LONDON — Autism and ADHD services in England are at risk of sliding into chaos as costs rise sharply and unregulated private providers continue to expand to meet demand, NHS bosses have warned.
The NHS Alliance, which represents health managers, says the current system is a bad deal for both patients and taxpayers. It points to wide differences in what the NHS is being charged for assessments and ongoing care, with one local health board reportedly paying between £300 and £3,000 for similar services.
The group says local managers are now trying to keep services safe and consistent while demand remains high and waiting lists stay long.
Sharp rises in spending and wide variation in prices
The NHS Alliance said it had gathered information from integrated care boards, which control budgets for local services, to understand how autism and ADHD care is currently being funded and delivered.
It found that spending was increasing rapidly in several areas. One board reported costs rising ten-fold in a year to £1.5 million a month. Another saw annual spending jump from £4 million to £30 million over two years.
In Cheshire and Merseyside, spending on adult ADHD has risen from £11 million in 2023-24 to a projected £51 million this year. The group said some boards described expenditure as out of control, and argued that such steep growth is placing huge pressure on local budgets.
The alliance also said the absence of a fixed national tariff means guide prices can vary sharply between providers, unlike the set prices used for routine operations in other parts of the NHS.
Right to choose has brought more providers and more pressure
The growth has been fuelled in part by the right to choose policy, which allows patients to opt for NHS or non-NHS autism and ADHD services. The policy was designed to help people avoid the long waits that have built up in recent years.
The NHS Alliance said the rule has brought more providers into the market, including private firms and charities, and has helped reduce some of the longest delays for adults and children. But it added that the wider use of non-NHS services has come at a significant cost.
Some local boards are now working with many more providers than before. One reported dealing with 48 providers, four times the number it had two years earlier. Managers say that makes it harder to oversee care properly and to understand what is being delivered.
Safety checks and regulation are becoming harder to manage
The NHS Alliance said the rapid expansion in providers is creating problems for quality control and patient safety. NHS managers are struggling to check standards across a much larger and more complex market while demand for assessments remains high.
Its concerns are sharpened by the fact that providers offering assessments only do not have to register with the Care Quality Commission, the main health and social care regulator in England. That, the alliance says, leaves gaps in oversight at a time when services are under strain.
Rebecca Gray of the NHS Alliance said managers were caught between a rock and a hard place. She said they understood the frustration caused by long delays, but were facing soaring costs that were running out of control. Mel Merritt of the National Autistic Society said the system was clearly in crisis and that people were still facing unacceptable waits despite the money being spent.
Government promises review and a new national approach
The government said an independent review into services and the reasons for rising demand, including whether there is over-diagnosis of autism and ADHD, would be published soon.
It said it would act on the findings and promised a new national approach for autism, ADHD and mental health. NHS bosses are waiting for that review as they assess the scale of pressure on local services and budgets.
The Independent Healthcare Providers Network said private providers were helping the NHS cope with growing demand by bringing significant capacity and innovation. It agreed, however, that better co-ordination is needed, including a national tariff to make sure the NHS pays consistent prices.
For local health leaders, the immediate challenge is keeping services available while avoiding further financial damage and preserving basic standards of care.
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