Plans to limit ADHD diagnoses branded “rationing” of NHS care

Plans to limit formal ADHD diagnosis have been criticised as “rationing” NHS care ahead of a government review expected next week.

The review is expected to recommend that people with attention deficit hyperactivity disorder symptoms should not automatically receive a formal diagnosis, but instead be triaged and offered support based on their needs.

Under the proposed system, NHS services would prioritise people most acutely affected by ADHD, including those at risk of self-harm or unable to work.

People considered less severely affected may not be referred to NHS clinics for a formal diagnosis. Instead, they could receive support following a broader assessment of their needs.

Henry Shelford, chief executive of ADHD UK, said the review proposed “rationing”.

He said: “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.”

The 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 people making sickness benefit claims linked to mental health, autism and ADHD diagnoses.

Led by University College London clinical psychologist and psychoanalyst professor Peter Fonagy, its interim report concluded that the current system requires children and adults to obtain a formal diagnosis before accessing support.

Official figures show patients are waiting years to be assessed, with 800,000 people on NHS waiting lists, while complaints about autism and ADHD services in England have more than tripled in five years.

Growing numbers of adults and young people with ADHD are not in education, training or work, with about 100,000 receiving health-related benefits because of their condition.

The ADHD taskforce has calculated that undiagnosed and untreated ADHD costs £17bn.

The review is expected to recommend that only people who would benefit from a formal diagnosis, including those who require medication, are referred to ADHD clinics.

Under the proposed needs-based assessment, people would be triaged according to their difficulties and how well they can cope at school, college, work or in other settings.

Targeted early support could then be offered regardless of whether they had received a diagnosis.

Experts cited possible measures including one-to-one help for children to cope with lessons, quiet rooms in schools, classes to help parents support children with ADHD symptoms and flexible working arrangements.

The final report is also expected to propose a similar needs-based approach for autism and mental health support more broadly.

Experts have criticised the proposals, arguing they would in effect ration health services and that schools and workplaces can already offer early support without a formal diagnosis.

Shelford said that, on average, a woman with ADHD would die nine years younger than her peers and a man seven years younger.

“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.”

Shelford said investing in ADHD services offered a high return on investment to the country, noting that last year the NHS spent £574m on a single weight-loss drug because treating people meant they could get 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 by people who are autistic and autistic people with ADHD.”

A government spokesperson declined to 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.”