Right. Let's get on with it. Welcome back to the Global ADHD Conference. A huge thank you to ADHD Australia for carrying us through the night. We're starting the day... The The UK's second day with a genuinely big moment because our first guest holds one of the most important jobs in public accountability in this country. And it genuinely is one of the most important jobs in the country. And we are incredibly pretty excited to have her here. Paula Sussex is the Ombudsman. She took office as the Parliamentary and Health Service Ombudsman in August 2025. And so correct me if I'm wrong very quickly, I think, as of yesterday, her office has a brand new name. It is the Public Service Ombudsman.

It's where people can take their complaints about NHS England and UK government departments via MPs when they haven't been resolved and acts as an extraordinarily important arbiter for people. Before that, Paula was the chief executive of the charity commission. She was chief executive of the student loans company, which she led through the pandemic and CEO of the fintech firm, One ID. She's a trained barrister. She's a London Business School graduate. She was named CEO of the Year at the National Centre of Diversity's Freddie Awards, and she was awarded a CBE for services to higher education. In August her... In August, her office published incredibly important document improving ADHD and autism services, commissioning with confidence.

And commissioning of ADHD services is something that is incredibly important to us and the fact that she and the Ombudsman have done this is is... I can't tell... It's such a big deal. It had found that complaints about ADHD and autism had more than tripled in four years and it called for a clear national guidance, a clear right to choose, for ADHD and autism diagnosis to be brought brought into CQC registration inspection. If you've got questions, as you know, you can put them in the Q and A. Right. And that's the Ombudsman talking directly to people with ADHD. We are honoured. Without further ado, welcome Paula Sussex.

Good morning, Henry. So super to see you again. You're looking you're looking really well. Henry and I shared a a roundtable a few months ago, I think, and it was an excellent discussion on ADHD. So good morning, everyone. In the various other countries, I'm just gonna simply say good day. It is a pleasure and a privilege to be here kicking off The UK leg, albeit a little bit early in the morning for some of us, but we'll manage. We'll manage. So as Henry said, and I'll talk a little bit about the Ombudsman role for particularly those of you who are perhaps less familiar with it. We are a parliamentary body, completely independent, and we have two jurisdictions. One is the NHS in England, as Henry said, and the other one is.

UK government services. So that keeps us busy. We have a particular and unique platform. It takes us to parliament, to the relevant committees for health, but also, of course, through the media. And what we very much prize, and indeed working with ADHD UK, is working, yes, with the advocacy sector, but also with the clinicians and the administrators in the system. We are impartial. For those of you familiar with the model, it is important that our evidence, our reports are absolutely impartially based, and we think that's what gives them more power when we make recommendations. So in terms of, volumes, we handle, about 35,000 complaints about the NHS in England, and this is over all pathways. Today, obviously, we're talking about ADHD.

But the complaints we handle are some very serious conditions, primary care, mental care, dentistry, all of it. We have a particular act to govern our work in health, which means it also gives us the power to look at clinical care. So that enables us to go into quite some detail. And in areas we then become, of course, quite expert in the care pathways. I would probably not say I am anywhere near expert as many of the speakers that you've had in ADHD. So I'm quite certain that when we get to questions, and maybe some, if you can forgive me, that I'll take back to the office for a more detailed response. So if we can flip briefly onto the next slide. Thank you very much for handling the slides for me. The strategic aims.

Of the Ombudsman, these are particularly important to me. Henry has spoken very kindly and glowingly about our role and the significance of that role, but it's only if we really use it. And so you can see on the left hand side, we are very, very determined that our recommendations make impact, make change, and that will mean that we need to follow through. For those of you in The UK, you will know that the NHS is, one would say, in a state of generational change, significant organization change, the care quality commission ditto. So there's significant turbulence, shall we say, in health, and it is our role as a stable organisation.

To spot the policy and structural issues as they are going through this change and make sure that they don't get missed. All of you will know, I'm sure, that our evidence base comes from those individual complaints, those individual complaints. So those individual complaints on which we provide individual redress aggregate to give us systemic insights. And so you'll see as I go through this presentation, we really are looking beyond the presenting issues of the of the way that the England or The UK provides ADHD services, and we're going into the structure of the system behind it. Key roles for the integrated care boards that I'll talk about in a minute.

