Welcome, Tim.

Hi. And thank you very much for inviting me, Henry. I'm very pleased to be here.

I'm, like, crazy level thrilled. Like, it's you're yeah. I mean, you are an extraordinary person who's had an extraordinary career and continues to with insights into ADHD and the NHS that no one else has. And you're closing out our global conference, which is, as I think you've just heard, kindly waiting the wings. We've been live for twenty eight hours with ADHD Australia taking for We've our had extraordinary speakers from Lisa just now who talking from lived experience in the heart on ADHD and autism. We've had celebrities like Sam Thompson. We've had entrepreneurs like Ben Branson. It's the list goes on. So it's been wonderful.

And you are signing us out, I'm very, very excited. So this is an in conversation section. We are talking together and which is the point at which I am supposed to find the questions very smoothly, and I'm getting slightly tripped up. Exciting. Do you want tell me, like, what does it mean to be the, National Clinical Director for Mental Health at NHS England? Because I know how serious it is, but others might not.

Broadly, you've got two two main jobs. One is that you is that you run a program that you're the clinical director for a program of work. So, for example, perinatal mental health or community mental health teams or whatever. And your job is to help roll those out across the country. That sounds terribly easy, but actually scaling up is complicated, extremely complicated. And it's often very difficult to know whether you will you'll be able to actually reliably take an innovation and spread it around the country, and it's still doing the same thing that you started off doing. So that's one half. The other half is that you spend the time advising ministers.

Mainly in the Department of Health, but you are also expected to provide advice across different government departments. So that might include the home office around terrorism and mental health or whatever. It might be number 10. It might be areas like the foreign office when you're running a global ministerial summit or it could be housing and so on. So it's a it's quite a it's a it's a job which basically don't do it unless you're willing to work twenty four seven. And I'm very relieved not to be working twenty four seven anymore.

Although, I think it's been a busy period because you've just come back from a global summit.

I have. I've just I I set up the Global Ministerial Summit on Mental Health in 2018, and we brought over about 50 odd countries from around the world came to the summit, including 25 ministerial delegations from all over. And we we actually flew over 200 people with lived experience from all over the world. So it was it was really important that we had such a strong emphasis on on bringing people with lived experience and the politicians there. And the whole thing culminated in a a meeting which I sort of engineered and in bringing all the people with lived experience to tell them the recommendations from the global summit, from all the work that happened in two days, to tell the politicians.

What they needed to do. And I can tell you, politicians listen far more to people with lived experience than they do to academics.

We sometimes feel like it's the other way around. But Yeah. No. I know. I know. Think health services I think it's together. It's the combo deal that works. Like, data and evidence, lived experience for for heart, and you also put those two together for you stopped doing that.

What are you doing now? Well, I'm I'm now national clinical lead for new models of mental health care. So I'm overseeing a set of pilots that will radically change the way that you that we deliver mental health care. And I think the bit that that is really important for this for this summit, this conference is is that we we are aiming for these pilots to be open twenty four seven in the middle of their neighborhood of about 40,000 people, and it would be it wouldn't say no to people. So, yeah, we've had questions. Would you would you treat people with ADHD? Well, the answer is yes. I would, and I do.

I think one of the hardest aspects right now in terms of mental health care provision is the lack of places to go when there's a crisis. And so we get people contacting us and, you know, in crisis or actually pre crisis where Yeah. There's just nowhere. Like, you you just until until and it's that is a so to hear that kind of plan is is coming is a genuinely wonderful thing.

Well it's a huge gap. Fingers crossed that this will be scaled up.

And that's always Yeah. No. Fair enough. Yeah. You know.

At the moment, we the the government don't appear to have a whole lot of money, scaling up something that I think is important for everyone because we're not gonna say there's there'll be no wrong door. If you come to the center from your neighborhood, we will we will find some way of working with you. And it's working across with the voluntary sector and with with social care, local communities, and it's and the whole thing is coproduced with the local community. So it's always asking the local community, what do you want? What do you need? And each local community is different. So I'm doing that, but I'm also chairing, as I think, you know, care ADHD Yeah. Which is taking more time. And.

But as a, you know, as a chair, I'm it's got a very circumscribed role, which is to make sure we deliver high quality, low cost services.

