Health service managers across England have raised concerns about the sustainability of autism and ADHD care, citing escalating expenses and the rapid growth of unregulated private providers entering the market.
The NHS Alliance, which represents health administrators, characterizes the current system as problematic for both patients and taxpayers. The organization points to significant disparities in service pricing, with some local health boards paying anywhere from £300 to £3,000 for comparable assessments and care. The expansion of new providers—including both private companies and charitable organizations—has created challenges for NHS managers attempting to verify quality and safety standards.
Costs have risen dramatically in several regions. One board reported a tenfold increase in spending within a year, reaching £1.5 million monthly. Another experienced annual expenditures climb from £4 million to £30 million over two years. In Cheshire and Merseyside, adult ADHD spending has grown from £11 million in 2023-24 to a projected £51 million this year. Unlike routine procedures such as hip and knee replacements, which operate under fixed pricing structures, autism and ADHD services rely only on guide prices that providers are not required to follow.
The proliferation of providers has also complicated oversight efforts. One board reported managing relationships with 48 providers, quadruple the number from two years prior. Additionally, assessment-only providers face no requirement to register with the Care Quality Commission, the regulatory body responsible for health and care facilities.
The government has announced that an independent review examining service delivery and rising demand—including whether these conditions are being overdiagnosed—will be released soon, with commitments to implement a new national framework. Meanwhile, representatives from patient advocacy organizations and private provider groups have acknowledged systemic problems and called for improved coordination and consistent pricing standards.
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