Our other two goals this year is not just to be talking to the NHS and talking to parliament and and insistent on the recommendations that we think need to be made in this area as in others, but it is also to look to our own service. How are we making a person centered, efficient, digital, empathetic service to our users, our complaints? As you can imagine, our complainants, as you can imagine, most of the users, most of our customers come to us after they have taken their complaint to their local NHS trust or GP or integrated care board, and they come to us at... Sometimes at the end of their rope quite understandably, and we have to deliver the best possible service. Now many of you will know that complaints are rising across the piece.

All of the the brilliant advocacy organizations who are present on this great conference will probably be feeling it as well. So we are we are facing significant rise in demand for our services. That means that we are using more technology to stay on on top of that demand. We are, by the by, doing some research into what is driving the demand. It is clearly an aspect of public trust and confidence in government, but also in the health sector. So it's really important that as we use our voice, that we're using our voice constructively. I think one can use not contributing to the doom loop if we can still use that expression. So that's.

Hopefully enough about the Ombudsman, and indeed we did... You're quite right, Henry. Thank you. We changed our name to the Public Service Ombudsman just yesterday. A name change is not an achievement, but we believe it is necessary for our awareness that parliamentary and health service Ombudsman did not mean enough, did not really talk about what we do. And with the team yesterday here in our London office and also in our Manchester office, we talked about the words public and service and what they mean to us. To me personally, they are important. Now let's turn to the commissioning system. If we just flip on to the next slide. Thank you so much. So commissioning... Actually, one more slide. Thank you. Commissioning has the unfortunate.

Perhaps, aura to it of being a bureaucratic abstract technical term, but it is absolutely fundamental. So the... As most people on this call in The UK will know, the NHS spends roughly 200,000,000,000 per annum on effectively locally organized services, and they are split between the integrated care board for the most part. So how good commissioning works is fundamental when it comes to the care, the diagnosis and the care and support for ADHD. What we're looking for in good commissioning is the very best of how organizations understand need, make those informed decisions about services, allocate the resources effectively, ensure people where they can receive support, and that they communicate it clearly.

And you will see a clear theme running through this presentation that at the moment, that is nowhere near clear enough. One thing I should say is that we're deeply aware of the shortages of skills in The UK and also the shortage of the supply of support and services. The scope of the jurisdiction of the Ombudsman means in certain cases, can point to insufficiency of supply as maladministration, which is our key legal principle, our key legal test, but not often, and you will see in this report we're talking about how effectively the system works. So as you can see on the slide, we have very many issues of delays, really fragmented pathways, poor communication. Later on I'll talk on a couple of case studies which really bring this to light.

And also in the system, and a system that is growing to meet demand in the private provision of care, some degree of, if I say confusion, I think that's perhaps not an overstatement of how a patient, how an individual can go about navigating this system. One particular finding that the team went deep into was that the data was simply not there and simply not sufficient and understood well enough to understand the different areas of need in the different countries. And for those of you very familiar with the term postcode lottery, yes, we did see an awful lot of postcode lottery. So going on to how it feels in The UK, the back drop, and if you could just go to the next survey... The next slide. Thank you so much.

It is true that people are fundamentally finding that they need to fight their way through a confusing system to secure care. I don't need to tell this audience that we're talking about individuals who already in a state of, you know, potentially distress and that accessing and understanding the system itself can compound it. So on the next slide, we will see some of the statistics. I am sure they are quite quite familiar to many of you in The UK. Quite possibly, Henry, we actually quite possibly borrowed them from ADHD UK. What is really important to me behind all of these statistics is that The UK has run a task force into ADHD and autism, and the task force itself estimated that unsupported ADHD.

Cost The UK economy at least 17,000,000,000 through its effect on health, education, employment, and welfare. So it is true that ADHD care has to be a system wide response. It has an economic impact. That is the economic case for addressing it. And what we at the Ombudsman do is to look for where we can add value. There are very many brilliant organizations on this conference and congress who are... Have formidable influencing powers. Our role is to go particularly to the aspects of what we see from our complainants, but also the drivers of that economic loss, that economic impact on the country, and use our particular role to address them. On to the next slide. Thank you. So our report, and these... I do encourage you to read it. It is a.

