Debate contribution: ADHD Services

Debate contribution by Mr Mike Nesbitt on 9 February 2026.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

9 February 2026

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

ADHD Services

Assembly identifier

Official Report component 5369753

Read the official Assembly record

Text

Thank you very much, Madam Principal Deputy Speaker. I cannot imagine that there is a single MLA who is not acutely aware from their constituency work of the strength of feeling on the issue. I thank the movers of the motion and the amendment and everybody who has contributed in a way that demonstrates knowledge of and empathy for the condition. I recognise fully the impact that the absence of a commissioned service is having; the resulting delays in assessment and treatment; and what that means for individuals with ADHD and their families. We are talking about their well-being, education, employment and family life. We are also talking about the judicial system at times. The uncertainty and long waits have a cumulative effect on parents and carers who are simply trying to do the right thing by their loved ones. As has been said, the situation is not unique to Northern Ireland. Other UK regions are in a similar position. As Members may be aware, the UK Government recently launched an independent review of mental health, ADHD and autism. The Government want to better understand prevalence, trends and inequities to inform new models of support and pathways in England. In recognition of gaps here, we commissioned a comprehensive needs assessment in February 2025. We wanted to establish, for the first time, a clear evidence base on demand, capacity and future service options. The assessment covers children and adults. It was designed to determine the demand for a commissioned service and to make recommendations on what such a service might look like, including indicative implementation and staffing costs. It also specifically included consideration of the prison population, recognising its significantly higher prevalence of ADHD compared with the general population and the associated linkages with, for example, early criminality, a greater likelihood of reoffending and aggressive behaviour. The review was a complex piece of work, reflecting long-standing gaps in data relating to ADHD prevalence and, indeed, future demand, particularly for adult ADHD services. It required extensive engagement and analysis. It included a desk-based literature review, significant information gathering, modelling and analysis, and engagement with representative bodies, clinicians, trusts, the voluntary and community sector, departmental leads and people with lived experience, including carers. As Members have predicted, I will highlight the fact that any future commissioning decisions have to be taken in the context of overall affordability at a time when we face critical funding constraints across Health and Social Care (HSC). It is a horrible thing for me to say — I get that — but it is an honest assessment. I say to Members that the worst aspect of my role is to sit with people, look them in the eye and say, "I understand your need, but I cannot meet it — at least, not yet". The needs assessment recommends a phased approach to implementation. That reflects uncertainty around future demand and the need to improve data monitoring and reporting before making longer-term commitments on workforce and service configuration. The report will set out 19 recommendations and provide indicative costings and workforce requirements for the first phase of service provision. Not unexpectedly, it highlights the fact that a fully commissioned service would require significant additional and recurrent funding. The report is clear that there are no cost-neutral options for implementation. Any form of service would require either new investment or a reallocation of funding from other highly pressurised areas. In a way, it is a pity that the debate has come today. It might have been better next week or perhaps in two weeks' time, because that is the timescale in which I expect the report to be made public. You have heard from my remarks that we have, as you might imagine, come close to completing our analysis of those 19 recommendations. I would like to see it in your hands not in months or weeks but, preferably, within days. I turn to shared care. In the absence of a commissioned service, many individuals have opted to seek private assessments and, in some cases, private treatment at their own expense. The question is why, and the answer is one word: love. They love their children, and they want the best for them. The waiting lists for ADHD services in Health and Social Care are either non-existent or far too long, so, of course, they turn to the only available option, which is to go private and pay for it, whether they can afford it or not, because of love. It is clear that the use of private clinics to seek diagnosis and treatment has increased significantly in recent years. I find that unacceptable, and I will try to reassure Members by saying that I have opened communications with the chair of the Royal College of General Practitioners Northern Ireland because I want to better understand the obstacles to shared care working as, I believe, it was intended. Members have given examples of where it does not work as it should do or as was intended. My Department is not responsible for any arrangements agreed between patients and private providers. However, clinics providing private assessments have been advised that they must advise service users that they will remain under private care until such times as they reach the top of the HSC waiting list. Shared care arrangements that go beyond just ADHD provision are voluntary; they are not part of a GP's core contractual obligations. GPs can decline if they feel that they lack the capacity or clinical assurance to safely manage prescribing and monitoring responsibilities. An issue that I want to understand with GPs is one that Mr McHugh brought up, which is why somebody who has been on medication for a significant time suddenly finds that it is being denied to them. I have heard of that in my experience as a constituency MLA, and I do not yet understand the underlying reasons why. Most ADHD medications, as I have said, are classified as amber list. That places specific responsibilities on the specialist prescriber and the patient's GP under the shared care arrangement. Therefore, while specialists can initiate treatment and provide ongoing clinical oversight, it is ultimately for GPs to decide whether they wish to assume responsibility for their part of the shared care agreement. Shared care involves planned, joint management between a specialist and a GP of a long-term condition. It should be supported by enhanced information sharing. In that system, specialist medicines or those initiated by a hospital specialist require complex prescribing and/or monitoring, which is not routinely undertaken in general practice. I recognise that GPs may have reservations about the robustness of assessments carried out by certain private providers, but, where there is uncertainty about diagnostic standards or continuity of specialist oversight, GPs may be reluctant to assume responsibility for ongoing care, because, ultimately, they are responsible — the buck stops with them. I turn to the wider support for children and young people. Alongside the work on service options, the Department is progressing reforms for children and young people that adopt an inclusive and needs-led approach. For example, my Department published the children and young people's emotional health and well-being framework for public consultation. That closed in September 2025. The framework proposes an inclusive and needs-based approach to neurodiversity that will not require diagnosis or diagnostic labels as a precursor to assistance and intervention. In adopting that approach, the framework seeks to reduce stigma, promote earlier intervention for children and young people and enhance outcomes for young people across the spectrum of their health, education and developmental needs. The development of the framework has been informed by a review of existing pathways across children's autism spectrum disorder (ASD) and ADHD. The framework will also seek to clarify the roles and responsibilities of everybody tasked with working to support children and young people who present with neurodevelopmental and emotional health and well-being needs. That will involve not only Health but other Departments, including Education.

