NHS leaders have warned that the costs of meeting soaring demand for attention deficit hyperactivity disorder (ADHD) and autism services in England are “running out of control” and have become unsustainable, with spending in some areas rising by as much as tenfold over the course of a year.
The NHS Alliance, which represents health managers, said the rise in demand since the coronavirus pandemic was forcing some to close waiting lists and look at reining in other services they provide.
One integrated care board (ICB) cited in a report said its monthly spend had risen from £146,000 in 2024-25 to £1.5m last year.
Another said spending on adult ADHD services had risen from £11m in 2023-24 to a projected £51m this financial year.
Increased demand and a lack of NHS capacity has led to a big influx of new providers, the report said, fuelled by patients’ right to choose which allows people seeking diagnosis for themselves or a child to opt for any qualified provider.
One ICB told the NHS Alliance it now had 80 providers on its patch. Another said that two years ago it had received invoices from 12 to 14 providers, a figure which had risen to 48.
The rapid expansion of new providers has also prompted concerns from ICBs about quality assurance and regulation, especially when large numbers of small, non-regulated providers enter the market that are able to deliver assessments but not ongoing care, the report said.
This increased capacity has helped to ease some delays for assessments, but – due to the lack of a national tariff – has resulted in huge variations in the prices paid for services, adding to already severe cost pressures, the report said. One ICB told the NHS Alliance it was paying £300 to £3,000 for similar services.
Rebecca Gray, the director of the NHS Alliance’s mental health network, said: “Local health leaders are caught between a rock and a hard place.
“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.
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“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.”
The NHS Alliance is calling for a national mandatory price (or tariff) for ADHD and autism services and a national service specification applied consistently across all NHS-funded providers.