Very thorough piece of work, though I say so myself, came from about a year's work. And as Henry said at the start, we looked at about 3,000 complaints from the last four years from memory, significant rise in complaints. And the body of our recommendations comes from a very deep dive into around 90 of those reports... 90 of those complaints. We worked as we always do with the advocacy sector, of course, our complaints with whom we will have, you know, lengthy lengthy dialogues as we go through the complaint management process. But also importantly with the Department of Health and Social Care who are in The UK, of course, many of the answers in effect to ADHD care in The UK.

It is really important that we work with all of those stakeholders. It's important to me that these reports are constructive, evidence based. They are critical. They have to be critical In the cases that we were assessing, the majority of those ninety five were cases where we upheld an injustice. And as many of you will know, that often the remedy it talks to an apology, but the complainant is also looking for this not to happen to other people, simply not to happen to other people. Let's go to one of those complaint case studies, and if you kindly go to the next slide. Thank you. So this is one of the cases that I, my chief executive, and very many of us at the Ombudsman studied in some detail.

And this relates to the... Particularly the role of the right to choose. And for those of you not from The UK, quite possibly in your countries, you have something similar. But let me talk about the case of Rich. So Rich was looking for an ADHD assessment and as will often be the starting point, to his GP to ask for advice and to ask for assessment. He was conscious of his rights to choose in a sort of high level way, the right to choose gives individuals simply the right to choose an assessment from an NHS provider NHS funded provider. However, his GP practice and indeed his ICB were not clear that he could go to an alternative NHS provider, sent him to a provider that simply didn't exist.

And in the end, Rich decided to go to private provision at a cost of almost £4,000. But in the meantime, and as you... Many of you will be familiar, there were very many months spent trying to navigate the system. And as you can see here, Rich talks powerfully about the system failings. When we investigated the case of Rich, we indeed found multiple failings of information, clarity of how the system could work, and where Rich could go for support. The ICB and the GP, we found to have been maladministrative, and we recommended that the ICB reimburse the costs of his private assessment and treatment and made a further payment to account for the distress. This is a very typical of the cases that we saw, and.

I resorted in the meetings where we were reviewing this to describe it as being an episode from Kafka. It is bad enough to be looking for support in ADHD, but to be in effect and unintentionally given the runaround in a confusing system is too much. So if we go to the next slide, and we'll talk about our analysis of what we thought were the key systemic challenges. So I've already alluded to it, multiple, multiple cases in the first instance of poor information about the pathways, poor communication, how that affects patient rights, and what their options are. And we find that this is not only for patients and individuals, but also at multiple points in the system, so the GPs themselves, integrated care boards, and also.

I would describe it as often a conflict with what the central guidance of Right to Choose and Shared Care will give, and often this was GPs or ICBs who were attempting to reconcile their local duties and their local understandings at the system level, at the administrative level, with what the department was saying. The second area is that in certain areas the national guidelines are perhaps not keeping up with the modern world, particularly the digitally enabled world of diagnosis. And we spent some time looking at the National Institute for Clinical Excellence's guidelines in this area, And we found that, understandably, the rapid market growth had... You started to bring on board digital technologies.

And that NICE simply didn't have the evidence base to be giving clear guidelines. So spare a moment to get some sympathy, give some sympathy for the GPs who were working with clinical guidelines and attempting to deploy them on a world of assessment and diagnosis that had simply changed. And then linked to that, we also found that much of the confusion was also caused where a provider was not registered or regulated with CQC. And in some respects, this is a sort of surprisingly simple gap. Understandably, we saw a number of cases where the GP or the ICB, but particularly the GP, did not... Was not confident that they could trust the diagnosis from the the organization that had given the assessment of ADHD.

And so net result would reject the assessment and the patient would have to go around the system again, understandably, because there was no registration. They have a responsibility as everyone will know, including I think doctor Anita Thakon next as the next speaker, that there are very serious clinical responsibilities and if there isn't confidence and a clarity throughout the system, this can cause this confusion. So if we go to the penultimate slide, we choose our recommendations very carefully. We work very closely with the organizations. I am not a fan of making a policy recommendation that is ultimately alien or will not be recognized or indeed accepted. Even though some of these recommendations, and as you can imagine.

