New NHS data reveals a dramatic five-fold increase in ADHD prescriptions among wealthier Britons over the past decade, driven by a surge in private clinic diagnoses that bypass lengthy NHS waiting lists. Experts describe this trend as a phenomenon where "sharp-elbowed" individuals from middle-class backgrounds are jumping queues of up to ten years by obtaining private assessments and then requesting NHS GPs to continue prescribing stimulant medications.
Escalating Demand and Private Sector Reliance
Approximately 700,000 people in England are currently awaiting an ADHD assessment through the NHS, with some facing delays of nearly a decade. In response, many patients are turning to private clinics, either by paying around £1,000 themselves or utilising the Right to Choose scheme, which allows the NHS to cover the costs of private assessments. This shift has led to half of all NHS ADHD assessments now being conducted in the private sector.
The financial impact on the NHS is substantial, with spending on private ADHD companies soaring to an estimated £128 million last year, up from £36 million just two years earlier, according to the Centre for Health and the Public Interest. Thea Stein, chief executive of the Nuffield Trust think tank, attributes this growing reliance on private care directly to expanding NHS waiting lists, stating that more patients are seeking private diagnoses as delays worsen.
Demographic Shifts and Awareness
One of the most notable changes has been the rise in diagnoses among middle-aged women, with many pursuing assessments after their children receive diagnoses and they research symptoms themselves. A decade ago, less than a quarter of ADHD patients were female; now, that proportion has risen to four in ten. Among individuals in their forties and fifties, more women than men are taking ADHD medication.
Dr Mukesh Kripalani, lead adult consultant psychiatrist at the ADHD Centre, explains that ADHD symptoms often become more evident in women during menopause. "You might see boys bouncing off the walls, whereas women tend to internalise those symptoms," he notes, highlighting how awareness has grown that ADHD is not solely a condition affecting young boys.
Socioeconomic Disparities and Access Issues
NHS prescription data, which categorises patients into five groups based on deprivation levels, shows a significant shift in the socioeconomic profile of ADHD patients. Ten years ago, there were nearly twice as many patients from the most deprived areas compared to the least deprived. Today, there is almost parity between these groups, indicating that wealthier individuals are increasingly accessing diagnoses and treatments.
However, this trend has led to challenges in the healthcare system. Local GP practices have the discretion to accept or reject shared care agreements, where they take over managing ADHD drugs initially prescribed by private specialists. Dr Kripalani reports that "a lot of GPs have started to put blanket barriers" on accepting private diagnoses, citing concerns about quality.
Patient Risks and Policy Responses
Healthwatch England, an independent statutory body, warns that these barriers leave some patients stranded without access to NHS-prescribed medication, forcing them to pay up to £300 monthly for private prescriptions. William Pett, head of policy and research at Healthwatch, emphasises that shared care agreements are "crucial for anyone who has received a private ADHD diagnosis and needs access to NHS‑prescribed medication and treatment."
He adds that without these agreements, patients risk wasting money on private diagnoses and facing either prolonged NHS waits or exorbitant ongoing private costs. In response to the surge in demand, Health Secretary Wes Streeting has ordered a national review of ADHD services to examine potential overdiagnosis and ensure equitable access across the population.
