Suspension or prioritisation? Exploring the ethics of age-based rationing in adult ADHD services

Debates over how to allocate limited diagnostic resources have become increasingly pressing in attention-deficit/hyperactivity disorder (ADHD) services. In May 2025, the Coventry and Warwickshire Integrated Care Board temporarily paused National Health Service referrals for ADHD assessments for those over 25 years. The aim was to reduce long waiting times, particularly for children and young people, but the decision has raised controversy over potentially unfair treatment. In this paper, we focus on a distinction that has received limited attention outside emergency contexts: the difference between prioritising patients within a shared entitlement and suspending eligibility for a defined demographic. We examine this distinction through three normative frameworks: efficiency, temporal egalitarianism and whole-life egalitarianism, each of which captures a distinct moral dimension of age-based allocation, drawing on evidence from the Integrated Care Board’s own impact assessment. We argue that although prioritising younger cohorts may be defensible under conditions of scarcity, suspending access for adults requires stronger justification than the claim that the policy is temporary. We conclude that on the available evidence, this requirement is not met. The ethical case for the decision, therefore, remains insufficiently established.