That this was the case, took quite some... I perhaps won't describe it as negotiation, but certainly much persuasion. I'm delighted to say that all three of these have been accepted in principle. Let me talk you through them. So the first one, and I've mentioned in a number of places, the perhaps the lack of coherence between the Right to Choose and Shared Care policies themselves in The UK dating back to the early two thousands and what the integrated care boards must do and their obligations, we have called for a national commissioning guidance specifically about ADHD, and for our report, of course, it was also for autism. Frankly, we aim for this to give the ICBs more clarity about what I call the rules of the road.

And linked to that is also that the ICBs need support. Many of you will know that along with the reorganization of the National Health Service, there are quite significant cuts in the infrastructure of the commissioning landscape, otherwise known as ICBs, are being asked to reduce their headcount. So they need support to build up good commissioning skills that is the root cause. We're also delighted linked to that that the Department of Health and Social Care has accepted our offer to work with them on this commissioning programme, which they have set up in the commissioning programme designed to strengthen skills, and that will range from assessing needs to good commercial and supplier management skills.

So we will be working with a couple of ICB leads later on in the year to define exactly how we can support that. And as we are increasingly doing, we are working with organizations to help them with using the voice of the patient that comes through complaints and taking thematic insight of how it feels for the individual. The second distinct recommendation is we have called for the DHSO to catalyze or call for a revised evidence base to enable NICE to look again at the a... AI enabled tech... Diagnostic technologies. We need to see that coordinated approach. I'm very delighted to say that on my board, we have a board member who is also the vice chair of the National Institute for Clinical Excellence.

So we are very optimistic that we can work our way through that. And then finally, we have called on the department to ask the care quality commission to look at, to accept rather, the need to regulate diagnostic only providers, that specific regulatory gap that I mentioned before that is causing a lack of confidence. I am delighted to say that the department has done that and that CQC this will require legislation, that CQC, with whom we are building a stronger relationship, has that on their work program going forward over the next year. So in effect, there is a combination of some fairly crunchy policy asks, support for the integrated care board, but critically, our role as the Ombudsman, our lens, and where I hope we are providing.

Value add to all of the great work that you are doing is to come at this from the policy and structural angle. We are... We have a unique perspective in parliament and with the... What we call the infrastructure bodies here. We have good close relationships with them. And as you saw from the first slide on our strategy, we... Once we set a policy recommendation of this and we will not set many across my entire jurisdiction this year, we will work to execute with the organizations who have the primary responsibility. So just finally, if we look at how the report has landed and some of the next steps, so just on to the next slide, thank you very much, which I think you'll be glad to know is the last slide. We were pleased.

With the media coverage. This is of course super important to us that we get this awareness. As we say, and you can see here that indeed one of my colleagues has already been working with the Medical Royal Colleges, it is very important that we do some of our work behind closed doors, some of our work very much not behind closed doors. And I was pleased to be able to talk through the report on Radio four, our national radio station, on its launch. So we need coverage, but very specifically, our job now is to stand behind those national bodies, the department, CQC, working with NICE to ensure that the recommendations that they have accepted in principle are executed.

And I think with that, that's probably enough from me, Henry. Very happy to take any questions. Thank you.

Well, thank you. Thank Extremely for what you're doing and have done is absolutely brilliant and very, very important. I can't honestly can't thank you enough for the importance of that report and the work that's happening. I thought some of your descriptions of fighting your way through confusing care, know, one of the things we've set out to do is try to help people navigate that. And it's just getting more and more complicated. Mhmm. In particular, the regionalization, localization that because different ICBs are putting in different things. We've had to change from giving national recommendations to giving local ones. Which we had to do earlier this year. I'm very excited as you know about potential for NICE to look again.

The guidelines are so incredibly important. And having been involved with them, I'm not sure people fully understand how thorough they are and how extensive. Yes. And if they go and look and they put their evidence there, it's as a part of their guidelines and what they've done. It's extraordinary difficult work. But that's why one of the reasons they have such strength. It's great about what you said about the care quality commission that you're highlighting the regulatory gap. Can't tell you how frustrating it was to see lines in the media. This is prior to the report talking about unregulated providers. And partly without the nuance that it wasn't assessment.

