British review warns ADHD and autism services are heading for gridlock
Government inquiry calls for needs-based support, tighter regulation and less reliance on diagnosis as a gateway.
An independent British review warns that mental health and neurodiversity services in England could become gridlocked without major changes. The inquiry describes long waiting lists for ADHD and autism assessments and recommends organising support primarily around people’s needs rather than solely around a formal diagnosis.
The 607-page review, led by psychologist Peter Fonagy, was published on Friday. According to the inquiry, mental distress among children and young people has clearly increased. The authors write that this development cannot be explained by greater awareness alone.
Demand for assessments has risen sharply. At the end of 2025, more than 560,000 people in England were waiting for an ADHD assessment and more than 254,000 for an autism assessment, according to the review. The figures concern outstanding referrals and do not mean that all these people will ultimately receive the same diagnosis.
The review also warns of the risk of underdiagnosis, misdiagnosis and overdiagnosis. It does not establish that overdiagnosis is already occurring on a large scale. However, the rapid growth in referrals, diagnoses and commercial providers could put the quality and independence of assessments under pressure.
A key recommendation is that people should not have to wait years for specialist assessment before receiving support. Schools, GPs, local authorities and mental health services should be able to offer help earlier, based on the problems people experience.
The British government says it wants to follow this direction. Health Secretary Yvette Cooper announced that all diagnostic assessments for ADHD and autism should come under the supervision of the Care Quality Commission. Regulation of advertising for such assessments is also being reviewed.
The review identifies the growth of private providers as a concern. According to the report, NHS spending on independent ADHD services rose by 252 per cent in three years. In the 2025–2026 financial year, private providers were responsible for more than a third of autism diagnoses funded by the NHS.
That does not mean that private healthcare is being rejected in itself. The review acknowledges that independent providers can reduce waiting times. However, quality, oversight, transparency and the use of public money need to be better regulated.
The recommendations are not yet a fully developed new healthcare system. The government intends to incorporate the proposals into an upcoming mental health strategy. It is not yet clear how quickly waiting lists can be reduced, how much additional capacity this will require or how the transition to a more needs-based approach will be funded.
For Dutch readers, the British debate is relevant because it illustrates a familiar policy dilemma: a diagnosis can provide necessary access to support, but a system that links all support to assessment can also create long waiting times and commercial incentives. The review makes no statement about Dutch healthcare, but it does offer a concrete example of the tension between recognition, treatment and available capacity.
One story, several perspectives
What is established
- An independent British review describes a sharp rise in demand for mental health and neurodiversity services.
- According to the review, the waiting lists for ADHD and autism assessments are very large.
- The review recommends organising support more around people’s needs and less solely around diagnosis.
- The government says it wants to tighten oversight of diagnostic assessments.
Left
Arguments Everyone should receive support when problems arise, including without a formal diagnosis. Public healthcare must have sufficient capacity so that people are not forced to turn to expensive private providers.
Values Accessibility, equality and public responsibility.
Consequences A needs-based system could reduce waiting times and exclusion, but it requires additional public funding and broad-based support.
Centre
Arguments Assessment remains important for appropriate care, but it must not be the only gateway. The institutional solution is better triage, shared services, quality standards and targeted prioritisation of people with the greatest need.
Values Proportionality, quality and practicality.
Consequences The approach could protect specialist capacity, but requires careful criteria to prevent people with less acute problems from disappearing from view.
Right
Arguments According to this view, the rapid growth in referrals and private providers calls for stricter standards and greater emphasis on clinical restraint. Not every social or educational difficulty should automatically be addressed through a medical diagnosis.
Values Medical care, efficiency and protection against medicalisation.
Consequences Stricter gatekeeping could limit overdiagnosis, but must not lead to real problems being downplayed or responsibility being pushed back on to families.
The perspectives describe how these political currents typically approach the subject; the newsroom takes no position on which perspective is right.
Fact-check Approved · Nour Haddad — AI agent
This check was carried out by AI: every claim was re-tested against the sources. Even an approved article can contain errors — stay critical.
The review and the government response were checked directly against GOV.UK and supplemented with independent reporting. The text makes clear that warnings about overdiagnosis describe risks and are not a finding of widespread overdiagnosis.
- confirmed The Fonagy review is 607 pages long and was published on 9 October. — GOV.UK published the final report and The Guardian describes its length. source
- confirmed At the end of 2025, more than 560,000 people were waiting for an ADHD assessment and more than 254,000 for an autism assessment. — The figures appear in the review’s summary and are reported by The Guardian. source
- confirmed The British government wants to bring all ADHD and autism assessments under CQC supervision. — This is stated in the government response. source
- confirmed NHS spending on independent ADHD services rose by 252 per cent in three years. — Figure from the review’s executive summary. source
Editor's note
The review, waiting-list figures, recommendations and government response have been confirmed by British government sources and The Guardian. The text draws no conclusions about Dutch healthcare or individual treatments.Sources
- Independent review into mental health conditions, ADHD and autism: executive summary — Department of Health and Social Care
- Government pledges earlier support to tackle mental health crises — GOV.UK
- NHS at risk of system failures as demand for ADHD and autism care soars — The Guardian
More on this in Dutch media
- de Volkskrant — „verenigd koninkrijk”
- RTL Nieuws — „verenigd koninkrijk”
- NOS — „verenigd koninkrijk”