NHS & ICBs Private & independent healthcare

Clinical waiting-list management for NHS Trusts, ICBs & VCSE providers

See who on your waiting list is getting worse,
before they reach crisis.

Gwelwch pwy ar eich rhestr aros sy'n gwaethygu, cyn iddynt gyrraedd argyfwng.

A risk-sorted caseload for every mental health, ADHD and autism waiting list. Patients complete the standard questionnaires services already use; every response is scored against explainable clinical rules, and rising risk escalates to a named worker with a full audit trail.

Holdfast clinician caseload dashboard: patients sorted by risk level (RED, AMBER, GREEN) with trend-concern flags, engagement status, named worker and open-escalation counts, filterable by clinical pathway

A clinical tool, not another wellbeing app

Consumer wellbeing apps sit outside the clinical pathway. Holdfast sits inside it: the referral, the clinician, the escalation and the record all live in one place, and the care team is the customer.

Built for the care team

Clinicians and support workers work from a risk-sorted caseload, an escalation queue and a daily worklist. The patient app is the channel that feeds them.

Standard clinical instruments

PHQ-9, GAD-7, CORE-10, ASRS, AQ-10 and more, scored against named rules a Clinical Safety Officer can read. Self-help is never the response to risk.

Accountable by design

Every escalation has a named owner, a respond-by time and an audit trail. Commissioners get aggregate wait and outcome reporting, never patient data.

The waiting list is a clinical blind spot

42%

of mental health patients say their condition deteriorated while waiting

Source: CQC survey, cited via Anxious Minds

40%

of waitlisted patients received no support at all during the wait

Source: Rethink, NHS data analysis (2025)

2+ years

typical wait for an ADHD assessment in England, some areas over 10 years

Source: NHS England, ADHD Taskforce report

Untracked deterioration leads to crises and costlier care later. Holdfast sorts the list by risk automatically, so the same staff can safely support more people - and catch decline before it becomes a crisis, not by chance.

Holdfast Today's worklist: urgent patients listed with the reason they need contact, days waiting, one-tap outcome buttons (Spoke, Left message, No answer, No action needed) and a link to the open escalation

Who needs you today, and why

A worker opens their caseload and sees who needs them next - filtered by risk, pathway, and who's gone quiet. No spreadsheet, no manual triage.

The daily worklist

Who to contact today, why, and a one-tap outcome. Every contact becomes reportable outreach activity. Enabled per ICB.

Holdfast escalations queue: each escalation shows what triggered it in plain language, a respond-by time and an SLA breached flag, with worker assignment, clinical notes, a Mental Health Act assessment referral option, and Acknowledge and Resolve actions

Escalations that land with a named owner

When risk crosses a threshold, the escalation states exactly what triggered it, who owns it and when a response is due. Missed response times are flagged, and re-notified, not left in an inbox.

Workers acknowledge, add clinical notes, record a Mental Health Act assessment referral and resolve, and every step is written to the audit log.

Holdfast patient history view: line charts plotting a patient's loneliness rating, overall risk score, PHQ-9 and GAD-7 over successive check-ins, with AMBER and RED threshold lines marked on the risk-score chart and a View as table option on each

The trend, not just the last answer

Every measure a patient has given is plotted over time - mood, risk score, PHQ-9, GAD-7 - months before their next appointment.

These charts are what the trend rules watch: a climbing score, a sliding rating, repeated amber results. Each can raise a review on its own, and every chart drops to a plain table.

How it fits how the NHS is actually organised

A Trust runs the platform, an ICB commissions it, and each clinical team keeps its own caseload. Every layer is a real data boundary, not just a filter.

England's 36 ICBs (down from 42) each stay their own commissioning boundary in Holdfast, matching real funding agreements. An administrator can add a new Trust, its ICBs and teams, and invite staff, in minutes.

Nothing starts without consent. Every patient gives explicit, withdrawable consent before their first check-in. Equity data is optional and always reported anonymously.

Want the detail, step by step?
See exactly how it works, from Trust setup to a patient's check-in.

Built for every waiting list, not just one

ADHD, autism, memory and trauma pathways wait just as long, tracked mostly on paper. Holdfast digitises the same standard questionnaires services already trust, routed straight to the assessing clinician.

Mental health

CORE-10, WSAS, AUDIT-C, PHQ-9 and GAD-7 on a regular check-in cadence.

Adult ADHD

ASRS screening, digitised, with the same risk-monitoring loop.

Child ADHD

SNAP-IV, completed by a parent or carer through their own login.

Autism

AQ-10, in adult, adolescent and child variants.

Older adult & memory services

6-CIT, DAST-10 and GDS-15 for the memory-service backlog.

Trauma & PTSD

TSQ for quick triage, or PCL-5 for full severity detail.

Every form and check-in Holdfast covers

Browse every questionnaire, screener and check-in Holdfast supports, grouped by pathway, with who completes each one and how it is scored and used.

Browse the full library →

That turns an invisible backlog into a reportable figure, pathway by pathway. See how a carer completes a check-in, or a clinician raises a one-off screener.

Holdfast patient assessment history: a PHQ-9 result expanded to show every question, its answer and score, with the self-harm indicator row highlighted and an Escalation triggered column reading 'Yes - self-harm risk item threshold met'

Every answer scored, risky ones flagged

Each questionnaire opens to a full item-by-item breakdown - every question, answer and score. High-risk items, like the PHQ-9 self-harm question, can trigger an escalation on their own.

