Prescription of Medication for ADHD (S.R.9/2025): Response of the Minister for Health and Social Services and the Minister for Social Security

Findings

Comments

1

Repeat prescriptions for ADHD medication provided under Health and Community Services can only be issued by a psychiatrist. The Panel learned that there is currently one on Island psychiatrist and was informed that the psychiatrist was spending the majority of their time issuing repeat prescriptions.

Prescriptions for ADHD medicines can be issued by other practitioners; Currently this prescribing is undertaken in secondary care by one (part-time) Consultant Psychiatrist, who is supported by a junior doctor. Between them, they currently have a prescribing caseload of 360 patients.

2

Health and Community Services have tried to recruit nurses who are specialised in ADHD and can provide a diagnosis, however, they are extremely rare. In addition, most nurses with this specialised skill may not feel fulfilled in writing 300+ prescriptions per month – the current caseload.

Noted

3

Health and Community Services have discussed the possibility of training an existing nurse to issue prescriptions, however, this has yet to be determined.

An update is now available in the response below.

Findings

Comments

4

ADHD medication is not on the Prescribed List of Medications due to global shortages and is not currently eligible for subsidy from the Health Insurance Fund (HIF).

ADHD medication is not on the Prescribed List. An application for medicines for ADHD to be added to the Prescribed List is under review by PBAC but, to date, inclusion has not received endorsement from primary care  providers  who have  raised  concerns  about  issues  including ongoing  medicines  shortages,  the  Share  Care Agreement, and the role of community Pharmacy.

5

In addition to the one on Island consultant psychiatrist being authorised to issue repeat prescriptions for ADHD medication provided under Health and Community Services, they are also the only person who can provide an ADHD diagnosis.

This is not entirely correct. Other practitioners are able to provide a diagnosis, but only when they feel appropriately trained and experienced in this specific area to do so. In adult services, very few of the practitioners have the necessary training and experience currently.

6

A nurse from the Health and Community Services Department's education team has been seconded to assist with the ADHD waiting list who is also qualified to assess for ADHD diagnosis. The secondment of the nurse is due to be reviewed with a discussion as to how to use the services of the nurse going forward.

Noted

7

The current waiting list from referral to a diagnosis of ADHD is 3 and a half years. The number of adults on the waiting list is currently at 778, a reduction from 817 in June of this year. The Panel was informed that this was due to the work undertaken by a nurse who had been seconded to work on the waiting list.

The  current  waiting list has  now  reached  924 people (January 2025).

8

The lengthy waiting list was having a negative impact on the wellbeing of those waiting to be assessed/diagnosed.

Noted

9

Lack of communication from Health and Community Services whilst on the waiting list was having an impact on the wellbeing of those waiting for an assessment/diagnosis.

Noted

10

The hospital pharmacy opening hours are Monday to Friday, 9am to 5pm and

Noted

Findings

Comments

the Panel learned from members of the public that at times, these impact on the working day. The Panel also learned from members of the public that the waiting area for collection of ADHD medication within the hospital is inadequate for those with who are neurodiverse and/or with neurological illnesses, with reference to poor lighting, the lack of seating and loud Tannoy announcements.

11

The waiting list for assessment and diagnosis of ADHD is arranged in chronological order and is not prioritised for those who may be in need of a diagnosis more than others. In addition, it is possible that some people on the waiting list could be suffering from a different neurological condition other than ADHD.

Noted

12

The Panel learned that there was a global shortage of medication, as a consequence prescriptions for ADHD medication were being issued for one month as opposed to 6 weeks/3 months.

Noted

13

The Panel learned that there was a danger that due to the global shortage of medication, patients may have to go without their standard medication and substitute it for another product with the same characteristics. Although this had not happened in Jersey, it had happened in other jurisdictions.

Noted

14

Should ADHD medication be included on the Prescribed List of Medications, the cost per annum would be an additional £800,000 which would need to be subsidised by the Health Insurance Fund.

