NHS managers warn of chaos in ADHD and autism care

Leadership within the NHS is expressing concerns that the provision of care for autism and ADHD could soon become unmanageable. They point to escalating expenses and the exploitation of significant demand by private companies operating without oversight as key contributors to this potential crisis.

The NHS Alliance, a body representing healthcare managers, asserts that the current framework for these services in England is detrimental to both patients and those funding the system.

They highlight significant discrepancies in the amounts the NHS is charged for diagnoses and treatment; for example, one local health authority observed payments ranging from £300 to £3,000 for comparable services.

The organisation notes a rapid increase in the number of new service providers, encompassing both commercial entities and charitable organisations. This expansion is making it difficult for NHS managers to guarantee the standards and safety of the care delivered.

The government announced that an independent investigation into these services, aiming to understand the surge in demand and whether over-diagnosis is a factor, would be released in the near future.

Officials stated they would implement the recommendations from this review, promising a "new national approach" for mental health, autism, and ADHD care.

In anticipation of this report, the NHS Alliance has been gathering data from integrated care boards, which manage local service budgets, to assess the current state of care.

Through the "right to choose" policy, individuals can opt to receive care for autism and ADHD from either NHS or non-NHS providers.

This initiative was introduced with the goal of helping patients avoid the extensive waiting lists that have emerged in recent years.

The NHS Alliance indicated that this policy has led to a proliferation of new providers, which has helped to shorten some of the longest waiting times for both adults and children, but at a considerable financial cost.

Their findings revealed that several boards reported significant increases in spending, describing these costs as "out of control."

One board experienced a tenfold rise in expenses within a single year, reaching £1.5 million per month.

Another board saw its annual expenditure climb from £4 million to £30 million over two years, while in Cheshire and Merseyside, adult ADHD spending increased from £11 million in 2023-24 to an anticipated £51 million this year.

The organisation identified a particular challenge in the vast disparities in pricing among non-NHS providers.

Unlike standard surgical procedures such as hip and knee replacements, which have fixed tariffs regardless of whether the NHS or a private entity performs them, there are only recommended prices for autism and ADHD services, which providers are not obligated to follow.

Local health authorities have also noted a rapid growth in the number of providers. One board indicated it was collaborating with 48 providers, four times more than just two years prior.

This proliferation of providers was creating difficulties for boards in their efforts to monitor the quality and safety of the care and support being offered.

Providers whose sole function is conducting assessments are not required to register with the Care Quality Commission, the regulatory body for health and social care services.