It is and it's a big deal. Right? Like, the high quality, low call the high quality, low price, like, is and and working out how to to to do that and not being there. And I do wanna talk to that because actually we obviously run a lot of support groups. We can Yeah. I talk to a lot of people and actually a lot of the time people are like, my local options are close to me, particularly if you're outside of England without Right to Choose. And I absolutely do direct people to care at ADHD and I'm going to say the price because I think it's important because one of the things that we see is some really high prices. And not only on the front door.

It's when people are then if they're opting for medication, what that looks like. And and I've seen that up to £250 per month just in a consultation fee plus prescription on top. So you're you're ending up looking at sort of £400 a month and.

Which is beyond a lot of people lot lot of people can't afford that kind of money. I totally agree. No. And the.

Care ADHD prices, which I do believe are like one of the lowest, if not the the lowest, is a $3.99 for the assessment and medication initiation is $5.99. Like it's an important service. And then you're doing Right to Choose as well. I think it shows the heart of what you're trying to do, what care ADHD are doing, which is this focused quality service, but looking at price to make it as successful to everyone, recognising that we have a problem. Some people the NHS is not there. I can't.

I mean, there's a I should say that that I mean, my my reason for joining care ADHD from the start, was very strongly motivated by apart from personal ones, I've got two of my kids have got ADHD, and it took them a long time to get any service or any help, really. And although I I'm pretty sure, yeah, when they got diagnosed and I have to say, I I I did probably what the usual parent thing is. But what do you mean they're just like me? You sort of think so I I've got personal reasons, but but, you know, having done the guideline on it and having, you know, have the chance to really look at what the evidence is. I don't know if you know, but I'm guessing you do know that actually the evidence behind the treatment.

In ADHD is really remarkably good. Yeah. So much so that actually the use of medications, so methylphenidate and lisdexamfetamine, In in children, the effect size is about three to four times as big as almost all the other psychiatric drugs. So it's it's it is an incredibly effective intervention. And, again, with children, we've got huge amounts of evidence around parenting programs, around behavioral interventions, about enhancing those interventions by linking up with the school. So when I was approached by care ADHD, I and we we and I know both Mark Patterson and and Bobby Pratt up well. I've worked with Bobby before. I I said I would be chair if on two two for two key reasons. One, if we are going for really high quality.

Nice concordant care, and I can guarantee that, and I would hold them account to that, and that we could demonstrate that we were the lowest cost and a lower cost than the NHS. If we could do both of those, I would be chair. And they both agree. And I I it's a great opportunity to do something that I think you know, I spent fifty sixteen years doing NICE guidelines. That's what they are all about. High quality, low cost care. And I think we're proving it can be done. They are a fantastic team, I have to say.

But I've certainly been obviously very impressed by them and got to know them as well. As I have onto our questions. I'm just trying to say, were your children diagnosed before or after you did the ADHD guidelines for NADH? Oh, after. Yeah. No, after. And did you when you looked at those, there was no epiphany about you. There was once it was brought home that you recognized.

When when I did the guideline, I do remember one of the guideline group members who's an expert in children, she did come up to me and tapped me on the shoulder and said I mean, I I won't say exactly what she said, but it was it was very funny. I think she she said, you're so fortunate to be very bright because ADHD doesn't work so well if you're not. And I sort of I was completely taken aback. It was sort of she'd obviously been looking out close. I I sort of guessed that it was quite likely. I I I share a lot of similarities with my children who have been diagnosed, so it's it was it's not a surprise.

The tell us about doing the guidelines because it was a bigger deal than I think people know, and people know it was a big deal. Okay. So when we came up to doing the guidelines.

I had long conversations with with NICE because it was a very contentious contentious diagnosis, and there were there were a lot of people in the press and in the what I think of as a sort of anti psychiatric lobby who were saying this was medicating children in particular who were basically naughty children, and there was nothing more to it. And Yeah. So I spoke with NICE and said, I thought it was really important that we looked at the evidence behind the diagnosis. We we've never done that in NICE guidance before or since.

Oh, wow. So.

