Scheme to put through such a large-scale change isn’t appropriate.
We do not think it meets the requirements of the Health and Social Care Act because it creates a mirage of choice rather than real choice.
They wouldn’t want this restriction if they aren’t going to use it.
We anticipate ADHD Assessment waits to jump almost immediately from months to multiple years. These changes will be fast. The consultation ends at the end of February. Implementation from the 1st April and the first impacts seen almost immediately.
We need to push to stop this right now and with your help we think we can.
Each and every one of us needs to write to our MP and ensure our voice be heard. Right to Choose was a right given to the people by Parliament and only Parliament should decide its future.
NHS England has now clarified that despite language to the contrary (they have told us they will do it differently next year), and a form that doesn’t allow you to select responding as an individual, we can respond to the consultation. It is therefore important they we do so. You can get details on responding here.
Who this impacts
People in England
This is an NHS England change. Right to Choose is not an option in the other devolved Nations
Everyone accessing NHS ADHD services
Local NHS ADHD services will be further stretched. This will impact wait times for new assessments, availability of annual reviews, and availability of review appointments.
Your New ADHD Assessment
This will curtail your ability to be seen outside your NHS area. When you could wait 2 to 4 months many will instead wait 10+ years.
Your current Right to Choose Treatment may be stopped
Your provider may be no longer funded to provide their treatment and/or annual review for you. They will be forced to discharge you to the local waitlist.
Some detail on what's happening
A bureaucrat’s sleight of hand is removing NHS patient choice
There is a bureaucrat’s sleight of hand happening to make a major change in the NHS without proper political oversight. The NHS’s “terms and conditions” [a.k.a NHS Payment Scheme Policy] are being used to remove NHS Right to Choose / NHS Choice as we know it. One simple clause – buried in the change to the NHS Payment Scheme Policy – changes Right to Choose.
About NHS Right to Choose?
NHS Right to Choose was given via two Acts of Parliament. The 2009 Health Act and the 2018 Mental Heath Act and reconfirmed in the current Health and Social Care Act. It applies to England only. It allows you to have NHS care in any part of NHS England. Not just your local NHS.
Why this change shouldn’t happen in this way
We don’t think this change should happen at all. But irrespective of that no change as significant as this should be done in this way.
- The Right to Choose your NHS care was given to the people by Parliament as sovereign. It is wrong to remove this universal Right without it being debated and decided in Parliament.
- Such large changes should not be made before Wes Streeting’s 10-year NHS plan and NHS England’s ADHD Taskforce have yet reported. They report in a few months. Allowing big changes to happen prior to those strategic overviews circumnavigates proper representation and review.
- The General Public has not been adequately consulted. The NHS Payment Scheme consultation was not promoted to the public; the consultation forms are misleading (NHS England has acknowledged their need to change its language), and the form itself is clearly not designed for the public. Such an important change should have proper public consultation.
- The health inequalities review is inadequate. There is a single paragraph on the impact on disbabled people (denying any impact) – despite this change, have a significant impact on people with the disability ADHD and other disabilities.
- The rapidity of the process does not allow for adequate risk management. NHS England is currently unable to proper monitor those it is failing via long waits for ADHD treatment. Right now NHS England is being forced to respond to a prevention of future deaths notice about someone who took their own life while waiting for ADHD assessment and treatment. The implementation of this change will de-facto reduce NHS access to ADHD Assessment and Treatment capacity and, as a consequence, we have no doubt it will cost lives.
- This change restricts people’s ability to be seen outside of their local NHS area. The impact on regional inequality has not been evaluated.
- Without options in the NHS then opting elsewhere becomes solely the preserve of those who can pay to go private. The impact on economic inequality has not been evaluated.
Timeline
Now
Consultation “Open”. There has now been “clarification” that members of the public can respond. We have details on that here.
Feb 28th
Consultation ends
April 1st
New terms implemented
April 1st to 30th
Right to Choose Providers told their service limits. We expect most to be capped at 25-40 patients per year per area. Many areas have over 10,000 people waiting. This is a reward for failure as this negatively impacts the worst NHS waitlist areas the most.
Consequently
Waitlists climb. Right to Choose provider wait times move from weeks to years. NHS ADHD services, already overwhelmed, become even more buried. NHS waitlists – now not as reduced by Right To Choose – climb even faster.
This goes against NHS Choices (a part of the NHS Constitution)
Right to Choose was created as the NHS’s safety valve against local NHS service failures. If your area’s NHS bureaucrats are underperforming – for example, a failure to resource a clinical area properly means waits of years for you compared to just weeks next door – you can instead be seen in next door’s NHS service. Regardless of who is running that NHS service – a local NHS trust, a GP surgery (often private), a pharmacy (usually private), or other private organisation. NHS choice is specifically patient choice for NHS care regardless of NHS contracted provider:
The NHS is offering more and more options to enable you to make choices that best suit your circumstances, giving you greater control of your care, and hopefully better results….in most cases you have the legal right to choose the hospital or service you’d like to go to. This will include many private hospitals if they provide services to the NHS and it does not cost the NHS any more than a referral to a standard NHS hospital. [Link to source]
Wes Streeting has consistently argued for more use of private sector organisations in the NHS.
