UK Government to Crack Down on Private ADHD and Autism Assessments Amid Overdiagnosis Concerns

The UK government is set to strengthen legislation to improve standards and curb over-diagnoses of ADHD and autism, following a critical report highlighting concerns about the quality and consistency of assessments conducted by private clinics.

The Department of Health and Social Care (DHSC) announced it will enhance oversight of mental health and neurodevelopmental services, making all diagnostic assessments for ADHD and autism regulated by the Care Quality Commission (CQC). Health Secretary Yvette Cooper stated that these measures aim to ensure high-quality assessments and prevent the NHS from being overcharged by independent providers.

A government-commissioned review, led by clinical psychologist Professor Peter Fonagy, found that the current model of care may be harming a generation of children through overdiagnosis. The report raised significant concerns about the financial incentives associated with assessment activity and the lack of consistent oversight, transparency, and quality assurance for the substantial public funds being spent.

Independent firms now conduct over half of all NHS-funded ADHD assessments and more than a third of autism assessments. Spending on independent-sector ADHD provision has surged by approximately 252% in three years, as the NHS grappled with demand. This influx of providers has been partly fueled by the 'Right to Choose' policy, allowing individuals to select any qualified provider at the NHS's expense. Some integrated care boards have reported a tenfold increase in their monthly spending on ADHD and autism services within a single year.

The review noted that while private providers can help reduce waiting times, safeguards for quality and value for money have not kept pace. It identified substantial price variations for similar services and suggested that existing payment structures might inadvertently encourage combined ADHD and autism assessments due to higher revenue potential. This has led to a situation where children with more severe mental health issues face long waits for care because the 'first come, first served' system is overwhelmed.

Currently, private providers are not required to be regulated by the CQC or to share detailed statistics on their caseloads. They are also permitted to advertise their services directly to the public, a practice not allowed for prescription medications.

The report further found that the proportion of NHS GPs willing to accept 'shared care arrangements' for privately initiated prescriptions has fallen, leaving many families who paid for private assessments tied to ongoing private prescription costs or facing the need to rejoin NHS queues for reassessment.

To address these issues, the review recommends that all ADHD and autism assessment providers be regulated by the CQC, adhering to consistent standards for quality, training, data reporting, and oversight. It also calls for all providers to submit comparable information on activity, waiting times, quality, and outcomes as a condition of public funding. Furthermore, the report suggests banning direct-to-public advertising of ADHD and autism assessments to ensure access is based on clinical need rather than marketing.

In response, the DHSC confirmed its intention to strengthen regulations around assessments and review advertising practices. Cooper emphasized that these actions will provide public confidence in the quality of assessments and the financial probity of independent and private providers.