We had a whole work stream, which I personally oversaw now. I didn't chair the guideline. I I did what I call facilitated the guideline. I chaired the very first NICE guideline and set out the the the methods, but we have an independent chair. My job is to lead a research team and to facilitate the guideline group. So I I helped them work their way through everything, and I had a research team that did all the work for them. And then I helped the guideline group understand what that research evidence meant and then how to make recommendations out of it. So we had a work stream on diagnosis. And, you know, when when we finally produced the guideline, I could stand up and perfectly happily talk about the reality of that diagnosis.

And and to the shock of of some people, I remember in one interview with the press afterwards, where I was asked, well, is it really real? What do you mean? How do you know it's real? What blood test can you do? And I said, well, you know, in diabetes, there is no blood test that proves that you have diabetes, but you can measure blood glucose. And if blood glucose goes above a certain level, we know that that's harmful to people. And in exactly the same way, we can measure people's behavior and experience. And we know that when hyperactivity and impulsivity and inattention reach a certain kind of level, it's it impairs their function, and they can't I I failed to see how that's different.

And I do think that. I think that's it's one of the things that we can do is we can we can see what impairments come with those kind of behaviors and experiences. So to go back to your question, Henry, yes, it was a very big deal. It's the biggest deal of any guideline that we've done. So I I after we launched it, I spent three days continuously in TV studios, radio studios, interviews with journalists from Tokyo all the way over to Los Angeles. Worldwide interest. Absolutely worldwide interest. And we we used to produce a hard copy of the full guideline, which is big. Yeah? I mean, it's one and a half thousand pages. But but the the guideline without all the evidence, you could get links to the evidence.

But the guideline, 200 and something pages. We had to go to a reprint. We're selling it all all over the world. I mean, it was it was extraordinary. The it was the biggest biggest launch we ever had, biggest interests that we ever had. And as I say, the evidence in it is some of the strongest evidence in mental health.

And something to say to the guidelines, and as you just said, Tim, all of the information is there. Like you can go to the NICE website and go and click into the research, you can go and see what was presented. It's it's it's there to be seen and and obviously, you've talked about there to back up the recommendations that that that have been put in place and have changed many people's lives for the better, myself included. Well, that's great to hear, Henry. It's well, if I actually gonna say, yeah. Thank you. Because I be honest. It's yeah. Right. Must not cry. The Most of those interviews weren't so friendly. Lot of and why you did all the research and evidenced it was because a lot of people are just like, it's naughty kids or.

It's not real. You know, we deal with newspaper articles saying it's just a fashion, it's a fad. Another one saying it's a social contagion. Another just going it doesn't exist at all, it's just a made up thing. And right now, we're in the midst of a big debate. To be honest, we're in the midst of what can only be classed as a culture war in terms of the characterization of ADHD as we're just trying layabouts, trying to get on benefits, is the framing pointing to unprecedented unprecedented demand, linking it to COVID in terms of the demand. We're all at home suddenly navel gazing.

What's your view? What's your view on the increased demand? What's your view on the debate? I don't think there is increased demand, but I could be wrong about that. I know that there's some speculation that entering a world of social media and our connection to the Internet that this is changing us. And I do recognize myself that that when you're bombarded with emails, with messages from all different places, I know that from my point of view, my level my ability to concentrate goes down and down.

Yeah? That I know I've had this discussion with another, and one of their points was that the big difference is when you withdraw those things, then the situation of them changes. I worry I just took your point away. No. No. Not at all. I was going to say What's the idea of she's jumping in? What.

What I was gonna say was that that although I recognize that those, you know, those being bombarded all the time isn't great for my my ability to concentrate and focus my attention. And I'm sure it's not for anyone with ADHD. I'm not sure it's the cause. Yeah. I'm I'm yeah. I'm sure it makes things worse. Now I there there was a study which no doubt you've seen, which is I think King's College did it, have made the they've they've made the assertion that they think that about five percent of the population have ADHD and that we're not seeing a a a sudden rise in ADHD. We're actually just seeing more people coming forward. And, obviously, you know, with the possibility that you can get help.

It's more likely that people will come forward. So, certainly, yeah, it's I'm not sure. This has happened with a lot of different mental health problems, which is that they you know, anxiety and depression and and so on is that, you know, more people are on antidepressants than ever before all this kind of thing. Are we over medicalizing, etcetera, etcetera? I counter that by saying when I started being national clinical director in 2016, our estimates were that we were actually seeing and helping only one in four children who had a mental health problem, And that we're seeing probably a little bit more than that, but not much more in adults. And, basically.

