Spending by UK health trusts on diagnosing Attention Deficit Hyperactivity Disorder (ADHD) and autism has increased tenfold in the past year, leading to what NHS leaders describe as 'unsustainable' and 'out of control' costs. Private clinics are charging the NHS up to £3,000 per patient for assessments, contributing to a surge in expenditure that is impacting other essential services for people with learning disabilities.
The NHS Alliance, representing health trusts, published a report detailing a 'relentless rise' in spending across 42 NHS care boards. Some regions have reported dramatic increases, with one integrated care board's monthly spending escalating from £146,000 to £1.5 million. In another instance, spending in Kent and Medway rose from less than £1 million to £28.9 million in a single year. Projections for Cheshire and Merseyside indicate adult ADHD services alone could reach £51 million by 2026-27, an increase from £11 million in the previous fiscal year.
The report highlights significant price variations among private clinics, with initial assessment fees ranging from £300 to £3,000. The NHS Alliance attributes this financial strain, in part, to the 'Right to Choose' initiative, which allows patients to receive private assessments with the NHS covering the cost. This system has been described as a 'Wild West' of private clinics, some of which conduct diagnostic assessments online.
Referrals for ADHD have seen a 20-fold increase since 2000, with an estimated 800,000 people currently awaiting assessment in England. NHS England estimates that approximately 2.5 million people in England live with ADHD, many undiagnosed.
Concerns are mounting regarding the quality and safety of care provided, as NHS managers struggle to oversee the growing number of assessments. The NHS Alliance is advocating for a national fixed tariff to regulate the fees charged by private clinics and a national service specification to ensure high-quality assessments for autism, ADHD, and mental health services.
Experts suggest that the rising demand is driven by increased awareness of ADHD, better recognition of symptoms, and greater public discussion, including on social media, rather than a proportional increase in the number of individuals affected. High-profile figures, such as actors Sheridan Smith and Robbie Williams, have publicly shared their diagnoses, which campaigners believe has helped reduce stigma and encourage more people to seek help. IMAGE3
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Conversely, recent figures indicate a rise in waiting times for autism assessments, with over a quarter of patients waiting at least three months for an initial specialist appointment.
NHS England stated that it is taking action to improve access to ADHD and autism support and ensure value for money. An interim report released in March identified 'institutional incentives' to seek a diagnosis, which can facilitate accommodations in educational and professional settings. The increasing prevalence of mental health issues, such as depression and anxiety, has also been noted, with a 40% rise in working-age individuals out of work due to long-term sickness reporting these conditions since before the pandemic.