NHS Review Targeting ADHD Diagnoses Criticized as Healthcare Rationing

Proposals to restrict the number of patients receiving formal ADHD diagnoses have been condemned as “rationing” healthcare, pushing children and adults toward self-diagnosis via social media.

These comments precede a government review due next week, which is expected to recommend that patients with ADHD symptoms should not automatically receive a formal diagnosis, but instead be “triaged” and offered support without one.

This “needs-based” system, first reported by the Times, would direct NHS services toward those most severely affected by ADHD, such as individuals at risk of self-harm or unable to work.

Less severely affected individuals may not be referred for a formal diagnosis but would receive help based on a “holistic” assessment of their needs.

The government’s independent review of mental health conditions, autism, and ADHD was commissioned in December by then-health secretary Wes Streeting, amid concerns over the sharp rise in sickness benefit claims linked to these diagnoses.

Led by Prof Peter Fonagy, a clinical psychologist and psychoanalyst at University College London, the interim review concluded that the current system forces children and adults to obtain a formal diagnosis merely to access support.

Official figures show patients are waiting years for assessments, with 800,000 on NHS waiting lists. Complaints about autism and ADHD services in England have more than tripled in five years.

Consequently, growing numbers of adults and young people with ADHD are not in education, training, or work, with about 100,000 on health-related benefits due to their condition. The ADHD taskforce calculated that the cost of undiagnosed, untreated ADHD is £17bn.

Fonagy’s review will recommend that only patients who would benefit from a formal diagnosis, such as those needing medication, be referred to ADHD clinics.

Under the proposed holistic needs-based assessment, patients would be triaged according to their difficulties and ability to cope in school, college, work, or other settings. They would receive targeted early support regardless of whether they have a diagnosis.

Such support could include one-to-one help for children to cope with lessons, quiet rooms in schools, classes to help parents support children with ADHD symptoms, and encouraging employers to offer staff with ADHD flexible hours.

The final report is expected to propose a similarly holistic approach to supporting people with autism and mental health more widely.

However, experts said the proposals would effectively introduce rationing of health services, noting that schools and workplaces are already able to offer early support without a formal diagnosis.

Henry Shelford, chief executive of ADHD UK, said: “This [review] proposes rationing. There is no ‘mild’ ADHD. Diagnosis requires evidence of a debilitating impact on your life. We already have a clinically drawn line of need. Without a formal diagnosis, it appears we will be left to self-diagnose via social media. Schools and businesses shouldn’t be forced to rely on TikTok to know when to put in adjustments and support.”

“On average, a woman with ADHD will die nine years younger than her peers. A man with ADHD will die seven years younger than his peers. In almost any other area, those numbers would have this treated as a health emergency, but the stigma and misunderstanding around ADHD means instead we’re treated as an inconvenience and proposed to be ‘disappeared’, untreated, from the waiting lists. Diagnosis means people turning their lives around, more people in employment and succeeding in careers. Investing in ADHD services has a high return on investment to the country. Last year, the NHS spent £574m on a single weight-loss drug because treating people gets them back to work. The same is true of ADHD, with cheaper medication and better evidence.”

Mel Merritt, head of policy and influencing at the National Autistic Society, said: “Denying people a diagnosis will only worsen inequalities experienced.”

A government spokesperson would not comment on the forthcoming report, but said: “Last December, we asked clinical psychologist Prof Peter Fonagy to lead an independent review, examining the prevalence of – and support for – ADHD, autism, and mental health conditions. Prof Fonagy’s final report will be published shortly and will inform our new national approach in this area.”

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