Senior health officials in England are raising alarm about the sustainability of autism and ADHD services, citing rapidly escalating expenses and a proliferation of largely unregulated private providers entering the market. The NHS Alliance, an organization representing health managers, characterizes the current arrangement as problematic for both patients and taxpayers, pointing to significant inconsistencies in pricing across different regions and providers.
Cost pressures have become severe in multiple areas. Some integrated care boards reported spending increases of extraordinary magnitude, with one board’s monthly expenditure on these services climbing to £1.5m following a tenfold rise within a year. In the Cheshire and Merseyside region, adult ADHD spending is projected to reach £51 million in the current year, compared to £11m in 2023-24. Another board experienced annual spending jump from £4m to £30m over two years. These surges have prompted health managers to describe spending as “out of control.”
A central challenge involves the absence of standardized pricing mechanisms. Unlike procedures such as hip and knee replacements, which operate under set tariffs regardless of whether the NHS or private sector provides them, autism and ADHD services rely only on guide prices that providers are not obligated to follow. This has resulted in extreme variation, with one board paying anywhere from £300 to £3,000 for comparable services. Additionally, the number of providers has expanded dramatically, with one board increasing from 12 providers to 48 within two years, complicating quality assurance efforts.
Regulatory gaps present additional concerns. Assessment-only providers are not required to register with the Care Quality Commission, the health and care regulatory authority, limiting oversight capabilities. Rebecca Gray of the NHS Alliance characterized managers as “caught between a rock and a hard place,” balancing pressure to reduce lengthy waiting lists against unsustainable spending trajectories.
The government has commissioned an independent review examining service provision and factors driving increased demand, including potential over-diagnosis, with findings to be released soon. Officials pledged to implement findings through a revised national framework for autism, ADHD, and mental health services.
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