NHS ‘heavily dependent’ on private ADHD providers – with a 252% increase in spending

A report has warned that the NHS has become ‘heavily dependent’ on private ADHD providers, who are pushing ICBs massively over budget with little oversight.

The Centre for Health and the Public Interest (CHPI) found NHS spending on private ADHD services has risen 252% over a three-year period.

Analysis of data from 32 of 42 ICBs suggested there would be a £164m overspend on ADHD services in England in 2025/26 – more than double the original planned budget.

The report, which was based on freedom of information requests, company data and ICB board minutes, also highlighted a lack of regulation and scrutiny.

It found 19 companies providing £1.9m worth of ADHD services to the NHS with no evidence of a contract.

And 14 companies providing £3.5m of ADHD services to the NHS over the same period were not registered with the CQC, it said.

The ‘rapid growth’ in private provision of ADHD services to the NHS that had happened under the Right to Choose framework had been unplanned and now threatens to ‘undermine the financial stability of local NHS services’, it concluded.

As such ‘scarce health care resources are potentially being moved away from being used to treat patients who are most in need to provide income for private companies,’ it continued.

The under-regulated market has attracted private equity firms with one unnamed provider recording a 33% profit, it said.

Report author, CHPI director David Rowland, called for Right to Choose should be scrapped or revised.

Under the current system, ICBs are having to pay for services they may not consider necessary or cannot afford.

All companies that deliver ADHD services should have a direct contract with the NHS, he added.

The needs of the very large numbers of patients seeking ADHD services cannot be met effectively in a ‘highly fragmented, disjointed market-based system which is under-regulated’, he concluded.

In December, the Government launched an independent review into rising diagnoses of ADHD and autism, as well as other mental health conditions in England. 

It will be investigating the reasons behind the growing prevalence and the knock-on demand for services in both adults and children.

Pulse exclusively revealed in March that the review would take place, when the Government said it would crack down on ‘unregulated private sector’ therapists and counsellors.

GPs have been pushing back against shared care agreements for ADHD partly due to the complexities and bureaucracy of dealing with multiple private providers under Right to Choose.

An independent Government taskforce has recommended incentivising GP practices to take on some aspects of care for ADHD. 

In its second and final report, the taskforce, commissioned by NHS England last year, also called for GPs to take a greater leadership role on ADHD.

Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said the use of ‘Right to Choose’ providers has been an understandable response by patients and GPs to unmet need, rather than a policy choice driven by rational service planning.

But the ‘variable quality’ of services offered by some providers has placed GPs in a very difficult position.

‘When patients are diagnosed with ADHD by non-NHS providers, they often struggle to access appropriate clinical reviews, medication titration or timely specialist advice,’ he said.

The responsibility frequently falls back on GPs ‘who may not have the specialist expertise, time or resources required to manage patients safely,’ he added.

An NHS England spokesperson said: ‘We know we have a lot to do to improve ADHD services and that patients wait too long for a diagnosis, which is why we commissioned an independent ADHD taskforce to consider how to improve care and service models.

‘Given some of the issues around variation in funding, NHS England has already started a consultation on supporting local systems to agree appropriate reimbursement for services.’

An Independent Healthcare Providers Network (IHPN) spokesperson said: ‘Independent providers play an essential role in supporting NHS ADHD services, particularly through the Right to Choose pathway, helping patients access timely, high-quality assessments where NHS waiting times remain unacceptably long. Claims that these services are “unregulated” are simply inaccurate: ADHD services are regulated by the CQC and, as required by law, providers are registered with the CQC.

‘Moreover, providers operate under the terms of the NHS Standard Contract and follow NICE-approved clinical guidelines – the exact same standards expected of NHS services. While any concerns about safety, quality or consistency of care should always be taken seriously and addressed through robust regulation and commissioning, the overriding challenge facing ADHD services is a long-standing lack of capacity and unacceptably long waiting times for diagnosis. This is set out clearly in the independently commissioned NHS England ADHD Taskforce report, which we strongly welcome.’