This article first appeared on 1 February 2026 in my LinkedIn newsletter, now called #NDChat.

This article is a response to a recent article in The Times (behind a paywall). It first came to my attention in a post by Leanne Maskell, who exposed much that had been “overlooked” in the article. My article builds on that and considers the standards being applied, and whether they are applied consistently or conveniently.

The Times recently published an article on rising ADHD prescriptions which claimed that demand is being driven by “sharp-elbowed, middle-class patients” — people portrayed as using private or alternative routes to move ahead of NHS queues and secure treatment through the public system (The Times, 2026).

The phrase is not incidental. “Sharp-elbowed” signals competition, impropriety and moral overreach. It frames access not simply as unequal, but as something actively taken by those prepared to push. The article does not question the clinical legitimacy of ADHD diagnosis; instead, it places explanatory weight on who is accessing assessment and how, inviting the reader to interpret rising recognition through the lens of behaviour and character.

What makes this framing worth examining is not the data cited, but how starkly it contrasts with the language the same newspaper uses elsewhere when people respond to limited public provision by paying privately.

What The Times said about ADHD access

The Times article advanced a clear narrative. It suggested that people with greater financial and cultural capital are more able to obtain ADHD diagnosis outside traditional NHS waiting lists, either privately or via alternative recognised pathways, and that this is contributing to increased prescribing (The Times, 2026).

The article cited NHS prescribing data showing substantial growth in ADHD medication use over recent years, alongside significant regional variation. In some areas, prescribing rates were reported to be several times higher than in others. This variation was presented as evidence of unequal access rather than uneven service capacity.

Parents were highlighted in particular, especially those seeking assessment for themselves after their children were diagnosed. The explanatory emphasis rested on assertiveness and advantage rather than historic under-recognition or constrained provision.

How the same paper describes access elsewhere

This framing contrasts sharply with The Times’ editorial position on private advantage in education.

In multiple editorials opposing the introduction of VAT on private school fees, The Times described such proposals as “the politics of envy” and “class antagonism”, arguing that fee-paying families were being unfairly targeted for making “sensible choices” in response to an overstretched state education system (The Times Editorial Board, 2023; 2024).

In those pieces, responsibility was located with public provision rather than individual behaviour. A recurring feature of the argument was the reminder that families who pay private school fees continue to contribute through general taxation to state education. Their private spending was framed as additional rather than exploitative, pragmatic rather than unfair.

In this context, navigating scarcity through private means was normalised and defended.

Setting the two frames side by side

In education coverage, paying privately to manage limited public provision is described as rational navigation, and criticism of it is dismissed as ideological or resentful.

In ADHD coverage, paying privately or using alternative access routes in response to limited public provision is described as “sharp-elbowed”.

In both cases, public systems are under strain. In both cases, access is uneven. In both cases, individuals continue to fund the public system through taxation.

Only the language changes.

The contrast does not require interpretation. It is visible on the page.

ADHD prescribing data and system pressures

National data show that ADHD diagnosis and prescribing have increased significantly in England. NHS Digital estimates that approximately 2.5 million people in England meet diagnostic criteria for ADHD, while a substantial proportion remain undiagnosed (NHS Digital, 2024).

Parliamentary analysis reported over 500,000 open referrals for ADHD assessment in England, with waiting times in many areas measured in years rather than months (House of Commons Library, 2025).

Prescribing data show that ADHD medication use has risen sharply since the COVID-19 pandemic, with an estimated 18 per cent year-on-year increase between 2019 and 2024, and a more than threefold increase over the past decade (BMJ Group analysis, 2024).

These trends coincide with longstanding evidence of underdiagnosis, particularly among adults and women, rather than with any established change in prevalence (Faraone et al., 2021).

Right to Choose and what it is

One of the access routes referred to in media coverage is NHS Right to Choose.

Right to Choose is a lawful NHS commissioning mechanism in England. It allows patients to be referred to alternative providers when local NHS services cannot meet demand. Providers delivering ADHD assessments under this route hold NHS contracts and provide NHS-funded care (NHS England, 2023).

Patients using Right to Choose are not bypassing the NHS. They are accessing NHS-commissioned care in response to long waits in local services.

Shared care and what the evidence shows

A further assumption embedded in the “sharp-elbowed” framing is that private or alternative diagnoses lead straightforwardly to NHS prescribing.

Professional guidance does not support this assumption.

The British Medical Association and Local Medical Committees state clearly that shared care agreements are discretionary clinical arrangements. General practitioners are under no contractual obligation to accept shared care initiated by private providers, and refusals are common (BMA, 2022; LMC England, 2023).

In practice, many patients experience refusal of shared care, withdrawal of temporary agreements, enforced returns to NHS waiting lists, or prolonged periods of self-funded prescribing despite holding valid diagnoses, including those obtained through NHS-commissioned pathways.

A personal example offered as evidence

This issue is not abstract for me.

My own ADHD diagnosis was conducted privately by a consultant psychiatrist with decades of NHS experience, including previous leadership of an NHS ADHD clinic. The assessment was detailed, cautious and carried out to standards consistent with NHS practice.

It was pursued not to gain advantage, but because NHS waiting times made timely access impossible.

That diagnosis did not lead to automatic NHS treatment. Even after later receiving a diagnosis via an NHS-commissioned Right to Choose pathway, shared care was refused twice. NHS prescribing followed only after formal escalation. The combined cost of assessment, follow-up and medication ran into several thousand pounds.

This experience aligns with professional guidance and wider reporting. It does not align with the suggestion of easy transfer or queue-jumping.

What actually explains rising prescriptions

Rising ADHD prescriptions are consistent with delayed recognition meeting constrained supply.

Population studies show stable prevalence alongside increased diagnosis, particularly among adults and women (Faraone et al., 2021). NHS data demonstrate severe capacity constraints in neurodevelopmental services and marked regional variation in access (NHS Digital, 2024).

These factors provide a sufficient explanation. A moral one is not required.

A final thought

People who pay private school fees continue to fund state education through taxation. People who pay for private or NHS-commissioned ADHD assessment continue to fund the NHS in exactly the same way.

In one context, The Times describes private navigation as rational and defends it against moral criticism. In another, it describes similar navigation as “sharp-elbowed”.

Placed side by side, using the paper’s own words and published data, these accounts speak for themselves.

This is double standards in plain sight.

References

The Times (2026). Article on rising ADHD prescriptions.

The Times Editorial Board (2023). Editorial opposing VAT on private school fees.

The Times Editorial Board (2024). Editorial describing private school taxation as “the politics of envy”.

NHS Digital (2024). ADHD prevalence, referrals and prescribing data for England.

House of Commons Library (2025). ADHD in England: diagnosis rates, waiting lists and service pressures.

BMJ Group (2024). Analysis of ADHD prescribing trends in England.

Faraone, S. V., et al. (2021). The worldwide prevalence of ADHD: a systematic review and meta-regression analysis. World Psychiatry.

British Medical Association (2022). Shared care prescribing guidance.

Local Medical Committees England (2023). Position statements on shared care for ADHD.

NHS England (2023). Right to Choose: commissioning framework and patient guidance.