What that what that meant was that we're saying, I will only see you if it's very severe. Or and this is a slightly jokey way of putting it, which is it's a bit like saying, you drink quarter of a bottle of vodka a day. Oh, that's okay. Come back when it's when it's one. Yeah. And you think that's that's absurd, but that is what's been happening. So I it was my job to try and increase the number of kids that we we were seeing. And I'm thankful to say that we've nearly reached half of all children that need help are getting help in the NHS. Sadly, and unfortunately, kids with ADHD and autism, that has not happened for them in the same way at all. And, equally, I think with adults with ADHD and autism.

They they are not getting that kind of help, which is what makes Right to Choose so important.

It yeah. It does. And.

So to to to just to summarize that, I don't think there is evidence that that this is a bunch of people running around going, no. I don't fancy working or or no. I I want some stimulants or or whatever else. I think this is absolutely real. When you meet people with ADHD, as you know, just as well as I do, there are some tragic stories, and it leads to untreated leads to an awful loss of difficulty. And conversely, you know, I I remember doing a radio program when we launched it. It was a phone in. And this mother phoned in and said that her son who was five, who she thought was very bright but couldn't couldn't be sure. He didn't read. He didn't write. He couldn't really sit still in class or anything. They were thinking of excluding him.

She got him help privately. He got an assessment. He was put on some medication. Within six months, he was reading. He was writing. Yeah. He was able to stay in the classroom. Yeah. And you just think, yeah, that that is a kid who could have been excluded from school at the age of five or six, and you think this is this is perfectly real.

Yeah. And how many, yeah, and how many more? Like, you know the numbers we're missing. And in terms of over diagnosis, it's like there's a big study done and it looks at nine million GP records. It was published in January of this year and it showed zero point three two percent of those had a record of having ADHD, which is nudging ten percent, if that, of the actual population of people with ADHD. And so we're wildly underdiagnosed. And if we think about things like PTSD, PTSD was first recognized, like you're going to correct me if I've got this wrong, first recognized I think in 1980 and formalized within the NHS in the 1990s. Like, we wouldn't be shocked if we saw PTSD rates increasing because we just didn't recognize it before.

That's exactly the situation we've got here. It's like, it's a farcical piece of evidence. Say, oh, numbers are going up. You're like, well, of course they are. It's, you know, it's because we didn't count before. Absolutely.

I mean, it's a little bit like I remember when we when we did work on on children that following abuse and traumatic experiences, recognizing that many of those kids had PTSD and that you really had to ask about it, you shouldn't just leave it. And, you know, since then, people have begun to recognize that that's, you know, big surprise. Of course, they've got PTSD. I mean, that's what happens to most of us when you go through very, very traumatic experiences. I I I think that it's it's a a similar problem across across mental health that we don't we fail to recognize that experiences like anxiety and depression and post traumatic stress and so on, ADHD and autism, that these things actually impair people's lives, that you fail to function.

And it's associated with, you know, significant levels of distress just as it is with physical health problems. And Yeah. You know, we recognize that little by little, more and more. And I think ADHD in particular and autism are behind the curve of the rest of mental health. It's being seriously under recognized. And people, like you say, are resistant.

They think. Yeah. When you when you have people saying it's not serious, like, what do you say to them? Well, I usually give the the the example of of diabetes.

You you can measure this perfectly easily, and there is no test for diabetes. So you're left to measurement. And you can measure the level of impairment. And when you reach a level of hyperactivity or inattention or impulsivity that causes impairment or distress, you know that, you know, it's it's perfectly reasonable to have treatment strategies that will help. And you do the same in any any physical health problem as well.

It is. It is a immense frustration where they you know, we see and understand the importance of a diagnosis, enlightenment it gives with through the knowledge it gives, benefit many find from medication, and that's being being, yeah, being stopped. We've seen high suicide rates.

Absolutely. And yeah. Which I I I agree. It's it's not just the ADHD that's helped. It's the corollaries. It's the, you know, it's the the you know, I know a lot of people with ADHD who get quite anxious, who get quite depressed, who go out Particularly undiagnosed.

