Kent NHS’s Escalating Autism and ADHD Crisis: £28.9m Spent, £20m Budgeted and Full Outcomes Still Unknown

There is a number buried in the latest NHS Kent and Medway Board ICB papers which ought to stop anyone skimming. Spending on autism and ADHD assessment and treatment rose from just £640,000 in 2023/24 to £28.91 million in 2025/26. That is more than 45 times the original figure — an increase of roughly 4,417% in two years.

Then something rather extraordinary happened.

NHS Kent and Medway began 2026/27 with an autism and ADHD budget of just £20.02 million — £8.89 million, or 30.8%, below what it had actually spent the previous year. The ICB itself acknowledges that this allocation did not fully cover existing backlog commitments, treatment and assessments already started, priority cases, prescribing costs or continuing growth in the provider market. NHS-Kent-and-Medway-Board-Part-…

This wasn’t simply an unfortunate forecast subsequently overtaken by events. The Board paper says the £20.02m opening position was “based on affordability for the ICB”. Affordability may explain why the budget number was chosen. It doesn’t make existing patients, assessments already under way, prescribing commitments or an established £28.91m annual run-rate disappear.

Reality has now caught up with the spreadsheet. At the end of Quarter One, the forecast had already risen to £24.5m. The ICB’s current most-likely forecast is £32.1m, around £12.1m — 60% — above the opening budget and approximately £3.2m higher than the previous year’s actual expenditure.

And even the ICB’s best-case scenario is described as “unlikely”, based on its discussions with providers about Indicative Activity Plans and proposed tariff arrangements. The overall residual risk attached to the position is rated HIGH.

The warning signs were there long before this budget was set.

In October 2024, Kent County Council’s Health Overview and Scrutiny Committee was told that referrals to the commissioned adult autism and ADHD service had risen 600% against contracted activity in two-and-a-half years. A total of 31,314 referrals had been received since April 2022, compared with contracted annual activity of 2,131. Some 71% of the demand related to ADHD. The official minutes record that the financial envelope remained unchanged and that Right to Choose created a financial risk for the ICB.

So by late 2024 elected councillors scrutinising the health service had already been told that demand had accelerated dramatically and that the mechanism allowing patients to choose accredited alternative providers carried a financial risk.

By January 2026, KCC papers were discussing the new Neurodevelopmental Support Pathway and the This is Me programme. Officials said early experience suggested fewer referrals were entering neurodevelopmental waiting lists and expressed confidence that the redesigned pathway would put waiting-list figures onto a “downward trajectory” by meeting families’ needs earlier.

Eight months later, the ICB’s own position is considerably less comfortable. Its September Board paper says autism and ADHD demand continues to exceed commissioned capacity across children, young people and adults, while long waits, fragmented pathways, inconsistent provider information and limited support outside diagnostic services are creating clinical, equality, operational and financial problems.

There is another problem sitting underneath that £28.91m bill: the NHS still doesn’t have a complete picture of what it is buying.

The Board paper admits provider reporting is inconsistent. Waiting-list visibility, diagnostic outcomes, prescribing, titration and follow-up information are “not yet sufficient for full assurance”. It also identifies an unquantified risk of duplicate entries across statutory and Right to Choose waiting lists, while new providers can create financial liabilities before commissioners have a complete picture of demand, activity, quality or whole-pathway cost.

That helps answer an obvious question prompted by the extraordinary increase in expenditure: how many people were actually diagnosed?

At present, there is no clean published Kent and Medway figure allowing us responsibly to say that £28.91m produced X autism diagnoses and Y ADHD diagnoses during 2025/26. Indeed, an NHS Kent and Medway FOI response dated 26 May was asked how many adults were waiting for an ADHD diagnosis and how many adults received an ADHD assessment during 2025/26. On both questions the answer was that the ICB did not hold the information.

