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Is the ADHD and autism assessment market still economically viable in 2027?

Most providers are still profitable, but ICBs are capping NHS funding and self-pay is limited by income. What decides viability in 2026: payer mix, cost per assessment and positioning.

Dr. Moniem Abdu · Co-Founder & CEO, Cerebric· · Updated · 12 min read
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Market
In this article
  1. Key takeaways
  2. 1. Demand
  3. 2. Demand that is paid for
  4. 3. Supply, price, cost and margin
  5. 4. Levers on margin
  6. 5. Where demand goes next
  7. About the author
  8. Citations

Demand for ADHD and autism assessment has never been higher, and most larger providers are still profitable. But ICBs are capping NHS funding and self-pay is limited by income, so viability now depends on payer mix, cost per assessment and positioning.

Key takeaways#

  1. About 960,000 open referrals are waiting for an ADHD assessment, and new referrals are still rising.
  2. Only part of that demand is paid for, by the NHS or by patients themselves.
  3. Providers deliver hundreds of thousands of assessments a year, at widely varying margins.
  4. Providers can protect their margin through a number of levers.
  5. Demand could shift from assessment to support, as support stops depending on a diagnosis.

How we built this. The figures come from NHS England data, company accounts, regulators and published research, with a source next to each. Where no data exists, such as how many people pay for their own assessment, we give our own estimate as a range and show how we reached it.

1. About 960,000 open referrals are waiting for an ADHD assessment, and new referrals are still rising#

By June 2026, about 960,000 open referrals were on the recorded ADHD waiting list, up 39% in a year (NHS England ADHD Management Information), and about 295,000 were waiting for an autism assessment, a figure held down by one provider's missing June return. Of autism referrals open for at least 13 weeks, only 3.8% had a first appointment within 13 weeks (NHS England Autism Statistics).

Recorded ADHD waiting lists grew about 23 times and autism lists about 16 times between April 2019 and June 2026Open referrals in England waiting for or in assessment, all ages, by month. The ADHD line counts mental health services, the only part recorded since 2019, so it leaves out the 179,000 children waiting for community paediatrics in June 2026.June 2026:ADHD780,00023.1× April 2019Plus about 179,000 children's referrals waiting in community paediatrics: about 960,000 in all.Autism295,00016.3× April 2019Dashed line: from February 2025 NHS England's ADHD figures include new submissions from independent providers, which account for most of that month's jump, so later months are not directly comparable with earlier ones. Shaded: January to June 2026, from NHS England's monthly releases published after the review.

In the 12 months to June 2026, about 520,000 new referrals were made: 228,000 adult and 108,000 child referrals for ADHD (NHS England ADHD Management Information), and 183,500 for autism (NHS England Autism Statistics). These count referrals to mental health services, so children referred to community paediatrics come on top. And the pool of possible demand is larger still. 13.9% of adults in England screen positive for possible ADHD, and fewer than 1 in 10 of them report a diagnosis (Adult Psychiatric Morbidity Survey 2023/4). Adult ADHD diagnoses have grown fastest, and women now lead new adult diagnoses (ADHD and autism diagnosis trends); most adults who screen positive for ADHD traits also have at least one other condition (the Fonagy review in charts).

Of every 100 adults who screen positive for ADHD, about 90 have no diagnosisAdults in England who screen positive for possible ADHD on a six-question survey screen (13.9% of all adults in 2023/4), by whether they report a professional diagnosis. A positive screen is not a diagnosis.On ADHD medication (3)Diagnosed, no medication (7)No diagnosis (90)

2. Only part of that demand is paid for, by the NHS or by patients themselves#

Demand only becomes revenue when someone pays: the NHS, through a contract or Right to Choose, or patients themselves. For ADHD, ICBs could spend about £412m on assessment and treatment in 2025/26, by one estimate (CHPI), several times the £24m to £78m we estimate patients pay themselves for ADHD assessments.

Patients pay an estimated £51m to £157m a year for ADHD and autism assessments, limited by income#

Our estimate is £51m to £157m a year for ADHD and autism assessments together, with a midpoint of about £90m. It counts people referred to the NHS who then pay privately and people who go straight to private, and How big is the private self-pay market for ADHD and autism assessments in England? sets out how we sized it. The people already waiting are a further, one-off pool: they have already taken the NHS route, so applying the share of NHS referrals who go on to pay (about 4% to 12%) to everyone on the waiting lists in June 2026 gives about £66m to £200m. That pool is growing: the recorded ADHD waiting list grew by 39% in the year to June 2026 (NHS England ADHD Management Information). No survey measures how many people pay for their own assessment, so the estimate rests on proxies: NHS referrals as the measure of yearly demand, survey shares of people who pay for private care, IHPN's benchmark for people who go straight to private, and median private prices. It is a guide to scale, not a measurement.