The Department is considering responses to the consultation on the children and young people's emotional health and well-being framework, and work is ongoing with colleagues from the Public Health Agency and child health to develop the definitions and requirements that will underpin the pathway and support commissioning going forward. Before concluding, I will touch on some issues that Members have raised. As I said, it is my ambition to publish the needs assessment within days, rather than weeks. I have touched on shared care, and I will continue to try to understand better the issues to do with it. Members talked about the cost-benefit analysis primarily in relation to the economy but also in keeping people out of the justice system. Mr Durkan talked about the role of the education system in trapping data. That all proves to me that we need a whole-of-government approach, but it needs to be led by the Department of Health. Mention was also made of the local growth fund. I assure Mr McGrath that the Executive are as one in requiring a rebalance of the 30:70 split between resource and capital. We are asking the UK Government to look at that again. None of us understand why they have gone for such an imbalanced split. When we were in Europe, we had the European social fund. The Shared Prosperity Fund did not replace that. As we stand, the local growth fund will not replace that either. Perhaps those who supported Brexit in 2016 might care to reflect on that. I want to be clear that I recognise the strength of feeling and the genuine need that we have to do better. The Department has taken important steps to build the evidence base through the needs assessment, alongside progressing more inclusive, needs-led approaches for children and young people. However, any decision to commission ADHD services must be taken on the basis of that evidence and in the context of significant financial and workforce constraints. I hope that Members realise that what I want here is what I want for every Health and Social Care service: a consistent, standardised regional service with no postcode lotteries. I am committed to transparency, continued engagement with stakeholders and ensuring that future decisions are proportionate, realistic and focused on achieving the best possible outcomes within the available resources. I look forward to the publication of the needs assessment within the next few days.

1,732 words. Text as published by the Northern Ireland Assembly.

Assessment

Not flagged

Jev’s structured answers

Assessed 21 October 2026 at 14:33 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

Disagree with this assessment?

Classifications can be challenged. A person reads every challenge, and any change is recorded publicly above with its reason.

Challenge this classification