Right? You're trying to Well, yes. Trying to work out life and Yeah. And it's it's extraordinarily different and difficult.

Yeah.

We've seen the figures around life expectancy too. Again, that same study of 9,000,000 GP records showing a significant reduction in life, I think, between four point five and eleven years less. For women, it's for men, it's seven years less. For women, it's nine years less on average. Like, it's a huge difference in that probably to physical health that we are seeing, absolutely seeing. I actually did I did the to just compare, I went and looked up like what is the life reduction for smoking, and it's about, I think it's eleven years, isn't it? So it's not like we're nudging the same sort of numbers and getting absolutely none of the attention, and especially when, obviously, got these treatment options.

We're seeing the government just sort of talk to ADHD as a problem, seeing all of the expense of an assessment and intervention and none of the benefits. Like what do you say to that?

I think I think it's up to us collectively, people with lived experience and professionals, to just push to one side all this negative stuff about, well, is it real? Isn't it not real? Etcetera, etcetera. And say, you know, we have a a sizable number of people who have significant impairment, significant levels of distress, significant negative impact on their lives get often getting worse the longer this goes on. Yeah. And we have some really good treatment strategies that can help them address that. And it's wrong to stop that happening in exactly the same way as it's wrong to deny people anticancer treatments. And these work. That's the point is that we've got really good evidence that these these interventions work.

We do. I like how, obviously, you in my own life. Like, and men the people I talk to. And it's certainly a frustration for me that we talk about millions of people. I think the NHS task force came up with a number of around 3,000,000 in England alone, and you're looking at things like increased exclusions from schools, likely to be in people referral units, increase percentage of victim of crime, in, like, being in crime. And so a number of the big national problems, we did a talking to an organisation working with NEETs and their estimates, which is, like I have to caveat very carefully, not academic, very much sort of screening and.

And one person trying to see. The figures they came back from testing one hundred people was eighty percent screened positive for ADHD. So you're seeing some of the major challenges of the country around the criminal justice system, around education, around needs and young people's employment, and the intervention on ADHD being potentially one of the most significant interventions we could get. And instead, we're just being told, oh, you just go get an assessment to live a life of, like, on benefits and give up on life. And all the conversations I have with people, I genuinely can't think of one where it's been different, is like I have ADHD and it's been a struggle and I want to change my life and I want to go for the positive.

Through through the assessment process. Talk about waiting times. What do you think about them?

I mean, waiting times shouldn't be happening. I mean, I I say that slightly glibly. I I know that they are there. So the NHS has not been able to train enough people to to be able to diagnose and treat.

I think it's important to say the NHS because within Right to Choose, we have seen the ability to to scale and to train And the NHS and the behemoth that it is does not have that kind of flexibility.

Oh, that's absolutely true. I have been I mean, I I don't wanna shout too much about care ADHD because I'm obviously biased. But the the team have done a fantastic job of scaling up exactly as you say. I mean Yeah. Know, my job is not actually to get them to scale up. My job is to hold them to account on those two key issues. I want it to be highest quality we can get, and I want it to be outstanding. And the second thing is I want it to be the lowest possible cost. But they have scaled up in a way I've never seen. I mean, it's extraordinarily, you know, brilliantly done, training people, you know, bringing people through, getting the right governance processes in place at the same time, you know, I've been deeply impressed.

As if I I I I have to probably, my c I do have to say I have seen it in in in some other Right to Choose providers and some not, to be very clear. We've had some awful examples where wait times have become catastrophically long and real mismanagement of waiting. But I think that ability for the private sector and supporting the NHS to scale up is clearly fundamentally different and something the NHS should be using. I think there obviously have been teething problems with all, and I think people have been pretty honest about those. But it's nothing to do with the quality of the assessment service itself.

It's It is true in large parts of the country that the waiting times for the NHS are so long that it it it means no one is no one's really bothering.

Yeah? Let's talk about Sheffield. I laugh. Why am I you have some links with Sheffield. What's going on there? The last figures we saw for people is the BBC figures. We were in sort of background, providing some support and advice there. In particular, we were saying to the BBC, you must not accept the answer of when you ask how long do people wait, do not accept the answer of we're currently seeing people who were seen in X because it hides a lie. It's a lie of omission in my view because it hides how many people are waiting, how big the service is. And if the quantity of people have increased, then you might be saying, oh, last saw some we're seeing people who were put on our list in 2023.

