As a UK-trained consultant psychiatrist, fully indemnified, appraised and regulated by the General Medical Council, with specialist expertise in adult attention deficit hyperactivity disorder (ADHD) assessment and treatment, I read your article on rising ADHD care costs with concern and frustration (NHS ADHD spending over budget by £164m as unregulated clinics boom, 12 January).
For the past eight months I have been navigating the opaque Care Quality Commission (CQC) registration process to provide high-quality, fully regulated ADHD assessments in an independent setting, alongside two similarly qualified colleagues. Until this process is complete, I am legally prohibited from seeing patients.
It is therefore deeply troubling to learn from your article that multiple companies have been awarded NHS ADHD contracts despite not having CQC registration. In addition, some health professions fall outside the CQC remit and thus can set up a practice “diagnosing and treating” ADHD tomorrow – for example, a psychologist working with a prescribing pharmacist.
I have also previously worked for a large private provider that expanded rapidly to deliver NHS ADHD contracts. While many clinicians were conscientious, the model was contract-driven and narrowly focused rather than patient need- or clinician-led. Clinicians were put under pressure to prioritise throughput, continuity of care was fragile, and patients only discovered that their clinician could be replaced overnight after it had happened – an experience many found deeply upsetting.
These problems are the predictable result of an overstretched public system outsourcing into a fragmented and unevenly regulated market, while placing the greatest regulatory burden on small, expert psychiatrist-led services. High-quality ADHD assessment requires time, expertise and continuity. Regulation should enable this – not obstruct it.
Dr Vicky Cleak
Southampton
The NHS has as much incentive as private providers to overdiagnose ADHD. This is largely due to the appeal, for patients and clinicians, of a quick fix using amphetamines for the condition. I know this because my daughter was prescribed them by an NHS clinician when her self-diagnosis was supported after a one-hour assessment and questionnaire.
When the amphetamines didn’t work, he increased the dose. When the symptoms got worse, he prescribed antidepressants, seemingly determined to find the answer in a pill. Her request for therapy was dismissed, as he felt she needed to feel better with a drug intervention before she could benefit. Her symptoms abated after a significant change to her circumstances, which at the time we all neglected to pay enough attention to. I can only be grateful that the drug interventions didn’t cause long-term damage or dependency, as I suspect they have in others who have been let down by the focus on diagnostic and drug-based interventions for complex disorders.
Name and address supplied
Aside from the wild west of ADHD provision, parents should be aware of what they are walking into when seeking diagnostic referrals for their children. The effectiveness of behavioural interventions is dependent on consistent application within the family; it is arguably easier to be compliant with medication than to engage in sustained behavioural change. The only medications recommended by the NHS National Institute for Health and Care Excellence are psychostimulants or amphetamines – in lay parlance, “speed”.
As discovered by the generations freely issued with tranquillisers, the long-term health costs of a seemingly miraculous fix are great. The need for non-pharmacological treatment for ADHD that restores neuroplasticity at minimal risk has never been greater.
Mona Sood
Southend-on-Sea
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