NHS bosses warn of chaos in ADHD and autism care amid spiraling costs

The National Health Service (NHS) faces a potential crisis in autism and ADHD care, with managers warning of impending chaos driven by spiraling costs and the unchecked expansion of private providers. The NHS Alliance, representing health managers, argues the current system offers a "bad deal" for both patients and taxpayers, citing significant disparities in what health boards are charged for assessments and care.

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Autism and ADHD care is at risk of descending into chaos, NHS bosses are warning, as costs spiral out of control and unregulated private providers capitalise on the huge demand for help.

Managers are struggling to ensure the quality and safety of services as the number of providers, including private firms and charities, has rapidly increased. The "right to choose" policy, intended to help patients bypass long waiting lists, has inadvertently fueled this expansion. While it has reduced some waits, the costs have become "out of control," with one board's monthly spending jumping tenfold to £1.5 million, and another's annual spend rising from £4 million to £30 million over two years.

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The current system represents a "bad deal" for patients and taxpayers alike.

A key issue is the wide variation in fees charged by non-NHS providers. Unlike for procedures like hip replacements, where tariffs are set, autism and ADHD services only have guide prices that are not strictly enforced. This lack of regulation, coupled with the sheer number of providers, one board now works with 48, four times more than two years ago, makes quality and safety checks difficult. Providers offering only assessments do not even need to be registered with the Care Quality Commission.

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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 being "caught between a rock and a hard place." They understand the frustration caused by long delays but face soaring costs in their efforts to meet demand. She reiterated that the situation is detrimental to patients and taxpayers, risking the collapse of the entire system into "chaos."

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She said the situation was a "bad deal for patients and taxpayers" and there was a risk the whole system would fall into "chaos".