The Government has commissioned an independent review of the rising demand for autism and ADHD services and whether these conditions are being over diagnosed.
Ahead of the review the NHS Alliance (formerly NHS Confederation), an independent body that represents healthcare managers and commissioners, has revealed that ADHD and autism NHS costs have been spiralling in recent years.
Costs “Out Of Control”
According to the NHS Alliance, one integrated car board (ICB) saw costs increase tenfold to £1.5 million per month, another’s annual spending increased from £4 million to £30 million per year within two years.
In Cheshire and Merseyside, spending on adult ADHD services increased from £11 million in 2023-24 to a projected £51 million this year.
Despite these cost increases in June the National Autistic Society reported that there were 294,000 on NHS waiting lists for an autism assessment.
Mel Merritt, Head of Policy and Influencing at the National Autistic Society, said:
“Andy Burnham has said that he wants the Government to stop paying for failure when we should be instead investing in success.”
ADHD and Autism NHS System
The current costs crisis seems to be caused by those long waiting lists and several policies interacting to create a perfect storm.
Unlike many procedures, there is no mandatory national tariff for autism and ADHD services. There are non-mandatory guide prices but providers are under no obligation to follow them.
At the same time, the NHS Right to Choose policy has allowed patients to choose both NHS and non-NHS providers for their care.
Prices charged for similar services can vary drastically across providers. One ICB reported paying between £300 and £3000 for similar services.
This has led to an influx of private and charity providers into the system with one ICB reporting that it now works with 48 providers, four times as many as two years ago. This proliferation is also making it harder for ICBs to manage the quality of the care provided.
Providers carrying our assessments do not have to register with the Care Quality Commission, so they are also less regulated than other NHS services.
Commenting on the news, CEO of Psyomics, Dr Melinda Rees said: “Rising demand for ADHD and autism services is putting enormous pressure on the NHS, but increasing capacity alone won’t solve the problem. We need pathways that help services understand people’s needs earlier, support better-informed clinical decisions and make the best use of specialist capacity.
“Getting the right information to clinicians at the right time will be critical to building services that are both sustainable and accessible.”
Reactions
Rebecca Gray Director of the Mental Health Network at the NHS Alliance, speaking to Times Radio, said that “there definitely needs to be change”. She called for greater consistency in assessments, stronger oversight to ensure money is spent effectively, and improved regulation, including a national specification setting out what a good assessment should look like.
“The current situation is unsustainable and delivers a bad deal for patients and taxpayers.”
“We hope forthcoming national investigations including the Independent Review into mental health conditions, ADHD and autism will shine a light on what lies behind the recent surge in demand for assessments.”
Mel Merritt, of the National Autistic Society, said: “Spending is rising on short-term solutions due to years of a lack of long-term investment in improving services.”
Short term thinking is indicative of a system in crisis mode.
Steve Gilbert OBE, Chair of the UK Healthcare and Life Sciences Innovation (UKHLSI) Mental Health working group and former Vice Chair for the Independent Mental Health Act Review said: “As a group working to reduce unwarranted variation in mental health services, particularly for people with severe and enduring mental illness, we recognise how important timely diagnosis is for ADHD and autism.
“Unfortunately, long waits aren’t unique to these conditions. People with bipolar disorder wait an average of 9.5 years for an accurate diagnosis, and Right to Choose doesn’t help them: the scheme currently doesn’t extend to bipolar assessments at all. Right to Choose is a valuable route to faster care, but if some providers are using it to cash in, the NHS is right to tighten how it’s funded.”
Find out more
To find out more about UK Healthcare and Life Sciences Innovation (UKHLSI) and the Mental Health Working Group, please contact enquiries@ukhlsi.co.uk