Accurately estimating the cost impact to the HIF of including medicines for ADHD is problematic due  to  uncertainties  around  service  model, capacity,  the  rate  at  which  newly  diagnosed patients are started on treatment and the transfer of  patients  currently  accessing  supplies  of medicines  through  private  prescription. Additional costs comprise · increased cost of the medicine · Dispensing fees · HIF subsidy (£55.28 adult) and four consultations per year

Findings

Comments

ADHD  medicines  procured  via  community pharmacy tend to be 40% more expensive that secured through General Hospital arrangements. A figure of £800,000 pa was estimated for drug costs  alone  based  on  likely  total prevalence/uptake figures previously provided by the  adult  and  CAMHS  services.  With  current volumes, drug cost would be in the region of £450k pa.

15

The Minister for Social Security informed the Panel that she has reliance on the expert advice from the Pharmaceutical Benefit Advisory Committee (PBAC) and informed the Panel that any decisions could not be made without that expert advice.

Noted

16

The Pharmaceutical Benefits Advisory Committee (PBAC) meet quarterly and provide recommendations to the Minister for Social Security on medications which should be included/excluded on the Prescribed List of Medication. This list qualifies medicine to be subsidised under the Health Insurance Fund (HIF).

Noted

17

The Panel understands that a Shared Care Pathway is in discussion with both the Minister for Health and Social Services and the Minister for Social Security. The discussions involve the Shared Care Pathway allowing a referral to be made by a GP and moved onto secondary care to for diagnosis and treatment, following which it would be moved back to the GP for ongoing monitoring. Until the Shared Care Pathway protocols are agreed, it is difficult to see how primary care will form part of the overall management of patients with ADHD.

Noted

18

The Panel understands that some GPs from small practices are reluctant to sign up to the Shared Care Pathway due to the responsibility of prescribing ADHD medication on a day-today

Noted

Findings

Comments

basis and not having the flow of patients to gain the experience required.

19

Following the written submissions from members of the public, the Panel learned that to have GPs prescribe repeat medication would be of benefit and may ease the existing pressure on the one psychiatrist

Noted

20

The Department of Health and Community Services is currently discussing with GPs the possibility of them undertaking special interest sessions in some services – one being ADHD. If a GP was particularly interested in an area and wanted to develop some expertise, the GP could work in that area and receive supervision from the specialist which would increase capacity and help with the service.

This is still in discussion.

21

Shared Care Pathways are used successfully in Jersey, however, do not cover mental health issues. In the UK, they successfully cover areas such as mental health, cancer and chronic conditions such as diabetes. The benefits of Shared Care Pathways include patient satisfaction, efficiency and cost savings and better health outcomes

Noted

22

The Minister for Health and Social Services and the Minister for Social Security hold different roles with regards to the health service. It is uncertain which Minister would have responsibility for the Shared Care Pathway, or if the role would be shared.

The Minister for Health and Social Services holds responsibility  for  Shared  Care  Pathways  but recognises  the  role  played  by the minister  for Social Security where HIF funding is required or impacted.

23

The Minister for Social Security informed the Panel that one Minister with sole responsibility for the Shared Care Pathway is not something that she would be opposed to.

Noted

Findings

Comments

24

Awareness of ADHD is not as prominent as it should be. The Panel was informed that this was due to it being an evolving situation and areas needed to be resolved prior to undertaking raising awareness.

Noted

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

The Minister for Health and Social Services should implement a training programme for nurses to provide them authorisation to issue repeat prescriptions for ADHD medication to ultimately establish a clinic or hub for ADHD patients to pick up medication and receive advice. A costed update should be provided to the Panel within 3 months of publication of this report.

MH SS

Partially accept

The need to increase prescribing capacity within the service is accepted. Training is available for nurses to become prescribers (there are currently 2 nurses from within adult mental health services undertaking this course); this is a formal, approved training programme within the UK that is delivered by health faculties within universities. However, even if nurses are trained to be prescribers, they will need to want to work in this specialist area and will need significant supervision and support during the training.

