The Health Secretary has announced an independent review into rising demand for mental health, ADHD and autism services, framing it as an essential step toward understanding whether England is facing genuine clinical escalation, systemic under-support or patterns of over-diagnosis. Wes Streeting has positioned the review as a strictly clinical exercise, insisting that only an evidence-based assessment can ensure people receive timely, accurate diagnoses and appropriate support. It is a significant intervention in a landscape defined by spiralling waiting lists, fragmented provision and deepening public anxiety about access to care.
The context, however, is politically charged. Demand for mental health services has risen sharply over two decades. ADHD referrals, in particular, have accelerated, driven by increased awareness, reduced stigma and changes in clinical practice. Yet behind this surge sits a system struggling to cope. Many areas face long waits for therapy, specialist assessment and community-based support. At the same time ministers are seeking to reform the welfare system and contain a rising benefits bill, prompting questions about whether clinical reviews may become entangled with economic objectives. The Department of Health and Social Care has been explicit that this review is separate from welfare reform proposals, but the timing inevitably raises concern among patients, clinicians and advocacy groups.
The government argues that some individuals are being referred for assessment or treatment when they may not need clinical intervention, contributing to unsustainable caseloads and longer waits for those with more complex or severe needs. Whether this reflects patterns of over-diagnosis or simply the consequences of a system that has failed to provide early support remains an open question. The review will need to interrogate the evidence with rigour. Diagnostic pathways for ADHD and autism, in particular, vary significantly across the country, shaped by local resource constraints rather than nationally consistent standards. The result is a postcode lottery where unmet need and inappropriate referral can coexist.
Streeting has emphasised that reform must be grounded in clinical clarity rather than political expedience. This will be essential for maintaining public trust. Earlier this year the government was forced to retreat from proposed disability benefit cuts after widespread opposition, including from within its own party. The episode underscored the political sensitivity of policies that intersect with mental health and disability, and it has heightened scrutiny on any initiative that risks conflating clinical assessment with eligibility for welfare support.
For the NHS, the implications are profound. A credible, independent review could help disentangle genuine diagnostic need from the structural failures that push people into specialist pathways because earlier interventions are unavailable. It could identify gaps in community provision, clarify what constitutes appropriate referral and create a more sustainable model of care that reduces pressure on specialist services. But it must also confront the reality that rising demand reflects real social and clinical trends, not merely errors of classification. Economic pressure cannot be allowed to overshadow clinical judgement.
The central challenge will be to deliver reform that protects access rather than constraining it. The risk is that concern about over-diagnosis becomes a proxy for restricting pathways and tightening thresholds in ways that leave patients unsupported. The opportunity, conversely, is to build a system in which diagnosis is timely, consistent and anchored in the right level of care at the right moment, with early support available long before a patient reaches crisis.
Streeting’s review will set the tone for future policy. If it strengthens evidence-based practice and improves access to appropriate care, it could help stabilise a system under immense strain. If it blurs clinical aims with fiscal pressures, it risks eroding trust and deepening the very problems it seeks to solve. The stakes are high, and the service will be watching closely.
