The NHS is overspending on attention deficit hyperactivity disorder (ADHD) services by £164m a year, according to a report by an independent think tank.
Demand for ADHD assessments have soared as awareness of the condition has increased, leaving NHS services overstretched with more than half a million people now waiting for an assessment.
To cope with demand, the NHS has been referring patients to private companies providing ADHD services. As a result, over the past three years, the health service has become heavily dependent on private companies to deliver these services.
The research, by the Centre for Health and the Public Interest (CHPI), revealed the unplanned extra private spending “threatens to undermine the financial stability of local NHS services” and take funds away from those most in need.
Experts have also warned that assessments provided by private providers can be unreliable.
“An ADHD assessment is complex, and unregulated clinics may vary in quality or thoroughness. Misdiagnosis can have real consequences, both for people who are inaccurately diagnosed and for those whose needs aren’t properly identified, so careful oversight and professional standards are very important,” Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic told the Independent.
According to the CHIP, report 19 companies provided £1.9 million worth of ADHD services to NHS patients over a three-year period where there was no evidence of a contract with the NHS.
Additionally, 14 companies which provided £3.5 million worth of ADHD services to NHS bodies were not registered with the Care Quality Commission (CQC).
The findings come after health secretary, Wes Streeting, announced a review into whether mental health conditions such as ADHD are being over-diagnosed and if gaps in support exist.
The report reveals spending on ADHD services is estimated to reach £314m by April 2026 – more than double the year’s budget of £150m.
The figures, which cover 32 of England’s 42 integrated care boards (ICBs), raise concerns that other services could face cuts to offset the overspend.
Data was also provided from 19 ICBs on how much of their ADHD budget went on private companies, revealing spending has more than tripled in three years, from £16.3m in 2022-23 to £58m last year.
Due to the high demand, many adult ADHD services provided by the NHS have stopped taking on new patients. As a result, some people seeking a diagnosis turn to private providers via the right-to-choose pathway and bypass long local waitlists.
However, the report warns the right-to-choose system “should be scrapped” and is particularly easy to access. It explained the “right-to-choose” regulation prevents local NHS bodies from requiring that a private company gains authorisation before providing care to patients, ICBs are having to pay invoices sent by private companies to pay for services that they may not consider necessary or are unable to afford.
As a result they prevent the NHS from planning care for their local populations and exacerbate existing health inequalities, the report added.
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 that patients are waiting far too long for an ADHD diagnosis. NHS England commissioned an independent ADHD Taskforce to consider how to improve care and service models, and we are careful considering the recommendations of their recent report.
“As we continue to work to put ADHD services on a more sustainable footing, all patients have the legal right to choose a clinically appropriate provider to deliver their care – and as with any contractor, providers must meet standards set by their local NHS contractual agreements, legislation and regulations set by the CQC, GMC and guidance from NICE.
“NHS England is currently consulting on non-mandatory guide prices to help local systems agree appropriate reimbursement for these services.”
