NHS bosses are warning that care for autism and attention deficit hyperactivity disorder (ADHD) is at risk of descending into chaos as costs spiral out of control. Unregulated private providers are capitalizing on the immense demand for help, leading to significant financial strain and concerns over the quality of care.

The NHS Alliance, representing health managers in England, has stated that the current system represents a poor deal for both patients and taxpayers. They have highlighted substantial variations in the prices charged by different providers for similar assessments and treatments. In one instance, a local health board was found to be paying between £300 and £3,000 for comparable services.

According to the NHS Alliance, there has been a rapid proliferation of new providers, including private firms and charities. This expansion is making it difficult for NHS managers to effectively monitor and ensure the quality and safety of the care being delivered. The government has acknowledged these concerns and stated that an independent review into the services and the reasons behind the rising demand, including the possibility of over-diagnosis, will be published soon.

This situation has significant implications for the future of autism and ADHD care in England. The government has promised to act on the findings of the review, signaling a potential "new national approach" for these services and mental health support. However, ahead of this, the NHS Alliance's findings underscore the immediate pressures facing local health services.

The "right to choose" policy, intended to help patients bypass lengthy waiting lists by opting for care from both NHS and non-NHS providers, is cited as a factor contributing to the influx of new providers. While this policy has helped reduce some of the longest waits for adults and children, it has come at a considerable financial cost. Some integrated care boards, responsible for local health budgets, have reported sharp and "out of control" rises in spending.

Specific examples illustrate the scale of the financial increase. One board experienced a tenfold rise in costs within a year, reaching £1.5 million per month. Another saw its annual spend jump from £4 million to £30 million over two years. In Cheshire and Merseyside, spending on adult ADHD alone is projected to surge from £11 million in 2023-24 to £51 million this year.

A particular challenge identified by the NHS Alliance is the wide disparity in charges from non-NHS providers. Unlike routine operations where tariffs are standardized, autism and ADHD services lack such fixed pricing, with only guide prices available that providers are not obligated to adhere to. This lack of regulation also extends to providers who conduct assessments only, as they are not required to be registered with the Care Quality Commission.

Rebecca Gray of the NHS Alliance described the situation as managers being "caught between a rock and a hard place." While understanding the distress caused by long waiting lists, they face soaring costs in their efforts to meet demand. She reiterated that this scenario is detrimental to patients and taxpayers, with a genuine risk of the entire system collapsing into chaos.