City of York Council

Equalities Impact Assessment

Who is submitting the proposal?

Directorate:		Public Health
Service Area:		Healthy Child Service
Name of the proposal:		Autism and ADHD Strategy
Lead officer:		Phillippa Hickey
Date assessment completed:
Names of those who contributed to the assessment:
Name	Job title		Organisation	Area of expertise
Phillippa Hickey	Public Health Registrar		CYC	Public Health

Step 1 – Aims and intended outcomes 

1.1

What is the purpose of the proposal? Please explain your proposal in Plain English avoiding acronyms and jargon.

This strategy, which has been produced with input from people with lived experience and key partners, provides a framework for action to improve the lives of Autistic people and people with ADHD, and ensure York in an inclusive city that works for all. Autistic people and people with ADHD belong in York. They are a core part of our city: friends, children, co-workers, parents, politicians, sports people, business owners, teachers, and many more. In a city which values its diversity, embeds human rights into its practice, and welcomes all, York gains so much strength and vibrancy from having so many neurodivergent residents living in our city. However, our society and public services have much further to go before they can claim to be truly inclusive and supportive of all autistic people and those with ADHD. Over the last years, awareness and discussion of neurodiversity has increased, but efforts to change society, as well as increased resourcing of support for neurodivergent people, have not kept pace. We have written this Autism and ADHD Strategy because we believe that working to move forwards across health, care and civic partners to strengthen systems and raise awareness of neurodiversity in York will ensure that the experience of living in the city as a neurodivergent individual will be no different to that of someone who is neurotypical. In York, the assessment, diagnosis, care and support systems for autistic people and people with ADHD are under significant strain, and people frequently report feeling under-supported. A whole-system approach, presented in this strategy, is needed to have a positive impact on autistic people and people with ADHD, as well as their carers and families, and to make society more inclusive and supportive.

1.2

Are there any external considerations? (Legislation/government directive/codes of practice etc.)

The impact of this strategy will be system wide. Assessment, diagnosis and support are not provided by one singular provider in York. They are provided by a number of partners such as York Hospital, CAMHS and The Retreat, and this strategy will require all partners to collaborate to implement the commitments set out in this strategy. City of York Council (CYC) and Humber and North Yorkshire Integrated Care Board (ICB) both have a duty to plan services, develop partnerships and commission together in response to the National Autism Strategy under the Autism Act. The strategy also considers civic society and raising awareness of measures that can be taken to enable and inclusive and equal.

1.3

Who are the stakeholders and what are their interests?

Service users - Autistic people, those with ADHD and carers engage with various services for assessment, diagnosis and support from various providers across the system. CYC / ICB – A number of Local Authority departments and the ICB have a duty to respond to the national autism strategy and do so through ensuring inclusivity is considered and included in the services they commission. Service Providers- York Hospital, North Yorkshire and York CAMHS, The Retreat – Children under 5 years old are assessed at the child development centre at York, those aged 5-18 are assessed through CAMHS, and adults are assessed by The Retreat. Primary Care – GPs refer patients to providers for diagnostic assessment and acts as a data source for people who have an autism and/ or ADHD diagnosis on their record. Third Sector- An array of third sector organisations which provide support and information for autistic people, those with ADHD and carers Education sector – SEN teams can refer patients to service providers and also contribute to an individual’s Education, Health and Care plan (EHCP). The majority of autistic children and those with ADHD are in mainstream education so teachers and other members of staff in schools need to have the skills to be able to support them and make reasonable adjustments in the school environment to make them more inclusive. Working groups/ Forums- Provided feedback during consultation process and helped produce priorities and commitments.

1.4

What results/outcomes do we want to achieve and for whom?  This section should explain what outcomes you want to achieve for service users, staff and/or the wider community. Demonstrate how the proposal links to the Council Plan (2019- 2023) and other corporate strategies and plans

Together, we want to create a society that works for Autistic People and People with ADHD in York. Our three key sections are: 1) Change society for inclusion- support autistic people and those with ADHD to live a full and flourishing life in York 2) Make diagnosis and assessment work- ensure all policies and pathways are clear and understood by all, and as timely as possible. 3) Improve support in every setting – ensure better support for autistic people and those with ADHD in every sphere of life. Professionals should be responsive to needs and information, support and adjustments should be available to all, not just those with a formal diagnosis. This ties into the Council Plan which sets out the vision of making York a more accessible place where everyone feels valued and aims to increase opportunities for everyone living in York to live healthy and fulfilling lives.

