Recent attention has focused on NHS ADHD services running significantly over budget, with growing reliance on private providers. Framed narrowly, this can appear as a story of rising demand and escalating costs. Clinically, however, it reflects something more fundamental: a system struggling to absorb need early, and therefore paying more later.
In Oxfordshire, this pattern is familiar.
When assessment pathways stall or are capped, demand does not disappear. It simply re-emerges elsewhere — often in more acute and complex forms. Adults who wait years for assessment do not remain static. They present later with compounded difficulties: chronic anxiety, depressive symptoms, workplace breakdown, or repeated cycles of failure and self-doubt. By the time care is accessed, intervention is often more intensive and more costly.
Private provision, in this context, is not a parallel system competing for demand. It is a downstream response to capacity constraints.
Most patients we see do not arrive seeking private care by preference. They arrive after extended periods of waiting, uncertainty, and deterioration. Many have delayed seeking help for as long as possible, only turning to private assessment when the cost of waiting becomes greater than the financial burden of care.
This is particularly relevant in a county like Oxfordshire, where a large proportion of the population works in high-cognitive-load environments: education, research, healthcare, technology, and professional services. Untreated ADHD in such settings has tangible consequences — reduced productivity, increased sickness absence, and loss of skilled individuals from roles they are otherwise well suited to perform.
From a system perspective, the focus on “overspending” risks obscuring the real cost driver: delay.
Capping assessments may offer short-term budget control, but it displaces cost rather than reducing it. Individuals pushed into fragmented care pathways often experience disrupted titration, inconsistent follow-up, and difficulties transferring care between providers. This fragmentation increases clinical risk and places additional strain on both NHS and private services.
There is also an ethical dimension. ADHD is a neurodevelopmental condition, not an elective diagnosis. Restricting access to assessment based on capacity rather than need effectively shifts responsibility onto patients — many of whom already struggle with organisation, persistence, and advocacy. For some, navigating multiple pathways becomes an insurmountable barrier.
From a clinical standpoint, earlier assessment is not simply preferable; it is economically rational. Timely diagnosis reduces secondary mental health complications, supports sustained employment, and lowers long-term service use. Delayed recognition does the opposite.
The current situation is therefore less about excessive demand than about structural mismatch. Services designed around outdated assumptions about ADHD prevalence are now contending with reality. Until capacity aligns with need, spending will continue to rise — not because care is too generous, but because it arrives too late.
A sustainable approach requires investment in consistent assessment pathways, continuity of care, and integrated follow-up. Without this, cost will continue to migrate across systems, and patients will continue to bear the personal consequences of delay.
