Following The Pembrokeshire Herald's recent article, "Staggering rise in autism and ADHD delays across west Wales" (June 17, 2025), I feel compelled to share critical, direct evidence that exposes a deeper, systemic failure within our local ADHD services, particularly under the Hywel Dda University Health Board. While the Herald rightly highlights increasing waiting lists, the true crisis lies in the inadequate provision of care for those already diagnosed, and the alarming lack of oversight.
As a local resident and an individual who has directly experienced these services, I have spent months meticulously gathering evidence, including Freedom of Information (FOI) data, that paints a concerning picture:
The Unacknowledged Elephant in the Room: The Capacity Crisis Centered on a Single Point of Failure
The Hywel Dda University Health Board operates only one specialist Adult ADHD Service, located at the Wellfield Resource Centre in Carmarthen, covering the vast three counties of Carmarthenshire, Pembrokeshire, and Ceredigion. What has been consistently overlooked, and is central to this crisis, is the historical reliance on one single individual, Dr. Justin Cressey-Rodgers, who until January 2025, served as the sole adult ADHD specialist for all three clinics, while simultaneously being a consultant in psychiatry of substance misuse at CDAT Penlan, Carmarthen.
This dual and expansive role meant that one doctor bore the primary burden of diagnosing and managing ADHD for the entire adult population across the region, while also being deeply involved in substance misuse services. My FOI data (FOI/16681/25) unequivocally shows the waiting list for adult ADHD diagnostic assessments soaring to 3,710 individuals by 2024. This staggering figure, coupled with the long-standing reliance on such extremely limited specialist capacity, raises immediate and serious questions about the feasibility of providing structured, ongoing, and safe follow-up care. The health board itself acknowledges a "significant waiting list" and confirms that the "current waiting time for an adult ADHD assessment is approximately 58 weeks."
When I directly questioned how one doctor (or such a limited team) could manage so many cases, I was met with an inadequate explanation: that he has a wife, two secretaries, and three receptionists. This is not a clinical care model; this is a clear indicator of a system pushed beyond safe capacity, relying heavily on administrative support instead of proper medical oversight and sufficient clinical staffing. The appointment of an Adult ADHD Clinical Nurse Specialist in January 2020, while a positive step, clearly hasn't alleviated the core capacity issues leading to these profound delays and continued patient distress.
Ignoring Warnings: My Personal Experience of Service Failure and Systemic Barriers
My own journey through this system exemplifies these failures. After receiving an ADHD diagnosis from Dr. Cressey-Rodgers, I found myself adrift. I submitted a formal, recorded delivery complaint about the lack of support and oversight, yet I received no response. I was left to navigate a national medication shortage alone, without adequate clinical guidance or ongoing review. The data shows 564 adults waiting for medication after diagnosis – another critical bottleneck in the system, even for those who have cleared the initial, lengthy assessment hurdle.
Compounding this crisis, recent figures highlight that Wales has the worst rate in the UK of GPs agreeing to share the care of ADHD patients with private doctors. This forces already vulnerable individuals into an impossible choice: face debilitating, multi-year NHS waiting lists, or pay for private diagnoses and then struggle to find a GP willing to prescribe their medication. This systemic barrier further fragments care and leaves patients without the integrated support they desperately need.
This situation echoes the very concerns now being raised by the Royal College of Paediatrics and Child Health (RCPCH) regarding "long waits, inconsistent access, and a growing gap between policy and practice." For adults, and particularly for vulnerable women, this gap has devastating consequences. It forces individuals, many with co-occurring mental health and trauma histories, into a precarious position, struggling to access vital medication and support.
The Overlooked Consequences: Costing Lives, Creating Trauma
The Herald's article notes the RCPCH's warning that "without urgent action, the impact on children’s lives — including their mental health, education, and future wellbeing — will be severe." I assert that this impact is already severe for adults too, and its roots lie in the very issues I'm highlighting:
 

• Lack of follow-up care: Diagnoses without proper ongoing support are diagnoses that set patients up for failure.
   
• Systemic unaccountability: When formal complaints go unanswered, and practitioners are not challenged on their practices, it erodes trust and perpetuates a cycle of harm.
   
• Exacerbated vulnerability: For individuals with histories of trauma and substance use, fragmented and unsupported care can directly contribute to relapse and mental health crises, as I have personally experienced. The article on measles warns about children with unmet health needs facing long-term disadvantages; the same applies, if not more so, to adults with ADHD reliant on a failing system.
   

A Call for Urgent Scrutiny and Rectification
It is time for the Hywel Dda University Health Board and the Welsh Government to move beyond acknowledging waiting lists and confront the deeper systemic issues. I urge The Pembrokeshire Herald to investigate:
 

• The specific capacity and clinical oversight model for Adult ADHD services within Hywel Dda, particularly the historical reliance on Dr. Justin Cressey-Rodgers as the sole adult ADHD specialist and substance misuse psychiatrist across all three counties until very recently.
   
• The systemic barriers to integrated care, including the low rate of GP shared care agreements for ADHD patients in Wales, and its impact on treatment access.
   
• The process for handling patient complaints related to ADHD services and the outcomes of such complaints.
   
• The transition (or lack thereof) from child to adult ADHD services in practice, and how historical diagnoses without follow-up are being managed.
   

I am providing the FOI data and prescribing snapshot I previously shared, which underscore the scale of this issue. This is not just about numbers; it is about thousands of local lives, including vulnerable children and women, who were promised help but received a diagnosis without the fundamental support needed to thrive.
The silence around these specific failures is costing lives and perpetuating a cycle of unmet needs and further trauma. It is time for accountability and urgent action.
Sincerely,
Denise Byrnes
Concerned Local Resident