The changes specifically target NHS Right to Choose pathways and services that are run by private organisations. Wes Streeting has consistently said he supports the private sector helping with wait lists in the NHS. However, this action is in direct contradiction of that.
working class people should not be left behind while middle and upper class people get to jump the queue. [Link to source]
… That’s why I am determined to rid my department and the NHS of any cultural sniffiness about dealing with the private sector…
…There will be more arguments to be won along the way, against the ideologues who do not believe the NHS should have any relationship with the private sector … [Link to source]
What is happening in ADHD Assessments now?
The NHS sub-contracts substancial parts of its work – Pharmacies like Boots, most GP surgeries are private companies.
Local NHS ADHD Assessment wait times are sometimes in the millenia (over 2,000 years for patients in Sheffield), often over a decade, and usually years [Source: BBC Verify] which means many patients have counted themselves lucky to have a choice outside their area.
ADHD services are under additional pressure because GPs are dropping ADHD patient care as a part of their industrial action [Source]. This means ADHD patients are being passed back to already overwhelmed local services.
A substantial number of NHS Integrated Care Boards have contracted out ADHD Assessments and Support to private medical providers. This has been essential in getting ADHD wait lists down.
What is this change?
This change restricts each NHS contracted provider to just 25-40 patients per NHS area. The clause limits expenditure to £100k per Right to Choose provider for each ICB area that equates to 25-40 patients per NHS area. Some areas have over 10,000 people waiting. Restricting service when the local NHS has failed their population so badly is wrong.
Many Right to Choose providers would be unable to take on any new patients because of GPs refusing to take on monthly medication due to a combination of: GPs industrial action, and a lack of NHS support for GPs to issue and manage ADHD medication.
Speaking to industry insiders we estimate this will reduce NHS ADHD assessment capacity by 100,000 per year. Right now the NHS capacity would take 8 years to get through its backlog [Source: BBC Verify]. The NHS needs this capacity to deal with the ADHD Assessment backlog.
The important clauses highlighted
6.1 Elective and activity-based payments
We propose that commissioners will be required to set payment limits for elective services, and all services paid for on an activity basis, based on the
value of planned levels of activity.
About this proposal
106. We propose that commissioners will be required to set a payment limit for elective services, and all services paid for on an activity basis, where the planned value of activity is above £0.1m. This would cover nationally and locally priced services and apply to both NHS and independent sector providers, including Community Diagnostic Centres (CDCs).
… “will in effect reduce the choices available to that patient” …
What happens next?
The NHS’s bureaucratic aim was a quiet back-water change. A change that would go unnoticed and unchallenged until it had been signed, sealed and delivered.
It is a clever strategy:
- it’s hidden away,
- the public has limited in its ability to input
- it’s complicated so harder to get it understood to get energy into any opposition campaign,
- it has some vagueness to it – they can argue it’s just an option. That vagueness allows them to argue we can’t truly tell how bad it is going to be. It allows some to say, “Let’s just see what happens and then protest if we need to”. At which point it will be too late.
- they can argue it just helps with planning. Healthcare can’t always be planned. If an ICB commissions support for 1000 people with heart attacks, you don’t expect them to stop support at person 1,001.
If we don’t make noise. If we don’t challenge it. They will succeed.
What do we expect to happen if this succeeds?
All the following problems will get worse:
- ADHD Assessment wait times for both adults and children will go up. For some those are already 10+ years
- Medication Reviews and Annual Reviews after initial titration will become even more difficult.
- The number of people who have to stop ADHD medication because of NHS failures will increase. This includes:
- Children moving from child to adult services. This is already awful, with many finding medication stops at 18 and is dropped for years. This often has long-term life implications.
- Children or Adults moving NHS areas. Right now you have to have a new assessment each time. Each time you are back of the queue. Unless you went Right to Choose.
- GPs dropping their ADHD patients to local ADHD services that are overwhelmed. We’re aware of multiple cases of patients being dropped and finding medication suddenly stopped.
- A lack of annual reviews for ADHD medication, meaning people are dropped from their ADHD medication
People currently receiving medication via Right To Choose may find it stopped.
In effect Right to Choose will almost certainly be constrained into effective oblivion.
We don’t agree with this change. But regardless of that this is too big and too important a change to be done without public scrutiny. Choice is a fundamental part of the NHS constitution. A right given by Parliament. It shouldn’t just be taken away in a hidden away terms-and-conditions change.
Please protest this change by writing to your MP today.
Further Information / Progress Updates
Our response to NHS England’s Statements
Clarification from NHS England that individuals can respond to the consultation but serious problems remain about how an individual’s response is included, treated, and the impact of it.
