• Scale of need:In June 2025, 236,225 people had an open referral for suspected autism; 89.4% were waiting ≥13 weeks.

• Why this matters:Delays worsen educational disruption, family strain, and crisis presentations, while compounding health inequalities.

• What to do now:Commission hub-and-spoke MDT pathways with single-front door triage, scalable digital components, and embedded post-diagnostic support.

• Accountability:Link contracts to median wait reduction, throughput per WTE, and equity of completion, aligned with NHS Oversight Framework metrics.

 

 

Context & system signals

• The Integrated Performance Report (Sept 2025) confirms autism referrals are rising faster than capacity, with most breaching 13 weeks.
• The NHS Oversight Framework signals a tougher regime: productivity, equity, and outcomes will dominate future oversight.
• The Healthcare Inequalities Improvement Programme highlights how neurodevelopmental delays fall hardest on deprived communities.
• Meanwhile, the Learning Disability & Autism Programme shows inpatient reductions, proof community capacity can shift demand, but also highlighting how fragile current provision is.

Strategic implications

1. Autism waits are now a board-level risk metric. With 236k+ open referrals, this is no longer an operational backlog but a systemic risk.
2. Community infrastructure is the rate-limiting factor. Without investment in community MDTs, inpatient reduction simply displaces demand.
3. Equity risk is material. Delays disproportionately harm deprived and minority communities, widening inequalities that are now under active oversight.
4. Commissioning must evolve. Outcome-linked contracts tied to wait reduction, equity, and family experience will become the expectation.

Blueprint: an ethical, scalable ASD pathway

Single front door with tiered triage

• Rapid triage tools separate straightforward vs complex cases.
• Outcome: reduced specialist bottlenecks; faster signposting.

Hub-and-spoke MDT model

• Regional hubs concentrate specialist expertise; spokes manage pre-assessments.
• Digital tools for histories and rating scales.
• Outcome: higher throughput per WTE; consistent quality.

Post-diagnostic support by default

• Standard offer: family education, school liaison, brief interventions.
• Outcome: reduced re-referrals and crisis escalation.

Equity guardrails

• Flexible hours, translated comms, VCSE partnerships.
• Track completion by deprivation and ethnicity.

Governance and board assurance

• KPIs: median wait, completions/WTE, DNA rates, equity outcomes.
• Aligned with NHSOF dashboards for transparency.

Inequalities lens

Autism backlog delays compound inequity: children in deprived communities face longer waits and less support. Designing-in equity, through community outreach, culturally competent teams, and equity KPIs, is essential.

How ProMedical would align

• Deploy MDT pods across hubs/spokes with flexible cover.
• Provide operational playbooks and live dashboards for commissioners.
• Embed inequalities commitments in delivery models.
• Maintain IG maturity aligned with the Board’s OpenSAFELY direction.

Final word — Altin Biba, MBA, AMBA

“Backlogs this large aren’t just a scheduling problem, they’re a pathway problem. If we build assessment models that are scalable, ethical, and accountable for equity, families feel the difference quickly. That’s the benchmark ProMedical holds itself to.”

References

• NHS England. Integrated Performance Report, September 2025 (Item 4.1)
• NHS England. NHS Oversight Framework metrics list, September 2025 (Item 4.1.1)
• NHS England. Healthcare Inequalities Improvement Programme & Race and Health Observatory report, September 2025 (Item 6)
• NHS England. Update on Learning Disability & Autism Programme, September 2025 (Item 7)
• NHS England. Summary of OpenSAFELY Data Analytics Pilot Directions, September 2025 (Item 11)