My thoughts on BBC Panorama's 'Private ADHD Clinics Exposed'

Many people will have watched the recent BBC #panorama documentary on #adhd called 'Private ADHD Clinics Exposed'. I am an adult with ADHD who, after many years, sought out a private diagnosis due to the unacceptably long waiting list in my area. Ironically I am also the Head of ADHD Services for a private company and work closely with the NHS to reduce the waiting lists for so many people who might be struggling or need answers. After taking a couple of days to gather my thoughts and opinions on it, I wanted to address some of the issues that were raised.

It is ethically concerning that someone would go undercover to seek out ADHD assessments when they do not believe they have ADHD. This is especially worrying when so many people with attention, concentration, focus, memory, and emotion regulation difficulties struggle to access an ADHD assessment. A recent statement on 15th May 2023 by Leeds and York NHS Trust (https://www.leedsandyorkpft.nhs.uk/news/articles/panorama-documentary-adhd-private-clinics-response/) confirmed that there are approximately 3000 people on the waiting list for an assessment; however, this journalist, with no clear difficulty or need, was prioritised above one of the 3000 waiting patients.

The programme absolutely uncovered poor clinical practice, which is unacceptable and appalling, and I applaud the bravery and courage of the clinicians who highlighted such dangerous, unethical and lazy practice. Every single clinician has a duty to call out and highlight such practices. Sadly, some clinicians/businesses allow such poor and unethical practices. However, it suggested that an in-person ADHD assessment by an NHS psychiatrist is the only high-quality assessment, which is simply untrue.

There was very limited detail about what the journalist’s 3.5-hour assessment consisted of, and the premise of the entire programme was based on the opinion of one NHS psychiatrist, Dr Mike Smith, who subsequently worked and continues to work in private practice, according to his LinkedIn profile (https://www.linkedin.com/in/michael-smith-3a0a1a67/). It would have been far more valid and interesting to see a group of unbiased clinicians determine a clinical outcome from watching a 3.5-hour assessment recording.

There are many appropriately qualified and registered professionals, such as psychologists, paediatricians, ADHD nurse specialists and allied health professionals, who have a wealth of experience in this area and who undertake thorough holistic assessments in line with NICE guidance (https://www.nice.org.uk/guidance/ng87). A multidisciplinary team should undertake detailed assessments by gathering information from several sources before carefully considering a person's presenting challenges and strengths.

From research, evidence and experience, I know that ADHD is rarely clear-cut and often accompanied by a range of comorbid conditions. It can sometimes be incredibly challenging to determine or distinguish between ADHD and other conditions. Best practice and guidance in autism assessments dictate the requirement of a multi-disciplinary team for this very reason. Why is this not the case for ADHD? I would absolutely welcome this change in future NICE guidelines.

In my experience, poor practice exists regardless of the setting. It exists in the NHS and the private sector. It is simply untrue that one profession or sector is better at ADHD assessments than another, as the programme appears to suggest. Many clinicians, including the NHS psychiatrist featured in the programme and myself, work in both sectors, and it is ludicrous to attribute the quality of clinical practice to where someone works. I know many clinicians who work in the NHS who are incredibly dedicated and passionate about helping and supporting neurodivergent people. They often choose to work privately to be able to do this more. For the majority, it is not about money, but even if it is, how is this instantly viewed as being negative? We are all aware of and impacted by living in a cost-of-living crisis. However, when a clinician sees an appointment as £ signs rather than an opportunity to help and support someone, that clinician should not be working privately.

Already I have seen evidence of uncertainty and increased anxiety in individuals who have sought a private ADHD assessment. Although I am grateful to Panorama for highlighting poor practice, it has subsequently increased the stigma for those with an ADHD diagnosis. I really believe that the BBC not only missed an excellent opportunity to highlight the real situation for many ADHDers who are waiting years for a diagnosis or treatment due to lack of funding in the same way as those awaiting autism or dyspraxia assessments but also to highlight what a high-quality, robust and thorough ADHD assessment actually looks like in children, young people and adults. These might be face-to-face or online; what matters is how they are administered, the quantity, quality and detail of the information gathered and how the clinical outcome is determined.

First published on LinkedIn on 17 May 2023.