Part 6: Dissecting the BBC's response to Panorama ADHD complaints
The BBC doesn't think the BBC got anything wrong. I beg to differ.
To be honest, I didn’t expect anything else.
The BBC, after investigating the flood of complaints about last week’s Panorama exposé on private ADHD clinics, has decided that the BBC didn’t do anything wrong. Case closed?
Well, no. Not quite.
This is part three of the Panorama Saga (hey, it rhymes! Read parts one and two). At this point, you shouldn’t be surprised that the BBC is so full of shit, it might as well be an overflowing Glastonbury toilet.
You’ll have to forgive the slightly acerbic tone in this post. I’m tired, sick, and cranky. And, frankly, really fucking disappointed. It’s dismaying that a public service broadcaster with a storied history could just double-down when confronted with points where it very plainly got things wrong.
Before you get to my line-by-line teardown, I’m going to copy the entire response so you can read it in its full unedited context.
The Response
Dear Mr Hughes
Thank you for your message about the Panorama programme Private ADHD Clinics Exposed.
We received a large number of comments both before and after the programme was broadcast, many of which have raised the same points about our journalism.
With that in mind we are providing a single response which will address these key issues, rather than responding to every single point which has been made individually, in accordance with our complaints framework.
The programme explains from the outset that our investigation was prompted by an email from a mother who was worried about the way her daughter had been diagnosed by a private clinic. Panorama then spoke to dozens of patients and members of staff at private ADHD clinics, who confirmed many of the allegations made in the original email. They told the programme that people were being diagnosed following rushed and inadequate assessments, and that almost everyone who paid for an assessment at a private clinic was being diagnosed with ADHD. There was, therefore, a risk that people were being misdiagnosed and given inappropriate treatment.
Panorama also spoke to senior clinicians within the NHS who expressed concerns about the behaviour of some clinics and the quality of the diagnostic reports they were producing. The clinicians felt they could not safely prescribe powerful, long-term medication on the basis of such assessments. In some cases it meant patients were having to be reassessed by NHS specialist services, which was adding to waiting lists.
In order to test the quality of assessments being carried out by private clinics, it was important for the programme’s reporter to first understand how they should be conducted. NHS consultant psychiatrist Mike Smith, who leads a specialist adult ADHD service, agreed to carry out an assessment because he was worried about the pressure on NHS waiting lists and the quality of diagnostic reports he had seen from some private clinics.
The assessment took place on a day when Dr Smith did not have an ADHD clinic, so it did not prevent a patient on the waiting list from being assessed. Panorama’s reporter answered all of the questions honestly. Following a thorough and detailed assessment, Dr Smith found he did not have the condition and did not meet the clinical threshold for any of the 18 symptoms associated with ADHD.
Panorama’s reporter also gave honest answers to all of the questions about symptoms during his assessments at the three private clinics. However, the assessments were very different from the one conducted by Dr Smith. The assessors appeared to be following a tick-box list of questions and asked few follow up questions. The reporter did not pretend to have ADHD symptoms. Like many people, he sometimes exhibits ADHD-like traits, such as fidgeting. One of the most important aims of an assessment should be to distinguish between these traits and the much more pervasive and impactful symptoms that add up to ADHD.
A number of conditions - such as anxiety, some personality disorders and the effects of trauma - can present in a similar way to ADHD. Diagnosing ADHD in adulthood relies on an experienced and appropriately qualified clinician carrying out a comprehensive and detailed assessment, in order to rule out all the other possible explanations for symptoms reported by a patient. Experts in the condition told Panorama that this could not be done safely in under two hours.
The National Institute of Health and Care Excellence (NICE) guidelines say that someone should only be diagnosed with ADHD if the symptoms have a serious impact on their life and that a full psychiatric history should be taken. The private clinics featured in the programme did not appear to follow these guidelines and two of the clinics provided statements acknowledging that their own procedures were not followed in issuing medication to our reporter, and that their processes had since been reviewed.