December 2020, you assume two years, actually double the number of joined or the services halved and in fact it's twice as long. And so we said to them very clearly, you should get the number of people waiting and you find out the throughput number of people we've seen in the last year. And for Sheffield, that was over 6,000 people waiting and three assessments. So an effective wait time for over two thousand years.

I mean, as you know, well, first off, I was born in Sheffield, and I've lived in Sheffield for all about ten years of my life when my parents moved just down south. But I came back to medical school, I trained here. And I've worked in mental health services in Sheffield for forty forty forty one years now. So it wouldn't really be fair for me to comment on on Sheffield directly.

Too tempting.

But let me say the general case. I know that when you have long waiting lists, it's almost impossible to fathom the real need in an area because people don't bother coming forward if they know that it's for you.

I hear you on that. I push back. I would push back partly because I thought it about doing a ranking, and worked out the maths, which is like you've got a population. You've got an age estimate, which quite easily available, you can do some pretty simple maths on roughly how many ADHD are likely to be there and you can work out and you've got the medication numbers per area, you can work out roughly, take a take a ratio assumption And you can go, you've got this many people you've not seen as well as your queue. So, like, you like, there are some things you can do now. I entirely entirely agree with you.

I think my point was that you you can't use the waiting list as evidence of unmet need.

It's going to be well because you've got and we've seen that in areas. You've got shadow, like Yeah. Someone described it as a shadow waiting list where people are just put off. We've seen that amongst some in some areas like where GPs make it very hard to get put on the list. We've got triaging now in some areas which create multiple lists. It becomes hard to get clarity. I have to say, NHS England, I know they're in their their last throes, but actually, you've done some quite good work on creating data points Yeah. So that that can be seen more clearly. It's I have to say, slightly boggled my mind that that those things didn't exist before. I think that shows my lack of understanding of those kind of big systems that have evolved.

So we're seeing new providers emerge, Carrier ADHD being an example of that, supported by Right to Choose. What's happening?

I mean okay. Again, this is caveat about the fact that I'm chair of care ADHD. I think that since care ADHD came you know, arrived, which is now it was April 2024. I think it's been a very positive influence on the service. I'm aware that some other companies, private companies, are are following our example of enhancing quality, but some are not. You know. Yeah. I I I genuinely worry about that. I think that.

I I also think that It's it's something that we struggle with, which is and I think it's particularly hard in this country, which is there's a sort of understanding that you have to say everyone's perfect in the medical world and trying to show the differences is very, very hard because it either meets the medical standard or doesn't. Yeah, maybe a conversation or another time. Definitely would like to help steer people. You know, we put reviews on the site, people have recommended, suggested, they'd just get manipulated. They wouldn't have the volume to be be reliable. Okay. Back to waiting times. And Yeah. So what are what are we seeing happening in Right to Choose now? What does care ADHD seeing happen?

Okay. So my understanding of right to choose, which is you know, I'm I'm not a lawyer. I'm not a, you know, sort of it's basically that that if somebody has a health problem of any kind that they they can go to their local NHS, and if their local NHS says, we can't see you for well over eighteen weeks, which is the standard they should be seen with.

I think the eighteen weeks which we're going to go to is different from Right to Choose. So Right to Choose is the ability to choose where you're going to quote a commissioner. He said it's the National Health Service, not the Regional Health Service. And it was put in place, some legislation put in place to say you as a person within the NHS and NHS England, you have if you don't want to be seen locally, can choose to be seen elsewhere. It's your NHS, you wanna you're living in Brighton, want to be seen in Sheffield or vice versa, then that is your right. And that's right that's right to choose. Is different.

I think the I think the given that it's the ICB that has to put up the money for health care, if there was a local place which had, which you could be seen and treated relatively easily, they would probably be unwilling to fund anything outside of the area.

But they have It's unlikely people would want want to, like.

I think they have an obligation to do it if someone can't get the service locally. And my understanding is that is that, you know, we now have a lot of people who recognize that they probably have got ADHD. Yeah.

