Why NHS Waiting Times Vary by Area (ICBs & Trusts Explained)

One of the most frustrating things about NHS SEND waits is that they are so uneven. A family in one town might wait a year for an autism assessment; a family thirty miles away might wait three. This is not random — it comes down to how the NHS is organised locally.

Services are commissioned locally

In England, Integrated Care Boards (ICBs) plan and fund NHS services for their area, and local trusts deliver them. Each ICB makes its own decisions about how much assessment capacity to commission, which is why budgets, capacity and waits differ so much from one area to the next. The Children’s Commissioner has documented wide regional variation in neurodevelopmental waiting times.

Different areas use different pathways

The route to an assessment is not the same everywhere. In some areas, autism and ADHD assessments run through CAMHS; in others, through community paediatrics or a dedicated neurodevelopmental service. These pathways have different capacity and different waits, which adds to the variation. See CAMHS waiting times for neurodivergent children for more.

What this means for you

Because waits are local, the most accurate figure always comes from your own ICB or the service holding your referral. National ranges — like those in our NHS waiting times estimator — give you a realistic ballpark, but your local wait may be shorter or longer. Understanding why waits are so long and what you can do while waiting can help you plan around the variation.

Sources

• Children’s Commissioner — waiting times for neurodevelopmental assessments
• NHS England — Community Health Services Waiting Lists

Guidance here refers to the system in England; arrangements differ in Scotland, Wales and Northern Ireland. For planning only; not clinical advice. Data reviewed: June 2026.