A Guardian investigation has uncovered a deepening crisis within NHS England's services for Attention Deficit Hyperactivity Disorder (ADHD), with the system projected to overshoot its budget by a staggering £164m this year. The surge in demand for diagnoses has overwhelmed public provision, funnelling hundreds of thousands of people towards a fragmented and often poorly regulated private sector.
A System at Breaking Point
The investigation, which took several months, found that NHS spending on ADHD services is on track to reach £314m by April 2026. This figure more than doubles the annual budget of £150m, creating a financial black hole that local integrated care boards (ICBs) will be forced to cover. The analysis was based on data from 32 of England's 42 ICBs.
Compounding the problem, a rapidly growing portion of this expenditure is flowing to private companies. Data from nineteen ICBs shows that NHS spending on private ADHD services more than tripled in three years, soaring from £16.3m in 2022-23 to £58m last year. This shift is largely driven by patients exercising their "Right to Choose" to bypass agonisingly long NHS waiting lists.
The Private Sector: A Profitable but Patchy Solution
The investigation, led by the Guardian's consumer affairs correspondent Sarah Marsh, highlights serious concerns about the quality and regulation of private ADHD services. Many of these providers are private equity-backed firms making "huge" profits, yet there is little consistent criteria for how they are approved to carry out NHS-funded work. Alarmingly, some are not even registered with the Care Quality Commission.
"There is still no single national framework setting out what a good ADHD assessment looks like," Marsh noted. This absence of a consistent baseline means patients and GPs are frequently left arguing over whether a private diagnosis is valid or sufficient.
While some have positive private experiences, the investigation gathered numerous accounts of systemic failures: rushed assessments, a lack of follow-up support, and the critical breakdown of shared-care agreements. These agreements, where a GP takes on prescribing medication after a private diagnosis, are often refused, leaving patients stranded and untreated after spending thousands of pounds.
Patients Caught in the Crossfire of a Political Debate
The crisis is unfolding against a politically charged backdrop. The health secretary, Wes Streeting, has ordered a clinical review into the diagnosis of ADHD, autism, and mental health conditions. However, the announcement sparked a polarised response, with some commentators arguing about overdiagnosis.
Sarah Marsh warns that this debate risks obscuring the real suffering at the heart of the issue. "They're not seeking help because they want a diagnosis," she stated. "They're seeking help because they are struggling." The investigation underscores that people are turning to private clinics out of sheer desperation, not on a whim.
The human cost of this broken system can be devastating, as tragically illustrated by the Guardian's reporting on the death of Ryan White. For many, the pathway to care has become a prolonged period of isolation, administrative dead-ends, and clinical risk.
Call for Systemic Overhaul
The central question raised by the investigation is whether the current spending—projected to be £164m over budget—is effective. "The big thing that struck me is that you've got a system that is just not functioning well, and the people really affected are the patients," Marsh concluded.
The report calls for urgent scrutiny and reform to create a coherent, well-regulated pathway for ADHD diagnosis and care. It argues that Streeting's review must start by asking why so many people feel forced to pay, wait, and fight through a system that consistently fails to join up. For the hundreds of thousands trapped in this crisis, a functional solution cannot come soon enough.
