Health managers in England, United Kingdom, have warned that services for people seeking autism and ADHD assessments could descend into chaos as costs surge and private providers expand rapidly to meet growing demand.
The NHS Alliance, which represents health managers, described the current system as a “bad deal” for both patients and taxpayers, citing significant differences in the amount local health boards pay for similar assessments and care.
In one case, a local health board was reportedly paying between £300 and £3,000 for comparable services.
The warning comes as more patients turn to private and non-NHS providers under the government’s “right to choose” policy, which allows people to seek care outside their local NHS service in an effort to avoid lengthy waiting lists.
While the policy has helped cut some of the longest waits for autism and ADHD assessments among adults and children, the NHS Alliance said it has also contributed to rapidly increasing expenditure.
One health board saw its spending rise tenfold within a year to £1.5m per month. Another reported that its annual expenditure increased from £4m to £30m over two years.
In Cheshire and Merseyside, spending on adult ADHD services rose from £11m in 2023-24 to a projected £51m this year.
The NHS Alliance said the absence of fixed national tariffs for autism and ADHD services was contributing to wide price variations. Unlike procedures such as hip and knee replacements, which have standard NHS tariffs, autism and ADHD services operate under guide prices that providers are not required to follow.
Health managers are also dealing with a sharp increase in the number of providers. One NHS board said it was working with 48 providers, four times the number it had two years earlier.
The rapid expansion has raised concerns about whether local health authorities can adequately monitor the quality and safety of services.
Providers that only conduct assessments are not required to register with the Care Quality Commission, England’s health and social care regulator.
Rebecca Gray of the NHS Alliance said managers were “caught between a rock and a hard place”.
“They understand the anguish and frustration caused by long delays in the system as people wait for assessments, treatment and support.
“But in working to meeting demand they face soaring costs that are running out of control.”
She said the situation was a “bad deal for patients and taxpayers” and warned that the entire system could fall into “chaos”.
The National Autistic Society also said the system was facing a crisis.
Mel Merritt said: “Spending is rising on short-term solutions due to years of a lack of long-term investment in improving services.”
She added that despite the money being spent, people continued to face “unacceptable” delays.
The UK government said an independent review examining autism and ADHD services, including the reasons behind rising demand and the possibility of over-diagnosis, would be published soon.
It said the findings would inform a “new national approach” covering autism, ADHD and mental health services.
