Hundreds of thousands of individuals in England are seeking diagnoses for attention deficit hyperactivity disorder (ADHD), but the system designed to assist them is revealing significant financial and operational shortcomings. An investigation by The Guardian has uncovered that ADHD services are on track to exceed their budgets by £164 million this year, highlighting a fragmented system that has driven patients towards a largely unregulated private sector.
This investigation, led by consumer affairs correspondent Sarah Marsh, points to a troubling trend where increasing demand for ADHD diagnoses is not being met by the National Health Service (NHS). As waiting times lengthen, many are compelled to seek private assessments, often at a substantial financial cost and with varying quality of care.
Investigation Reveals Overspending and Regulatory Gaps
The inquiry began in August when David Rowland, director of the Centre for Health and the Public Interest, began examining NHS spending on ADHD services. His research indicated a widening gap between what NHS England budgeted and what it is likely to spend. Data from 32 of England’s 42 integrated care boards (ICBs) suggests that spending on ADHD services could reach £314 million by April 2026, more than double the annual budget of £150 million.
This escalating expenditure reflects a growing reliance on private providers, with spending on private ADHD services more than tripling from £16.3 million in 2022-23 to £58 million last year. Many patients are opting for these services to avoid the lengthy waiting lists associated with the NHS, but this shift raises concerns about the quality and regulation of care being provided.
Marsh’s findings highlight that many private companies, often backed by private equity, are generating significant profits in this under-regulated market. There is a lack of stringent criteria governing these providers, making it difficult for patients and general practitioners (GPs) to ascertain the quality of assessments and treatments being offered.
Patients Caught in a Fragmented System
ADHD is characterized by difficulties in maintaining attention, hyperactive behavior, and impulsivity. However, as Marsh notes, the diagnostic process can often feel more convoluted than illuminating. Individuals seeking help are not doing so lightly; they are driven by genuine struggles that require timely intervention. The current system, however, often leaves them navigating a maze of private assessments, paperwork, and uncertainty.
Many patients report challenges even after receiving a private diagnosis. Common issues include difficulties in securing shared-care agreements with GPs, rushed assessments, and unclear next steps post-diagnosis. “For many, it’s the period after diagnosis that falls apart,” Marsh explains. Patients may find themselves still unwell, waiting for appropriate care in a system that appears disjointed and unresponsive.
The consequences of these administrative gaps can be severe. Tragic cases, such as the death of Ryan White, underscore the potential dangers of a system that fails to adequately support those who are vulnerable.
The political discourse surrounding ADHD diagnoses has become increasingly contentious. Recently, Wes Streeting, the health secretary, initiated a clinical review of mental health diagnoses, including ADHD and autism, acknowledging the rising rates of these conditions. Yet, responses to this initiative have been polarized, highlighting a deeper societal debate over the validity of ADHD diagnoses.
As the investigation reveals, the central issue is not merely whether ADHD is being overdiagnosed, but rather why so many individuals feel compelled to seek help at great personal expense. Marsh emphasizes the need for a comprehensive review of the system to understand why patients are struggling to obtain necessary support.
The investigation raises critical questions about the efficiency of spending within the NHS and the effectiveness of the pathways available for ADHD diagnoses. It suggests that urgent reforms are needed to ensure that funds are utilized effectively and that patients receive the care they deserve.
Moving forward, there is hope that the findings from this investigation will catalyze discussions on improving the ADHD care system in England. Both the NHS and private providers must reflect on how to better serve those in need, ensuring that no one is left behind in a system that is failing to deliver.
