NHS bosses warn of chaos in ADHD and autism care

NHS managers across England are warning that the cost of providing autism and ADHD assessments and care is spiralling out of control as unregulated private providers rush to meet soaring demand. The NHS Alliance, which represents health managers, says the current system is a “bad deal” for both patients and taxpayers, citing dramatic variations in what local health boards are charged for similar services – ranging from £300 to £3,000 per assessment. Recent data gathered from integrated care boards reveal that spending on these services has exploded: one board’s monthly outlay jumped ten‑fold to £1.5 million, another’s annual spend surged from £4 million to £30 million in two years, and in Cheshire and Merseyside adult ADHD costs are projected to rise from £11 million in 2023‑24 to £51 million this year. The rapid expansion of providers – now 48 in some areas, four times the number two years ago – has left NHS managers struggling to verify the quality and safety of care, especially as many assessment‑only providers are not required to register with the Care Quality Commission.

The surge in private and charitable providers is a direct result of the NHS “right to choose” policy, which allows patients to seek care from non‑NHS services in order to bypass long waiting lists that have built up in recent years. While the policy has helped reduce some of the longest waits for both adults and children, it has also introduced a market with only guide prices, not mandatory tariffs, unlike the fixed rates applied to routine surgeries such as hip and knee replacements. This lack of price regulation has led to stark inconsistencies in charges and has made it difficult for NHS boards to control spending. The government has promised an independent review into the rising demand and potential over‑diagnosis of autism and ADHD, pledging to act on its findings and to develop a “new national approach” for these conditions and mental health more broadly.

Reactions to the crisis have been mixed. Rebecca Gray of the NHS Alliance described managers as “caught between a rock and a hard place,” acknowledging the frustration of patients waiting for assessments while warning that unchecked costs could push the system into chaos. The Independent Healthcare Providers Network defended private sector involvement, arguing that providers bring “significant capacity and innovation” but agreed that better coordination and a national tariff are needed to ensure consistent pricing. Meanwhile, Mel Merritt of the National Autistic Society called the situation a clear crisis, blaming rising short‑term spending on years of insufficient long‑term investment and noting that, despite the influx of funds, patients continue to face “unacceptable” delays. The upcoming review and proposed national tariff will determine whether the NHS can rein in costs while maintaining access and quality of care for those with autism and ADHD.

⚡ Effects Interpreter