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Following a successful randomised control trial by NIHR East Midlands, HIEM piloted the use of the innovation QbTest within three NHS mental health trusts. This provided the evidence base for a national programme called Focus ADHD. The programme was rolled out across England by Health Innovation Networks between 2020 and 2023. It enabled NHS mental health trusts and community paediatric services to improve the ADHD assessment offered to children and young people. This national programme accelerated the uptake and implementation of an objective ADHD assessment tool the QbTest (measuring the three core components of attention, impulsivity and activity) to supplement the current clinical assessment processes. The offer for trusts included supporting changes in pathways, workforce and data collection.
Attention Deficit Hyperactivity Disorder (ADHD) is a treatable disorder that affects around 5% (1 in 20) of school-aged children worldwide. Undiagnosed and/or untreated ADHD can have a significant impact on personal development, academic outcomes and family interaction. Additional mental health problems related to poor management of ADHD include depression, anxiety, sleep and eating disorders and self-harm.
There is no simple test to determine whether a child has ADHD. The process for diagnosing ADHD can include multiple steps and is based on clinical judgement informed by subjective reports from parents, teachers and observation of the patient.
Children in the UK wait 18 months on average to obtain an accurate diagnosis, more than the European average of 11 months. Assessment for diagnosing ADHD is estimated to cost the NHS £23 million a year and the total cost for patients over their lifetime is estimated at more than £102,000 (assessment, treatment, management, education and social support).
Based on a successful pilot within three mental health trusts in the East Midlands, in 2020 England’s 15 local Health Innovation Networks were commissioned by the NHS to lead the coordinated, rapid national roll-out of the Focus ADHD programme.
This programme was based on implementing the QbTest technology, (developed by Qbtech ltd) within mental health trusts and paediatric services.
Depsite the Covid-19 pandemic at the start of the national roll out from April 2020 it exceeded all national targets, benefiting 71,102 young people (by March 2024) and saving an estimated £38.5M for the NHS by releasing healthcare capacity and reducing the number of appointments.
Capitalising on the HINs’ twin abilities to operate locally whilst working in a coordinated way to drive rapid innovation implementation, this trailblazing programme (launched at the start of the Covid-19 pandemic) went from a standing start to national adoption within less than three years. The programme won four national awards and by March 2024 had supported 71,102 young people and was being delivered in 79 NHS trusts across England.
The intervention has enabled a big reduction in time from assessment to diagnosis by an average of 153 days, increasing staff capacity by reducing the number of appointments needed for diagnosis (an estimated 95,097 hours of clinical time released 2020 to 2024) with estimated NHS savings of £38.5M, enabling redirection of resources to other parts of the ADHD pathway.
In March 2023 the National Institute for Clinical Excellence (NICE) published a Medical Innovation Briefing (MIB) – highlighting the benefits of objective testing technology when used as part of a comprehensive ADHD assessment – and in September 2023 NICE recommended Qbtest to support ADHD diagnosis for children and young people.
Whilst the formal HIN programme (Focus ADHD) completed in March 2023, the ability of the HINs to not just drive adoption – but drive it in ways that it stays embedded when we step back – is enabling ongoing implementation of the QbTest. For example, between 2023 to 2024 during the 12 months following the formal end of the national HIN programme, the innovation spread to a further 10 NHS trusts and an additional 15,000 children and young people benefited.
Critical learning from this programme is relevant to any NHS transformation programme, and a blueprint document captures this knowledge: Innovation, Implementation, Readiness and Resourcing
Ongoing impacts of the implementation of the programme (April 2020 to March 2024):
Critical success factors
It would not have been possible to grow and expand so rapidly throughout every NHS region in England, without the support of Health Innovation East Midlands and the other local HINs. “They broker connections into health systems that would have taken us years to develop alone. They understand the conditions critical to successful innovation adoption, and we have drawn on their expertise throughout our ongoing journey. For any company seeking markets within the NHS, the knowledge, support, and insight of the HINs is invaluable.” Tony Doyle, Commercial Director, Qbtech (developer of the QbTest)
It would not have been possible to grow and expand so rapidly throughout every NHS region in England, without the support of Health Innovation East Midlands and the other local HINs.
“They broker connections into health systems that would have taken us years to develop alone. They understand the conditions critical to successful innovation adoption, and we have drawn on their expertise throughout our ongoing journey. For any company seeking markets within the NHS, the knowledge, support, and insight of the HINs is invaluable.”
Tony Doyle, Commercial Director, Qbtech (developer of the QbTest)
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Focus ADHD national programme evaluation Popular 1.24 MB It’s important to note the context in which this evaluation was carried out. The evaluation team believe that some of the findings are likely to have been heavily impacted by disruption and delays to services caused by COVID-19.