Senior figures within the NHS are raising concerns about the sustainability and quality of autism and ADHD services in England, citing significant cost increases and challenges in managing a rapidly expanding network of providers.
The NHS Alliance, which represents health managers, has highlighted substantial variations in pricing for similar services, with one local health board reporting charges ranging from £300 to £3,000. Several integrated care boards have documented spending increases described as out of control, with one board’s costs rising ten-fold in a year to £1.5m monthly. Another saw annual expenditure increase from £4m to £30m over two years, while Cheshire and Merseyside’s adult ADHD spending is projected to reach £51 million this year, up from £11m in 2023-24.
A right to choose policy allowing patients to access both NHS and private providers has contributed to the expansion of new organizations in the sector. While this has helped reduce waiting lists, it has also created oversight difficulties. One board reported managing relationships with 48 providers, compared to 12 two years earlier. Many assessment-only providers operate without registration with the Care Quality Commission, complicating quality and safety monitoring.
Unlike routine surgical procedures, which operate under set tariffs regardless of provider type, autism and ADHD services rely only on non-binding guide prices. Rebecca Gray of the NHS Alliance stated managers were facing an untenable situation, caught between addressing patient demand and controlling unsustainable expenditure.
The government has committed to publishing an independent review examining service delivery and the causes of rising demand, including potential over-diagnosis concerns, with plans to introduce a new national approach. Meanwhile, advocacy organizations have characterized the situation as a systemic crisis requiring long-term investment rather than short-term solutions.
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