The National Health Service (NHS) in England is facing significant financial strain due to escalating costs associated with Attention Deficit Hyperactivity Disorder (ADHD) services, with spending already exceeding budget by £164 million annually. A key driver of this increase is a growing reliance on private providers for ADHD assessments and treatment, a trend fueled by lengthy NHS waiting lists and a policy known as “Right to Choose.”
The “Right to Choose” initiative, allows patients in England to request an ADHD assessment from a private provider at the NHS’s expense. While intended to alleviate pressure on overwhelmed NHS services, it has inadvertently contributed to a surge in demand for private assessments, attracting significant investment from private equity firms. More than half a million people in England are currently awaiting an ADHD assessment.
Data reveals a dramatic increase in NHS expenditure on private ADHD services, tripling over the past three years. In , the NHS funded approximately 100,000 ADHD assessments in the private sector through the Right to Choose scheme. This has led to substantial profits for private companies involved in providing these services. Three private-equity backed providers generated combined gross annual profits of £31.5 million in their latest company accounts.
The rapid growth in private sector involvement has raised concerns about the quality and consistency of ADHD assessments. Experts warn that assessments provided by private providers can be unreliable, potentially leading to misdiagnosis or inadequate care. The lack of enforceable national regulations governing how ADHD assessments should be conducted exacerbates this issue, resulting in “enormous variation” in how guidance from the National Institute for Health and Care Excellence (NICE) is interpreted.
Companies like ADHD360, owned by Keys Group and backed by G Square Capital, offer “essential care packages” including assessment and treatment for £1,740. ADHD360’s turnover nearly doubled in a year, reaching £22.5 million with gross profits of £9.7 million. Psychiatry UK, owned by Queen’s Park Equity, reported £53 million in revenue for .
The current system, where the NHS is obligated to pay private providers for assessments if they can get patients through the door, is described by David Rowland, director of the Centre for Health and the Public Interest, as creating a situation where “if the private sector can get patients through the door, the NHS has to pay for them.” He notes that clinics actively advertise their services on social media to attract patients.
The financial pressures are prompting some NHS Integrated Care Boards (ICBs) to impose caps on the number of assessments they will fund, a move that charities say is negatively impacting patients. Coventry and Warwickshire, for example, have stopped accepting new referrals for adult ADHD assessments, including those utilizing the Right to Choose scheme.
The high diagnosis rates observed in some private clinics – with 80-85% of patients referred to Care ADHD receiving a diagnosis – have also drawn scrutiny. Mark Pattison, CEO of Care ADHD, argues that this reflects the rigorous process patients must undergo to even access an assessment and that private clinics may offer a more efficient service through the use of technology.
The situation is creating a complex cycle where patients face long waiting lists for NHS assessments, turn to private providers, and then encounter difficulties accessing ongoing care and medication through the NHS. Kathleen Helm, a patient from West Yorkshire, shared her experience of receiving a private diagnosis and subsequent challenges in obtaining NHS prescriptions. She ultimately had to undergo another assessment through the Right to Choose scheme simply to have her medication covered.
Similarly, Danielle Vaughan experienced delays in accessing medication after initially receiving a private diagnosis. She was later informed by her GP that private diagnoses would no longer be accepted, forcing her to restart the assessment process through the Right to Choose program.
NHS Providers and the NHS Confederation acknowledge the financial challenges and emphasize the need to prioritize resources for those with the highest need, including children and young people, individuals with co-occurring mental health conditions, and those with substance use issues. Rebecca Gray, mental health director speaking on behalf of these organizations, stated that NHS leaders are “having to prioritise those with the highest need.”
The NHS estimates that 2.5 million people in England have ADHD, but only approximately 820,000 have been formally diagnosed. The increasing demand for ADHD services, coupled with the financial pressures on the NHS, highlights the urgent need for sustainable solutions to ensure equitable access to timely and high-quality care.
