The tragic death of a brilliant young man has exposed severe shortcomings in the NHS's 'right to choose' system for patients seeking help for Attention Deficit Hyperactivity Disorder (ADHD). Ryan White, described by his sister as "super bright, witty, personable, generous and kind", took his own life on 12 May 2024 after being failed by a fragmented care pathway.
A System in Crisis: The 'Wild West' of ADHD Care
Ryan's story is not an isolated incident. He was one of many patients navigating the 'right to choose' pathway, introduced in 2018 to reduce decade-long NHS waiting lists. This allows patients to select a private provider for assessment and diagnosis, before requesting their NHS GP to enter a 'shared care' agreement for ongoing prescriptions and monitoring.
However, this system has been labelled a "wild west" by experts. Marios Adamou, a consultant psychiatrist and founder of the UK Adult ADHD Network (UKAAN), stated the policy was rolled out prematurely without proper standards for assessments or assessor qualifications. "Right to choose was poorly regulated, poorly managed and some people are making lots of money out of it," Adamou told the Guardian.
The core failure lies in the voluntary nature of shared care. Not all GPs agree to it, and some reject private diagnoses outright, leaving patients like Ryan in an administrative limbo. This occurs even when the NHS has funded the private assessment, due to a lack of official rules for private providers to follow.
Ryan's Fight: Falling Through Every Crack
Ryan White, a former scholarship winner at the prestigious Bancroft's school in London, had endured significant family trauma, including finding his mother dead in 2019. Initially treated for bipolar disorder, he sought clarity and was referred for an ADHD assessment with the private provider Psychiatry UK in September 2022.
He was diagnosed five months later, but a community mental health review was required due to his past mental health history. "Nobody chased anything, or took responsibility," his sister Leigh said. By June 2023, his housing situation collapsed, triggering a rapid decline. In a devastating twist, he was deregistered by his GP practice after expressing frustration at the delays.
Stuck without a GP and exhausted, Ryan sent desperate messages to Psychiatry UK. One went unanswered. Tragically, after his death, the provider continued to send messages about medication changes, unaware he had died. An internal report by Psychiatry UK into Ryan's case later recommended better follow-up procedures with GPs and community teams.
"Ryan tried so hard to get help. He was brilliant, but he was left to fall through every crack," Leigh White said. "He was fighting a system that demands stability from people who are already in crisis."
Call for Urgent Reform and Standardisation
Experts are now calling for an urgent overhaul. Dr Jaime Craig, of the Association of Clinical Psychologists, highlighted concerns about assessor qualifications and assessment rigour. He revealed cases where patients seeking autism or ADHD assessments actually had a visual impairment or language processing issues, risking misdiagnosis and inappropriate medication.
Andrew Jay, director at North East ADHD, warned of NHS pressure to drive down costs, leading to "a very basic level of care" and reports that may not reflect a proper assessment's depth. Adamou urged the NHS to halt "uncontrolled" spending via right to choose and divert funds to NHS pathways with specific quality standards.
In response, Dr Joanne Farrow, medical director at Psychiatry UK, apologised for any part the provider played in Ryan not getting help and outlined investments in safety infrastructure and a new contact centre. Danielle Henry of the Independent Healthcare Providers Network noted private providers now deliver over half of NHS-funded ADHD assessments and emphasised their CQC regulation, but agreed shared care problems need urgent resolution.
Ryan White's death stands as a stark indictment of a system where innovation has outpaced regulation, with vulnerable patients paying the ultimate price.
