Understanding Right to Choose: NHS Indicative Activity Plans
What’s Changing for ADHD & Autism Assessments?
Over the past year, many families have noticed something shifting in the world of ADHD and autism assessments.
There seem to be more providers available through the NHS Right to Choose (RTC) pathway, more options, more visibility, and in some cases, the hope of shorter waiting times.
On the surface, this looks like progress.
But behind the scenes, there’s a quieter change happening that’s beginning to shape what access actually looks like in practice.
At Lycali, we believe it’s important that families not only have access to services, but also understand how the system works, so they can make informed, confident decisions.
What’s changing behind the scenes?
Local NHS organisations, known as Integrated Care Boards (ICBs), are now planning services in a more structured way.
One of the key tools being used is something called an Indicative Activity Plan.
In simple terms, this means:
Providers are given a set number of assessments they can carry out each year
Funding is allocated more tightly and predictably
Services are expected to work within defined capacity limits
So rather than unlimited referrals being accepted, there is now a cap on how many people can be seen within a given timeframe.
Why is this happening?
Demand for ADHD and autism assessments has grown significantly and importantly, for good reason.
We’re seeing:
Greater awareness and understanding of neurodivergence
Reduced stigma around seeking support
More adults and families recognising lifelong patterns
Increased advocacy for appropriate care
While this is a positive shift, it has also led to:
Very long waiting lists
Services becoming overwhelmed
Increased pressure on NHS funding
These new planning approaches aim to bring more balance and sustainability into the system.
So why are there more providers now?
You may have noticed that there are now more RTC providers available, many offering remote assessments across England.
This is part of a wider move to:
Spread demand across multiple services
Increase geographical flexibility
Offer more visible “choice” to families
However, there’s an important nuance here.
More providers doesn’t always mean more overall capacity.
Is access actually improving?
This is where things can feel confusing.
Although there are more providers:
Each one may only have a limited number of funded assessment slots
These slots can fill very quickly
Total NHS-funded capacity may remain relatively similar, just distributed differently
In practice, the system is shifting from:
A few large providers with long waiting lists➡️ to Many smaller providers with capped availability
What this means for families
For those navigating the RTC pathway, experiences can vary.
You might notice:
More choice, but not always more availability
There may be several providers listed, but each could already be full or nearing capacity.
Faster access, if you get in early
If you secure a place quickly, waiting times can be significantly shorter.
Services filling quickly
Some providers reach capacity within weeks of opening referrals.
A need for flexibility
Families may find themselves:
Checking multiple providers
Reconsidering options
Moving between pathways
A Lycali perspective: keeping people at the centre
At Lycali, we want to be clear about something important.
The increase in demand for ADHD and autism assessments is not a problem to be reduced.
It reflects:
People understanding themselves more deeply
Families advocating for the right support
A shift towards more neuroaffirming, inclusive care
Seeking an assessment is not about adding pressure to the system. It’s about clarity, validation, and access to meaningful support.
System changes may affect how services are delivered, but they do not change the validity of your experience.
When NHS options feel limited
We know that for many families, navigating this landscape can feel overwhelming, especially when:
Referrals are paused
Waiting times are uncertain
Information is unclear or constantly changing
In some cases, people begin to explore private assessment options.
This can feel like a big step, and it’s important that it’s done with the right information and support.
How Lycali can support you
At Lycali, we take a neuroaffirming, person-centred approach, grounded in our framework and clinical integrity.
We can support you to:
Understand your options clearly (NHS, RTC, and private pathways)
Talk through what feels right for you or your child
Access high-quality, evidence-based assessments
Move forward with clarity, not confusion
There’s no pressure, just guidance, transparency, and support.
The system is evolving.
While there may be more providers available, access is becoming more time-sensitive and capacity-led.
Understanding this can help you make decisions that feel proactive rather than reactive.
And most importantly, you are not alone in navigating this.