NHS bosses warn of chaos in ADHD and autism care

Autism and ADHD care is at risk of descending into chaos, NHS bosses are warning, as costs spiral out of control and unregulated private providers capitalise on the huge demand for help.

The NHS Alliance, which represents health managers, says the current system represents a "bad deal" for patients and taxpayers alike.

It points to big variations in what the NHS is being charged for assessments and care - in one case, a local health board was paying £300 to £3,000 for similar services.

The group says there has been a rapid expansion in new providers – both private firms and charities are involved - and NHS managers are struggling to ensure the quality and safety of care being provided.

The government said an independent review into services would be published soon and it would act on the findings of that, promising a “new national approach” for autism, ADHD and mental health.

Ahead of that, the NHS Alliance has been gathering information from integrated care boards, which hold the budgets for local services, about the current state of care.

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Under the right to choose policy, patients can decide to opt for care from both NHS and non-NHS autism and ADHD services.

The initiative is aimed at helping patients bypass the long waiting lists that have developed in recent years.

The NHS Alliance said the policy has led to an influx of new providers, helping to reduce some of the longest waits for adults and children, but at a cost.

It found a number of boards were reporting sharp rises in spending, describing it as "out of control".

One board saw costs rising 10-fold in a year, to £1.5m a month.

Another saw annual spend jump from £4m a year to £30m over the course of two years.

It said a particular problem was the huge variation in what was being charged by non-NHS providers.

Unlike for routine operations, like hip and knee replacements, where there is a set tariff for different treatments regardless of whether the NHS or private sector carry them out, for autism and ADHD there are only guide prices that do not have to be kept to.

Local health bosses have also reported a rapid increase in providers. One board reported working with 48 providers – four times more than in two years previously.

This expansion was causing problems with the ability of boards to check the quality and safety of the care and support being provided.

Providers who carry out assessments only do not have to be registered with the Care Quality Commission, the regulatory body for health and care.

Rebecca Gray of the NHS Alliance said managers were "caught between a rock and a hard place".

"They understand the anguish and frustration caused by long delays in the system as people wait for assessments, treatment and support.

"But in working to meeting demand they face soaring costs that are running out of control."

She said the situation was a "bad deal for patients and taxpayers" and there was a risk the whole system would fall into "chaos".

Mel Merritt, of the National Autistic Society, said it was clear the system was in crisis.

"Spending is rising on short-term solutions due to years of a lack of long-term investment in improving services."

And she added despite the sums being spent people were still facing "unacceptable" delays.