A 607-page review of NHS England’s mental health, ADHD and autism services says the current system needs a radical overhaul to prevent services from becoming overwhelmed.
The review was commissioned in 2025 by Wes Streeting, then the health secretary, amid concerns about growing waits for assessment, diagnosis and care. It says the existing approach is failing people waiting for help, people with the most severe needs who cannot reach specialist services, and society more broadly.
Its central proposal is to make support available according to people’s needs, rather than making a formal diagnosis the main gateway to care.
Why the review says change is needed
The report says continuing with the current system is not sustainable. It cites an estimated annual cost of £300bn from mental ill health and warns that demand for mental health and neurodevelopmental services is continuing to place pressure on the NHS.
More than 560,000 people are waiting for an ADHD assessment, while more than 254,000 are waiting for an autism assessment. The review expects the number of people with either diagnosis to rise further.
At the same time, the estimated proportions of the population thought to have ADHD and autism have remained broadly stable, at 3.8% and 1.2% respectively. The report says this contrast requires careful consideration, rather than a simple conclusion that rising diagnoses prove widespread overdiagnosis.
What it says about diagnosis
Prof Simon Wessely said the rapid increase in ADHD and autism diagnoses, together with larger assessment backlogs, creates a risk that some people could be misdiagnosed.
Among children aged six to 11, the proportion with an ADHD diagnosis has increased more than sixfold in five years, reaching 2.7%. For 12- to 17-year-olds, it has risen more than 15-fold, to 3.9%.
However, the review says the available evidence does not establish that overdiagnosis is currently happening at scale. It describes a changing balance of risks: underdiagnosis remains important, but misdiagnosis and overdiagnosis may now require greater attention in policy and service delivery.
Prof Peter Fonagy said diagnosis remains essential and should be protected. The proposed change is that it should no longer be the only route through which someone can receive help.
A needs-led route to support
The review recommends that people should be able to seek support through a wider range of settings, including:
- schools and family hubs;
- GPs and community services;
- mental health services and social care; and
- employers.
It proposes support at the point of need, without requiring a diagnosis first. It also recommends a single service for mental health and neurodevelopmental support, with the aim of making care more joined up.
The Department of Health and Social Care has committed to an overhaul intended to provide earlier, needs-led help for children, young people and adults without long waits for clinical diagnosis.
Replacing first-come-first-served waiting lists
The review recommends that waiting lists should be actively reviewed and prioritised according to need, rather than simply by the date someone joined the queue.
People with the highest needs should receive specialist assessment sooner. Examples given include people experiencing self-harm, multiple difficulties, or a risk of imminent school exclusion or unemployment.
The recommendation does not mean that people with less acute symptoms should lose a route to diagnosis. The report says no one should be removed from a pathway without appropriate assessment, communication and discussion.
Private assessments and advertising
The review recommends banning private companies from advertising ADHD and autism assessments. It also notes that NHS spending on independent-sector ADHD services rose by 252% over three years, while private providers carried out more than a third of NHS-funded autism assessments in the 2025-26 financial year.
Yvette Cooper said the government would make all diagnostic assessments for ADHD and autism regulated by the Care Quality Commission. She did not commit to banning private-sector advertising to the public. Instead, she said the Advertising Standards Authority would be asked to review advertising to support accurate information and prevent exploitation.
What the proposals mean for people waiting
The review points towards a system in which someone could receive practical or clinical support before a diagnostic assessment is complete, while still retaining access to diagnosis where it is needed.
For people facing the most urgent risks, the proposed priority system could mean earlier specialist assessment. For everyone else, the stated aim is to preserve a route to diagnosis while expanding access to help that does not depend on reaching the front of a long queue.
The main uncertainty is implementation. The review sets out the direction of change, but the fact that the government has committed to an overhaul does not by itself explain how quickly services, staffing and pathways will change.
AI tools were used to assist with the preparation of this article.
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