Only. Partly just some incredible frustration that obviously was NHS ICBs that had commissioned them. They wouldn't be in the system because they hadn't been commissioned. You're just like, oh my goodness. Yeah. Yes. But that regulatory role. Right. We have, and obviously you mentioned the task force and Anita's following up and of thrilled about that. Well, we've had lots of questions come in and I'll come to those. Yeah, I'll come to those now. I'm going to do them in the sort of order they've been updated in. We've got 19 questions at this time. And if anyone wants to put anymore, do just go to the globaladhd.hit live page, and you can put your questions in and upvote others. Hi Paula. Can you think of any.

Other medical condition that has the potential impact on life expectancy if untreated? Where people are being actively discouraged by the NHS from getting a diagnosis? Is this an example of discriminatory practice against disabled people by the NHS? And if so, how can we challenge it? I mean, there's two sort of questions. Like, can you think of another medical condition which is having this sort of push against? And, yeah, and then do you think it's a discriminatory practice? A.

Difficult one for me to answer, particularly to that discriminatory point. I I think, sadly, there are some other conditions. There are some other care pathways where we see similar... I I wouldn't necessarily describe it as being actively discouraged. It's rather what we mostly see as a system struggling to be able to address it. And sometimes, you know, as I'm sure you've been discussing, this is a question of resources. But but often, this is just a question of what is our policy here? What is our policy here? These are very difficult issues, but, you know, we are particularly keen that the government has seized of the fact that these conditions are not just, you know, super distressing to the to the individual.

But they also come with an an economic cost. Later on in the year, we... In fact, next month, we will be highlighting another care pathway, which or another service, which is wheelchair services, which, again, we see many different structural faults in commissioning. It is not at all deliberate, but what we're seeing is an economic impact to the country of not getting these things right. And I think that is understood people who cannot live their lives because they cannot get, you know, wheelchair services to enable them to live happy, independent, economic lives. So I think in a sense, there, you know, there are other aspects. It's a question, yes, of resources, but also of.

The system working as effectively and as efficiently as it can and making the very best of those resources.

And because it's a very important point around the choices of what to do and the implementation of what's been... The rules and implementation of what's been laid out. And it's like, have I got it correct that the Ombudsman's role is focused on what are the rules that have been laid out and them being... Them happening essentially. The economic decisions, is that's for the... That's the political decision. It is. And... Yes. And they do, yeah, they do that. Yours... Yeah. So your role is around the systems that are being put in, are they being put in correctly. And I think what we're finding is within ADHD is a challenge around the economic decision, where people trying to look at change the systems or.

What's not, well because of the economic pressure. Mhmm. Gages. Yes.

And as I said, Henry, we we we at the Ombudsman seek to come at this where we have a unique where we have a unique... Where we can we can spot deficiencies in the system. This is when we're doing our systemic investigations, of course, and where we can drive them through drive them through. And it all comes from the voice of the complainant, the voice of the patient. And one thing that I didn't mention because it's not that prominent in our report, which I know you know very well, Henry, is we... Through our patient voice work linked, which is our second major policy focus for the NHS this year, we are starting to push hard on the patient voice in service design. So that's where I expect that we will be saying more about how the ICBs.

Will engage their local area, their patients of the future, and the decisions that they make around their resources. That's that point that you were making about local guidance. So local and national need to be coherent because we operate to both sets of rules, and you can see that we've recommended that. But locally, we need ICBs engaging with their community and service design as well as feedback on where the system or the service is not delivering as it could do.

That's very interesting and very important. Going on to some questions. Once the findings are published, do you check that commissioners have actually acted on them?

Will see with this particular what a very good question this particular report talks to the findings and the recommendations which go to DHSO, the Department of Health and Social Care, Care Quality Commission, to a degree the National Institute for Clinical Excellence. And we have... I'm not gonna quite say personal contacts, but not to get too boring about it, we will track them with those organizations as you would track any progress on a project. So, you know, I and my counterpart in the department, we will simply follow through as these... The the pathway of these recommendations. So if you take the CQC regulation, we will... We understand what the steps are to lay the regulations for the legislation to close that regulatory gap.

We will have it set out month by month, quarter by quarter, we'll have an estimation from CQC and the department. When do you think you can get this done? And then we simply check-in and say, how are you doing on that recommendation? And that is something that that that I personally follow through. The the point of making very specific targeted recommendations, which we... Where we have our value add position, so we're not duplicating all the, Henry, is that we we stand behind them and ensure that they happen. In terms of the local commissioners, this... The the systemic work that we've presented underneath that are, you know, many hundreds of cases where we individually, if we have a finding.