The programme’s findings have subsequently been supported by some of the UK’s leading experts. Dr Ulrich Muller-Sedgwick, a spokesman for the Royal College of Psychiatrists, told Radio 4’s PM programme on Monday 15th May that a good quality ADHD assessment takes three hours. He said he was concerned that co-existing mental health conditions were being missed in rushed assessments and that people may receive the wrong treatment as a result.
Professor Marios Adamou, who is the longest serving consultant psychiatrist treating adult ADHD in the NHS, told the Today programme on 15th May that 50 per cent of diagnoses from private clinics turned out to be incorrect when they were checked by his specialist ADHD service.
The programme is clear about the fact that there are considerable problems getting an NHS assessment for ADHD and made reference both to the three year wait that one of the contributors faced on the NHS and the five year wait faced by new patients at Dr Smith’s clinic.
Many viewers have suggested it is these waiting lists, and the wider issues faced by people with ADHD, which the programme should have set out to address. For example, the difficulties people sometimes experience trying to get “shared care” with the NHS. We recognise that the difficulties presented by these issues are important.
However that does not deny the importance and validity of our investigation, in which the failings of these private clinics were clearly set out and raise matters of clear public interest in their own right.
It is important to add that the programme did not seek to question the legitimacy of the condition, or the profound impact it can have on people’s lives, and we do not believe it did so. Rather it made the point that many people being assessed by private clinics will have ADHD and was also clear about the fact that the drugs offered by the three clinics are a standard treatment for ADHD and that they are safe and effective if properly prescribed.
We are sorry you didn’t enjoy the programme, but Panorama’s research uncovered serious failings by some private clinics and we believe there was a clear public interest in broadcasting the findings.
We appreciate your feedback here and we’re grateful to you for getting in touch. Your comments are very welcome, and they have been recorded and shared with senior management.
King regards,
BBC Complaints Team
The Response to the Response
Right. Now you’ve read the whole thing, including the typos. “King regards” indeed.
I’m going to reply to some specific points.
“The programme explains from the outset that our investigation was prompted by an email from a mother who was worried about the way her daughter had been diagnosed by a private clinic.”
We have no idea whether the daughter is satisfied with her care or agrees with her diagnosis. She’s curiously absent from this whole saga — which is weird because, in no small way, it’s about her.
“Panorama then spoke to dozens of patients and members of staff at private ADHD clinics, who confirmed many of the allegations made in the original email. They told the programme that people were being diagnosed following rushed and inadequate assessments, and that almost everyone who paid for an assessment at a private clinic was being diagnosed with ADHD. There was, therefore, a risk that people were being misdiagnosed and given inappropriate treatment.”
Sigh. This again. First, high diagnosis rates aren’t inherently weird. One NHS clinic, according to data obtained from an FOIA request, has a 95 percent diagnosis rate!
Three words, BBC: Self-selecting sample.
If you think you have ADHD, you’re more inclined to pay hundreds of pounds (or wait for half a decade) in order to be assessed. If you don’t, you’re less inclined to go through that process.
Moreover, assessments usually follow a pre-screening process where you describe your symptoms and their impact on your life. If you don’t have any symptoms, you won’t get an assessment.
“Panorama’s reporter also gave honest answers to all of the questions about symptoms during his assessments at the three private clinics. However, the assessments were very different from the one conducted by Dr Smith. The assessors appeared to be following a tick-box list of questions and asked few follow up questions.”
ADHD has well-defined characteristics. They’re documented in the DSM-V. Any questions would have to align with the condition’s definition in order to be clinically useful.
Again, this isn’t the smoking gun you think it is.
“Diagnosing ADHD in adulthood relies on an experienced and appropriately qualified clinician carrying out a comprehensive and detailed assessment, in order to rule out all the other possible explanations for symptoms reported by a patient. Experts in the condition told Panorama that this could not be done safely in under two hours.”