But we had any of the task, of course, showed it weights, and this is only on the NHS lists of of around half a million. Yeah. Then there are additional people waiting for on with Right to Choose providers. Yeah. It's a it's a higher number than that. So if.

You have that in any physical health problem and there was no sir or very little service or a service as in some places you're waiting two, three, four years for for being seen, then, obviously, you should have that right to go and get assessed and treated elsewhere where they can do it. And if that's in the private sector, then so be it. And that should apply for people with any condition. Now I I do understand that that that some ICBs want to cap that. But, obviously, that that, you know, that isn't it's not acceptable.

Unless they're to do that across the board on everything. I entirely understand that if an ICB said we've run out of money, we're actually gonna have to cap health care, then, okay, that's a matter between them and central government, but they can't do it selectively. They can't say, oh, we're going to cap ADHD, but we're going to carry on with heart transplant.

Why can't they do that? Because it.

Discriminates against people because of their diagnosis. You know, it it's wrong to say we're not treating people with a mental health problem, but we are treating people with a physical health problem.

Doesn't doesn't health care just make those choices anyway? That's isn't that what commissioners and I isn't that what commissioners and ICBs do anyway, which is like, oh, we're gonna fund this and more and that one less?

Okay. So an ICB's job is really to know what the needs are of their their local population and then to match their provision of health care according to that need. So if they're doing their job right, if they have an awful lot of unmet need around ADHD, they need to rejig their provision of services so they can meet those needs. Now, obviously, they can't do that if they don't have the staff to do it, and that's where Right to Choose comes in. Yeah.

And very importantly, the eighteen week promise of the NHS. So Right to Choose is the right to be seen in any part of the NHS. The eighteen week promise of the NHS is probably a level above that in terms of surety. What are you able to tell us about that?

Just not quite sure what what what you're asking, Henry.

So number of so the current wait list that the Labour Government are focused on is people who have the promise of being seen within eighteen weeks on the NHS. Yeah. And ADHD has been excluded from that. So the targets, the number that when the government says we've got x amount of people waiting, we're not included. And as such, we're deprioritized for dealing with the waitlist around ADHD. However, if you are and do have the eighteen week promise within the NHS, which is for consultant led work, then the right to choose rests with you to use your right. If you're not being seen within eighteen weeks or something that should be seen within eighteen weeks, the ICB actually has to offer you alternatives if they exist.

And at the moment, we're seeing reductions being put in place for our individual activity plans. This would go over that. So are you able to talk to us around individual activity plans around the wait times?

All all I can say is that that I I I I personally believe it's wrong to to to pick ADHD or autism and say, we're we're not gonna do it for them, but we are going to do it for everyone else. I think that's fundamentally morally wrong. I also think it's probably illegal. Yeah. I it needs it needs to be contested.

And I think we've seen some legal advice that's that says that.

I think that's probably true. I'm not an expert on this by any means. It's not not really been something I've I've had to deal with very much.

It's a bit it's an extraordinary thing we're seeing. Right? You've got an area which is saying we won't see any adults with ADHD over the age of 25. Like, clear age discrimination, just and Fundamentally wrong, in my view. I completely agree. How important do you think Right to Choose and Choices in the NHS for ADHD?

Well, at the moment, it's very important. It would be less important if the NHS itself got to grips with providing high quality Yeah. Services for ADHD. I don't think they're going to do that anytime soon. As you say, to do this effectively and to scale it up to a national level, I think it would be difficult for the NHS to do that. So right to choose at the moment is probably the best way in which that can be addressed. That unmet need can be addressed.

And ICDs have an obligation. Right? If people, if not people aren't being seen in eighteen weeks, an obligation obligation to create a plan. Yeah. At least that's my my understanding. And I think you've talked about that you disagreeing with this and, like, in your view, is it a like, is it a matter of patient safety? Like, why do you think it's so important?

Why is it is it Do do people get a timely ADHD assessment? Oh, for for the same reason that they should when, you know, when when they're depressed. I mean, it's you know, there are consequences for the people who have ADHD with who go untreated. You know, if it's kids, we're talking about failing at school, losing friendships, you know, often end up being bullied. And, you know, by the time they're 16, 17, 18, you know, they're using drugs. They're they've got high rates of self harm. They've, you know, they've got increased risk of suicide. They don't get jobs. It's you sort of think it becomes a conveyor belt in which failure is always around the corner. Yeah. I mean, interesting. I was talking to to.

