Full Breakdown
NHS faces “unsustainable” costs as demand for ADHD and autism services soars
8/28/2026, 8:41:31 PM
Escalating costs of ADHD and autism services
The NHS Alliance warns that spending on ADHD and autism assessments in England has risen sharply since the COVID-19 pandemic. One integrated care board (ICB) reported monthly expenditures climbing from £146,000 in 2024-25 to £1.5 million the previous year – a ten-fold increase. Another ICB said its annual budget for adult ADHD services jumped from £11 million in 2023-24 to a projected £51 million.
Price variation is extreme: the same service has been billed at £300 to £3,000 by different providers. The number of contracted providers has surged, with one ICB now working with 80 providers, up from 12-14 two years earlier, while another reports 48 active contracts.
The Parliamentary and Health Service Ombudsman (PHSO) recorded a more than 200 % rise in complaints, from 410 in 2021-22 to 1,257 in 2025-26. The National Autistic Society estimates ? 294,000 people are on NHS waiting lists for an autism assessment.
Background: post-pandemic demand surge
The “right-to-choose” policy, introduced to let patients select any qualified NHS or private provider, has encouraged a rapid influx of private firms and charities, many not required to register with the Care Quality Commission. The lack of a mandatory national tariff means local ICBs negotiate prices individually, creating the wide cost disparities noted above.
Key figures & groups
- Mel Merritt – Head of Policy and Influencing, National Autistic Society.
- Andy Burnham – Mayor of Greater Manchester.
- Integrated Care Boards (ICBs) – Regional bodies that hold NHS service budgets.
- Parliamentary and Health Service Ombudsman (PHSO) – Independent watchdog.
Official statements & responses
A government spokesperson confirmed that an independent review led by clinical psychologist Professor Peter Fonagy will be published later this summer and will inform a “new national approach” for autism, ADHD, and mental health.
PHSO chief Paula Sussex called the system a “postcode lottery,” urging the government to publish clear national guidance, a mandatory tariff, and a service specification.
Criticism & opposition
“Andy Burnham has said that he wants the Government to stop paying for failure when we should be instead investing in success.” — Head
“We hope forthcoming national investigations … will shine a light on what lies behind the recent surge in demand for assessments.” — Mel Merritt
“Spending is rising on short-term solutions due to years of a lack of long-term investment.” — Mel Merritt
Andy Burnham has similarly urged the government to stop “paying for failure” and fund sustainable pathways.
Data & statistics
- Monthly spend increase: £146,000 -> £1.5 million.
- Adult ADHD annual spend: £11 million -> £51 million (projected).
- Provider count: 12-14 -> 48-80 within two years.
- Service price range: £300 – £3,000 per assessment.
- PHSO complaints: 410 -> 1,257 (2021-22 to 2025-26).
- Waiting list for autism assessments: ? 294,000 people.
Conflicting reports & gaps
Different ICBs describe the surge in varying terms: one cites a £1.5 million monthly spend, another notes an annual rise from £4 million to £30 million over two years. The absence of a mandatory tariff leaves the exact cost per assessment ambiguous.
What’s next
- Publication of the independent review (led by Professor Peter Fonagy) later this summer.
- Calls from the NHS Alliance and the PHSO for a national mandatory tariff and a service specification for ADHD and autism assessments.
- Anticipated investigations aimed at clarifying patient choice, funding models, and quality oversight.
