More than 800,000 patients are stuck on NHS waiting lists to be assessed for attention deficit hyperactivity disorder (ADHD), some for years. Under a major shake-up, many could be offered support without a formal diagnosis.

The proposals come ahead of a government review due next week, covering mental health, autism and ADHD services across England. Officials say the aim is to direct resources towards patients most acutely affected by their symptoms.

Needs-Based Triage Planned

The review, led by clinical psychologist Professor Peter Fonagy of University College London, is expected to conclude that patients are forced to secure a formal diagnosis just to access support. It is expected to recommend a needs-based triage system instead.

Under the plan, NHS services would prioritise patients most severely affected by ADHD, including those at risk of self-harm or unable to work. Less severely affected patients would be offered help based on a broader needs assessment.

Formal diagnosis would still be reserved for those who would benefit, such as patients requiring medication. Others could be offered quiet rooms in schools, parenting classes or flexible working arrangements, regardless of diagnosis status.

The review was commissioned in December by the then-health secretary amid concern over rising sickness benefit claims linked to mental health, autism and ADHD. The delays have fuelled repeated warnings that patients are waiting years to be assessed.

Complaints about autism and ADHD services in England have more than tripled over the past five years, according to the review. Around 100,000 people receive health-related benefits linked to ADHD symptoms.

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Backlash Over Rationing

Henry Shelford, chief executive of ADHD UK, said the proposals amounted to rationing of healthcare. He said there is 'no mild ADHD', since diagnosis requires proof of a debilitating impact on a patient's life.

Shelford warned that without a formal diagnosis, patients would be left to self-diagnose via social media. He said schools and employers should not have to rely on online trends for guidance on support.

He noted that, on average, women with ADHD die nine years younger than their peers, while men die seven years younger. 'In almost any other area, those numbers would have this treated as a health emergency,' he said.

Shelford argued that investment in ADHD treatment offers strong returns for the health system. He pointed to NHS spending on a weight-loss drug last year that helped patients return to work.

Mel Merritt, of the National Autistic Society, said denying patients a diagnosis would worsen inequalities faced by autistic people. She added this includes those who live with ADHD symptoms.

Andy Bell, of the Centre for Mental Health, said swift access to effective support matters most for patients. He noted a diagnosis can help many understand their distress and receive treatment.

Wider NHS Shake-Up

The final report is expected to recommend a similar needs-based model for autism diagnosis and mental health support. The shake-up would extend beyond ADHD services alone, reshaping how NHS England assesses patients across several conditions.

The ADHD Taskforce, established in 2024 to advise the NHS and government on care improvements, estimated the cost of undiagnosed and untreated ADHD to the economy at £17 billion. It published its findings in two parts, the second arriving in November 2025.

A government spokesperson said Professor Fonagy's final report would be published shortly. The findings are expected to inform a new national approach to ADHD, autism and mental health conditions.

Officials say the proposed changes are intended to help patients access practical support sooner. The aim is to end years-long waits for a diagnosis before any help is provided.

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