A Guardian investigation has exposed 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 £164 million this year. The surge in demand for assessments and treatment has overwhelmed public provision, funnelling hundreds of thousands of patients into a fragmented and often poorly regulated private marketplace.
A System Pushed to Breaking Point
The investigation, which took several months, found that NHS spending on ADHD services is on track to more than double. Analysis of data from 32 of England's 42 Integrated Care Boards (ICBs) projects expenditure will reach £314 million by April 2026, far exceeding the annual budget of £150 million. This widening financial gap threatens to drain resources from other vital local health services.
Compounding the problem is a dramatic shift towards private provision. Data from nineteen ICBs shows that NHS spending on private ADHD services more than tripled in just three years, soaring from £16.3 million in 2022-23 to £58 million last year. This explosion is largely driven by patients exercising their 'Right to Choose' to escape prohibitively long NHS waiting lists.
The Pitfalls of a Private 'Wild West'
The report raises serious concerns about the quality and regulation of private ADHD services. The investigation found that private equity-backed firms are making huge profits from the current chaos, with little consistent criteria for what constitutes a proper assessment or which qualifications a diagnostician must hold.
While some clinics adhere to standards from bodies like the UK Adult ADHD Network, the absence of a single, mandatory national framework means quality is a postcode lottery. This inconsistency leaves patients and GPs in impossible positions, often arguing over whether a private diagnosis is valid enough to trigger ongoing NHS care through a 'shared-care agreement'.
Sarah Marsh, the Guardian's Consumer Affairs Correspondent who worked on the investigation, noted a common pattern of failure. "For a lot of people, it's the bit after diagnosis that falls apart," she said. "They might have spent months waiting and hundreds or thousands of pounds on an assessment, only to find their GP won't accept it, or the clinic won't respond, or their medication isn't reviewed properly."
Political Debate Obscures Patient Suffering
The crisis has become entangled in a heated political debate about the potential overdiagnosis of neurodiverse conditions. Comments from figures like Reform UK's Richard Tice, who described school accommodations for neurodiverse children as "insane", have polarised the discussion.
In response, Health Secretary Wes Streeting has ordered a clinical review into the diagnosis of ADHD, autism, and mental health conditions. However, campaigners warn against framing the issue solely around diagnosis rates. Marsh emphasises the human reality behind the statistics: "They're not seeking help because they want a diagnosis... They're seeking help because they are struggling."
The tragic case of Ryan White, reported by the Guardian, underscores the devastating potential consequences when clinical and administrative support fails, turning a pathway to care into a prolonged period of isolation and risk.
An Urgent Call for Systemic Reform
The investigation concludes that the current model is fundamentally broken, failing both patients and taxpayers. The core questions it raises are whether the millions being spent are effective and how the system can be rebuilt to provide timely, safe, and continuous care.
With NHS budgets stretched thin and private providers operating in a regulatory grey area, patients are left trapped in a labyrinth. The report serves as a stark call for the government's review to focus not just on diagnostic thresholds, but on why so many people are being forced to pay, wait, and fight their way through a system that too often abandons them.
