NHS spending on autism and ADHD services in Kent has increased an astonishing 45-fold in just two years – and is set to rise even further.
But while some question whether growing awareness is encouraging unnecessary diagnoses, others argue people who have struggled for years are finally getting the help they desperately need. We look at what’s driving the extraordinary increase and the debate surrounding it…
Kent GP Dr John Ribchester says growing awareness of autism and ADHD has led to a dramatic rise in patients seeking assessments
Kent’s NHS spending on autism and ADHD services has rocketed from just £640,000 to almost £29 million in two years – and the bill could climb as high as £46 million this year.
The extraordinary increase has raised serious questions about how the cash-strapped health service can afford to meet soaring demand for assessments and treatment.
But others warn that a growing “moral panic” around the conditions risks stigmatising those affected and discouraging people from seeking help.
Dr John Ribchester, of Whitstable Medical Practice, says the number of patients seeking assessments has risen dramatically, particularly as awareness of how autism and ADHD affect women and girls has grown.
“It is a very hot topic nationally at the moment,” he said.
“There’s a massive expansion of diagnoses and cost as well.”
But for people like Margate journalist Jodie Nesling, who was diagnosed with ADHD as an adult, the growing debate risks overlooking those who have spent years struggling without answers.
“I didn’t go looking for a label,” she said.
“I went looking for an explanation for things that had been affecting my work, relationships and health for years, and the diagnosis is what finally made support possible.”
What’s behind the increase in demand?
Dr Julian Spinks, a Medway-based GP, has also experienced a noticeable rise in people seeking assessments for autism and ADHD (attention deficit hyperactivity disorder).
He says patients who might once have struggled without medical support are increasingly recognising that their difficulties could warrant professional help.
“There’s been a steady increase for some time and that reflects two things – greater awareness and people coming forward for themselves or their children, and there’s been a degree of readjustment of diagnostic criteria and thresholds before you get the diagnosis.”
For years, autism and ADHD were commonly associated with boys displaying obvious behavioural difficulties at school.
But growing recognition of how the conditions can present differently, particularly in women and girls, has led to more people seeking help.
Dr Ribchester said: “Go back a decade and most people diagnosed with ADHD or autism were the difficult-to-handle boy at school – that was the classic description.
“But the criteria has expanded to include adults. For girls especially, difficulty in staying attentive, anxiety, etc, have been included in the diagnostic criteria.”
Autism and ADHD are neurodevelopmental conditions rather than mental illnesses, although they can exist alongside mental health problems.
ADHD can affect attention, impulse control and activity levels, while autism can influence communication, social interaction, sensory processing and behaviour.
Both vary considerably between individuals, and some characteristics can overlap with experiences common among the wider population.
Dr Spinks says greater awareness has helped people with less obvious difficulties come forward, but deciding when those difficulties amount to a diagnosable condition is not always straightforward.
“It’s a continuum from absolutely normal to very severely affected. The question of at what point you put a formal diagnosis on it is a hard one,” he said.
A government-commissioned review published earlier this month found that while recorded diagnoses and referrals for autism and ADHD have risen dramatically, the best available evidence suggests the underlying prevalence of the conditions has remained relatively stable.
GP Dr Julian Spinks says there has been ‘a steady increase’ in people coming forward seeking support for autism and ADHD
It revealed that monthly referrals for ADHD assessments in England had more than tripled, from about 5,000 in 2019 to 17,000 in 2024.
The review also warned of an increased risk of misdiagnosis and overdiagnosis, but found insufficient evidence to conclude this was happening on a large scale.
An extraordinary rise in spending
Figures presented to NHS Kent and Medway’s Integrated Care Board (ICB) in September show spending on autism and ADHD assessment and treatment services increased from £640,000 in 2023/24 to £28.91 million in 2025/26.
That represents a staggering 4,417% rise in just two years.
The ICB is responsible for planning and funding most NHS services across Kent and Medway, deciding how the area’s healthcare budget is spent.
Despite spending almost £29 million last year, it allocated just £20.02 million for the current financial year.
Its board papers acknowledge that the original budget was based on affordability rather than the full cost of meeting existing commitments and growing demand.