And we uphold or partly uphold the complaint, which is our system, we will go to the individual integrated care board. And generally speaking, we work in a similar way. So we say to the integrated care board, this is our recommendation of what you need to do, which is often reviewing policies, for example, at a local area, at a local level. We aim to have the board saying it agrees and will comply before we leave them alone. Sometimes that takes them a little bit of time. In the work in our strategy over the next couple of years, we will be following up again on that. We do have very high compliance, generally speaking, but we're keen to follow through to see over the years to come because we often work with the same ICB.

The same hospital hospital trust, the same... Less so with GP practices. There are many thousands to see actually how have those recommendations changed. And this is, yes, in ADHD, but it can be in maternity or in acute or in the EDs, etcetera, etcetera. So as you can tell, I'm very focused on these happening.

And is a part of the reason the recommendations have such weight is because and to the ICB, is because by having that recommendation in place, it gives them a very good idea of what's gonna happen if complaints come following that stream.

Exactly. Exactly. Henry, in some respects, the work we do in systemic is to stop this from happening again, is to stop this from happening again. When we can see patterns and trends, we aggregate it. We go to what we think is the root cause, what we can address in the system. And the idea is that we stop these things from happening again in all... In both of our jurisdictions.

I I... What I've taken from that is this wonderful, lovely idea that the aim of the Ombudsman is to put itself out of business. Exactly.

Is... I often say that, Henry. I often say that. It is absolutely... Success would be that there is no Ombudsman.

Yeah. That's absolutely. We've had a question. What makes the complaint most likely to lead to real change rather than just an apology?

Oh, I... If we could ask the individual who's asked that good question, what is real change? At the individual level, there are absolutely... I can think of a case that I... That was one of mine recently. Forgive me. It was IVF from memory where the ICB changed its policy on IVF. It was not IVF. It was sterilization. I remember now. It's female sterilization. So at a local level, we believe, going back to your previous colleague, that the rules for male sterilization were different to the rules of female sterilization. And the the rationale on which they'd rejected this individual's... This woman's request for sterilization were unsound. And the ICB has.

Brought them in line, has changed it. But at the, you know, the national level, these recommendations, I'm going to rather rashly say, you have my word personally as Ombudsman, that I will do everything in my power to make sure that these carefully crafted. And, Henry, I've no doubt you worked with the team on those recommendations towards the final parts of the report. We think they are the right ones. If we can get those over the line, then we go some way to making ADHD care in The UK better.

The recommendations are very powerful. Your involvement is very powerful. It's... We have... Well you know from the numbers the challenges and we know the people and we know the stories and we know what's happening. The importance is sort of brought home very hard. Jim, we can't thank you enough. You talked around the difficulty of information and the report talks about how the lack of it. And we do see that endemic across. We also see it in education. The Department of Education doesn't know how many kids have ADHD. Yeah. Don't know their outcomes. It's not recorded anyway. In the same way that say, as a result of the autism act, say autism is. And one of the big drivers that, you know, we want is data. It's the same on the.

At the moment it seems like we're fighting solely on the cost of an ADHD assessment and not the benefit, both individual and the economy. And Anita, you referenced her number on the cost of undiagnosed untreated ADHD at 70,000,000,000 to the economy. And that's what we want to focus on. We see so many people being able to change their lives and a result of diagnosis and support. And that's obviously a benefit for them and benefit for all. What We patterns in the complaints surprised you the most?

Oh, what a very good question. Not a very good question. I think in terms of surprise, disappoint, or possibly depress, was the the lack of the lack of clarity, the confusion at the local level, you know, which I've spoken a lot about, you know, the the number of GPs the number of GPs making inconsistent decisions with the ICB, but that's all because the clarity of how the system should work is not there. I hope some of this is because the ICBs are in flux. The system of ICBs is in flux, and as we know, it's... They are consolidating further. So we're talking about policies being interpreted by people who are simply moving around in jobs, etcetera, which I'm sure is exacerbating. I'm sure you're seeing it, Henry. But I think that.

Surprised me because in, yes, in a world of, you know, constrained public finances, it is so important that we make the very, very best of it, and we can do better. So I so I was surprised that some... You know, there are many, many difficult choices around ADHD care for sure, but there are some, I would say, relatively simple things in terms of how does this work, how should it operate. We also see on the other area of commissioning that I referred to in wheelchair where we are likely to recommend the center to provide more guidance simply on how it operates. So an ICB could say what's the right, you know, you know, what are the others doing? What's the right choice here? Because that's also, as you will know.