Of about 550,000 people seeking an assessment a year, between 35,000 and 113,000 are likely to pay privatelyHow we estimated it: demand × the share likely to pay × the price. Yearly demand is new referrals to NHS-funded ADHD and autism services in England in the 12 months to June 2026, plus people who go straight to private (44% of those who pay, IHPN's benchmark). The other view counts everyone on those waiting lists in June 2026, who have already taken the NHS route. Each block's width is its number of people; the amber band is the share likely to pay privately.Share of people likely to payAdult ADHD237k people21k pay (9%)Adult autism90k people8k pay (9%)Child ADHD116k people17k pay (15%)Child autism103k people16k pay (15%)Likely to pay privatelyRest of yearly demandAt the midpoint, this gives about 62k paid assessments a year, worth about £90m a year: £43m for ADHD and £47m for autism.This counts people seeking an assessment in one year: new NHS referrals plus those who go straight to private. New referrals are still rising: 31% more ADHD and autism referrals were made in June 2026 than in June 2025 (ADHD up 47%, autism up 7%; NHS England).Limitations• The share who pay is a proxy: no survey measures who pays for their own ADHD or autism assessment.• People who go straight to private are estimated from IHPN's benchmark for all UK private healthcare (44%), including private GP visits.• Insurers and employers aren't included; some major insurers exclude these assessments.• Assessments only: titration, follow-ups and prescriptions are extra.

Three things hold self-pay back:

  • Insurers often don't pay for these assessments. Bupa, for example, excludes ADHD and autism assessments as developmental conditions, and the Financial Ombudsman upheld its refusal to pay in 2025.
  • Higher-income adults and families are two to three and a half times as likely to pay privately as lower-income ones (Healthwatch England; Sutton Trust), and across all private healthcare, about 2 in 5 people who consider it go on to use it, by our calculation from YouGov.
  • Possible ADHD is more common among adults in financial difficulty. Adults in problem debt screen positive for possible ADHD at more than twice the rate of other adults, 28.1% against 12.7% (Adult Psychiatric Morbidity Survey 2023/4).

More people are turning to private care, though. Private healthcare use rose from 9% of adults in 2023 to 16% in 2025 (Healthwatch England), so the self-pay market may grow significantly.

NHS-funded demand is being capped, because ICBs could spend twice their budget#

ICBs budgeted an estimated £196m for ADHD assessment and treatment in 2025/26 but could spend about £412m, by CHPI's extrapolation from 32 ICBs (CHPI). ADHD and autism spending rose seven to ten times since 2023/24 in some areas, and ADHD assessment spending rose 44-fold in two years in one (Financial Times). ICBs put most of the overspend down to Right to Choose, which lets patients pick any provider holding an NHS contract with any ICB, so the paying ICB could not control the volume (CHPI).

ICBs are now capping NHS-funded demand at three points: who qualifies, when they can be seen and how many assessments are paid for.

ICBs limit NHS-funded assessment in three ways, and each hits providers differently: fewer patients, later revenue or a ceiling on paid workThe three ways ICBs now control NHS-funded ADHD and autism assessment, what each one limits, and what it means for a provider, with an example of each.Referral criteriaWho qualifiesFewer patients can be referredCheshire and Merseyside funds assessments only for people with significant impairment in at least two areas of life.Minimum waitsWhen they can be seenRevenue arrives later, which strains cash flowWest Yorkshire makes everyone who chooses an independent provider wait at least two years from referral. The charity ADHD UK has threatened legal action over it.Activity plansHow many are paid forA ceiling on paid volume, and a risk of unpaid work above itIHPN's members say about a third of ICBs set them 2026/27 plans about a third below what they delivered in 2025/26. Almost 60% of ICBs cap or plan to cap assessments.

National prices may be next: NHS England will consult on a national set of prices, and intends new payment arrangements to apply from April 2027 (DHSC). Behind all three limits is a shift towards support based on need, with assessment prioritised for those who would benefit most, which the Fonagy review also recommends (pp439–441).

Median private prices are 16% to 59% higher than NHS face-to-face guide prices#

Median private prices are higher than NHS face-to-face guide prices for every assessment, by 16% for an adult ADHD assessment and by up to 59% for an adult autism assessment (NHS Payment Scheme 2026/27 prices, after the August 2026 pay award update; ADHD Private; published fees at 13 providers for autism, October 2026). Our guide to the 2026/27 NHS payment rules lists every guide price and when each one is paid.

