As the demand for attention deficit hyperactivity disorder (ADHD) diagnoses in England soars, the system designed to support these patients has spiraled into a fragmented and highly profitable private sector, leaving many dangerously unsupported. A Guardian investigation has uncovered that NHS England’s ADHD services are on track to overspend their £150 million annual budget by a staggering £164 million this year.
The months-long investigation revealed a growing trend of patients turning to the “right to choose” option to bypass lengthy NHS waiting lists, funneling an increasing share of ADHD funding into private providers. Data from 32 of England’s 42 integrated care boards showed that spending on private ADHD services more than tripled over three years, rising from £16.3 million in 2022-23 to £58 million last year.
However, this private sector boom is largely unregulated, with some providers not even registered with the Care Quality Commission carrying out NHS-funded assessments. Patients reported a range of issues, including rushed or superficial assessments, difficulties securing shared-care agreements with GPs, and a lack of long-term support after diagnosis.
“For a lot of people, it’s the bit after diagnosis that falls apart,” said Sarah Marsh, the Guardian’s consumer affairs correspondent who worked on the investigation. “They might have spent months waiting and hundreds or thousands of pounds on an assessment, only to find their GP won’t accept it, or the clinic won’t respond, or their medication isn’t reviewed properly. So they’re left stuck – still unwell, still waiting, but now in a system that doesn’t seem to belong to anyone.”
The crisis has become entangled in a politically charged debate over the perceived “overdiagnosis” of neurodivergent conditions. Health Secretary Wes Streeting has ordered a clinical review, drawing criticism from some who argue it could further marginalize those seeking help. However, Marsh cautions that this debate obscures the reality of people genuinely struggling and desperately seeking support.
“What I would say from researching this is you’ve got people that need help,” Marsh said. “Whether ADHD is the right diagnosis or a misdiagnosis is kind of by the by. They’re not seeking help because they want a diagnosis. They’re seeking help because they are struggling.”
As the NHS’s ADHD services teeter on the brink of collapse, the investigation’s findings have raised urgent questions about the effectiveness of the current system and the need for a comprehensive, nationwide framework to ensure quality and consistency in ADHD care. The patients trapped in this broken system can only hope that the spotlight on this crisis will spur meaningful reform.
