Below you will find two columns, left one for the original response (and paragraph number, in square brackets) and the right one with arranged commentary for the specific point brought up as well as the tile of the “argument”.
Original
Commentary
[1] Dear Audience Member
[2] Thank you for your message about the Panorama programme Private ADHD Clinics Exposed.
[3] 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.
[4] 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.
[5] 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.
Summary: BBC claims that the public interest is rooted in the investigation that resulted after initial email from an unnamed mother [5]
BBC Guideline(s): BBCG Section 1.3 - Public interest
Argument(s): A14. High conversation rate debate and misrepresentation A16. Justification of Public Interest
Notes: TODO
[6] 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.
Summary: BBC claims that there was interest expressed by the NHS clinicians as well [6]
BBC Guideline(s): BBCG Section 1.3 - Public interest
Argument(s): TODO
Notes: If the NHS worked properly then there wouldn’t be a need in private clinics and no “adding to waiting lists”, bffr
[7] 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.
[8] 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.
Summary: BBC claims that Dr. Smith took the reporter in the off-time not impacting the waitlist and carried out the assessment because he was worried about the quality of diagnostic reports from some private clinics. Reporter answered all questions honestly. BBC further claims that Dr Smith found that the reporter did not have the condition or met the thresholds for any of 18 ADHD symptoms [7-8]
BBC Guideline(s): TODO
Argument(s): TODO
Notes: note “all of the questions”, contrasting with “all of the questions about symptoms during his assessment”
[9] 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.
Summary: BBC reinforces that the reporter gave honest answers to all questions during the assessment to private clinics as well, claiming that assessors were ticking boxes and few follow-up questions were asked. Reported didn’t pretend to have ADHD symptoms [9]
BBC Guideline(s): TODO
Argument(s): TODO
Notes: note the part “all of the questions about symptoms during his assessment” vs “all of the questions” above, which might not include the ASRS checklist and pre-assessment questionnaire or other questions.
[10] 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.
[11] 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.
Summary: BBC elaborates on why accurate ADHD diagnosis is important, mentions comorbidity and refers to NICE for requirements for assessment and clinician credentials as well as “serious impact” criteria for ADHD diagnosis, claiming that private clinics did not appear to follow the guidelines mentioned. Mentions two clinics admitting to their procedures not being followed and subsequently reviewed. [10-11]
BBC Guideline(s): TODO
Argument(s): TODO
Notes: TODO
[12] 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.
Summary: BBC continues to claim that “3 h ADHD assessment” is the standard and the bar [12]
BBC Guideline(s): TODO
Argument(s): TODO
Notes: TODO
[13] 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.
Summary: BBC refers to Prof. Adamou claiming that 50% of diagnoses from private clinics were incorrect when checked by his ADHD service [13]
BBC Guideline(s): TODO
Argument(s): A11. Reassessment percentage by Prof. Adamou
Notes: TODO
[14] 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.
[15] 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.
[16] 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.
Summary: BBC claims that it fulfilled it’s duty to present sufficient context ****by mentioning the 3-year and 5-year waitlists. Claims that focusing on wider issues of ADHD, whilst important, was not the goal of the investigation and it was in public interest [14-16]
BBC Guideline(s): TODO
Argument(s): TODO
Notes: TODO
[19] 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.
[20] Kind regards,
[21] BBCÂ Complaints Team