Fonagy Review: Help Without Waiting for an ADHD Diagnosis, and What the Government Has Actually Promised

Three weeks on

The Fonagy review and the government's response to it both came out on 9 October. Three weeks on, the headlines have moved on, but if you're on an ADHD waiting list or were diagnosed privately, you probably still want to know what's actually changing. The short answer is: some things have been promised, a lot still depends on a strategy that hasn't been published yet, and it all applies to England only.

What Fonagy found

The independent review was chaired by clinical psychologist Professor Peter Fonagy of UCL. It found that referrals and diagnoses for ADHD and autism "have risen significantly", while the number of people who actually have these conditions "appears broadly stable". It warned of a growing risk of over-diagnosis but, as the BBC put it, "could not yet conclude over-diagnosis was happening 'at scale'".

Fonagy's own summary was: "Diagnosis remains essential and must be protected - what has to change is that it is no longer the only door through which help can be reached."

What's been promised

The government's response includes:

• Help before a diagnosis. Support will be "available before and without a diagnosis" in schools, colleges and communities. It also says: "Where clinically appropriate, the system will continue to offer timely diagnosis and treatment, such as when someone may require medication."
• Regulation of all assessments. The government is "working towards" making every ADHD and autism diagnostic assessment regulated by the Care Quality Commission (CQC), whether it's NHS-funded, privately funded or self-funded.
• A national price list. NHS England will consult on set prices for NHS-funded ADHD and autism services, "covering assessment, post-diagnostic support and follow-ups", with new payment arrangements planned "from April 2027".
• A NICE review. NICE will "urgently consider the implications of the report for its guidance relating to autism and ADHD".
• Faster access. The Health Secretary "has asked NHS leaders to urgently examine how people can access advice, assessments and treatment more easily".

What isn't promised yet

There's no ADHD-specific waiting time target and no new money for ADHD assessment or treatment in the announcement. The big figures it mentions are mostly for wider programmes, like SEND support and mental health teams in schools. The review wanted direct-to-public advertising of NHS-funded assessments banned. Instead, the Health Secretary will write to the Advertising Standards Authority. A full response is due in a cross-government mental health strategy "in the coming months", and that hasn't come out yet.

Private diagnoses

At the moment, the CQC can regulate services that diagnose and treat, but in its own words "current legislation does not allow us to regulate services which only offer diagnosis and not treatment". It says it will regulate all ADHD and autism diagnostic assessments "once new regulations are in place". The CQC's statement gives no start date.

This is about checking the quality of assessments from now on. Nothing in the government's announcement mentions reviewing or cancelling diagnoses people already have, whether they came through the NHS, Right to Choose or a private clinic.

What clinicians say

The idea of help before a diagnosis has broad support. The worry is what happens to the diagnosis itself.

Support yes, but not instead of assessment

Professor Subodh Dave, President of the Royal College of Psychiatrists, said: "Those showing initial signs of distress shouldn't need a diagnosis to access basic levels of support at school, work or within their communities." Dr Ronny Cheung of the Royal College of Paediatrics and Child Health agreed: "Too often, a diagnosis is the only route to accessing meaningful help. This means that children and families can be left struggling alone while waiting for assessments." But he said it "must be accompanied by sustained investment in diagnostic and specialist services".

The fear of a holding place

Researchers quoted in the Science Media Centre's round-up were more cautious:

• Dr Monique Botha, Durham University: "Without protected access to timely assessment, adequate funding and accountability, there is a substantial risk that the bridge becomes a permanent holding place."
• Dr Hannah Bowers, University of Southampton: "those with mild to moderate needs might end up with support in place of a diagnosis instead of alongside."
• Dr Rachel Moseley, Bournemouth University, warned of "a threat that diagnosis and support will be rationed" for people "whose differences are less extreme", who "find a diagnosis 'life-saving'".
• Prof Andrea Danese, King's College London, said the model "will only work with a workforce large enough to assess people properly and to act in good time for those placed lower down the queue."
• Dr Gavin Stewart, King's College London: "Our best population level evidence strongly indicates that autism and ADHD remain substantially underdiagnosed, particularly among older adults, women and girls, and people from minoritised communities."

Prof Anita Thapar of Cardiff University, who chaired the 2025 Independent ADHD Taskforce, said "the announcement of another report created distress to many with lived experience of ADHD and those on waitlists". She added it is "not completely clear on first reading that increased NHS capacity is a priority".

Charities and watchdogs

• Mind (Dr Sarah Hughes, CEO): "Increased need for support is not due to a 'snowflake generation' or a case of overdiagnosis." Mind wants a "Same-Day Open Access model".
• Nuffield Trust (Thea Stein, CEO): "People who need support are facing a wild west of private companies trying to fill the gaps." She warned the findings "are at risk of gathering dust if the government doesn't work quickly to make hard choices and commit the funding".
• CQC (Adrian James, interim Chief Inspector of Mental Health Care) said regulating assessments "will close a significant gap in our oversight, meaning that people receiving these diagnoses can have far greater confidence".
• ADHD UK (Henry Shelford, CEO) responded on 17 September to a leak in The Times, before the final report was published: "This proposes rationing." … "There is no 'mild' ADHD. Diagnosis requires evidence of a debilitating impact on your life."

Crisis, not prevention

The Matthew Lock ADHD charity was set up by Richard and Christine Lock after their son Matthew, who had ADHD, died by suicide in 2023, aged 19. The BBC reported that the charity withdrew from the review over "serious concerns about the proposed risk-based triage system". It said: "A system that waits for people to become seriously unwell before providing effective treatment is not prevention. It is crisis management."

If you're struggling right now, you don't have to wait for a diagnosis or an appointment to talk to someone. You can call Samaritans free on 116 123, any time, day or night.

What happens next

The things to watch are the mental health strategy, the price list consultation, NICE's guidance review and a date for CQC regulation. None of it changes your care today. If you're waiting for an assessment, already diagnosed or have questions about treatment, your GP, prescriber or care team is the right person to talk to about your own situation.