Independent providers run over half of NHS-funded ADHD assessments, review finds

A large share of England’s NHS-funded assessment for ADHD and autism now takes place in the independent sector, and oversight has not kept pace, according to the independent review into mental health conditions, ADHD and autism, published by the Department of Health and Social Care on 9 October 2026. Provider estimates gathered by the review suggest independent providers delivered more than half of NHS-funded ADHD assessments and more than a third of autism assessments in 2025/26, with around 90 per cent of that activity running through non-contracted Right to Choose arrangements.

The review, chaired by Professor Peter Fonagy with Professor Gillian Baird and Professor Sir Simon Wessely as vice-chairs, makes ten priority recommendations. The one with the most direct commercial consequence is the fifth: make all ADHD and autism diagnostic assessments activity regulated by the Care Quality Commission (CQC), ban direct-to-public advertising of NHS-funded assessments, and require every provider, including those operating under Right to Choose, to submit consistent activity, quality and outcomes data as a condition of funding and accreditation.

What the review found

Demand is the starting point. Monthly ADHD referrals rose from around 5,000 in 2019 to around 17,000 in 2024, and open ADHD referrals exceeded 560,000 by the end of 2025, more than seventeen times the 2019 number, the review reports from NHS England management information. More than 254,000 people had an open autism referral by December 2025, over 90 per cent of them waiting longer than 13 weeks.

Spending has followed. Citing a January 2026 analysis by the Centre for Health and the Public Interest (CHPI), the review says NHS spending on independent-sector ADHD services rose by around 252 per cent over three years, with a projected overspend of GBP 164 million across the integrated care boards (ICBs) analysed. The CHPI report puts that overspend across 32 ICBs in 2025/26, against an estimated GBP 314 million spent by those boards on ADHD services, and found 14 companies that provided GBP 3.5 million of ADHD services to NHS bodies over three years without CQC registration. The review also cites an HSJ report that one ICB recorded a 30-fold rise in three years in its spending on autism and ADHD assessment and treatment, largely driven by private providers under Right to Choose, and now commissions from 42 private providers.

The review describes a concentrated market with thin reporting. A relatively small number of large independent providers completed around 220,000 NHS-funded assessments in a single year, with individual providers ranging from fewer than 100 assessments a year to more than 75,000. Of roughly 120 ADHD service providers, only around 10 submitted data. Prices for apparently equivalent assessments varied about fourfold between ICBs, and the review says non-mandatory tariffs may encourage combined ADHD and autism assessments because they pay more regardless of clinical indication. The highest provider operating margins approached one third, and GP acceptance of shared-care arrangements for medication started by independent providers has fallen to an average of around 62 per cent. Within the same providers, NHS-funded patients waited a mean of 151 days for an ADHD assessment and 170 days for an autism assessment, against 21.5 days for privately funded patients.

How it was produced, and what it does not show

The review drew on population surveys, administrative and clinical data including an analysis of Clinical Practice Research Datalink primary care records from 2000 to 2025, systematic reviews, a national survey of healthcare professionals and educators, focus groups and engagement with more than 50 organisations, building on an interim report published in March 2026.

Its own caveats matter. The review says it cannot conclude that overdiagnosis is occurring at scale, because population prevalence data for ADHD and autism in England are dated, with the most recent survey estimate for children from 2017, and no equivalent adult survey exists. The independent-sector shares are provider estimates. Comparable NHS data on case mix and outcomes are not routinely available, so the diagnostic conversion rates reported by independent autism providers, averaging 79 to 86 per cent in an Independent Healthcare Providers Network report the review cites, cannot be benchmarked. The spending growth figures cover a subset of ICBs. The recommendations chapter does not put a cost on the proposed reforms, and the report does not set out the government’s response.

Our reading

Analysis by The Healthcare Daily.

• For independent assessment providers, CQC regulation of the assessment itself and mandatory data returns would add fixed compliance cost. Larger operators with registration and reporting systems already in place are better placed than the long tail the review describes, some doing fewer than 100 assessments a year.
• A ban on direct-to-public advertising of NHS-funded assessments would remove one of the routes by which providers attract Right to Choose patients. With around 90 per cent of independent-sector activity non-contracted on the review’s figures, revenue that depends on patient-initiated referrals carries the most risk.
• For ICBs, fourfold price variation and the push towards outcome-based commissioning point to a common tariff for assessment. That would compress the margins the review flags at the top of the market and remove the incentive it identifies for combined ADHD and autism assessments.
• For investors, the case for neurodevelopmental assessment platforms rested on demand and NHS-funded volume. The review leaves demand intact but targets the payment route, so diligence should weight contract coverage, CQC status, shared-care acceptance and data readiness.
• Digital and AI suppliers have an opening: the review asks for a digitally and AI-enabled shared needs assessment and prioritisation framework and a clinically led review of existing ADHD and autism waiting lists, both of which need triage and data tools at national scale.