What the system can learn from our complaints and engagement
In recent years, we have seen a significant increase in complaints relating to ADHD and autism services. In 2025 to 2026, we received 1,257 complaints compared with 410 in 2021 to 2022, which represents an increase of over 200%. The issues raised span national, regional and local levels of the NHS, showing there are system-wide challenges that need national leadership and coordinated action across policy, commissioning and delivery.
These challenges affect both children and adults. There are also pressure points when people move from children’s and young people’s services to adult services.
The increase in complaints has happened at the same time as rising referrals for ADHD and autism assessments and more people waiting for assessment, treatment and support. This can be seen in various reports, such as the NHS ADHD Management Information, the NHS Autism Waiting Time Statistics, Nuffield Trust’s ‘Access to services for autism and ADHD’ and a research briefing for the House of Commons on ADHD statistics (England).
While complaints often relate to a single organisation, our investigations frequently point to underlying issues that span multiple parts of the NHS.
We have also engaged with a wide range of stakeholders to test, challenge and refine the findings in this report, including national policymakers, commissioners, NHS England teams, regulators, professional bodies, providers, advocacy organisations and independent experts. This reflects the fact that ADHD and autism services operate within a highly complex and rapidly evolving system where complaints are only one part of the picture. Our engagement highlighted the different pressures, perspectives and responsibilities across the system while reinforcing many of the themes emerging from complaints.
The issues and opportunities identified through these conversations and learning from our casework should also be viewed in the context of the Government’s independent review into mental health conditions, ADHD and autism. While the review is broader in scope, there is significant overlap between its emerging themes and our findings. Both point to a system struggling to keep pace with rising demand, including:
- the need to move away from service models focused primarily on diagnosis towards services that offer clear and practical support to help people live well
- the importance of providing help while people wait for assessment
- the challenges created by variation in local commissioning, service design and access to support.
Stakeholders also highlighted a shared concern that lasting improvement will require wider system reform, stronger coordination across organisations and a clearer vision for how ADHD and autism services should develop in the future.