At the Global Ministerial Summit that I've just come back from, and I I was talking to the chap who's the effectively the the national clinical director for mental health in France. And he was saying Uh-huh. Yeah. And he was saying that he failed all his exams at school. And he says in retrospect, he's he's now pretty sure that all of that failure is because he had ADHD that was untreated. And you sort of think with help, he's now risen to the top. He's got you know, he runs a very prestigious department of psychiatry. He's he's got a big research program, and he's the the equivalent of a national clinical director for mental health in in Paris. You you sort of think, well, yeah, he's a bright guy. He's lucky. Yeah. He got some help.

And things have worked out. But I know that en route, he had to go through a great deal of suffering and failure and the like. Me, I failed all my exams at school. I ended up with three o levels. Wow. I I yeah. It's the the How did you turn that around? That that's Well, what I discovered was that was that I can also if I get into the right frame of mind, I can hyperfocus. And it it basically means pressure does it. Yeah. Now pressure doesn't always do that for people. I'm quite lucky. Yeah. But it's a bit like I get my own my own version of of methylphenidate or lisdexamfetamine. And it is true that when I hyperfocus, I think my my wife would tell you you you know, she can't get through to me. It's just Yes. Hard.

Nothing else. There's just that. And I've noticed that in my son as well, that he he looked like he was heading for failing all his exams and that kind of stuff. And we we, you know, we got him some we we got him help, and he turned it around. It's all worked out incredibly well. He's you know? Yeah. He's he's done very well, Going to medical school and all this kind of stuff. So with the right help, there is actually no doubt that people can turn their lives around. That the longer someone doesn't have that help, the more problems arise. And as I said with that that mother who got got onto a phone in, her son would never have learned to read or write or do well at school if he hadn't had that help at that time.

And yet we have the people saying, like, oh, it's an ADHD intervention. It's, you know, just laughter benefits. Like, whereas, like, that case, almost certainly the exact opposite. How are you I just wanna reiterate that that the the medication.

Interventions in ADHD have the best evidence for benefit of any mental health intervention we've got. It's the strongest evidence we have.

Extremely important. How how have you dodged the you talked to me about using pressure to get stuff done. I guess I've got two questions. How have you dodged the anxiety bullet, is that people use pressure as anxiety, using anxiety to get stuff done and live a very anxious life, and that can be catastrophic. And then the other is how do you get the small stuff done?

No. I agree. The small stuff is yeah. I agree with you. It's the small stuff is always difficult. If if it comes to doing six six NICE guidelines all at the same time where I'm moving, Yeah. Each so for each one, you're ultra focused on just that thing. So I can do that, but then get home and, remember to do all the things that you need to do at home. That can be more of a challenge.

Yeah. You're amazing. It's been wonderful talking to you. Thank you. And I'd say thank you for all you've done for people with ADHD. I'm excited for your work with care ADHD and what's happening overall in Right to Choose. The accessibility through good price is important and I think we're going to, as a charity, going to be trying to make a bit more noise about that. We've talked for a long time about listing organisations and price because we're worried about some people finding themselves caught and that is something we'll do. It's important to have you been talking around right on eighteen weeks and what I think we should be doing. It's obviously a conversation that's going to continue.

Thank you. And thank you for being a part of our conference after your global summit, coming to our global conference. They're slightly different in but only a little bit.

I mean, I I I think this is probably much, much bigger and got probably a a bigger reach even though mine was, yeah, a ministerial summit or whatever else, and it sounds very, very important. But I also think, you know, summit having a conference like this where got a huge reach to people out there in different parts of the world, fantastic. And I'm very pleased to have been asked to join you.

Well, I'm thrilled that you said yes, and it's been absolutely wonderful. It's a it's a delight. And I think it's just important that people know that there are people in serious positions of Pan who are trying to make a difference for ADHD. A lot of the time, particularly now, it feels like a big fight and knowing that people like you there is a big deal, so thank you. Thank you. I have to say goodbye. We're out of time. Tim, thank you very, very much. Have a great rest of your day and evening. Thank you.