NHS private spending on ADHD & autism by ICB

How much is the NHS spending on private providers for ADHD and autism assessments and treatment? This map shows private sector spending across all 42 Integrated Care Boards (ICBs) in England, compiled from Freedom of Information requests submitted in January 2026.

The data reveals a system under pressure — spending on private neurodiversity assessments has more than doubled year-on-year, passing half a billion pounds across three years, including 2025/26 projections.

Most ICBs cannot report how many assessments that money actually bought, or what outcomes it achieved. The figures shown are minimums; four ICBs could not provide data.

The key findings

NHS Integrated Care Boards have spent, or project to spend, at least £512 million on private sector ADHD and autism assessments across 2023/24, 2024/25 and 2025/26. That figure — compiled from Freedom of Information responses across 42 English ICBs — represents only what was disclosed. The actual total is higher.

Private spending more than doubled in a single year. ICBs that reported data for both 2023/24 and 2024/25 showed a collective increase of 131%. West Yorkshire spent £17.6 million in 2024/25 alone. Greater Manchester — while actively restricting Right to Choose referrals — is projected to spend £22.3 million in 2025/26, the highest single-ICB figure in the dataset.

The more revealing finding is what ICBs could not tell us. Only 4 of 42 could provide data on how many assessments their private spending actually purchased. Only 4 could report average waiting times. Derby and Derbyshire — one of the few that tracked wait times — reported an average of 2,321 days from referral to assessment. That is 6.4 years.

This is not a data collection problem. It is a management problem. ICBs are commissioning hundreds of millions of pounds worth of neurodivergent assessments without measuring what that money buys. They receive invoices from private providers, they pay those invoices, and the numbers go up each year. Inputs are tracked. Outputs are not. Outcomes are invisible.

Four ICBs could not provide spending figures — three confirmed they do not hold the data, one has delayed their FOI response for over two months. Three ICBs have paused Right to Choose entirely. Eight have imposed restrictions. The system is not coping, and the bodies responsible for managing it cannot describe what is happening within their own budgets.

Why this matters

The pattern revealed by this data is straightforward. NHS services for ADHD and autism assessment cannot meet demand. Patients exercise their legal right to choose alternative providers. ICBs pay private companies to deliver what the NHS cannot. Spending doubles year after year. But at no point does anyone measure whether this expenditure is achieving anything.

ICBs cannot say how many people were assessed. They cannot say how long those people waited. They cannot say what happened after diagnosis — whether patients received treatment, support, or nothing at all. The money flows out; no information flows back.

This is not healthcare commissioning. It is invoice processing.

The block contract defence — “we pay NHS trusts a lump sum and cannot disaggregate ADHD and autism costs” — reveals the depth of the problem. These are ICBs responsible for the health of populations ranging from half a million to three million people. Neurodivergent conditions affect a significant percentage of those populations. Yet the financial infrastructure treats ADHD and autism as unworthy of separate tracking, invisible within the broader category of “mental health.”

Meanwhile, the people waiting six years for assessment are equally invisible. They do not appear in performance dashboards. Their wait is not measured against a target. They exist only as future invoices — either to private providers who will eventually assess them, or as costs to other services when unmet needs manifest as crisis presentations, unemployment, or family breakdown. The system is not failing to measure what matters. It is revealing what it considers unworthy of measurement.

Understanding the data

What are ICBs?

Integrated Care Boards replaced Clinical Commissioning Groups in July 2022 as part of NHS restructuring. There are 42 ICBs in England, each responsible for planning and commissioning healthcare services for their geographic population. This includes deciding how NHS funding is allocated locally — which services are provided directly by NHS trusts, which are contracted to private providers, and how resources are distributed across competing priorities.

For neurodivergent individuals, the ICB is the body that determines whether ADHD and autism assessment services exist in your area, how long you wait for them, and whether you can access alternatives when NHS provision fails. ICBs hold the budgets, sign the contracts, and — in theory — monitor performance. In practice, as this data reveals, many cannot account for basic metrics about the services they commission.

What is Right to Choose?

Right to Choose is a legal entitlement under the NHS Constitution that allows patients to select any qualified provider for their first outpatient appointment. For ADHD and autism assessments, this means patients referred by their GP can choose a private clinic with an NHS contract instead of waiting for local NHS services. The NHS pays the bill; a different provider delivers the assessment.

Right to Choose became an escape valve because NHS waiting times became unmanageable. When local services quote waits of two, three, or five years, patients understandably seek alternatives. Private RTC providers typically offer assessments within weeks or months. The result is a growing share of assessments shifting to the private sector — funded by the NHS but delivered outside it. Some ICBs have responded by restricting or pausing RTC referrals entirely, citing budget pressures. This transfers the cost back to patients who must now pay privately or continue waiting.

What is private spending?

The figures in this dataset represent money ICBs paid to private and independent sector providers for ADHD and autism assessments. This is distinct from block contracts — the lump sums ICBs pay to NHS trusts for a range of services. Private spending is typically invoiced per assessment through Right to Choose or similar commissioned arrangements.

