NHS bosses warn of chaos in ADHD and autism care

NHS leaders have warned that care for individuals with autism and ADHD is at risk of collapsing into disarray, citing soaring expenses and the influence of unregulated private providers capitalizing on the surge in demand. The NHS Alliance, representing health managers, maintains that the prevailing system in England is an unfair arrangement for both patients and taxpayers.

The group highlights substantial discrepancies in the fees charged by the NHS for assessments and care - for instance, a local health board paid between £300 and £3,000 for similar services. The alliance points to a swift growth of new providers, encompassing both private firms and charities, which has overwhelmed NHS managers in ensuring the quality and safety of the care provided.

The government has announced an independent review into the services and the reasons behind the rising demand, including the potential of over-diagnosing these conditions. It plans to release the findings soon and promises a "new national approach" for autism, ADHD, and mental health care. Prior to the review, the NHS Alliance has been collecting data from integrated care boards, which manage local services' budgets, regarding the current state of care.

The alliance contends that the "right to choose" policy, allowing patients to select between NHS and non-NHS autism and ADHD care, has led to a flood of new providers, alleviating some of the longest waiting times for adults and children. However, it has also resulted in a significant rise in spending, with one board experiencing a tenfold increase in costs to £1.5m monthly and another witnessing annual expenditures surge from £4m to £30m over two years.

A primary issue is the substantial variation in fees charged by non-NHS providers, unlike routine operations like hip and knee replacements, which have fixed tariffs regardless of the sector. Local health bosses have reported a rapid increase in providers, with one board managing 48 providers, four times more than two years ago.

This surge in providers is causing difficulties in checking the quality and safety of the care and support being delivered. While private providers are assisting the NHS in meeting the growing demand by providing additional capacity and innovation, Rebecca Gray of the NHS Alliance asserts that managers are caught between a rock and a hard place.

They acknowledge the frustration caused by long delays in the system for assessments, treatment, and support, but face unmanageable costs that are spiraling out of control. Gray described the situation as a "bad deal for patients and taxpayers" and warned of the potential for the system to descend into chaos. However, Mel Merritt of the National Autistic Society emphasizes that the system is in crisis, with expenses rising due to years of inadequate long-term investment in enhancing services, while people still face unacceptable delays in receiving care.