Step 2 – Gathering the information and feedback 

2.1	What sources of data, evidence and consultation feedback do we have to help us understand the impact of the proposal on equality rights and human rights? Please consider a range of sources, including: consultation exercises, surveys, feedback from staff, stakeholders, participants, research reports, the views of equality groups, as well your own experience of working in this area etc.
Source of data/supporting evidence		Reason for using
Public consultation events		Between November 2024 – March 2025, 'Listening Exercises' were held where members of the strategy group went out to over 20 organisations or boards with 3x 'conversation starters' on the strategy and captured feedback. In May 2025, an early draft strategy was circulated, and published for public discussion at the council's Health, Housing and Adults Scrutiny Committee. In June and July 2025, further consultation events were held on the draft strategy to further shape and refine it and then a formal public consultation on the strategy was held, and comments and feedback were incorporated into the strategy.
Autism and ADHD Health Needs Assessment		Provided data from health and care services as well as evidence from the literature on the health needs of autistic people and people with ADHD.
Strategy working group		This group which consisted of key partner agencies, academic and voluntary agencies and those with lived experience met several times and were involved in producing priorities and commitments detailed in the strategy.
Coproduction and public consultation		Feedback on strategy received from various stakeholders including those with lived experience.

Step 3 – Gaps in data and knowledge

3.1	What are the main gaps in information and understanding of the impact of your proposal?  Please indicate how any gaps will be dealt with.
Gaps in data or knowledge		Action to deal with this
Actual impact on service users, carers and families		Further consultation events will be held, including direct feedback from those with lived experience.

Step 4 – Analysing the impacts or effects.

4.1	Please consider what the evidence tells you about the likely impact (positive or negative) on people sharing a protected characteristic, i.e. how significant could the impacts be if we did not make any adjustments? Remember the duty is also positive – so please identify where the proposal offers opportunities to promote equality and/or foster good relations.
Equality Groups and Human Rights.		Key Findings/Impacts	Positive (+) Negative (-) Neutral (0)	High (H) Medium (M) Low (L)
Age		The commitments made in all three sections should positively impact autistic people and people with ADHD of all ages across York due to the aims of improving inclusivity, making diagnosis and assessment work at all stages and improving support in every setting. This should ensure that everyone with an autism/ ADHD diagnosis is able to live a good life in York	+	H
Disability		For autistic people and those with ADHD, this strategy has the potential to have a significantly positive impact on their lives. However, we recognise that this strategy is focused on Autism and ADHD, and not any other disabilities. Whilst the focus is on making York an inclusive place, we cannot be certain of any negative effects our commitments may have on people with other disabilities.	+/-	H
Gender		Autism in females is sometimes missed or misunderstood due to their ability to ‘mask’ and therefore are often diagnosed later than their male counterparts. This is also apparent with ADHD due to differences in how behaviours present. Although we have made commitments to increase neurodiversity awareness, there is no specific mention of increasing awareness of what this looks like in females/ those assigned female at birth, and so there is the potential that diagnosis in this group will continue to be delayed.	0	M
Gender Reassignment		As all genders follow the same pathway, there should be no impact.	0	L
Marriage and civil partnership		No specific impact	0	L
Pregnancy and maternity		Some of the commitments set out in this strategy focus on implementing hospital passports and reasonable adjustments in various settings including healthcare settings e.g. GP surgeries and hospitals. The aim of this is to support people in accessing the care they need, and this should positively impact pregnant women engaging with maternity services.	+	H
Race		Not enough robust evidence on race and Autism or ADHD to assess the impact	0	L
Religion and belief		No specific impact	0	L
Sexual orientation		No specific impact	0	L
Other Socio-economic groups including :		Could other socio-economic groups be affected e.g. carers, ex-offenders, low incomes?
Carer		The strategy includes commitments to providing support for carers particularly financially as there was considerable feedback around this during consultations. We are also committed to continue working with York Parent Carer Forum to co-produce information materials to ensure carers can access information and support at an appropriate time.	+	H
Low income groups		The strategy recognises the financial impact that having a neurodivergent child can have on a family, and we are committed to ensuring that families are signposted to info around finances and welfare benefits and resources.	+	H
Veterans, Armed Forces Community		No specific impacts	0	L
Other		None
Impact on human rights:
List any human rights impacted.

