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The NHS is overspending by £164m a year on attention deficit hyperactivity disorder (ADHD) services, with an increasing amount going to unregulated private assessments, a Guardian investigation has found.
Analysis shows that total spending on NHS ADHD services is expected to be more than double existing budgets. Further data shows the amount spent on private ADHD services has more than tripled over three years.
Experts have warned that assessments provided by private providers can be unreliable, pointing to cases in which patients have been harmed by poor continuity of care after private diagnoses.
Demand for ADHD assessments has reached record levels as awareness of the condition has increased and NHS services have become increasingly stretched, with more than half a million people now waiting for an assessment.
Last month the health secretary, Wes Streeting, announced a review into the diagnosis of mental health conditions such as ADHD, amid concern over the numbers of people with such conditions claiming sickness benefits.
Research shared with the Guardian shows spending on ADHD services is estimated to reach £314m by April 2026, more than double the year’s budget of £150m set aside for this area of healthcare.
The figures, which cover 32 of England’s 42 integrated care boards (ICBs), raise concerns that other services could face cuts to offset the £164m overspend.
Nineteen ICBs also provided data on how much of their ADHD budget went on private companies, showing the NHS’s increasing reliance on outsourcing. It showed spending had more than tripled in three years, from £16.3m in 2022-23 to £58m last year. This has prompted concern that companies are making millions from what critics say is an under-regulated market.
Due to how the data is collected, it could include some spending for other neurodiversity conditions as well as ADHD.
The chair of the all-party parliamentary group on ADHD, Jo Platt, said the findings showed services were “at breaking point” and that NHS costs had “soared while private providers profit from poorly regulated systems, leaving too many patients in limbo without proper oversight”.
The research by the Centre for Health and the Public Interest (CHPI) found one company – recently bought by a private equity firm – had reported profit margins of 33% over the past two years, mainly from providing NHS services. Another 14 companies delivered NHS-funded ADHD assessments without being registered with the Care Quality Commission.
A further 19 companies that provided £1.9m worth of neurodiversity services over three years had no NHS contract at all, meaning local health bodies cannot properly hold them to account.
Many NHS adult ADHD services in England have stopped taking on new patients due to high demand, so some turn to private providers via the right-to-choose pathway. This pathway lets patients pick their provider, including private ones, so they can bypass long local waitlists and get help faster.
The CHPI report warns that, for business investors, the right-to-choose system is particularly easy to access. A company needs only one contract to treat patients anywhere in the country, and there is no cap on how much they can earn, because local NHS bodies cannot restrict patient numbers.
The Guardian has uncovered cases of serious harm that appear to have been caused by problems with continuity of care after a private diagnosis.
In January, a coroner issued a prevention of future deaths report on the death of 27-year-old Sheridan Pickett, who died by suicide after receiving an online ADHD diagnosis and taking stimulant medication prescribed by a private clinic.
When Pickett was later admitted to an NHS hospital after an overdose, doctors warned that the ADHD drugs should not be restarted, but that information was never passed back to the private provider, which continued prescribing.
The coroner found there were no formal rules requiring information-sharing between private neurodevelopmental services and NHS teams, warning that without change similar deaths could occur.
Separately, experts said the standard of assessments carried out by private companies was not always good enough. One NHS clinician, speaking anonymously, said: “I do some private work myself, but I ensure that everything I produce aligns with NHS and nationally agreed quality standards for ADHD assessments.
“Some private providers do deliver good-quality assessments, but I’d estimate that around 70-80% do not, and there are certain ones I simply won’t work with when I see their name on the report.”
Andrew Jay founded the neurodiversity support platform Divergence after becoming frustrated with traditional ADHD care models. He said: “In a recent audit of assessments, including those of ‘right to choose’ providers, being sent for transfer to Divergence … 6% met our standards which are based on UK Adult ADHD Network quality assessment standards, the closest we have to a fixed standard for assessment reports.”
A Department of Health and Social Care spokesperson said: “No one with ADHD should be left without clear clinical oversight or feeling in limbo about their care. We have launched an independent review to examine how ADHD, mental health and autism services are delivered to help ensure patients can get the right support.
“All providers, including those in the independent sector, must meet the same standards for patient safety and quality as the NHS. Where shared care arrangements cannot be agreed, responsibility for prescribing and ongoing oversight remains with the specialist clinician, whether NHS or private.”
An NHS spokesperson said: “We know we have a lot to do to improve ADHD services and that patients wait too long for a diagnosis, which is why we commissioned an independent ADHD taskforce to consider how to improve care and service models.
“We are carefully considering the recommendations of their recent report, recognising the need for speedy improvement. Given some of the issues around variation in funding, NHS England has already started a consultation on supporting local systems to agree appropriate reimbursement for services.”
