NHS ADHD and Autism Spending Is Surging. Here's Why
On August 28, 2026, the NHS Alliance warned that the cost of meeting surging demand for ADHD and autism services in England is "running out of control" and unsustainable. The group, which represents health managers across England's integrated care system, said the post-pandemic demand spike is forcing some local leaders to close waiting lists and consider cutting back other services they provide.
The financial trajectory is stark. One integrated care board (ICB) — the local bodies that plan and pay for NHS care — cited in the NHS Alliance report said its monthly spend on ADHD and autism services had risen from £146,000 in 2024/25 to £1.5 million last year. Another ICB reported that spending on adult ADHD services alone had climbed from £11 million in 2023/24 to a projected £51 million in the current financial year. In one English region, spending on ADHD and autism tests rose from £1.75 million in 2024-25 to £18 million in 2025-26, a tenfold increase (The Times). The NHS Alliance report, covered by The Guardian, frames these figures as evidence of a system-wide mismatch between demand and funded capacity.
A central driver, according to the report, is the interaction between a shortage of in-house NHS diagnostic capacity and patients' right to choose any qualified provider. That right allows individuals seeking an ADHD or autism assessment to pick from any provider approved to deliver NHS-funded care. The result has been a rapid influx of new providers entering local markets. One ICB told the NHS Alliance it now has 80 providers operating on its patch. Another said that two years ago it received invoices from 12 to 14 providers; that figure has since risen to 48. Increased provider capacity did ease some assessment delays, the report acknowledged, but the absence of a national tariff — a standard price the NHS sets for a given procedure — meant ICBs faced enormous price variation for ostensibly similar services. One ICB reported paying anywhere from £300 to £3,000 for comparable assessments.
The proliferation of providers has also raised quality assurance concerns. The report noted that large numbers of small, non-regulated providers have entered the market, many of which can deliver diagnostic assessments but cannot provide ongoing care. For ICBs, this fragmentation complicates clinical governance and creates discontinuities in patient pathways, particularly for conditions like ADHD that typically require long-term medication management and periodic review.
Rebecca Gray, director of the NHS Alliance's mental health network, captured the position facing local commissioners: "Local health leaders are caught between a rock and a hard place." She described the current situation as unsustainable, delivering a bad deal for both patients and taxpayers. The NHS Alliance is now calling for two specific structural reforms: a national mandatory tariff for ADHD and autism services, and a national service specification applied consistently across all NHS-funded providers. A national tariff would set a uniform price floor and ceiling for defined assessments and interventions, reducing the cost variance that ICBs currently navigate. A national service specification would standardise the clinical content, staffing requirements, and care pathways that providers must meet to qualify for NHS funding.
The broader context here is one of demand and supply misalignment within a commissioner-led system that relies on patient choice to drive access. The NHS right to choose any qualified provider was designed to reduce waiting times by expanding capacity beyond traditional NHS trusts. But in the specific domain of neurodevelopmental assessments, that mechanism has operated without the price discipline or quality guardrails that a national tariff and service specification would impose. The result is a market in which supply has expanded rapidly, prices have diverged sharply, and quality oversight has lagged behind the pace of provider entry. For ICBs, the fiscal pressure is immediate and mechanical: every pound directed toward un-tariffed ADHD and autism assessments is a pound unavailable for other commissioned services.
The question now facing NHS England and the Department of Health and Social Care is whether a national tariff and service specification can be designed and implemented quickly enough to stabilise local finances before more waiting lists close. The NHS Alliance's intervention places the issue squarely on the desks of national policymakers, with local health leaders signalling they cannot absorb the current cost trajectory without reducing provision elsewhere.