Use the following guidance to inform your responses:

Indicate:

- Where you think that the proposal could have a POSITIVE impact on any of the equality groups like promoting equality and equal opportunities or improving relations within equality groups

- Where you think that the proposal could have a NEGATIVE impact on any of the equality groups, i.e. it could disadvantage them

- Where you think that this proposal has a NEUTRAL effect on any of the equality groups listed below i.e. it has no effect currently on equality groups.

It is important to remember that a proposal may be highly relevant to one aspect of equality and not relevant to another.

High impact (The proposal or process is very equality relevant)	There is significant potential for or evidence of adverse impact The proposal is institution wide or public facing The proposal has consequences for or affects significant numbers of people The proposal has the potential to make a significant contribution to promoting equality and the exercise of human rights.
Medium impact (The proposal or process is somewhat equality relevant)	There is some evidence to suggest potential for or evidence of adverse impact The proposal is institution wide or across services, but mainly internal The proposal has consequences for or affects some people The proposal has the potential to make a contribution to promoting equality and the exercise of human rights
Low impact (The proposal or process might be equality relevant)	There is little evidence to suggest that the proposal could result in adverse impact The proposal operates in a limited way The proposal has consequences for or affects few people The proposal may have the potential to contribute to promoting equality and the exercise of human rights

Step 5 - Mitigating adverse impacts and maximising positive impacts

5.1

Based on your findings, explain ways you plan to mitigate any unlawful prohibited conduct or unwanted adverse impact. Where positive impacts have been identified, what is been done to optimise opportunities to advance equality or foster good relations?

There is the potential for adverse impacts on disabled people who do not have Autism or ADHD due to the fact that this strategy focuses solely on these. However, we work with groups such as York Disability Rights Forum, the ICB Mental Health, Learning Disability and Autism Collaborative, York SENDIASS, York Parent Carer Forum and Connecting our City Neurodiversity and Mental Health working group to capture feedback on the strategy and commitments to try and negate any adverse impacts.

Step 6 – Recommendations and conclusions of the assessment

6.1	Having considered the potential or actual impacts you should be in a position to make an informed judgement on what should be done. In all cases, document your reasoning that justifies your decision. There are four main options you can take:
- No major change to the proposal – the EIA demonstrates the proposal is robust.  There is no                         potential  for unlawful discrimination or adverse impact and you have taken all opportunities to    advance equality and foster good relations, subject to continuing monitor and review.
- Adjust the proposal – the EIA identifies potential problems or missed opportunities. This involves taking steps to remove any barriers, to better advance quality or to foster good relations. - Continue with the proposal (despite the potential for adverse impact) – you should clearly set out the justifications for doing this and how you believe the decision is compatible with our obligations under the duty - Stop and remove the proposal – if there are adverse effects that are not justified and cannot be mitigated, you should consider stopping the proposal altogether. If a proposal leads to unlawful discrimination it should be removed or changed. Important: If there are any adverse impacts you cannot mitigate, please provide a compelling reason in the justification column.
Option selected		Conclusions/justification
No major change to proposal		The majority of impacts and effects will be positive, especially for autistic people and people with ADHD, and the commitments made in the strategy will begin the work towards making York truly inclusive and supportive for autistic people and those with ADHD.

Step 7 – Summary of agreed actions resulting from the assessment

7.1	What action, by whom, will be undertaken as a result of the impact assessment.
Impact/issue		Action to be taken	Person responsible	Timescale
Potential adverse impact on people with other disabilities		Continue to work with York Disability Rights Forum and the ICB Mental Health, Learning Disability and Autism Collaborative to address any issues identified	Phillippa Hickey	Ongoing
Later diagnosis in girls		Ensure that differences in presentation of behaviours in females and males is available in information and resources – bring to steering group	Phillippa Hickey	Ongoing

Step 8 - Monitor, review and improve

8. 1	How will the impact of your proposal be monitored and improved upon going forward?   Consider how will you identify the impact of activities on protected characteristics and other marginalised groups going forward? How will any learning and enhancements be capitalised on and embedded?
	Further consultation, as well as a steering group to take commitments forward. Work with providers and partners to monitor progress using qualitative and quantitative methods. The strategy working group will evolve into an Autism and ADHD Strategy Reference group which will meet regularly to form and oversee the action plan. This group will report into the Mental Health Partnership.