NHS spending on ADHD and autism assessments in England has surged tenfold over the course of a year, driven by soaring demand and a heavy reliance on private providers. According to a report published by the NHS Alliance, local health leaders have warned that the financial trajectory is running out of control and becoming unsustainable, forcing some regional care boards to scale back other critical services to cover assessment costs.
Right to Choose Policy Fuels Private Clinic Reliance
The dramatic acceleration in spending is largely tied to the NHS “Right to Choose” initiative, which allows patients seeking diagnosis for themselves or a child to opt for any qualified provider. According to the NHS Alliance, this pathway has resulted in a proliferation of private clinics offering online diagnostic assessments, creating what health leaders describe as a “Wild West” of private clinics.
Integrated Care Boards (ICBs) across England report massive cost increases due to this influx. One unnamed ICB told the NHS Alliance that its monthly spending on ADHD and autism services climbed from £146,000 in 2024-25 to £1.5 million last year. In Kent and Medway, expenditures rose from less than £1 million in 2023-24 to £28.9 million this year. Meanwhile, Cheshire and Merseyside projections show adult ADHD spending jumping from £11 million in 2023-24 to a projected £51 million for the 2026-27 financial year.
Price Disparities and Knock-On Effects for Patient Care
The lack of a standardized national tariff has led to wide pricing disparities across the country. According to the NHS Alliance report, private clinics charge anywhere from £300 to £3,000 for an initial assessment. Some regional trusts have received invoices from up to 80 separate private providers, complicating quality assurance and regulatory oversight.
Rebecca Gray, director of the NHS Alliance’s mental health network, stated that local health leaders are caught between managing severe public anguish over long waiting lists and absorbing uncontrollable financial costs. Gray noted that the current situation delivers a bad deal for patients and taxpayers alike.
Because NHS funding is finite, unplanned overspends in neurodiversity services have forced operational trade-offs. The Nuffield Trust chief executive, Thea Stein, noted that money spent under the Right to Choose framework directly impacts other healthcare sectors. For instance, one ICB reported having to delay the rollout of a Learning Disability Intensive Support Team to offset neurodiversity budget overruns.
Proposed Solutions and National Review
To curb runaway expenditures, the NHS Alliance is lobbying the government to introduce a national mandatory price tariff for ADHD and autism services. Health leaders argue this would establish cost predictability, ensure value for money, and standardize service quality. Additionally, the group recommends applying a consistent national service specification across all NHS-funded providers.
Regional health authorities are also implementing localized triage measures. Kent and Medway introduced prioritization schemes for children and young people to ensure individuals with the highest clinical need are assessed first, and the region is proposing similar protocols for adult assessments.
A broader government review examining the drivers behind surging demand—including potential overdiagnosis—is expected to be released soon, providing further insight into how the healthcare system manages neurodiversity care moving forward.