In October 2026, the independent Fonagy review of mental health conditions, autism and ADHD called for tighter regulation and oversight of private providers as it has “strong concerns about consistency and quality” of the assessments carried out.
The review warned that there was no “consistent oversight, transparency or quality assurance” of services supplied by the private sector, and a lack of data meant that “commissioners often cannot see what they are paying for”.
The review was commissioned in December 2025 by the then health secretary, Wes Streeting due to concerns over the rise of people making sickness benefit claims due to mental health, autism and ADHD diagnoses.
Led by Prof Peter Fonagy, a clinical psychologist and psychoanalyst at University College London, the review considered all aspects of the sector, including the involvement of the private sector.
There have been concerns for some time over the involvement of private providers in this field. The lack of NHS staff and infrastructure for carrying out assessments for neurodevelopmental disorders (ADHD and autism) has led to long waiting times, in some cases of years. As a result, people have increasingly turned to private providers, either privately funded assessments or, more commonly, via the Right to Choose referral system. This latter system means that the NHS funds assessments by private providers.
This sector has provided rich pickings for private companies, including attracting private equity investment, which often indicates investors expect large returns in a short time. Companies have been set up around the country to provide assessment services fueled by the Right-to-Choose referral system. With approval to work by a single ICB, a company can conduct assessments anywhere in England, often using remote assessments.
The Fonagy review reports that provider estimates suggest that independent providers delivered more than half of NHS-funded ADHD assessments and more than one third of autism assessments in 2025/26, with around 90% of this activity occurring through non-contracted Right to Choose arrangements.
Overhaul of regulation
The Fonagy review calls for an overhaul of the system, bringing all providers under the same CQC-regulated system to ensure “consistent quality standards across NHS, independent, voluntary and digital providers, and stronger national oversight and accountability.”
Increasing integration
The present system is fragmented with a limited number of providers submitting data, making it difficult for ICBs to plan, budget and as well keep track of what they are paying for.
The review noted that of approximately 120 ADHD service providers, only around 10 submitted data.
Fragmentation within the system, with both NHS and private providers, also causes issues with continuity of care.
This was highlighted in March 2025, when a coroner issued a prevention of future deaths report on the death of 27-year-old Sheridan Pickett, who died by suicide after receiving an online ADHD diagnosis and taking stimulant medication prescribed by a private clinic.
When Mr Pickett was admitted to an NHS hospital after an overdose, doctors warned that the ADHD drugs should not be restarted, but that information was never passed back to the private provider, which continued prescribing.
The coroner noted that there were no formal rules requiring information-sharing between private neurodevelopmental services and NHS teams, and warned that without change similar deaths could occur.
Control on funding
The rapid expansion of the private sector has created issues not only around standards of care and regulation, but also around funding.
In August 2026, HSJ reported that Kent and Medway ICB had seen its spending on autism and ADHD care increase 30-fold in three years and was paying 42 private providers, as well as two NHS providers.
Kent and Medway ICB’s spend on autism and ADHD assessment and treatment services has risen from under £1 million in 2023/24 to £28.9 million in 2025-26. The increase in spend has largely been driven by private providers offering services under the Right to Choose policy.
A report by the CHPI in early January 2026 Market failure. How the under-regulated market in NHS funded ADHD services impacts patients and the finances of the NHS noted that this rapid growth in NHS spending on private companies has been “unplanned and threatens to undermine the financial stability of local NHS services and take funds away from those most in need.”
In May 2025, Northamptonshire Integrated Care Board reported that it was having to pay private suppliers of ADHD and autism services three times as much as local NHS providers. Its annual bill of £3m was driven by patients opting for private treatment via Right to Choose. The ICB described the situation as “unsustainable”.
And a Guardian investigation reported that the NHS is overspending by £164m a year on ADHD services, with an increasing amount going to unregulated private assessments.
Leading companies, such as Psychiatry UK and Clinical Partners UK, have seen income surge on rising demand for assessments.
The Fonagy review found “substantial variation in prices for apparently equivalent assessments, with tariffs differing by around fourfold between integrated care boards”.
In March 2026, NHS England attempted to address this variation by introducing the first national guidance prices for neurodevelopmental assessments. But the tariff is not mandatory, and the huge variation in what ICBs pay when people choose to use NHS-funded independent providers for the services has continued.
Non-mandatory tariffs may actually have increased costs to ICBs, with the review noting that the “current non-mandatory tariffs may unintentionally incentivise combined ADHD and autism assessments because reimbursement is higher irrespective of clinical indication.” What is needed is “consistent pricing.”
Government response
The Secretary of State for Health and Social Care, Yvette Cooper, responding to the review said that the government will set out its response in a new mental health strategy in the coming months.
Cooper also said the government will take action to strengthen the oversight of mental health and neurodevelopmental services, and make all diagnostic assessments for ADHD and autism CQC-regulated, “so people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers.”
The government has now confirmed that a consultation on proposals for a national set of prices for NHS-funded autism and ADHD services will take place with the tariff expected to be introduced from April 2027. This would support a more consistent system covering assessment, post-diagnostic support and follow-ups.
The private sector will also be impacted by the review’s recommendation of a ban on direct-to-public advertising of NHS-funded ADHD and autism assessments. The review noted that access should be “through commissioned pathways based on clinical need rather than provider marketing.”
Whether a ban happens is unclear, however, with the government saying only that the Secretary of State will write to the Advertising Standards Authority on issues related to adverts for autism and ADHD services to ensure people receive accurate information and are not exploited by companies encouraging them to seek assessments they may not need.
A move to a needs-led plus diagnosis system
An overarching recommendation of the review is that the system should become needs-led plus diagnosis rather than diagnosis-led. This is likely to affect the numerous private providers that have sprung up, offering assessments to large numbers of people desperate for a diagnosis so they can access help.
The business model of many companies is to conduct as many diagnostic assessments as possible across as broad a geographical area as possible, which has produced large amounts of income from Right to Choose referrals. Support post-diagnosis may take more of a back seat in the business.
The review recommends developing a new commissioning framework, funding mechanisms, and guidance “to support local systems and their partners to move away from commissioning separate ADHD, autism and mental health assessment and support services and towards outcome-based commissioning of integrated support structured around need and functioning.” This implies that there will be less commissioning of partners that provide just assessment services, with a move to a more integrated approach; an approach that may not be as profitable.
The review does acknowledge a role for non-NHS providers, stating that “no single organisation can deliver this [a needs-led system] alone.” However, the NHS remains “central to clinical care, but its role increasingly includes convening and coordinating support with partners.”
The Independent Healthcare Providers Network highlights the mention of “support with partners” in its comments on the review, saying that “a successful, future national strategy must therefore harness the strengths of all regulated, high-quality provider capacity to maximise their capability and capacity.” In other words, the private sector should not be left out of any strategy.
The private providers’ concerns might also have been allayed by Co-chair of the report, Sir Simon Wessely, saying that many service users told the review team they were “very satisfied with the way the system worked”, so “pulling up the drawbridge” on the independent sector was not a possibility, according to a report in HSJ.
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