Mental health services are the area of the NHS most reliant on private companies to provide services. As the NHS’s capacity to deal with demand for mental health services, particularly inpatient services, has fallen over the years, private companies have been given substantial contracts to provide much of the inpatient care needed. So any money mental health services receive is in part paid to private companies in the business of making a profit out of caring for some of the NHS’s most vulnerable patients.
Mental health services also includes several services under the remit of public health services, including addiction services and some services for young people, and as such are commissioned by local councils. Following the transfer of commissioning of public health services to councils in 2013, the influx of non-NHS organisations, in particular not-for-profits, has increased.
Prior to the pandemic the NHS had already turned to private providers to boost capacity and as a result private health companies have a strong foothold in the NHS in this area.
Hospital care
For many years there have been regular reports from whistle-blowers and the Care Quality Commission (CQC) of appalling quality of care at private mental health hospitals. The past few years have seen a number of hospitals run by private companies castigated by the CQC, particularly in the area of CAMHS. The three leading companies, The Priory, Cygnet Healthcare, and Huntercombe Group (now Active Care Group) have all had to close wards as a result of damning CQC reports, and St Andrews Healthcare the leading not-for-profit in the sector has had severe limitations put on its services due to CQC reports.
Details of the numerous failures at the leading private companies and the charity St Andrew’s Healthcare can be found on this website as follows:
Active Care Group/Huntercombe Group
Ramsay Healthcare/Elysium Healthcare
Plus CQC reports were published in September 2019 in which it found 28 mental health units run by private companies to be “inadequate” in the past three years; in November 2017, where the CQC report found that nearly three-quarters of private clinics were failing to hit regulatory standards of care for addiction services; and from October 2018 to October 2019, the CQC rated as inadequate 14 independent mental health hospitals that admit people with a learning disability and/or autism, and put them into special measures.
In November 2018, The Times published a damning article exposing the companies and charities that make millions by providing substandard care to NHS patients. The article included one case where the directors of a psychiatric hospital that was found to provide substandard care to NHS patients by the CQC, had paid almost £25 million into a secretive trust in Belize. The article noted that the company had received £26.3 million for services over 18 months in 2016-17 from NHS contracts.
In October 2021, the CQC ruled that two Staffordshire hospitals, John Munroe Hospital in Rudyard and Edith Shaw Hospital in Leek, run by the company John Munroe Group, can no longer admit patients without permission from regulators, after inspectors flagged multiple instances of poor care, including patients being pushed and laughed at by staff. The hospitals were rated “inadequate” for a second time.
But despite numerous serious incidents, including suicides, bullying and abuse, the NHS is so short of capacity for mental health patients, that it continues to use these private companies.
Community care
Recently the involvement of the private sector in the diagnosis of conditions such as ADHD and autism has created major issues in funding and quality of care. Two framework contracts for services for mental health and wellbeing services began in 2025 (see here for more details) with many private companies awarded places. Companies accepted on these frameworks can work for any NHS provider in England and Wales.
Cost
A Guardian investigation published in January 2026 found that the the NHS is overspending by £164m a year on ADHD services, with an increasing amount going to unregulated private assessments. Nineteen ICBs provided data to the Guardian on how much of their ADHD budget went on private companies, and showed spending had more than tripled in three years, from £16.3m in 2022-23 to £58m in 2024-25.
A report by the CHPI warns that the ADHD and autism market is particularly attractive to private providers as a company needs only one contract to treat patients anywhere in the country, and there is no cap on how much they can earn, because local NHS bodies cannot restrict patient numbers.
In May 2025, Northamptonshire Integrated Care Board was reported as having to pay private suppliers of ADHD and autism services three times as much as local NHS providers. Its annual bill of £3m was driven by patients opting for private treatment via Right to Choose. The ICB described the situation as “unsustainable”.
In mid-2025, two private companies, Clinical Partners and Psychiatry UK, reported a huge increase in income as a result of people opting for private assessments under Right to Choose.
Clinical Partners, which provides a range of mental health, autism, and ADHD services, saw its turnover double from £14.5m in 2022 to £29.2m in 2024 and its profits rise from £11.4m in 2023 to £15.6m in 2024. Clinical Partners’s biggest NHS customers in 2024 Leeds Community Healthcare Trust and Birmingham Community Healthcare Foundation Trust, who spent £6m and £5m on the company’s services respectively.
Psychiatry UK, which carries out similar work for the NHS, saw its income triple in size to £53.3m between 2022 and 2024.
Continuity of Care Issues
A Guardian investigation into the diagnosis of ADHD and other neurodivergent conditions by private companies uncovered cases of serious harm that appear to have been caused by problems with continuity of care after a private diagnosis.
In March 2025, a coroner issued a prevention of future deaths report on the death of 27-year-old Sheridan Pickett, who died by suicide after receiving an online ADHD diagnosis and taking stimulant medication prescribed by a private clinic.
When Pickett was later admitted to an NHS hospital after an overdose, doctors warned that the ADHD drugs should not be restarted, but that information was never passed back to the private provider, which continued prescribing.
The coroner noted that there were no formal rules requiring information-sharing between private neurodevelopmental services and NHS teams, and warned that without change similar deaths could occur.
The Guardian reports that experts said the standard of assessments carried out by private companies was not always good enough. One NHS clinician, speaking anonymously, said: “Some private providers do deliver good-quality assessments, but I’d estimate that around 70-80% do not, and there are certain ones I simply won’t work with when I see their name on the report.”
In January 2026, the Guardian reported on the lack of joined-up care between the private sector and the NHS. Although the NHS is increasingly referring patients to private providers, which it will then pay for, many of these assessments are then rejected. This is leading to an inefficient system that wastes public money and leaves patients without care and mental health trusts struggling to cope.
In a letter shared with the Guardian, the Midlands partnership university NHS foundation trust acknowledged it was struggling to cope and the trend was contributing to long waiting lists and “reduced capacity for new and complex cases”.
The trust highlighted the structural weaknesses of right to choose itself. “There is limited regulation surrounding private ADHD providers,” it wrote, noting that providers could establish services and request to diagnose ADHD, but that “at times their assessments do not comply with Nice guidelines”.
Rather than relieving pressure on NHS services, the scheme appears to be recycling it. The trust said the current model “highlights the challenges and limitations” of a system that can diagnose quickly but cannot always find “appropriately skilled staff to support prescribing.”
Quality of Care Issues
The recent increase in private companies being used via the NHS right-to-choose system for ADHD and autism diagnosis has bought with it quality of care issues. As already discussed above often private diagnoses are being rejected by the NHS, this can be because they are not compliant with guidelines from the National Institute for Health and Care Excellence (Nice). There are also major issues with continuity of care.
Holistic ADHD Solutions (ADHDNET) was registered with the Norfolk and Waveney ICB, which meant patients from across England could use its services under “right to choose” rules. The provider has an office in Leeds but offered remote consultations for adults nationwide. However, in December 2025 the company was suspended from registration. A notice on the ICB’s website says the suspension is “a precaution to ensure people’s care remains safe”, and that the move was triggered by concerns “regarding service management, safety oversight, and continuity of care arrangements”.
“The suspension notice remains in place, and we continue to meet with the company and the [Care Quality Commission],” it adds. “The company has agreed to take a number of actions to address the concerns raised about the management of the service and patient safety.”
The company’s own website blames the development on an “administrative issue”.
HSJ reported that the company has dozens of poor Google reviews, many about post-assessment follow-up and poor communication.
