An independent government review of attention deficit hyperactivity disorder, autism, and mental health conditions has proposed a shift in how the NHS approaches ADHD diagnosis and care. The review, led by clinical psychologist Prof Peter Fonagy at University College London and commissioned last December, suggests that patients with ADHD symptoms should not automatically receive formal diagnoses but should instead be triaged and offered support based on individual needs assessn
Under the proposed approach, only patients who would clearly benefit from formal diagnosis—such as those requiring medication—would be referred to ADHD clinics. Others would receive targeted support through what the review describes as a holistic needs-based assessment, potentially including one-to-one assistance in educational settings, quiet spaces in schools, parenting classes, and workplace accommodations like flexible hours. The system aims to focus NHS services on individuals most severely affected, including those at risk of self-harm or unable to work.
The recommendations come amid significant pressures on the system. Current figures show 800,000 patients are on NHS waiting lists for ADHD assessment, and complaints about autism and ADHD services in England have more than tripled in five years. Approximately 100,000 adults with ADHD are on health-related benefits, and research has calculated the cost of undiagnosed and untreated ADHD at £17bn.
However, the proposals have drawn sharp criticism from advocacy groups and mental health organizations. Henry Shelford, chief executive of ADHD UK, characterized the approach as healthcare rationing, arguing that ADHD diagnosis requires evidence of debilitating impact and that individuals would be forced toward self-diagnosis through social media rather than formal medical assessment. The National Autistic Society and Centre for Mental Health have also expressed concerns that denying diagnoses could worsen inequalities and leave people without timely access to needed support.
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