The National Health Service in England is experiencing a significant loss of specialist personnel to the private sector, a trend that is weakening public mental health services and driving patients toward paid care. The exodus of psychologists, psychiatrists, and nurses from NHS ADHD and autism services has reached a point where one trust in Herefordshire and Worcestershire was forced to limit access to its neurodevelopmental team for children and young people.
The restriction, which applies only to the most urgent cases, was lifted recently, but the incident highlights the severe strain on public resources. The trust reported that the majority of staff leaving the service are moving to independent sector providers or Right to Choose providers. Right to Choose allows NHS patients to select private providers for assessments funded by the NHS, a mechanism intended to reduce waiting times but which has also accelerated the drain of talent from the public system.
Regulating the private diagnostic market
In response to the rapid expansion of private clinics offering diagnostic assessments, the Care Quality Commission (CQC) announced on Friday that it will begin inspecting these facilities. Currently, many private clinics offering only diagnostic tests for ADHD and autism operate without CQC regulation. This change means that non-NHS clinics providing these assessments will now be required to register with the watchdog.
The move follows a government-commissioned review by Professor Peter Fonagy, which described the current landscape of private neurodiversity services as a “wild west.” The inquiry raised concerns that financial incentives could lead to inappropriate diagnoses. The CQC’s interim inspector of mental health care, Adrian James, stated that this new responsibility would close a significant gap in oversight, giving patients greater confidence in the quality of services they receive.
Health Secretary Yvette Cooper emphasized that tighter regulation ensures assessments are high quality and that the NHS is not overcharged by independent providers. She noted that approximately 810,000 children and adults in England are currently waiting for an ADHD or autism assessment.
Impact on NHS capacity and inequality
The departure of staff to the private sector is creating a dual workforce, with some specialists working part-time in the NHS while holding private contracts. Thea Stein, chief executive of the Nuffield Trust, warned that this trend leaves the health service in a weaker position. She noted that if NHS services cannot maintain fully staffed teams, inequalities will widen, as those who can afford private care will receive support much faster than those relying on public services.
Rebecca Gray of the NHS Alliance confirmed that the growth of the private sector market makes independent work increasingly attractive due to shorter waiting times for patients. The Independent Healthcare Providers Network (IHPN) welcomed the CQC’s expanded role, noting that 83% of its members who deliver ADHD and autism assessments are already rated good or outstanding by the regulator.
The brain drain is not limited to neurodevelopmental services. Stein pointed out that similar patterns are occurring in physiotherapy and child and adolescent mental health services. The cumulative effect is a public system that is less able to meet the exploding demand for diagnoses, forcing more people to seek care elsewhere or endure long delays.
The Herefordshire and Worcestershire trust reported that 1,298 people had already waited at least two years for an assessment before the recent restrictions were implemented. The situation underscores the pressure on the NHS to retain staff while managing a backlog that continues to grow.
Source: The Guardian
