NHS warns of ADHD and autism care chaos amid soaring costs and unregulated providers

NHS managers have warned that care for people with autism and ADHD could descend into chaos as costs spiral and a flood of private and charitable providers enter the market. The NHS Alliance, an umbrella group for health managers, said the current system is a “bad deal” for patients and taxpayers alike.

The Alliance’s findings show stark variations in what the NHS is paying for similar services. One local health board reported paying between £300 and £3,000 for comparable assessments, while another saw its spending rise 10‑fold in a single year to £1.5 million a month. In two years a board’s annual spend jumped from £4 million to £30 million. The rapid expansion of providers—48 in one board’s case, four times the number two years earlier—has made it difficult for integrated care boards to monitor quality and safety.

Under the right‑to‑choose policy, patients can opt for services from both NHS and non‑NHS providers, a move intended to reduce the long waiting lists that have built up in recent years. The policy has indeed attracted new providers, which has helped cut some of the longest waits for adults and children, but at a steep cost. Unlike routine procedures such as hip or knee replacements, which are covered by set tariffs, autism and ADHD services only have guide prices that are not mandatory. As a result, non‑NHS providers can charge widely different fees, further inflating the NHS budget.

The NHS Alliance said that providers who conduct assessments only are not required to register with the Care Quality Commission, the regulator for health and care services. This lack of oversight has added to concerns about the safety and consistency of care.

Rebecca Gray, a senior executive at the NHS Alliance, said managers are “caught between a rock and a hard place.” She added that while they understand the “anguish and frustration” caused by long delays, they face “soaring costs that are running out of control.” Gray warned that the situation poses a risk of “chaos” for the entire system and described it as a “bad deal for patients and taxpayers.”

Mel Merritt of the National Autistic Society echoed these concerns, stating that the system is in crisis. “Spending is rising on short‑term solutions due to years of a lack of long‑term investment in improving services,” Merritt said. She added that despite the money being spent, people continue to face “unacceptable” delays.

The government has promised an independent review of autism, ADHD and mental health services, with a new national approach expected once the findings are released. In the meantime, the NHS Alliance is collecting information from integrated care boards to assess the current state of care and to inform the forthcoming review.

The crisis has highlighted a broader issue of cost control and quality assurance in specialist services. While the right‑to‑choose policy has helped reduce waiting times for some, the lack of standard pricing and regulatory oversight has created a fragmented market that is difficult for NHS managers to manage. The impending review and the government’s promised reforms aim to address these challenges, but the Alliance warns that without urgent action, the system could become unsustainable.

In summary, rising costs, wide price variations, and a surge in private and charitable providers are threatening the stability of autism and ADHD care. NHS managers, patient advocates, and policymakers are calling for clearer tariffs, stronger regulation, and a coordinated national strategy to prevent a breakdown in services.