A perfect storm of soaring demand, uneven regulation, and a heavy reliance on medication is engulfing NHS care for Attention Deficit Hyperactivity Disorder (ADHD), leading to a £164 million budget overspend and raising serious concerns about patient safety.
A Regulatory 'Wild West' for ADHD Clinics
Dr Vicky Cleak, a UK-trained consultant psychiatrist specialising in adult ADHD, has voiced profound frustration with the current system. Despite being fully qualified and regulated by the General Medical Council, she has spent eight months navigating an opaque Care Quality Commission (CQC) registration process to set up an independent, regulated service. Meanwhile, she notes, other providers without CQC registration have been awarded NHS contracts.
"Some health professions fall outside the CQC remit and thus can set up a practice 'diagnosing and treating' ADHD tomorrow," Dr Cleak warns, highlighting a significant regulatory gap. This creates a fragmented market where small, expert-led services face the greatest bureaucratic hurdles, while larger, contract-driven private providers prioritise patient throughput over continuity of care.
The Dangerous Appeal of the 'Quick Fix' Pill
The pressure to diagnose and medicate quickly is not confined to the private sector. One parent shared a distressing account of their daughter's experience within the NHS. After a one-hour assessment supported her self-diagnosis, she was promptly prescribed amphetamines.
"When the amphetamines didn’t work, he increased the dose. When the symptoms got worse, he prescribed antidepressants," the parent wrote. Requests for therapy were dismissed in favour of further drug interventions. The daughter's symptoms only abated after a significant change in her life circumstances, a factor overlooked during her clinical assessments.
This story underscores a critical issue: the NHS's primary recommended medications for ADHD are psychostimulants or amphetamines. As reader Mona Sood points out, the long-term health costs of such "seemingly miraculous" fixes can be great, drawing parallels with past generations freely issued tranquillisers.
Call for Better Regulation and Holistic Care
The consensus from these expert and public contributions is clear. The current model, born from an overstretched public system outsourcing to a poorly regulated market, is failing patients. High-quality ADHD assessment requires time, expertise, and continuity—elements often sacrificed in the rush to meet targets and control costs.
There is a pressing need for robust, fair regulation that ensures quality across all providers and a shift away from purely drug-based interventions. Experts argue for a greater focus on behavioural therapies and a more holistic understanding of patients' complex lives, warning that the system's over-reliance on pills risks causing long-term harm and dependency for vulnerable individuals.