Compliance evidence, built in from day one

A system holding patient data has to earn its place in the NHS. Holdfast maps its controls to the frameworks procurement teams assess against, with live evidence in-product - not a PDF at contract signing.

DTAC

The standard NHS gate for digital health tools. Every control is tagged against DTAC's sections, ready for an assessor to trace.

Read the DTAC self-assessment

DPIA

Required wherever special category health data is processed at this scale. Holdfast's self-assessed DPIA covers lawful basis, individual rights and a scored risk register.

Read the DPIA

Class I medical device

Self-assessed as a Class I medical device under UK MDR 2002: it prioritises and notifies, but never diagnoses or treats without a human in the loop.

Read the classification assessment

DSPT

The annual self-assessment every NHS data handler must complete. Holdfast's audit logging and tenant isolation give a Trust the evidence its submission needs.

See certification status

Cyber Essentials Plus

Independently verified, not self-assessed - required before any real patient data is processed.

See certification status

PCREF

Expects providers to evidence fair reach across communities. Ethnicity and gender data are optional, patient-supplied, and small-number-suppressed in every report.

See how consent and equity data are handled

Holdfast Security and compliance dashboard listing controls mapped to DTAC references, each marked ACTIVE or PENDING, alongside 24-hour login and rate-limiting counters and a recent security events log

Live control evidence, not a claim in a slide deck

An Admin sees exactly which controls are active today and which are queued - nothing marked done that isn't. On the app, a Face ID/passcode lock and jailbreak detection sit in front of the check-in data itself.

Every state change - consent, a safety plan, an escalation - is written to an immutable audit log with who and when. See what gets logged when a check-in escalates.

Clinical safety and information security stay separate on purpose. The Clinical Safety Officer's hazard log is a distinct, read-only view from the Admin's security dashboard.

Who it's for, and what each seat sees

Support worker

Owns a caseload, manages carer contacts, first responder to escalations.

Clinician

Reviews escalations, sets check-in cadence, authors safety plans.

Admin

Manages teams and staff across an ICB; sees the audit trail.

Clinical Safety Officer

Read-only ICB-wide seat reviewing the hazard log and safety case.

Commissioner

Read-only, aggregate outcomes and waiting-list reporting - never patient data.

Patient & carer

A short, private check-in; a carer's login covers just their patient.

The Holdfast patient home screen: a one-minute check-in next to a side panel showing the next check-in due, a note from the support worker, and pathway-specific self-help resources The Holdfast check-in in easy-read mode on a phone, with shorter sentences, larger touch targets and a clearly labelled rating scale

The patient side: something back, not just another form

Every check-in asks for something. Here's what patients get back while they wait.

Waiting Well resources

NHS-approved self-help matched to the patient's pathway and wait - not a generic list.

Self-management nudges

A repeated pattern - poor sleep, rising anxiety - surfaces a specific NHS resource. Rules a Clinical Safety Officer can read; paused while an escalation is open. Per-ICB opt-in.

A note from the named worker

A short templated message - send-only, with a standing link to urgent help. Per-ICB opt-in.

NHS Right to Choose

Past the pathway's review threshold, staff get an NHS signposting panel to share - information, not advice. See the full flow.

My wellness plan

A private plan in the patient's own words, shared only when they choose. See the optional add-on.

Built for every patient

Easy-read mode, five languages, and full screen-reader and keyboard support.

Save and finish later

Longer forms autosave as you go, on web and app.

A gentle first run

A short intro explains what a check-in is. On the app, Face ID, a fingerprint or a passcode guards the data before anything shows.

The Holdfast My wellness plan page: a patient's own answers to what keeps them well, their daily routine and what makes things harder, with a note that they have shared it with their care team and crisis support below A card on the patient home page showing the patient's own strategy back to them after repeated low mood, labelled as their own plan and not a reply from the care team

Optional add-on

My wellness plan: the patient's own words, on the record

While they wait, patients can write down what keeps them well, what makes things harder, the early signs they are struggling and what helps. It supports care planning - it is not the NHS agreed care plan, and it is never a crisis route.

Private until the patient shares it

A plan starts as a private draft. Sharing needs the patient's data-sharing consent, they can stop at any time, and withdrawing consent makes it private again straight away.

Their strategies, back at the right moment

When an area the patient named as an early sign stays low across check-ins, the app shows them what they wrote helps. A fixed rule, visible to a Clinical Safety Officer, that never changes the risk score - and it is withheld whenever there is an open escalation, a RED check-in, any risk to self or a flagged note.

Reviewed with the patient, not edited for them

The named worker reads a shared plan, adds a short note and marks it reviewed. Staff never edit the patient's text, and risk language in a shared plan is flagged for a person to read. A linked carer can help write it, but only the patient shares it.

Aggregate view for commissioners

Shared and reviewed plans are reported separately, with small numbers hidden and no league table, so the measure cannot be gamed.

Per-ICB opt-in, off by default, and not available on child pathways yet.

Why this exists

The founder

Holdfast is built by a solution architect and software developer working across digital healthcare and mental health - who is also neurodivergent and, after a long wait for formal assessment, decided to build something for everyone else waiting in silence.

The evolving solution

It started with filling in PHQ-9 and GAD-7 week after week during CBT: the numbers moved long before anyone clinical saw them. Holdfast closes that gap - keeping the instruments services already trust, but routing them somewhere that acts in real time.

Get in touch

Commissioning a mental health, ADHD or autism waiting-list service? We'd like to hear from you.

info@holdfasthub.co.uk