The 2 nurses that are undertaking the training currently do not work within the ADHD service, and to redeploy them into the service (should they wish to do so) will require an additional financial investment and the need to replace them within their current services.

Further to the completion of the Scrutiny review, the service has successfully recruited a senior nurse who has speciality training and experience in this area, and is a prescriber. This will increase capacity when she takes up post. Discussions are

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

also ongoing to potentially develop GP input into the service.

The  service  will  therefore  review  the capacity  and  delivery  of  the  service when the new post holder is in place, and will also review the roles of the nurses that have been trained to prescribe once they  are  near  to  completion  of  their training.

2

The Minister for Health and Social Services must consider the allocation of duties to the nurse to enable assessments and diagnosis to alleviate the pressure on the one on Island psychiatrist. This should be implemented following review of the secondment, due to take place imminently.

MH SS

Accept

The secondment arrangement has now been completed. As described above, the service  has  now  recruited  a  full-time specialist nurse into the service (yet to take up post) and continues to review the capacity and operating arrangements of the service on a regular basis.

3

The Minister for Health and Social Services should ensure there is clarity on the status of the waiting list for those currently waiting for an assessment/diagnosis. In addition, clear lines of communication must be available to those who have been referred. This should be implemented within 3 months of the presentation of this report.

MH SS

Accept

The service is currently in the process of reviewing  the  waiting  list  again,  and developing  a  potential  model  for prioritisation. All people on the waiting list will be contacted again by the service by  the  end  of  March  2025  with  an updated  position.  The  service  is  also exploring how to publish current waiting times on a regular basis.

Mar 2025

4

The Minister for Health and Social Services should, in conjunction the Minister for Infrastructure, should ensure a modified waiting area be included

MH SS

Reject

All waiting areas within the Acute facility are designed to be inclusive for all users and are in line with recognised best practice. A number of key elements such as materials, colour, lighting, acoustics, furniture and textures have been considered during the design process to ensure

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

as part of the new hospital. This should be in line with best practice for waiting areas for those with neurological conditions.

accommodation of all users. As part of the ongoing design development, consultation will take place with a range of stakeholders to confirm the interior design is suitable & accessible for all.

In particular, the proposed NHF Jersey Waiting Areas are designed to accommodate users with a range of conditions. Detailed below are the considerations for the key elements that reflect the best practice in this area. By incorporating these elements, the proposed design provides a supportive and inclusive environment for individuals with a wide range of neurological and neurodiverse conditions:

Use of Natural Materials (i.e. Timber- Effect Laminate):

Natural materials promote a calming environment and reduce sensory overload, which is beneficial for people with conditions like autism spectrum disorder (ASD), anxiety disorders or ADHD.

Neutral Colour Palette:

Neutral tones help minimise visual stimulation and create a sense of tranquillity. This is particularly helpful for individuals with sensory sensitivities or neurological conditions.

Colour-Coded Wayfinding:

Muted, distinct colours aid in orientation and navigation, especially for people with cognitive impairments, dementia, or ADHD. Keeping the colours muted ensures they are not overstimulating.

Consistency Across Floors:

A consistent design theme and cohesive materials palette with varying accent

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

colours maintains familiarity and reduces cognitive load for patients and visitors, which is crucial for those with memory or processing difficulties.

Lighting:

The lighting design ensures the use of LED lights and a backlit feature ceiling over the Waiting Area provides even illumination to prevent glare or flickering, as these can trigger migraines or sensory issues. Where possible Waiting Areas have been positioned adjacent to natural light as it helps regulate mood and supports circadian rhythms.

Acoustics:

For individuals with hyperacusis or sensory sensitivities ambient noise can be unpredictable and distressing in busy spaces, particularly open plan layouts containing mixed function zones.

