Sameer Modha knows the ADHD system all too well. Diagnosed himself, and with two children also diagnosed, he has a clear view of how the system works – and where it breaks down. While his own diagnosis was straightforward, his daughter's experience was very different. The diagnosis he obtained for her from a private provider – a very senior ex-Camhs director – was later rejected by the NHS as not compliant with National Institute for Health and Care Excellence (Nice) guidelines.
This is a common experience. The NHS increasingly refers patients to private providers under 'right to choose', only for those assessments to be rejected. The result is an inefficient system that wastes public money and leaves patients without care. One NHS trust has said this churn is clogging its ability to treat patients, as people cycle back into services after private assessments stall. The NHS is overspending an estimated £164m a year on ADHD services.
Modha had to have the diagnosis reconfirmed through the NHS – something that only happened after 'constant hassling' – and even then struggled to get different parts of the system to work together. He describes being 'caught between the private and state systems', with GPs reluctant to engage in shared care. The ADHD system in the UK has broken down, as Health Secretary Wes Streeting acknowledged this week, saying referrals for autism and ADHD amounted to an epidemic the government was failing to manage.
Under 'right to choose', patients with a GP referral can select a private provider for assessment and initial treatment funded by the NHS. In theory, care is then handed back to the NHS through shared-care arrangements, but often this does not happen. Trusts say patients assessed privately are being sent back into NHS services in growing numbers. The Midlands Partnership University NHS Foundation Trust acknowledged it was struggling to cope, with the trend contributing to long waiting lists and 'reduced capacity for new and complex cases'.
The trust highlighted structural weaknesses, noting 'limited regulation surrounding private ADHD providers' and that assessments 'at times do not comply with Nice guidelines'. Rather than relieving pressure, the scheme appears to be recycling it. Regulatory action has underlined the risks: ADHDNet, a private provider operating under right to choose, has been suspended from NHS work over concerns about 'service management, safety oversight and continuity of care arrangements'.
In NHS Greater Manchester, adult ADHD services are under severe strain. Referrals have risen by more than 400%, from about 2,700 in 2022 to more than 11,000 in 2024, with more than 25,000 adults now waiting for autism or ADHD assessments. Without change, waiting times could exceed seven or in some cases 10 years. Demand continues to outpace capacity, worsened by workforce shortages.