Median private prices are 16% to 59% higher than NHS face-to-face prices, but online clinics undercut the NHS virtual priceNHS guide price (inner column) against the median published private price (outer column), England, 2026. The first compares the NHS virtual price for an adult ADHD assessment with online-only clinics; the rest compare face-to-face NHS prices with private medians that include online clinics.NHS guide pricePrivate median price−4%private £680£708+16%private £995£860+30%private £1,250£961+59%private £1,850£1,163+50%private £2,050£1,366Adult ADHD, onlineAdult ADHDChild ADHDAdult autismChild autism

The private medians include online clinics, which charge less: a median of £680 for an adult ADHD assessment, below the NHS's £708 virtual price, against £1,000 for clinics with a physical site (ADHD Private). NHS payment arrives only when the pathway is complete, and virtual-only autism services have no guide price: their price is agreed locally (NHS Payment Scheme 2026/27).

3. Providers deliver hundreds of thousands of assessments a year, at widely varying margins#

At least 330 private clinics compete for the work, and only about 1 in 9 says it takes NHS Right to Choose referrals#

At least 332 private ADHD clinics, run by 249 companies, were listed in July 2026, and half of those companies were formed in 2020 or later (ADHD Private). That is a floor, not a full count: no public register exists, and autism-only clinics are not included. A relatively small number of large independent providers completed about 220,000 NHS-funded assessments in a single year (Fonagy review, p328), and independent providers now do more than half of all NHS-funded ADHD assessments, by the IHPN's estimate. Yet only 39 of 342 private clinics checked say they accept Right to Choose referrals (ADHD Private), which suggests most private clinics depend on self-pay.

Only 39 of 342 private ADHD clinics say they accept NHS Right to Choose referralsPrivate ADHD clinics listed on the ADHD Private directory, by whether their website says they accept Right to Choose referrals, September 2026. Each dot is one clinic.Accepts Right to Choose (39)Does not say it does (303)

Two proposals would add to what clinics must do. The government is working towards CQC regulation of all ADHD and autism diagnostic assessments, which would bring diagnosis-only clinics into scope, and the Fonagy review wants Right to Choose funding to depend on providers reporting referrals, wait times and outcomes separately for NHS-funded and private patients.

Operating margins range from a loss to 35%, against 8% for a large private hospital group#

Most of the 330-plus private clinics are small companies that don't publish profit figures, so margins can only be seen for larger providers that file full accounts. Among seven of them, operating margins in the latest filed year ranged from a loss of 7% to 35%: two made 25% and 35%, four made 9% to 17%, and one made a loss. For comparison, Spire Healthcare, a large UK private hospital group, made 8% in 2025 full-year results 2025. NHS trusts run close to break-even (Fonagy review, p329). One fast-growing provider is reported to make a 42% EBITDA margin (Financial Times), but that measure leaves out depreciation and amortisation, so it isn't comparable with the operating margins here.

Together, those seven providers turned over about £325m in their latest year, from NHS-funded and self-pay work, and some of it from other mental health services. The largest providers grew several-fold in a few years, and some are now for sale, but none had found a buyer by October 2026 (Financial Times).

4. Providers can protect their margin through a number of levers#

With NHS volume capped and prices heading towards a national tariff, the margin left is in what each assessment costs to deliver. Four levers stand out, in order of how much evidence backs them.

A. Triage before full assessment cut the estimated cost of a referral by about a quarter in one small study#

  • Screening out unsuitable referrals cut the estimated cost per referral from £1,011 to £731. At one NHS trust, triaging adult ADHD referrals against set criteria classed 39.6% of them as unsuitable for full assessment. It was a small proof-of-concept study (Fonagy review, p301).
  • Seeing everyone at the front door halved the wait for assessment. In one region, replacing paper triage with an assessment centre cut the median wait from 63 to 29 days, and raised monthly throughput by 27%, from 178 to 227 (Fonagy review, p304).

B. Automating admin and report writing lets a service grow without hiring at the same rate#

  • Before the assessment, automation can take on the admin. Digital screening, questionnaires, automated reminders and automated scheduling replace manual sending, chasing and booking, so admin hiring doesn't have to grow in step with referrals.
  • After the assessment, report writing takes a large share of clinician time. At one NHS community provider, an ADHD or autism report took around 6 hours, according to its AI supplier's case study, the top of the 3 to 6 hours a report takes by hand in the UK. An eight-week pilot found a potential 63% cut in report-writing time (Your Healthcare).

C. Patient finance could widen self-pay, but there is no evidence yet that it lifts bookings#

About a third of 18- to 44-year-olds would consider buy now, pay later for private healthcare (YouGov), but ADHD Private flags only 40 of the more than 330 clinics it lists as offering payment plans (ADHD Private), and no independent study shows that finance increases bookings. Finance also adds to the price: one provider's 24-month plans add about 29% to its assessment-and-treatment packages (ADHD360). Buy now, pay later has been regulated by the FCA since 15 July 2026 (FCA).

