Right to Choose stops feeling like a choice
Kent and Medway spent £28.9m on autism and ADHD assessments, then tightened provider activity, with patients left in limbo
NHS Kent and Medway spent £28.9m on autism and ADHD assessments last year against a £5.3m budget. It has now tightened activity across providers, but cannot say how many Right to Choose patients are waiting or how many have been affected by the changes. We look at how spending ran so far ahead of budget, what the NHS is doing about it, and what that means for patients left without any certainty about when they will be assessed.
Autism and ADHD assessments tightened without knowing how many patients are affected
Earlier this year, James thought he might finally be getting somewhere.
He had struggled with his mental health for decades, while treatment for depression and anxiety had never really worked. When his GP suggested he might instead have autism or ADHD, an assessment offered the possibility of something he had not had for a long time: a different answer, and perhaps a different way of getting better.
“Suddenly I saw there was a new path available,” he told the Kent Current.
We are calling him James and have withheld identifying details at his request.
He completed screening questionnaires with Psicon, one of the independent providers carrying out NHS assessments under the Right to Choose system. Then, in July, an email arrived telling patients in Kent and Medway that new NHS commissioning arrangements meant it could no longer progress all routine Right to Choose autism and ADHD assessments, with routine activity not expected to resume before April 2027.
“After completing the screening, I felt positive. Probably the most optimistic I had felt in a long time, thinking that I might be finally getting somewhere,” James said. “The email seemingly came out of nowhere and sideswiped me.”
Behind that email was a much bigger financial problem.
NHS Kent and Medway spent £28.9m on autism and ADHD assessment services in 2025/26, against a budget of £5.3m. The year before, expenditure had been £5.9m.
The integrated care board, which plans and pays for NHS services across Kent and Medway, says the increase was driven by a significant and sustained rise in demand across both traditional NHS pathways and Right to Choose. The latter added particular complexity because assessments were being delivered across a wider and changing provider market.
The jump is still extraordinary. In a single year, spending rose by £23m and ended up at more than five times the budget.
The ICB’s response has been to introduce provider-by-provider plans, setting expected levels of activity and financial envelopes for the current year. Providers are then expected to prioritise those with the highest clinical, safeguarding, educational, social care or vulnerability-related needs within the capacity available.
The problem is that the ICB cannot tell us very much about what that £28.9m actually bought. It does not hold a validated dataset that consistently distinguishes between routine assessments, prioritised assessments and escalated activity across all providers during 2025/26. It cannot say how many routine assessments will take place this year, how many Kent and Medway patients are currently waiting through Right to Choose, or how many have seen the timing of their assessment change as a result of the new arrangements.
What it can say is that getting a more robust understanding of waiting list demand, waiting times and patient groups is now a priority for 2026/27.
Which is not especially reassuring after spending nearly £30m on the service in 2025/26.
The ICB is keen to stress that routine assessments have not simply stopped.
“The 2026/27 arrangements do not stop routine ADHD or autism assessments,” it told us. Providers are instead expected to work within their individual activity plans and prioritise those judged to have the greatest need.
It also says the arrangements are “not presented as a complete solution” to the underlying demand and capacity problem, describing them instead as “immediate commissioning arrangements” intended to manage clinical, quality, equity and financial risk while a longer-term all-age pathway is developed.
Psicon’s correspondence with James shows why that distinction may not feel especially meaningful from the patient side.
The provider has confirmed that his screening indicated enough evidence to proceed to a full assessment and added him to its waiting list. It told him that it still aimed to see patients within nine to 12 months, but that this could no longer be guaranteed because waiting times would now depend on each ICB’s agreed activity levels.
James has therefore been accepted for assessment without anyone being able to tell him with confidence when that assessment will actually happen.
There is also a noticeable difference between how the changes were initially communicated to patients and how the ICB now describes them. Psicon told patients in July that it could not progress all routine assessments and that routine activity was not expected to resume before April 2027. The ICB says routine assessments have not stopped, only that providers must operate within the new limits, and says no decision has yet been made about what happens from next April.
The Kent Current asked Psicon how many Kent and Medway patients were affected, how much assessment activity it had been permitted to carry out this year and whether it expected routine activity to increase again from April 2027. It did not respond to those questions.
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The rest of this story looks at how Kent and Medway’s autism and ADHD assessment system ended up £23.6m over budget, what the ICB knew about the growing problem, and why it still cannot say how many patients are waiting or what happens next year.
