The cost of diagnosing attention deficit hyperactivity disorder (ADHD) and autism has surged sharply within the NHS, prompting concerns from health leaders about the sustainability of current spending levels. According to the NHS Alliance, an independent body representing health trusts, some regions have seen their monthly expenses for ADHD and autism assessments rise tenfold or more in just a year.
The sharp increase is largely attributed to the Right to Choose scheme, which allows patients to seek private providers for diagnostic assessments to circumvent long NHS waiting lists, with costs covered by the health service. This has led to a proliferation of private clinics, many offering online assessments, charging widely varying fees—from as low as £300 to as high as £3,000 per initial evaluation. The scheme, while intended to improve access, has been described by the NHS Alliance as creating a “wild west” environment.
One unnamed integrated care board reported monthly spending on ADHD and autism services rising from £146,000 in 2024-25 to £1.5 million last year. In Kent and Medway, annual expenditure jumped from less than £1 million in 2023-24 to £28.9 million in 2026-27, while Cheshire and Merseyside forecast spending on adult ADHD services increasing from £11 million in 2023-24 to a projected £51 million this financial year.
Rebecca Gray, director of the NHS Alliance’s mental health network, described the situation as unsustainable, warning that escalating costs could detract from other vital services. Thea Stein of the Nuffield Trust echoed these concerns, noting that increased spending on ADHD assessments may divert funds from broader health services.
Increasing demand for ADHD and autism assessments is driven by heightened public awareness, recognition of symptoms, and widespread discussion on social media, rather than a confirmed rise in prevalence. NHS England estimates that about 2.5 million people in England live with ADHD, many undiagnosed, while nearly 295,000 individuals currently await autism assessments, sometimes facing average waiting times of up to three years in certain regions.
In response to rising demand, some areas, including Kent and Medway, have introduced prioritization schemes to ensure those with the most urgent needs are assessed first. However, this raises concerns that people not prioritized may experience extended delays.
Advocates warn against framing increased diagnostic requests as overdiagnosis. Psychologist Rolland Park emphasized that diagnosis serves as a critical gateway to support for many families, underscoring the importance of timely and accurate assessments.
The National Autistic Society highlighted that rising costs reflect years of underinvestment in services, which has led to reliance on short-term solutions such as private providers under the Right to Choose scheme.
The NHS is reportedly working on proposals to develop guide prices for ADHD and autism assessments starting next year and is conducting an independent review of prevalence rates to inform future service planning. Meanwhile, the NHS Alliance is calling for a fixed national tariff to regulate private providers’ charges and for a national service specification to standardize quality across all NHS-funded assessments, aiming to ensure consistent and affordable care for patients.