Winning NHS-funded patients may also get harder: the Fonagy review recommends banning direct-to-public advertising of NHS-funded ADHD and autism assessments, as part of its recommendation 5 (p445), and the Secretary of State will write to the Advertising Standards Authority (DHSC).

D. Mixing clinician roles puts senior time where it matters most#

  • Junior clinicians take histories, so senior clinicians can focus on assessment and formulation. An hour of a consultant psychiatrist costs about £141, against £73 for a Band 7 nurse (PSSRU 2025), so using senior time only where it's needed lowers the cost of each assessment.
  • The Fonagy review recommends a similar skill-mix model across services. It calls for a tiered skill-mix model, with specialists working increasingly "through consultation and supervision" and direct specialist care reserved for the most complex cases (p432).
  • No public data compares employed and self-employed clinicians. Whether clinicians are employed or self-employed also shapes the cost of an assessment.

5. Demand could shift from assessment to support, as support stops depending on a diagnosis#

The Fonagy review wants support based on need, available without waiting for a diagnosis (pp439–441), and the government has backed that direction (DHSC). Two examples from outside the review suggest what that could mean for demand:

  • When funding depends on a diagnosis, diagnoses rise. In Australia, where disability funding required a diagnosis, the scheme led to a 32% increase in reported autism prevalence, which the authors say fits a lower threshold for recognising autism better than catch-up (Journal of Health Economics). Australia's Thriving Kids programme now offers support without a diagnosis to children aged 8 and under with low to moderate needs, from 1 October 2026 (Australian Government).
  • Support that needs no diagnosis already runs at scale. In England, NHS Talking Therapies, which people can refer themselves to without a diagnosis, received about 1.8 million referrals a year in each of the last five years (NHS England Digital). Referrals roughly doubled between 2012-13 and 2021-22 as the NHS set the service expansion targets, such as 1.9 million adults a year by 2023/24 (Nuffield Trust), not after a change in diagnosis rules. So it shows the scale of demand for such support, not the effect of dropping a diagnosis.

Footnotes

  1. Measured at UK Right to Choose and private neurodevelopmental providers using Cerebric, 2025–26. ↩

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About the author

Dr. Moniem Abdu headshot

Dr. Moniem Abdu

Founder & CEO, Cerebric

Dr. Moniem combines medical training with experience at McKinsey & Company's AI arm, QuantumBlack. His NHS experience revealed how poorly designed systems disrupt clinical focus, driving him to build clinician-first tools that reduce cognitive load and protect clinical judgement.

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Citations(28)
  1. NHS England: ADHD Management Information (August 2026)
  2. NHS England: Autism Statistics, July 2025 to June 2026
  3. NHS England Digital: Adult Psychiatric Morbidity Survey 2023/4, chapter 9: ADHD
  4. Centre for Health and the Public Interest: Market Failure (January 2026)
  5. Independent Healthcare Providers Network: Building Better Neurodevelopmental Services (July 2026)
  6. Financial Times: The taxpayer-funded ADHD boom (4 October 2026)
  7. ADHD Private: The UK Private ADHD Market in 2026
  8. Sutton Trust: Double Disadvantage? (October 2025)
  9. YouGov: One in seven Britons turned to private healthcare in the last 12 months (September 2025)
  10. Healthwatch England: The state of health and social care in 2026 (March 2026)
  11. Financial Ombudsman Service: decision on a declined claim for ADHD and autism assessments (November 2025)
  12. DHSC: Government pledges earlier support to tackle mental health crises (9 October 2026)
  13. YouGov: Are Britons willing to use Buy Now, Pay Later for medical services? (August 2023)
  14. Spire Healthcare: full-year results 2025 (March 2026)
  15. PSSRU: Unit Costs of Health and Social Care 2025
  16. NHS England: 2026/27 NHS Payment Scheme, ADHD and autism diagnostic assessment payment guidance
  17. Autism Eye: Assessment waiting times push charity to threaten legal action (October 2026)
  18. West Yorkshire Health and Care Partnership: Right to Choose activity plan FAQs
  19. Beam: Your Healthcare case study
  20. ADHD Private: clinics with payment plans
  21. ADHD360: pricing
  22. Your Healthcare: AI speeds up autism and ADHD assessments, report finds (December 2025)
  23. FCA: PS26/1, regulation of deferred payment credit (February 2026)
  24. Ranjan and Breunig: Journal of Health Economics, vol 105 (2026)
  25. Australian Government: About Thriving Kids
  26. Nuffield Trust: NHS Talking Therapies (IAPT) programme
  27. NHS England Digital: NHS Talking Therapies annual report 2025-26
  28. Independent review into mental health conditions, ADHD and autism: final report (DHSC, October 2026)

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