When asked about NHS spending on neurodivergent assessments, most ICBs stated they could not disaggregate the figures. ADHD and autism services are bundled within broader “mental health” block contracts with no separate line item. They know what they pay private providers because those invoices arrive individually. They do not know what NHS provision costs because they have never separated it out. This asymmetry — detailed private spending data alongside complete NHS opacity — tells its own story about where institutional attention is focused.

Methodology

This dataset was compiled from Freedom of Information requests submitted via WhatDoTheyKnow.com by Ronnie Cane to all 42 Integrated Care Boards in England during January 2026. Each ICB received an identical request asking for: NHS budgets and spending on NHS-provided ADHD & autism assessments and total spending on private/independent sector providers for ADHD and autism assessments for financial years 2023/24, 2024/25, and 2025/26; current Right to Choose referral status; and any age-based restrictions on RTC access; and questions regarding waiting list numbers and average waiting list times (which they largely did not have).

Of 42 ICBs, 38 provided spending data for at least one year. Four could not: three confirmed they do not hold the data, and one has delayed its FOI response for over two months. Where ICBs provided partial data — for example, 2024/25 only — those figures are included with gaps noted.

All figures shown are as reported by ICBs and represent minimum values. Actual private spending is higher than the totals presented, both because some ICBs did not respond and because several noted their figures excluded certain categories such as under-18 assessments or specific provider contracts. The data is updated as additional FOI responses arrive. No figures have been estimated or extrapolated — gaps in the dataset reflect gaps in ICB disclosure.

Regional breakdowns

East of England

Six ICBs serve the East of England, with combined private spending of approximately £45 million across reporting years. Norfolk and Waveney recorded the highest regional spend with £6.1 million in 2024/25, projected to reach £10.3 million in 2025/26. Suffolk and North East Essex shows similar growth — from £2 million to over £6 million. Cambridgeshire and Peterborough saw spending more than triple from £775,000 in 2023/24 to £2.6 million in 2024/25. Bedfordshire, Luton and Milton Keynes operates Right to Choose under restrictions; the rest of the region reported it active with no age restrictions. Hertfordshire and West Essex confirmed they do not hold this data.

London

Five ICBs cover London’s population of nearly ten million, with combined private spending of approximately £36 million across reporting years. North East London reported £7.2 million projected for 2025/26; South East London £8 million; North Central London £7 million. North West London and South West London have not provided data — North West London has delayed their FOI response for over two months, while South West London confirmed they do not hold the data. All London ICBs that provided data reported active RTC status with no restrictions.

Midlands

The Midlands contains eleven ICBs with combined reported spending of approximately £69 million — the third highest regional total. This region shows the widest variation in approach. Black Country has paused Right to Choose entirely, yet spending jumped from £54,000 in 2023/24 to £3 million projected for 2025/26 despite the pause. Coventry and Warwickshire restricts RTC for adults over 25, who are instead “signposted to talking therapies and digital support” — effectively a soft refusal. Herefordshire and Worcestershire shows the steepest regional growth trajectory, from £407,000 to a projected £7.4 million. Nottingham and Nottinghamshire confirmed they do not hold this data.

North East and Yorkshire

Four ICBs serve this region with combined spending of approximately £108 million — the second highest regional total. North East and North Cumbria projects £18.8 million for 2025/26, the highest in this region. West Yorkshire spent £17.6 million in 2024/25 — the highest single-year figure nationally — though this dropped to £13.8 million projected for 2025/26 under RTC restrictions. All four ICBs have active or restricted RTC, with none fully paused. The concentration of spending here reflects both large populations and relatively complete data disclosure.

North West

Three ICBs cover the North West with combined spending of approximately £82 million. Greater Manchester projects £22.3 million for 2025/26 — the highest single-ICB figure in the dataset — while operating under RTC restrictions. Cheshire and Merseyside spent £10.6 million in 2024/25 with RTC active. Lancashire and South Cumbria reported £5.6 million with no restrictions. The Greater Manchester situation illustrates the pressure dynamic: even with referrals restricted, projected spending continues to climb.

South East

Six ICBs serve the South East with combined spending of approximately £112 million — the highest regional total. Sussex reported £11.3 million in 2024/25, projected to nearly double to £21.4 million in 2025/26. Kent and Medway shows similar growth — from £6 million to £13.7 million. Buckinghamshire, Oxfordshire and Berkshire West jumped from £1.1 million to a projected £13.8 million. Hampshire and Isle of Wight, Frimley, and Surrey Heartlands all operate under RTC restrictions. Hampshire’s response explicitly noted that waiting list figures do not include Right to Choose referrals — an admission that their reported queues undercount true demand.

South West

Seven ICBs cover the South West with combined spending of approximately £60 million. Two ICBs have paused RTC entirely: Bristol, North Somerset and South Gloucestershire, and Gloucestershire. Bristol nonetheless projects £11.3 million for 2025/26 — pausing new referrals has not stopped existing demand generating invoices. Devon — which previously provided no data — now reports £7.3 million projected for 2025/26. Bath and North East Somerset, Swindon and Wiltshire noted that spending to one provider from April 2025 “cannot be disclosed or included in total figures,” suggesting contractual confidentiality is now obscuring public spending data.