Delayed medication
24. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
25. Mr U Complains about the delay between the Service diagnosing R with ADHD, and the Service initiating his medication. He believes this was due to a lack of prescribers rather than about need and risk.
26. The Trust responded to Mr U’s April 2025 complaint by addressing the time period at the point of the complaint. The Trust recognised Mr U’s frustration and referred to the appointment with the ADHD nurse in May, and a follow up appointments that month to address what support and help the family needed. It said R would have an appointment for initiation of medication in August 2025, stating this was the next available appointment.
27. In The Trust’s final response in July 2025, the Trust apologised for the wait the family had endured. It explained there had been an unprecedented increase in the number of children and young people referred to the Service, resulting in increased waiting times for assessment. It noted Mr U had contacted the duty team throughout the waiting period, who had responded to his concerns.
28. It explained there are currently long waiting lists for medication initiation appointments due to the delay in assessments and the availability of consultants. It said consultants were also under pressure to review children already on medication within set timeframes. This impacted on their capacity to start new medications.
29. The Trust said the Service has attempted to recruit additional doctors to support the Service and to reduce waiting lists. It informed Mr U it had managed to increase the number of prescribers recently and it aimed to develop the role of nurses within the clinical team in the future to help meet demand.
30. We can see from records the Service referred R to the ADHD team in January 2024. In September 2024 the Service made the diagnosis of ADHD and informed the family R was on the waiting list for initiation of medication. R attended an appointment for the initiation of medication in August 2025. This is 11 months after the diagnosis was made.
31. During this time, we can see from records both R’s parents contacted the Service at various times to express their concerns about R and the escalating behaviour and requesting updates. The records document the conversations held and advice and updates provided by the Trust.
32. The NHS ‘18 week referral to treatment targets’ sets out its commitment to provide patients with non-urgent, planned hospital treatment – including operations, procedures or medication – with 18 weeks of referral by their GP.
33. This guidance sets out the target for the start of treatment to be 18 weeks. The guidance does not define treatment as medication. Treatment can constitute any form of intervention.
34. NICE ADHD guidance refers to the management of this condition but dose not identify any specific time-scales.
35. We can see the Trust held a multi-disciplinary meeting in January 2024 and assigned R to the ADHD pathway. In February it expedited R to the top of the waiting list.
36. We can see after this time, the Service held a number of appointments with R to complete the assessment and there was contact between the Service and the family with the provision of updates.
37. This indicates the Trust responded to the referral within the timeframe of 18 weeks as set out in the NHS guidance. It provided intervention in terms of assessment and advice. It put R on the expedite waiting list for the initiation of medication.
38. In December 2024, we can see a conversation between the Service and Mrs U. She expressed her concerns and explained the type of behaviours R was demonstrating. The Service considered the behaviours she was describing were more in relation to R’s autism diagnosis. It offered support to the family through Early Help but the family declined because they had already had this input. Early Help is a supported approach for families needing extra support before issues escalate.
39. We asked our adviser whether they considered the timeframe in which the Service offered R the appointment for the initiation of medication to be reasonable.
40. Our adviser considered the Service acted within NHS guidance as set out above.
41. They also felt the situation needed to be seen within the context of the national picture.
42. They referred to NHS digital information which indicates ADHD treatment waiting times are currently very long, often taking several years for an initial assessment, followed by as additional ten to twelve months for medication titration. Although the NHS digital website is dated December 2025, we have used the data as a guide to help illustrate the pressures on ADHD services nationally.
43. NHS data indicates the ADHD treatment wait breakdown to be: • Initial wait time: 32 to 40 weeks • Titration (medication) wait: 44 to 52 weeks • Total time (assessment and titration): two to four years
44. Our adviser also considered the Trust’s explanation of a lack of prescribers to be a reasonable explanation for any delay. Again, this falls into the national picture of increased demand on services and inadequate numbers of prescribers in all areas across the country to meet the demands.
45. We do not underestimate how frustrating the wait was for the family. We understand R’s behaviour was escalating significantly, he was out of school, harming himself, struggling emotionally and was extremely unhappy. We realise the impact this situation would have had and continues to have on the family.
46. We consider the Trust acted within NHS ‘18 week referral to treatment targets’ guidance in terms of its intervention with R. We will not be taking this complaint further.
47. We hope R accesses the right support and medication to meet his needs. We hope he is able to attend school and socialise in the future and becomes more settled and regulated.