ADHD and autism costs in England ‘running out of control’, NHS leaders warn

NHS leaders in England warn that the cost of meeting rising demand for attention‑deficit hyperactivity disorder (ADHD) and autism services has become “running out of control” and is unsustainable, with spending in some areas surging as much as tenfold in a single year.

The warning comes from the NHS Alliance, the trade body that represents health managers, after a report showed that the pandemic‑driven increase in demand has forced some integrated care boards (ICBs) to close waiting lists and cut back other services. One board noted that its monthly spend on ADHD and autism rose from £146,000 in the 2024‑25 period to £1.5 million last year, while another projected spending on adult ADHD services to jump from £11 million in 2023‑24 to £51 million this financial year.

The surge in demand has attracted a large influx of new providers, driven by patients’ right to choose which qualified provider they can see for diagnosis. One ICB reported that it now has 80 providers on its roster, a sharp rise from the 12 to 14 it had two years ago. The rapid expansion has raised concerns about quality assurance and regulation, especially as many small, non‑regulated providers offer assessments but not ongoing care.

The increased capacity has eased some assessment delays, but the absence of a national tariff has led to wide price variations. In one case, an ICB said it was paying between £300 and £3,000 for similar services. This variability adds to the already severe cost pressures on local health budgets.

Rebecca Gray, director of the NHS Alliance’s mental health network, said that local health leaders are caught “between a rock and a hard place.” “They understand the anguish and frustration caused by long delays in the system as people wait for assessments, treatment and support,” she explained. “But in working to meet rising demand they face soaring costs that are running out of control. As commissioners they must balance their budgets. Unplanned overspends on ADHD and autism assessments and treatment can impact on other activities and disrupt long‑term planning. The current situation is unsustainable and delivers a bad deal for patients and taxpayers.”

The Alliance is calling for a national mandatory price, or tariff, for ADHD and autism services and a national service specification that would be applied consistently across all NHS‑funded providers. It argues that such measures would curb the uncontrolled cost growth, standardise quality and simplify procurement for local health authorities.

The report also highlighted that the lack of a national tariff has made it difficult for ICBs to compare costs and negotiate fair prices. The proliferation of providers, while increasing access, has also complicated oversight, as many small firms are not subject to the same regulatory scrutiny as larger organisations.

In the broader context, the NHS has struggled to keep pace with the pandemic’s aftermath, facing staffing shortages and infrastructure deficits that have limited its ability to absorb the surge in demand for neurodevelopmental services. The report suggests that without systemic changes, the financial burden will continue to grow, potentially diverting resources from other health priorities.

The NHS Alliance’s findings were presented to a coalition of health managers and policymakers, who are urged to consider the recommendations before the next funding cycle. If the call for a national tariff and specification is not adopted, local authorities may have to continue making ad‑hoc decisions that could further strain budgets and compromise service quality. The report underscores the urgent need for coordinated policy action to ensure that patients receive timely, high‑quality care without imposing unsustainable costs on the health system.