NHS leaders are warning that care for autism and ADHD is at risk of falling into chaos as costs spiral and a surge of unregulated private providers enters the market to meet high demand.
The NHS Alliance, which has been surveying integrated care boards responsible for local budgets, reports that the system is under significant strain.
A primary concern for health officials is the massive inconsistency in pricing for assessments and care. In one instance, a local health board reported paying between £300 and £3,000 for similar services.
Unlike routine procedures such as hip or knee replacements, which operate under a set national tariff, autism and ADHD services rely on guide prices that providers are not required to follow.
This lack of standardization has contributed to sharp spending increases, with some boards reporting costs rising 10-fold in a single year to £1.5 million per month. Another board saw its annual expenditure jump from £4 million to £30 million over two years.
The expansion of the private sector has been driven by the government's "right to choose" policy, which allows patients to opt for non-NHS services to bypass long waiting lists.
While this has helped reduce wait times for both children and adults, it has led to a rapid increase in the number of active providers.
One board noted it was currently working with 48 different providers, a four-fold increase compared to just two years ago.
NHS managers are now struggling to maintain oversight regarding the safety and quality of these services. A specific regulatory gap exists because providers offering assessments only are not required to be registered with the Care Quality Commission.
Rebecca Gray of the NHS Alliance described local managers as being "caught between a rock and a hard place," forced to balance the urgent need to address public frustration over long delays with the reality of soaring, uncontrolled costs.
Mel Merritt of the National Autistic Society echoed these concerns, stating that the current system is in crisis. She noted that current spending is largely focused on short-term fixes rather than long-term investment, yet many people still face "unacceptable" delays.
The government has stated that an independent review into these services will be published soon, promising a new national approach to autism, ADHD, and mental health care that will address these findings.
