Neurodiverse Pathways - Governance Update
Argyll and Bute Council · 12 May 2026
Back to Argyll and Bute HSCP Clinical and Care Governance Committee — 12 May 2026 and its agenda
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1 Meeting: Clinical & Care Governance Committee Date of Meeting: 12 May 2026 Title of Report: Neurodiverse Pathways – Governance Update Presented by: Nicola Gillespie, Head of Complex Care and Registered Services The CCG committee is asked to: ▪ Note the current update and progress in relation to ASD and ADHD pathways. ▪ Note the identified clinical, operational and governance risks. ▪ Note the interim mitigation actions in place to protect patient safety and service sustainability. EXECUTIVE SUMMARY Demand for neurodevelopmental assessment and support across Argyll & Bute continues to increase at a level that exceeds current service capacity. This has resulted in growing waiting lists, pressure on secondary care services, and identified governance risks, particularly in relation to ADHD prescribing and monitoring arrangements. Immediate interim actions have been taken to stabilise risk, including the decision to move to a Tier 4 only ADHD service, prioritising those with complex needs, comorbid mental illness and risk. A Short Life Working Group (SLWG) has been re‑established to provide coordinated oversight and support longer‑term pathway redesign. While these measures mitigate immediate risks, they do not address underlying system capacity constraints, which require ongoing strategic consideration. 1. RECOMMENDATIONS ▪ Note the current update and progress in relation to ASD and ADHD pathways. ▪ Note the identified clinical, operational and governance risks. ▪ Note the interim mitigation actions in place to protect patient safety and service sustainability.
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2 2. DETAIL OF REPORT Autistic Spectrum Disorder Pathway The ASD diagnostic service remains significantly constrained, with limited staffing and a waiting list in excess of 200 adults. Despite short‑term mitigation through commissioned external assessments, referral volumes continue to exceed available capacity. The service remains diagnostic only, with no commissioned post‑diagnostic support pathway, limiting the system’s ability to respond holistically to need. Referral quality and consistency continue to impact efficiency, and work is underway through the SLWG to review referral tools and processes, drawing on learning from other Health Boards. ADHD Pathway There is currently no dedicated, tiered ADHD service within Argyll & Bute. As a result, referrals have defaulted into secondary mental health services, creating significant pressure on Community Mental Health Teams (CMHTs) and consultant psychiatrist capacity. Adult ADHD waiting lists now exceed 230 individuals, with particularly high demand in Oban, Lorn and the Isles. A material clinical governance risk has emerged following notification from Lorne Medical Centre of its intention to cease prescribing ADHD medication in the absence of agreed shared care or enhanced service arrangements. This affects a significant cohort of existing patients and highlights broader system challenges around monitoring requirements, private diagnoses, and prescribing responsibility. In response, an interim decision has been taken to move to Tier 4 only acceptance criteria for ADHD referrals, aligning Argyll & Bute with practice in other areas and prioritising individuals where CMHT‑level intervention is clinically appropriate. Next Steps for ASD and ADHD Pathways 1. Move to a tier 4 ADHD service provision and ensure robust communication to GP colleagues and clients 2. Continue to work with our Primary Care colleagues to mitigate risk. 3. Continue to scope ASD service and develop options for in house vs commissioned service 4. Scope gaps and needs for future service 3. RELEVANT DATA AND INDICATORS, - Almost 500 adults are awaiting ASD or ADHD assessments. A review of referrals is underway to ensure appropriate service allocation and reduction of unnecessary demand. 4. CONTRIBUTION TO STRATEGIC PRIORITIES, The strategy aligns with agreed HSCP priorities and supports national policy implementation.
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3 Strategic Gaps: • No national funding for post-diagnostic support services. • Previous strategy development excluded key stakeholders and LD services. 5. GOVERNANCE IMPLICATIONS Financial Impact: • Current funding models do not support existing demand or sustainable pathway delivery. • Interim arrangements are being managed within existing resource but are not viable long term. • Future pathway options will require explicit consideration of affordability and funding gaps. Staff Governance: • The diagnostic practitioner is managed by the Senior Manager for LD with external mentoring support. Clinical and Care Governance: • Risk of harm associated with delayed diagnosis and interruption to ADHD prescribing and monitoring. • Pressure on CMHT capacity, with diversion of consultant time from people with severe and enduring mental illness. • Increased inequity of access due to geographic variation and reliance on private diagnosis routes. 6. PROFESSIONAL ADVISORY All professional standards and advisory requirements are being met. 7. EQUALITY & DIVERSITY IMPLICATIONS The strategy respects and promotes all protected characteristics and diversity principles, however if the service moves to a tier 3 or 4 only, this may impact those wishing to access services. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Fully compliant. 9. RISK ASSESSMENT Clinical risk associated with delayed or disconnected care. Reputational and legal risk arising from unmet need and variation in service access. These risks are currently mitigated through interim service controls, enhanced senior oversight, and SLWG governance. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT
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4 Clear communication with patients and Primary Care is being prepared and will be prioritised to manage expectations and reduce uncertainty. 11. CONCLUSIONS Significant pressures remain across neurodiverse pathways, driven by rising demand and limited capacity. Interim governance actions have been necessary to protect patient safety and clinical sustainability, however these measures underline the need for longer‑term system redesign 12. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 13. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) e.g. Finance and Policy Committee Budget outlook 01/01/24 e.g. Recommended to the IJB REPORT AUTHOR AND CONTACT Author Name: Nicola Gillespie Email: nicola.gillespie2@nhs.scot