The National Health Service (NHS) is facing criticism as new proposals emerge to limit formal diagnoses of attention deficit hyperactivity disorder (ADHD) in England. Expected to be included in a government review, these suggestions advocate for a ‘needs-based’ approach that prioritises patients with the most severe symptoms while directing those less acutely affected towards alternative support mechanisms without a formal diagnosis.

This review, led by Professor Peter Fonagy, a clinical psychologist at University College London, follows a significant rise in individuals claiming sickness benefits attributed to mental health issues, including ADHD and autism. Currently, approximately 800,000 patients are on NHS waiting lists for assessments, with complaints about autism and ADHD services more than tripling over the last five years. The interim findings suggest the existing system compels many to obtain formal diagnoses to access necessary support.

The proposed system aims to triage patients according to their challenges and functionalities, such as their ability to cope at school or work. Those identified as having a greater need for support, particularly individuals at risk of self-harm or those unable to work, would still be directed to ADHD clinics for formal assessment and potential medication. Conversely, individuals with less severe symptoms would receive targeted support based on a holistic assessment, regardless of diagnosis status.

However, experts are voicing concerns that this approach effectively amounts to ‘rationing’ healthcare services. They fear it could push individuals, particularly children and young adults, towards self-diagnosis, potentially influenced by social media platforms. Henry Shelford, chief executive of ADHD UK, has described the concept as troubling, emphasizing the critical nature of accurate diagnosis for accessing appropriate care. He highlighted alarming statistics, indicating women with ADHD may die nine years younger than their counterparts, while men face a seven-year reduction in life expectancy. Shelford noted that typical responses to such issues would constitute a health emergency, rather than the proposal to reduce formal ADHD diagnoses.

Furthermore, Shelford argued that the investment in ADHD services could yield significant returns for the healthcare system, drawing parallels to NHS expenditures on other treatments, such as weight-loss drugs, which are justified based on their potential to return individuals to work.

Mel Merritt, from the National Autistic Society, raised additional alarms, stating that restricting access to diagnoses could exacerbate existing inequalities among autistic individuals and those with ADHD. Meanwhile, Andy Bell, chief executive of the Centre for Mental Health, acknowledged that while diagnoses can facilitate access to effective treatment, support can also be provided without formal diagnoses in various settings, including schools and workplaces. He emphasised the necessity of timely access to mental health support to prevent deterioration of conditions while individuals await service provision.

The government has refrained from commenting directly on the impending recommendations. A spokesperson reiterated that Professor Fonagy’s independent review is expected to lay the groundwork for a new national strategy regarding ADHD, autism, and mental health conditions. The final report is anticipated imminently and will inform future approaches to managing these conditions within NHS frameworks.

This developing situation points to a significant shift in how ADHD assessment and treatment could be approached in England, eliciting strong responses from patient advocates and healthcare professionals alike.