The most likely forecast for 2026/27 is now £32.1 million – more than £12 million over budget – while a worst-case scenario could see spending reach approximately £46 million.
The ICB warns that without action to control costs spending will continue growing at a rate that is “not financially sustainable”.
But the colossal increase in spending does not necessarily mean there has been a corresponding rise in diagnoses.
The ICB admits it does not have complete information about assessments, diagnoses and treatment from some providers. It also warns that some patients may be on more than one waiting list, making it harder to judge the true level of demand.
Spending on ADHD and autism services in Kent and Medway has risen from £640,000 to almost £29m in two years, with this year’s total expected to be around £32m
The spending figures cover assessments, medication and ongoing treatment, rather than diagnoses alone.
Almost 50 providers delivering services
One factor behind the increasing bill is NHS Right to Choose, which allows eligible patients to be referred to other NHS-funded services, including those run by private healthcare companies, for autism and ADHD assessments.
For families facing years on NHS waiting lists, it can offer a quicker route to diagnosis and treatment. But the NHS still has to foot the bill, even when the care is provided by a private company.
There are currently 46 providers delivering autism and ADHD services in Kent and Medway, only 19 of which hold contracts directly with the local ICB.
The number has grown significantly since 2023/24, with more providers continuing to enter the market.
An ICB spokesperson said: “The increase in spend in recent years has been driven by a significant and sustained rise in demand for autism and ADHD assessment services, across both statutory NHS pathways and NHS Right to Choose provision.
“This is not solely a Right to Choose issue, but the growth in Right to Choose activity has added specific complexity because activity is delivered across a wider and changing provider market.”
‘Gaming the system’
The increase in people seeking diagnoses comes amid a wider political debate about disability benefits.
Faversham and Mid Kent MP Helen Whately, the shadow work and pensions secretary, believes some people are exploiting the welfare system, particularly Personal Independence Payment (PIP).
PIP is designed to help people with the additional costs of living with a long-term health condition or disability. People with autism or ADHD can qualify, although a diagnosis alone does not entitle someone to payments.
Faversham and Mid-Kent MP Helen Whately believes some people use autism and ADHD to ‘game the system’
Ms Whately said: “There are ‘sickfluencers’ online which actively encourage people to maximise their chance of getting PIP by using certain phrases.
“Some people who have severe needs aren’t getting the help they need while at some level there is gaming of the system.
“There’s a lot of information online which isn’t necessarily helpful which encourages people to go and seek a diagnosis.
“Clearly we have a problem with the welfare system where rather than giving support for people and the challenges they face, the PIP system especially is handing out cash in a way that I think is unhelpful.”
Are more people being diagnosed unnecessarily?
Dr Ashley Frawley, a visiting researcher at the Centre for Parenting Culture Studies at the University of Kent, believes awareness campaigns around neurodiversity can encourage people to interpret ordinary difficulties as symptoms of a disorder.
“We have been encouraged for decades, exponentially since the turn of the 20th century to think of yourself as neurotic, to symptomise these normal aspects of life, and it becomes impossible to think about parts of your behaviour as anything other than a disease,” she said.
“There’s a growing body of evidence that you can’t separate the growth of mental health awareness campaigns with the explosion in diagnoses.”
But she does not necessarily believe people are deliberately exploiting the system.
“There’s a material imperative but it doesn’t mean people are gaming the system – I think mostly people genuinely believe these things,” she said.
“Human beings become how they’re described and that’s what’s very tricky about this kind of thing.”
She argues that wider social problems, including poor working conditions, risk being overlooked when people’s difficulties are explained through medical diagnoses.
“There’s much, much deeper problems at play in terms of what we’re saying to people, crappy work and jobs, and how we encourage people to think about their problems, and how to overcome them,” she said.
Dr Ashley Frawley, of the University of Kent argues, that awareness campaigns around mental health, ADHD and autism encourage people to “symptomise normal aspects of life”
“It promises such simple solutions to much wider problems.”
Dr Ribchester also believes there are difficult judgements to be made about where normal personality traits end and a clinical condition begins.
