NHS managers have sounded the alarm over the runaway cost of ADHD and autism services in England, with some areas reporting a tenfold surge in spending within a single year as demand for assessments continues to outstrip capacity.
The NHS Alliance, which represents health leaders across the country, has published a stark report detailing how integrated care boards (ICBs) are buckling under unprecedented financial pressure. The findings paint a picture of a system stretched to breaking point — one where commissioners are being forced to close waiting lists and raid budgets earmarked for other vital services just to keep pace.
One ICB disclosed that its monthly expenditure had ballooned from £146,000 in 2024-25 to a staggering £1.5m last year. Another reported that spending on adult ADHD services alone had climbed from £11m in 2023-24 to a projected £51m for the current financial year.
A Marketplace Without Rules
The explosion in demand, largely attributed to a post-pandemic surge in referrals, has triggered a rush of new private providers into the market. This growth has been turbocharged by the NHS’s “right to choose” policy, which allows patients — or parents seeking diagnosis for their children — to select any qualified provider for their care.
The result has been a fragmented and chaotic landscape. One ICB revealed it now has 80 different providers operating within its area. Another said that just two years ago it was processing invoices from 12 to 14 providers; that number has since swelled to 48.
The lack of a standardised national tariff means prices for essentially the same service can vary wildly. One ICB reported paying anywhere between £300 and £3,000 for comparable assessments.
Quality Concerns Amid Rapid Expansion
The sheer speed at which new providers have entered the market has raised serious concerns about quality assurance and oversight. The NHS Alliance report highlights particular anxiety around small, non-regulated operators that can deliver one-off assessments but are not equipped to provide the ongoing care and support patients often need afterwards.
While the influx of providers has helped to reduce some waiting times — a genuine gain for patients who have languished on lists for months or even years — the absence of consistent pricing has compounded the financial strain on already overstretched ICBs.
A System “Caught Between a Rock and a Hard Place”
Rebecca Gray, director of the NHS Alliance’s mental health network, did not mince her words.
“Local health leaders are caught between a rock and a hard place,” she said. “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 meet rising demand they face soaring costs that are running out of control.
“As commissioners they must balance their budgets. Unplanned overspends on ADHD and autism assessments and treatment can impact on other activities and disrupt long-term planning. The current situation is unsustainable and delivers a bad deal for patients and taxpayers.”
Calls for National Reform
The NHS Alliance is now pressing the government to introduce a mandatory national tariff for ADHD and autism services, alongside a standardised service specification applied uniformly across all NHS-funded providers.
The hope is that such measures would bring order to a marketplace that has, in effect, been left to regulate itself — and ensure that patients receive consistent, high-quality care regardless of where they live or which provider they choose.
Why it Matters
The crisis laid bare in this report goes far beyond spreadsheets and budget lines. It represents a system failing some of its most vulnerable patients — people struggling with conditions that can profoundly affect every aspect of their lives, from education and employment to relationships and mental health. If ICBs continue to overspend on assessments at the expense of other services, the knock-on effects could be felt across the entire NHS. Without urgent intervention to standardise costs and tighten regulation, the current trajectory risks entrenching a two-tier service in which quality of care depends on geography and luck rather than need.