NHS ADHD bill heads for £314m as private reliance deepens

To feel the scale, start with the budget underneath the forecast. The system planned to spend roughly £150 million and is on course to spend £314 million instead⁠10. That is not a rounding error or a one-year spike. It is a service spending at more than twice its means, with the overspend alone — £164 million — larger than the original plan it was supposed to live within⁠10. In a health service where every extra pound is fought over, an overshoot of that size is what makes managers reach for words such as unsustainable⁠2⁠4⁠5.

The engine of that overshoot is private provision. Spending by the NHS on private ADHD services rose 252% over three years from £16.3 million in 2022-23, according to the Centre for Health and the Public Interest report "Market failure" by David Rowland, published 12 January 2026⁠7⁠9. The analysis, based on 32 of England's 42 integrated care boards, found the NHS "heavily dependent" on private providers that were pushing boards "massively over budget with little oversight"⁠9.

The language matters because it describes dependence, not choice. Pulse Today's account of the same CHPI work uses the same phrase: the NHS is heavily dependent on private ADHD providers⁠9. The NHS Alliance's late-August warning linked that dependence to demand: increased demand brought a rapid influx of new providers, accompanied by huge variation in price⁠2⁠4⁠5. When need rises faster than NHS capacity, boards buy assessments outside, and when many sellers arrive at once without a common rulebook, costs scatter⁠2⁠4⁠5.

That scatter is now visible in freedom of information data compiled in January 2026. Private neurodiversity spending more than doubled year-on-year and has exceeded half a billion pounds since 2023 across the 42 boards, yet most boards cannot report how many assessments the money actually bought⁠11. It is one thing to spend more to clear a backlog. It is another to spend more without being able to say what each pound purchased. The second condition is what the CHPI work calls an under-regulated market in NHS-funded ADHD services⁠7⁠9.

The patient-side measure moved in the same direction as the money. Complaints about autism and ADHD care more than tripled in five years in England, from 410 in 2021-22 to 1,257 in 2025-26⁠6. A tripling of complaints does not by itself prove that care got three times worse; it can also mean more people are in the system and more willing to complain. But the direction is hard to dismiss when it sits alongside waits that long predate the August warning.

More than 60% of adults and children face waiting lists exceeding a year⁠6⁠8. The Parliamentary and Health Service Ombudsman warned that services are "under significant pressure," with patients "falling through the gaps" and facing "long waiting times, variations in access and fragmented care"⁠6⁠8. That phrasing — falling through the gaps — captures what long waits plus fragmented provision feel like from the inside: referral to one place, assessment in another, treatment somewhere else, with no one clearly holding the thread⁠6⁠8.

This is where the clinical story and the financial story join. The same boards described as heavily dependent on private providers are also described as massively over budget with little oversight⁠9. The same services described as under significant pressure are the ones generating a tripling in complaints over five years⁠6⁠8. Demand explains part of this, but demand alone does not explain why spending can pass half a billion pounds since 2023 without most buyers able to count what was bought⁠11. That is a market design problem as much as a demand problem, which is why the CHPI report frames it as market failure⁠7⁠9.

Plainly put, England built a safety valve and then came to rely on it. The valve is private assessment capacity, purchased by integrated care boards when NHS clinics cannot see people fast enough. The reliance is what the 252% increase measures, starting from £16.3 million in 2022-23⁠7⁠9. The lack of control is what the oversight language measures: massively over budget with little oversight, in an analysis covering 32 of 42 boards⁠9. The human consequence is what the waits and complaints measure: more than a year of waiting for most, and complaints rising from 410 to 1,257⁠6⁠8.

There are limits to what the published reporting file can pin down, and they matter for honesty. The file confirms the £16.3 million starting point in 2022-23 and the 252% rise reported by Pulse from the CHPI work⁠7⁠9. It does not confirm a separate framing that puts the end point at £58 million in 2025-26, and the two descriptions should not be treated as interchangeable. A 252% increase and a move described as more than tripled point in the same direction, but they are different figures from different cuts of the data. The file also confirms the half-billion-pound cumulative total since 2023 and the inability of most boards to say how many assessments that bought, which is itself a finding about accountability⁠11.

Similarly, the sources establish the Alliance warning, the ombudsman warning and the CHPI warning as three distinct alarms, not one report repeated three times⁠2⁠7⁠8. The Alliance warned that costs were out of control and unsustainable amid surging demand, new entrants and wide price variation⁠2⁠4⁠5. The ombudsman warned that services were under significant pressure and that patients were falling through gaps created by waits, access variation and fragmented care⁠6⁠8. The CHPI work warned about the under-regulated market that connects those two: NHS money flowing to private services without the oversight that would normally accompany spending at this scale⁠7⁠9.