Clarification from NHS England
Clarification from NHS England that individuals can respond to the consultation but serious problems remain about how an individual’s response is included, treated, and the impact of it.
Over 12,000 emails to MPs!
ADHD, and this issue, is on the political agenda as it has never been before. We strongly believe that this is likely a sea change moment in how the political class view ADHD. We’ve proven ourselves as an important part of the electorate. That has the potential to be game-changing.
Question tabled in Parliament asking for guarantees on waiting times
Helen Morgan MP (LibDem Health and Social Care Spokesperson) has tabled a question to government ask if they will guarantee no deterioration in waiting times and if there will be any any minimum access guidance.
We asked NHS England if they can provide that guarantee. They said: “I couldn’t sit here nationally and give any guarantees at all”.
The government can give guarantees. We await their response.
New elective contract ‘unworkable’, say providers
HSJ (Health Services Journal) 21 February 2025 (Note: Paywall)
- New payment rules would force private hospitals to treat NHS patients free because of new payment cap, sources claim
- Lobby group says rules are “problematic”
- Guidance says providers are “obliged to accept referrals” but may not get paid
New national payment rules for private providers of elective care are “unworkable” and will undermine patient choice, the sector is warning.
…Independent sector sources say NHS England’s proposed 2025-26 contract, which will cap the amount commissioners will pay for elective activity, will effectively force private hospitals to treat some NHS patients for free….
…Private sector leaders told HSJ it effectively meant they could have to treat patients who choose them for free if their cap is reached. Sector sources said it was financially unviable for providers, and one branded the proposals “unworkable”… [Full article available here]
Last time NHS England published news on the NHS Payment Scheme was 2015 – nearly a decade ago. This is no place for major patient change.
NHS England is using a change to the NHS Payment Scheme to bring in a major change to Right to Choose. Their own records indicate that they didn’t publish news on it. In fact – they last published any news on the NHS payments system in 2015. Nearly a decade ago.
You can repeat the search yourself here: https://www.england.nhs.uk/news/?filter-keyword=&filter-category=payment-system
A backwater consultation to a backwater document is no place for major patient change. NHS England’s plan and process on this wrong.
Some Responses from MPs
Rt Hon David Lammy MP (Lab, Tottenham) Secretary of State for Foreign, Commonwealth and Development Affairs
I appreciate you sharing your concerns with me, and I sympathise with all those who have struggled, and continue to struggle, to get ADHD assessments.
Despite NHS England’s consultation now being over, I was glad to see that it allowed for the views of the public to be expressed, particularly views from those living with ADHD. The legal requirement is for NHS England to consult with health commissioners and providers, so I appreciate that this access was extended to the public. I also recognise that the language of the consultation did not make this clear enough, and NHS England has stated that it will improve this for future consultations.
Now that the consultation period is complete, NHS England will review the responses received and consider the perspectives of those involved before deciding its next actions.
It is vital that we work to improve our understanding of the challenges people living with ADHD face. I support NHS England’s ADHD Taskforce, which was established to look at current provisions and support access sectors, and their impact on patients. It is bringing expertise from the healthcare, education, and justice systems, and a focus is on improving access to services and support.
It is the responsibility of integrated care boards (ICBs) to ensure that their local patients receive appropriate support and care, including ADHD assessments. ICBs must operate within guidelines set out by the National Institute for Health and Care Excellence.
Wait times across the NHS are too high, and they need to be reduced urgently. It was great to see the Government has already met its target of delivering two million extra NHS appointments in its first year, seven months early. This was a pledge that I was elected on, and I am proud that it has been achieved so quickly.
Thank you once again for contacting me about this important issue.
Yours sincerely,
David
Rt Hon. David Lammy MP
Member of Parliament for Tottenham
Consultation Links and Information
The NHS Payment Scheme Consultation
Click here to directly access the NHS Payment Scheme Consultation. 15 documents, 399 pages. One single reference to the true impact on patients:
… “will in effect reduce the choices available to that patient” …
Guidance on responding to the consultation
The short answer – which we consider outrageous – is that you can’t. Only “qualified” organisations can respond. Despite it impacting you directly – neither us as a charity nor you as an individual are allowed a say. We strongly think that is wrong and ask you to write to your MP.
… only objections to the proposals from ICBs and “relevant providers” that count for the purposes of the statutory objection process. This means only these objections can determine whether NHS England can proceed to publish without further consultation …
The NHS Constitution
The NHS Constitution enshrines a patient’s rights to choices across the NHS. In doing so it ensures the National Health Service doesn’t devolve into the Regional Health Service. A patient in one part of the country should have the same rights to care as someone in another part of the country – this change over-rides this Constitutional right.
… you have the right to choose which provider (and the team within that provider) you are referred to from all those who have a contract to provide the service …
Our Patient Guidance for Right to Choose
We provide guidance to help patients understand their options for their NHS ADHD Assessment. Right now the shortest wait times are under a month.