To mitigate the noise levels perforated acoustic panels finished in timber-effect laminate have been proposed above the larger Waiting Areas. In addition, all corridors incorporate perforated metal ceiling tiles with an acoustic backing.

Furniture Layout:

The layout ensures clear and uncluttered pathways to enhance accessibility and reduce confusion. Within the larger waiting zones a diverse range of seating is provided.

Texture and Pattern:

Simple textures have been incorporated to avoid overly busy patterns in flooring or upholstery, as these can be visually overstimulating.

5

The Minister for Social Security should consult further with

MS S

Accept

PBAC will review the application for medicines for ADHD (adults and young people) to be added to the Prescribed List

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

Pharmaceutical Benefits Advisory Committee (PBAC) regarding the inclusion of ADHD medication on the Prescribed List of Medications. Due to the rising number of adults requiring ADHD medication, costings should be provided for the next 5 years to ensure its affordability. Discussion on this should be without delay with possible inclusion on the prescribed list by the end of Q2 2025.

at its next meeting. This will include an update on potential numbers/costs with the  MH/CAMHS  teams  invited  to provide  updates  to  the  meeting. Including  ADHD  medicines  on  the prescribed  list  will  require  additional HIF  funding  in  terms  of  drug  costs, dispensing costs and GP costs

6

The Minister for Health and Social Services, together with the Minister for Social Security must continue its discussions with the Primary Care Board to find a solution to additional medical professionals being authorised to prescribe medication. Should this not come to fruition, both Ministers should implement an alternative plan to offer training to existing medical professionals to qualify for prescribing.

MH SS/ MS S

Accept

Discussions  with  the  Primary  Care Board (and individual GP practices) are ongoing. MHSS continues to believe that an effective shared care model - whereby primary  care  clinicians  can  access specialist  support  if  required  and  a regular specialist review is undertaken – remains the most appropriate method to implement this.

7

The Minister for Health and Social Services should explore the option of funding GPs to undertake special interest sessions in ADHD, where they would receive training and

MH SS

Accept

Discussions continue with potentially interested GPs, as part of the ongoing work reviewing capacity and delivery models of the service. One GP practice has been identified as having a specific interest to date. This will require additional funding for the service.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

supervision from the ADHD specialist, helping to increase capacity and alleviate pressure on the waiting list for assessment/diagnosis. This should be carried out by Q2 2025 with an update provided to the Panel of its progress within 3 months of the presentation of this report.

8

The Minister for Health and Social Services, together with the Minister for Social Security, should discuss roles and responsibilities with a view to one Minister (or Assistant Minister) having sole responsibility for the Shared Care Pathway. These discussions should take place in line with the timeline for the implementation of the Shared Care Pathway with an update provided to the Panel within 3 months of presentation of this report.

MH SS/ MS S

Reject

The responsibility for developing a Care Pathway sits with MHSS. But in cases where this pathway is deployed across Secondary and Primary care, and seeks to use HIF funding, or increase costs to the HIF, (for example by increasing the volume  of  General  Practice appointments  which  received  HIF funding) there needs to be engagement and agreement from both Ministries. The Ministers work closely together and do not  consider  that  it  is  necessary  to provide for an Assistant Minister with responsibility for this specific area.

9

The Minister for Health and Social Services, together with the Minister for Social Security, must consider a programme of activity to support ADHD Awareness Month 2025. This should be carried out within ample time for preparation for the next

MH SS/ MS S

Partially Accept

Before Attention-Deficit / Hyperactivity Disorder (ADHD) Awareness Month in October  the  publication  of  the Neuroinclusive Jersey strategy in 2025 will  include  a  significant  focus  on ADHD  awareness  and  education.  The strategy  will  be  implemented  by  a steering group – inclusive of a number of individuals  with  ADHD  and representing the third sector – and the group  will  agree  an  approach  to

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

ADHD awareness month.

education  and  awareness including  any  plans  for awareness month.

raising, ADHD

10