“Personality is on a spectrum, and all of us may have elements of ADHD, anxiety, depressive tendencies or OCD, but it doesn’t mean we have that condition,” he said.
“How you determine the difference between a personality type and a clinical diagnosis is a judgement question.”
‘We are still underdiagnosing’
Jodie Nesling, who previously wrote for KentOnline about her own experience of being diagnosed with ADHD as an adult, disputes suggestions that too many people are being diagnosed.
“I find it very hard to comment on this moral panic when neurodivergent people are dying by suicide in unprecedented rates due to not being able to access support,” she said.
Citing Cambridge professor Duncan Astle, she said national diagnosis rates are “2.5% of boys, 0.7% of girls and 0.2% of the adult UK population”.
“This is incredibly low, and we are still underdiagnosing the condition,” she said.
Referencing the recent government review, she pointed to its conclusion that “the underlying prevalence of ADHD has stayed broadly stable while diagnosis and referrals have risen”.
“In other words, more of the people who have always had ADHD are finally being identified,” she said.
“That’s exactly what you’d expect after decades in which women and girls in particular were missed and explains why diagnostic rates for this category have quadrupled.”
Ms Nesling rejects the suggestion that awareness campaigns are encouraging people to mistake everyday difficulties for ADHD.
The Kent and Medway ICB board papers warn that without action to control costs its spending on autism and ADHD services is ‘not financially stable’
“Everyone loses their keys sometimes: ADHD isn’t that,” she said.
“A diagnosis requires symptoms that are persistent, present since childhood and causing real impairment across different areas of life, assessed by a qualified clinician.
“Awareness campaigns don’t create those symptoms, they help people recognise them, often after years of being told they were lazy, disorganised or not trying hard enough.”
She was also critical of Ms Whately’s comments about the benefits system.
“It feeds stigma, it puts people off seeking help, and it makes life harder for people who are already struggling to get basic support,” she said.
“I’m frankly tired of disabled people being treated as a problem to be managed by public figures, rather than as people with rights.”
Doctors caught in the middle
For GPs, the increase in demand has brought difficult decisions about who should be referred for an assessment and what support they might need.
Dr Spinks says there will always be people who fall into a grey area, where a diagnosis may be appropriate but extensive treatment is not necessarily needed.
“We have to acknowledge that, as with a lot of other conditions, the diagnosis can be made but they may not require the full intervention that others might,” he explained.
Dr Spinks and Dr Ribchester say much of the increase in demand is coming from parents seeking assessments for their children, although more adults are coming forward too.
“I sit in the middle between desperate parents and adults who want a diagnosis and need help and the health service, which expects you to act as a gatekeeper,” Dr Spinks said.
“That’s a difficult position to be in but ultimately I tend to lean towards wanting to support the patient in front of me.”
GPs are caught between growing numbers of patients seeking autism and ADHD assessments and an NHS struggling to meet demand. Picture: Stock image
What happens next?
With demand for assessments far outstripping NHS capacity, many patients are turning to Right to Choose providers rather than face years on a waiting list.
“It’s not so easy for us to work with [private providers], but I can understand for parents, if they’re faced with years of waiting, it’s a long time. If a child is falling behind, they want to get that resolution quickly,” Dr Spinks said.
“If it’s costing a lot more to provide these services there’s less money to do other things in the NHS given we have a fixed pot.”
Dr Ribchester says the use of independent providers reflects a genuine shortage of NHS capacity.
“From the patient’s perspective there’s a definite unmet need for diagnosis and treatment for sure,” he said.
“The question is how on earth you bridge this gap, it would be great if the NHS could recruit an awful lot more clinicians, but at the moment they’re not able to do that so help from the private sector is needed.”
The ICB says it is moving towards a system in which children and families can receive support based on their needs rather than having to wait for a formal diagnosis.
Its spokesperson said: “In Kent and Medway, we are moving towards a needs-led system, rather than focusing on diagnosis which is not always necessary to access support.
“We are rolling out the ‘This is Me’ approach in schools, which looks at a child’s strengths, needs and differences that helps everyone to meet their needs at home and at school.”
The ICB plans to introduce a new approach to commissioning services from April 2027, although the detailed arrangements have yet to be finalised.