A faster route to an ADHD or autism assessment is not necessarily an expansion of the workforce that provides it. Denis Campbell reports that private clinics are recruiting specialists from stretched NHS services, weakening the public teams whose long waiting lists helped create the private market.
At Herefordshire and Worcestershire health and care NHS trust, reduced staffing forced a temporary restriction of its under-18 neurodevelopmental service to the most serious cases. A board paper said most departing staff were taking jobs with independent-sector and Right to Choose providers. The trust says normal access will resume on Monday; 1,298 people have already waited at least two years for an assessment.
Right to Choose is not simply private care for people who can pay. It allows NHS patients to receive NHS-funded assessments from private providers, potentially getting help sooner. But the NHS Alliance describes “one ADHD workforce spread across different providers”. Moving clinicians between employers can improve an individual patient’s access without resolving the system’s shortage of capacity.
The Care Quality Commission is also extending oversight to private clinics offering diagnostic assessments alone, closing a gap in regulation. Services providing both diagnosis and treatment are already regulated. The Fonagy review raises concerns about financial incentives for inappropriate diagnoses; that is a warning about incentives, not proof that private assessments are generally invalid.
Better oversight and a sustainable workforce address different problems. Regulation can make assessments more trustworthy, but it cannot by itself replace departing psychologists, psychiatrists and nurses. Nuffield Trust chief executive Thea Stein warns that inequalities will widen if NHS teams cannot retain staff or grow: those able to pay may receive faster support while the public service becomes harder to reach.