When NHS doors close, digital innovation must open

By Professor Robert Thomson, Academic Co-Lead, Global Research Institute in Health and Care Technologies, Heriot-Watt University

Across England, a crisis is quietly unfolding as ADHD and neurodevelopmental services close their doors. Fifteen NHS services are no longer accepting new patients and thirty-one more have imposed strict access limits by age or severity. In Derbyshire alone, 3,700 people have no local options, reflecting a systemic failure that leaves vulnerable individuals unsupported. It's a situation that damages lives and public trust.

Louise Nichols' story, reported recently by the BBC, illustrates this frustration. After spending two years on a waiting list, she was dropped when Sheffield stopped assessing out-of-area patients. "I cannot understand why a national health service is not across the whole nation," she said, revealing the harsh reality policymakers must confront. Adult ADHD assessment waiting times now routinely stretch to eight years. Meanwhile, the recent ADHD taskforce report warns that delays risk worsening mental health, substance misuse, unemployment and criminal justice involvement.

Traditional, clinic-based diagnosis models rely heavily on face-to-face specialist consultations. Already strained pre-pandemic, what was once a trusted model now results in widespread unmet need. The deepening crisis underscores the urgent need for innovation, including digital technologies, to expand access and augment neurodevelopmental and mental health care. If more clinics and more appointments are not available, the next step must be to consider how symptom management can be assisted.

Digital health technologies offer the opportunity for an adjunctive approach by tracking cognitive function, behavioural patterns and mental state continuously in real-life settings. MIND Lab led by Dr Mel McKendrick, provides digital content creation alongside objective and subjective metrics. The aim is to build on this to create a multisensory platform to continuously monitor changes in mental state, cognitions and behavioural symptoms. Using non-invasive sensors, the real-time data helps healthcare professionals gain more precise and objective insights into conditions ranging from neurodevelopmental conditions like ADHD to neurological conditions like Parkinson's disease and mental health conditions like depression. The vision is to curate extensive datasets that cross-reference mental health with neurodevelopmental and neurodegenerative conditions, offering a deeper understanding of how these conditions overlap and interact.

Another focus is immersive technologies, including virtual and augmented reality, to create gamified interventions designed to make neurodevelopmental, neurological and mental health treatment more engaging and accessible. These innovations not only support real-time diagnostics but open new possibilities for personalised and effective interventions across a range of neurodevelopmental, neurological and mental health conditions, taking a symptoms-based approach to address overlapping and distinct symptoms across conditions.

Crucially, these tools are designed to work alongside clinicians rather than replace them. While some digital platforms may eventually support elements of assessment, clinical judgement will always remain central. In the same way, therapeutic features are intended as supportive measures, helping people manage symptoms while they wait for care or in situations where regular access to a therapist simply isn’t available. This shift to include supplementary tools will be particularly important as NHS services move to ration care based on age or severity. ADHD and many neurodevelopmental conditions rarely exist in isolation. Work led by Professor Kate Sang at Heriot-Watt University's Edinburgh Business School examined menstrual health challenges faced by some neurodivergent women, which can add complexity in diagnosis and treatment. Medication prescribed for one condition may impact symptoms of another, meaning that assessing by age or severity is far more complex than current models recognise. Further, neurodivergent women may face the dual challenge of gender and disability bias in accessing healthcare. Digital tools offer new ways to capture this complexity and support more precise, personalised and equitable care decisions.

Of course, diagnosis alone will not address the worsening crisis. Professor Thapar's ADHD taskforce and many other frontline professionals are calling for wider involvement of community NHS staff in supporting people with ADHD, recognising that specialist services cannot cope alone. However, this requires both the right training and appropriate tools. New approaches such as virtual and augmented reality therapies provide scalable treatments, offering engaging ways to help people without requiring frequent specialist appointments. Gamified digital therapies and remote learning platforms can reach individuals wherever they are, helping to bridge the gap when face-to-face care is unavailable.

A further obstacle compounds the crisis. In the UK, the average time from the development of health technology to widespread NHS adoption is 17 years. The innovations that could help patients like Louise Nichols today may not be available until well into the 2040s. This delay is driven by fragmented procurement, unclear funding routes and weak incentives for health boards and trusts to adopt them.

This is where universities can help but systemic change is urgently needed to ensure success. Universities and innovators must have scope to test solutions at scale in properly funded living labs where their impact can be evaluated in real social and clinical environments. Workforce development must be integrated with technology adoption, providing GPs and pharmacists with training linked to new digital platforms so staff can use new tools as soon as they are ready. Finally, procurement frameworks should shift from focusing only on lowest price to recognising long-term value, rewarding innovations that keep people healthier at home and reduce avoidable admissions.

At Heriot-Watt University, patients and their lived experience are central to our healthcare innovations, working closely with patients, carers and communities to ensure innovations meet actual needs. Active involvement through co-design, public engagement groups and advisory panels produces more relevant and effective solutions but it also improves clinical trial recruitment and ensures research addresses real service gaps. This patient-centred approach is vital as NHS services are forced to ration care.

Universities possess the experience, resources and multidisciplinary teams to drive this work. What they lack is a system prepared to translate research into mainstream care at pace. Closing the gap between development and delivery is within our control. That choice will determine the future for people like Louise Nichols, and for the thousands behind her, waiting for the system to change.

For more information about the work the Global Research Institute in Health and Care Technologies is doing visit https://www.hw.ac.uk/turning-ideas-into-impact