For children the ICB could provide something. It said 3,860 children were waiting for an ADHD assessment in January 2026, excluding Right to Choose patients. It also recorded 2,036 completed child ADHD assessments between February 2025 and January 2026, again excluding Right to Choose because February and March 2026 data were unavailable. But completed assessments aren’t the same thing as confirmed diagnoses, and the response didn’t provide a Kent-and-Medway total showing how many of those 2,036 assessments resulted in an ADHD diagnosis.

A smaller local example demonstrates why that distinction matters. Medway NHS Foundation Trust’s community paediatric service for Swale children aged up to 12 completed 177 ADHD assessments in 2023, of which 132 resulted in diagnoses. In 2024 it completed 178 assessments and recorded 122 diagnoses. Assessment numbers therefore cannot simply be treated as diagnosis numbers.

Nor can the £28.91m simply be divided by whatever assessment figure can be found to manufacture a “cost per diagnosis”. The expenditure covers considerably more than the diagnostic appointment itself. The ICB identifies continuing liabilities from assessment, titration, prescribing and review, while admitting the full cost of prescribing and shared-care arrangements isn’t yet completely visible.

That makes this more than a story about rapidly increasing demand. It’s also about financial and management information. An organisation facing expenditure of almost £29m last year and potentially £32.1m this year acknowledges gaps in its visibility of waiting lists, diagnostic outcomes and whole-pathway costs.

Its attempt to bring the bill under control also has limitations.

Providers have been issued with Indicative Activity Plans, or IAPs. But the Board paper explicitly warns that these are “indicative rather than absolute contractual limits” and providers aren’t required formally to accept them. The ICB therefore has to rely upon a wider collection of activity-management arrangements, reporting obligations, contract variations and other NHS contractual provisions.

As of 7 September, five providers were still being followed up over the 2026/27 arrangements. The ICB is strengthening invoice validation, scrutinising prescribing, seeking capped activity agreements with high-volume providers and introducing closer monitoring. But its own risk assessment still rates provider non-compliance, backlog liabilities and further market growth as high risks.

And financial control is now colliding directly with waiting times.

In May, before the latest Board paper, the ICB told an FOI requester that it was seeking to establish a minimum waiting time across all providers “within the financial envelope”. Yesterday, The Guardian reported that Kent and Medway is among 15 English ICBs using measures to control autism and ADHD assessment costs, and that Kent and Medway has now decided to impose a minimum wait. The newspaper doesn’t give the length of Kent and Medway’s minimum period. Nationally, it reports around 960,000 people waiting for ADHD assessment and 295,000 for autism assessment.

There is a legal boundary the ICB knows it must not cross. Its Board paper expressly says the arrangements must preserve lawful patient choice, including NHS Right to Choose, and mustn’t create an unlawful barrier or delay. It identifies possible legal risk from provider challenge, patient complaints and equality-related challenges if controls and prioritisation aren’t applied consistently and transparently. That isn’t evidence that Kent and Medway’s present arrangements are unlawful; it is evidence that the ICB itself recognises the legal risk.

None of this means the demand is imaginary or that the NHS has an easy alternative. Right to Choose has expanded rapidly; more providers have entered the market; referrals have soared; patients need support while waiting; and the ICB has a legal duty to live within finite resources. Its proposed longer-term answer is to move away from a system where diagnosis is effectively the gateway to help and towards earlier, needs-led support before, during and after assessment.

But one question remains difficult to escape.

If NHS Kent and Medway had already spent £28.91m, knew referrals had increased dramatically, knew thousands were waiting, knew treatment had already commenced and knew the Right to Choose market was expanding, why did it set a £20.02m opening budget which its own paper now admits didn’t fully reflect those commitments?

And alongside that sits another.

When public expenditure has risen from £640,000 to almost £29m in two years, shouldn’t the commissioner be able to tell the public, clearly and comprehensively, not only how much it paid — but how many people were assessed, how many were diagnosed, what treatment followed and what outcomes that money purchased?

At the moment, NHS Kent and Medway’s own documents suggest it cannot yet give that complete answer.

The Shepway Vox Team

Journalism For The People NOT The Powerful