You might want to have a word with the NHS Tees, Esk, and Wear Valleys NHS Foundation Trust who — sorry to snitch — says that an adult ADHD assessment can take between 1-2 hours.
Or the Central and North West London NHS Foundation Trust, which says an assessment can take up to 90 minutes!
“The private clinics featured in the programme did not appear to follow these guidelines and two of the clinics provided statements acknowledging that their own procedures were not followed in issuing medication to our reporter, and that their processes had since been reviewed.”
They also said that your program misrepresented the diagnostic process, including the lengths of the appointments, and indeed, whether medication was offered. Care to comment?
“Dr Ulrich Muller-Sedgwick, a spokesman for the Royal College of Psychiatrists, told Radio 4’s PM programme on Monday 15th May that a good quality ADHD assessment takes three hours. He said he was concerned that co-existing mental health conditions were being missed in rushed assessments and that people may receive the wrong treatment as a result.”
As above.
I genuinely have no idea where the three-hour thing came from. I don’t know anyone who had a three-hour ADHD assessment, whether private or via the NHS.
“Professor Marios Adamou, who is the longest serving consultant psychiatrist treating adult ADHD in the NHS, told the Today programme on 15th May that 50 per cent of diagnoses from private clinics turned out to be incorrect when they were checked by his specialist ADHD service.”
Sample size, please. I imagine it’s tiny, because who, having paid vast sums for a private diagnosis, says: “Yeah, I think I’ll get a second opinion. I don’t mind waiting for the next Olympic Games to get it.”
“The programme is clear about the fact that there are considerable problems getting an NHS assessment for ADHD and made reference both to the three year wait that one of the contributors faced on the NHS and the five year wait faced by new patients at Dr Smith’s clinic.
Many viewers have suggested it is these waiting lists, and the wider issues faced by people with ADHD, which the programme should have set out to address. For example, the difficulties people sometimes experience trying to get “shared care” with the NHS. We recognise that the difficulties presented by these issues are important.”
No it wasn’t. And also, for those with particularly gullible GPs, your program made getting shared care vastly harder.
I genuinely can’t wait until the license fee is scrapped and Panorama documentaries are interrupted with ads for Raycon headphones and NordVPN.
“However that does not deny the importance and validity of our investigation, in which the failings of these private clinics were clearly set out and raise matters of clear public interest in their own right.”
No, all the shit you got wrong denies the validity of your investigation.
“It is important to add that the programme did not seek to question the legitimacy of the condition, or the profound impact it can have on people’s lives, and we do not believe it did so.”
Yeah, beg to differ on that one.
“Rather it made the point that many people being assessed by private clinics will have ADHD and was also clear about the fact that the drugs offered by the three clinics are a standard treatment for ADHD and that they are safe and effective if properly prescribed.”
It did none of those things.
“We are sorry you didn’t enjoy the programme, but Panorama’s research uncovered serious failings by some private clinics and we believe there was a clear public interest in broadcasting the findings.”
Except it didn’t.
The presenter — who dressed like the lovechild of Elmer and Mercury Award-winning songwriter Badly Drawn Boy — trivialized the diagnostic process, compared the private clinics to an unrealistic representation of NHS care, and described life-saving and life-improving medication in the most histrionic and sensationalist of terms.
It was guff.
What now?
Later this week, the BBC will publish its fortnightly complaints report, so we’ll see how many people objected to this debacle. That’ll be interesting, at least.
The next step, for those still in arms, is to complain to the BBC’s Executive Complaints Unit (ECU). Those wishing to do so have 20 days from the receipt of the BBC’s initial response. After that, it’s Ofcom.
Complaints to the ECU must meet a certain criteria. They should describe the issues you wish to be revisited and also be under 1,000 words. The ECU won’t consider new points, except in exceptional circumstances.
The saga continues.
(Remember when I wrote about stuff other than the BBC mucking up? Good times. We’ll go back to them, I swear. )
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