We do see considerable postcode lottery, and that shouldn't be that shouldn't be the case. Postcode lottery, yes, if you have an insufficiency of supply of skilled practitioners and clinicians, but, you know, most of this is a, you know, is an online or nationally provided service, so there should be greater clarity and greater, therefore, consistency between the ICB areas.

Thank you. Yeah, I think it's very interesting. We've had a question come in which you probably want to clarify. So I see that using the old name, I see that the PHSO receives so many complaints, that it now advises that unless there's been a death or serious impairment as a result of an alleged breach, that the complaint will not be investigated, as there is no few alternative pathways. That's a concern for the public. Can you offer some comfort on that?

Yes. So our demand is riding along with other Ombudsman, other health authorities at something like 20% year on year. This is a significant spike. So one of the approaches we've taken is to look at the... In some parts, the severity, but also what we see as the public value model. The only comfort that I can give is that we we have a pretty carefully considered models take through what we consider to be the most severe or most serious. And every complaint, we will always take through the data of the complaint. So we will be, later on in this year, publishing a report that captures all of the thematic insights from all complaints that come to us. I am very sorry for.

Complainants who come to us if we cannot address it, but we do need to make the very best of the resources we have to address the most serious cases. We also do not want a backlog. We have a backlog that I am very uncomfortable about at the moment because that means that complainants can be waiting four or five months before we can address their complaint. Going back to what I said before, individuals who've been through a very distressing process over, you know, generally a year plus, We do not want to compound the distress by that delay. So we're making some hard choices here and... For which I apologize to those who don't get through to their complaint being addressed.

I also love the comment saying thank you very much, Paula, for this presentation and another talking about how actual comments are and important and useful. We have a question on what difference will it make for the CQC to start regulating diagnostic providers? This really wants to know what difference would it make day to day? Day to day.

We see too many instances of GPs not having personal confidence in the assessment. The CQC, who will register and inspect as we know, that CQC registration gives the frontline the confidence that they can rely on that assessment. I'm not... I I I quite understand how the private sector has grown up around this. I'm not making any comments about, you know, should this all be public servants. I I think there... You know, we are absolutely... Should be capable of working in a world where the private sector can can fill in some of the gaps in skills here, but we... The clinicians in the NHS needs to have confidence in those diagnoses. And we indeed have seen some assessments from some private providers that we have also.

Held against. So we need the CQC to have that full coverage of the market to avoid that lack of confidence, which means a GP will reject an assessment, and then the individual has to go through it all over again. Yeah.

Our last question, and we have to say goodbye to you and say hello to Anita. And what do you hope to happen from here?

Henry, I am laser focused on our recommendations. I know that the team are keen to stay in touch with ADHD UK to see where you are going with all your good work. I see us as part of this system. We have to play a coordinated and consolidated role to go at this mammoth task. So my personal focus is getting those recommendations over the line, but continuing to work and support you. And I know that our relationship will go on. Very, very grateful for this opportunity to talk to so many people this morning.

Very grateful for you being here for what you're doing. Genuinely, it is one of, if not the most important thing happening in ADHD. It's your authority and we're a stigmatized condition that people don't care for. And we find ourselves fighting and you know, we've had TV shows suggesting it's not even a condition at all. We find ourselves on the back foot very often. So to have the Ombudsman to have you looking into it and making recommendations is is so important and really genuinely grateful. We have a rather cheesy thank you that we're going to... Because otherwise I think it's very... Having done so many virtual meetings and presentations, you kind of just walk away having presented into hundreds of people and.

And so we want to give you a little thank you. Do genuinely want to say, Paula, thank you so much. Yeah, Henry, pleasure.

That's wonderful. Thank you so You've made Friday.

Very much more exciting than it was going to be. Well, you very much. I have to say goodbye to you. So thank you so, so much, and have a wonderful rest of your day, and wishing you the very best, and thank you for all the work. Good luck. Bye bye. Goodbye. And absolutely fantastic. The work the Ombudsman's doing, to have Paula here, for her to give her early morning to us, and very important and enormously enormously grateful.