Market failure. How the under-regulated market in NHS funded ADHD services impacts patients and the finances of the NHS.
This briefing note sets out an overview of how the large majority of NHS patients are assessed and treated for Attention Deficit Hyperactivity Disorder (ADHD) in England.
It builds on the Centre’s recent analysis of the market regulations underpinning the provision of NHS eye care services by private companies and the growing involvement of private equity investors in this area of care.
The study is based on a Freedom of Information survey between August and November 2025 of the 42 NHS Integrated Care Boards (ICBs) - which are responsible for organising NHS care across England - a review of the websites and annual accounts of a number of ADHD provider organisations, as well as a review of the board papers of the ICBs.
The report finds the following:
Finding 1) The NHS is now heavily dependent on private companies to deliver ADHD services and expenditure on these companies has been growing at a rapid rate over the past 3 years.
Finding 2) The rapid growth in NHS expenditure on private companies providing ADHD services has been unplanned and threatens to undermine the financial stability of local NHS services and take funds away from those most in need.
Finding 3) The large majority of care provided by private companies is being delivered to local NHS bodies without a direct contract in place. In some cases we found that there were no contracts in place at all with private companies. This prevents the NHS from holding private companies to account and ensuring patient safety.
Finding 4) There is no mandatory regulation for providers of ADHD assessments and no certified national qualification or training for those undertaking ADHD assessments.
Finding 5) The under-regulated market for NHS funded ADHD services has attracted private equity investors seeking large returns.
Key Facts
252% - the increase in NHS expenditure on private companies providing ADHD in England over a 3 year period.
33% - the profit margin of one of the private equity owned providers of NHS ADHD services
£164 million – the estimated overspend by 32 ICBs in England on ADHD services in 2025/6
£314 million – the estimated spend by 32 ICBs in England on ADHD services in 2025/6
19 - the number of companies which provided £1.9 million worth of ADHD services to NHS patients over a 3 year period where there was no evidence of a contract with the NHS.
14 - the number companies who provided £3.5 million worth of ADHD services to NHS bodies over a 3 year period who were not registered with the Care Quality Commission.
In producing this report we are keen to recognise the significant challenges faced by those individuals with neurodevelopmental conditions both in terms of the impact on their daily lives and also their difficulty in accessing timely diagnosis and treatment.
We should also stress that we have insufficient expertise to offer a view on the prevalence of ADHD and associated conditions within the population. Nor do we have expertise to comment on any issues relating to the diagnosis or treatment of the condition, or whether these services are being delivered to the standards required.
Our intention has been to identify issues affecting the organisation and delivery of ADHD services which are not in line with the public interest and to provide recommendations for improvement.
