Autism and ADHD care across the NHS faces a serious risk of collapse, according to health service leaders, as expenditure accelerates beyond control and a proliferation of unregulated private providers exploits surging demand for assessment and treatment.
The NHS Alliance, representing health managers across England, characterises the present arrangement as fundamentally flawed for both patients and the public purse. The organisation has raised alarm about dramatic inconsistencies in pricing for identical services—one local health board documented charges ranging from £300 to £3,000 for comparable assessments and interventions.
The expansion of new providers, encompassing both commercial enterprises and charitable organisations, has outpaced the capacity of NHS managers to maintain oversight of quality and safety standards. Referrals and recorded diagnoses for ADHD have risen substantially, particularly among adolescent and young adult females, intensifying pressure on the system.
The government has committed to publishing findings from an independent review into these services imminently and pledged to implement a comprehensive national strategy for autism, ADHD and mental health based on those conclusions.
How did the system reach this point?
The NHS Alliance gathered data from integrated care boards—the bodies responsible for local service budgets—to assess the current landscape. Under the right to choose policy, patients retain the option to select care from either NHS or independent providers offering autism and ADHD services. This mechanism was designed to alleviate the extended waiting lists that have accumulated over recent years.
While the policy has succeeded in attracting new providers and reducing some of the longest delays for both adults and children, it has triggered an explosion in costs. Multiple boards reported spending increases they characterised as spiralling beyond sustainable levels. One integrated care board experienced a tenfold rise in expenditure within a single year, reaching £1.5 million monthly. Another saw annual spending escalate from £4 million to £30 million across two years.
The backdrop to this crisis involves broader pressures on mental health and neurodevelopmental services. Complaints about autism and ADHD care in England have more than tripled over five years, reflecting mounting frustration with access and quality.
Why are costs so unpredictable?
A fundamental problem lies in the absence of standardised pricing. Unlike routine surgical procedures such as hip and knee replacements, where fixed tariffs apply uniformly across NHS and private provision, autism and ADHD services operate under guidance prices that providers are not obliged to follow. This creates a market without guardrails, allowing charges to fluctuate wildly based on provider discretion.
The regulatory landscape compounds the difficulty. Providers conducting assessments alone are not required to register with the Care Quality Commission, the statutory regulator for health and social care services. This gap in oversight means that quality assurance and safety monitoring fall entirely to local health boards, which lack the resources and expertise to police hundreds of independent operators effectively.
One integrated care board reported managing relationships with 48 separate providers—quadruple the number it worked with just two years earlier. This fragmentation makes consistent quality control virtually impossible and prevents boards from leveraging collective purchasing power to negotiate reasonable rates.
What are health leaders saying?
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 meeting demand they face soaring costs that are running out of control.Rebecca Gray of the NHS Alliance described managers as
caught between a rock and a hard place, caught between the urgent need to reduce waiting times and the imperative to control expenditure. She characterised the situation as
a bad deal for patients and taxpayersand warned of the risk that the entire system would descend into
chaos.
Mel Merritt of the National Autistic Society echoed the assessment that the system is in crisis.
Spending is rising on short-term solutions due to years of a lack of long-term investment in improving services.She stressed that despite the substantial sums being deployed, patients continue to experience
unacceptabledelays in accessing care.
What policy changes are underway?
The government launched an independent review on 4 December 2025 to examine the prevalence, trends and inequalities associated with mental health conditions, ADHD and autism. NHS England published new payment guidance for 2026/27 covering commissioning and provision of ADHD and autism diagnostic services, signalling that administrative reform is already underway. The guidance was last updated in July 2026 and represents an attempt to impose greater consistency across the fragmented landscape of providers.
However, these measures remain interim steps pending the review's conclusions. Some services are already operating at capacity limits—an NHS adult ADHD and autism service in south London remains closed to new national referrals due to demand, accepting only limited complex cases within a defined geographic area.
What happens next?
The independent review's findings are expected to emerge in summer 2026 and will inform the government's response as part of its 10 Year Health Plan commitment to address the mental health crisis affecting both adults and children. The government has signalled its intention to act decisively on the review's recommendations, though the specific shape of any new national approach remains to be determined.
Until those findings arrive, integrated care boards will continue navigating the tension between reducing waiting times and controlling costs, with the NHS Alliance warning that without urgent intervention, the current trajectory is unsustainable.
Key Facts
- Pricing for identical autism and ADHD services varies tenfold across NHS boards, from £300 to £3,000 per assessment
- One integrated care board experienced a tenfold increase in annual spending within a single year, reaching £1.5 million monthly
- The number of providers working with some boards has quadrupled in two years, complicating quality oversight and safety monitoring
- Providers conducting assessments alone are not required to register with the Care Quality Commission, creating a regulatory gap
- An independent government review into mental health, ADHD and autism services is expected to publish findings in summer 2026
