The UK Plan to Triage ADHD Care Without Automatic Diagnosis
A UK government review due next week is expected to say patients with ADHD symptoms should not automatically receive a formal diagnosis. They would instead be triaged and offered support without one. Details of the needs-based plan were first revealed in the Times and reported on Sept. 17, 2026 The Guardian.
The independent review covers mental health conditions, autism and ADHD. It was commissioned in December by then-health secretary Wes Streeting. It is led by Prof Peter Fonagy, a clinical psychologist and psychoanalyst at University College London. Its interim report concluded that children and adults must obtain a formal diagnosis in order to get support.
What would change
Under the proposal, NHS services would target those most acutely affected by ADHD, such as those at risk of self-harm or unable to work. People less severely affected may not be referred for formal diagnosis to NHS clinics but would be offered help based on a holistic assessment of needs. Only patients who would benefit from a formal diagnosis, such as those needing medication, would be referred to ADHD clinics. Triage here works like sorting in an emergency department, with the most urgent needs seen first.
That holistic assessment would triage patients according to difficulties and ability to cope at school, college, work or in other settings. The final report is expected to propose a similarly holistic approach to supporting people with autism and to mental health more widely.
Demand and waiting lists
Official figures cited in September 2026 put 800,000 patients on NHS waiting lists for ADHD assessment. Complaints about autism and ADHD services in England have more than tripled in five years. About 100,000 adults and young people with ADHD who are not in education, training or work are on health-related benefits due to their condition. The NHS ADHD taskforce calculated the cost of undiagnosed, untreated ADHD at £17 billion.
How diagnosis works today
NHS England's independent ADHD Taskforce Part 1 states that a clinical diagnosis requires a full and thorough clinical assessment and cannot be defined on questionnaires alone NHS England. Part 2 states that if questionnaires are used for triage they should be supplemented by qualitative descriptions and specific examples of difficulties and impairments associated with ADHD symptoms. NHS England guidance states that diagnosis should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional.
A 2024 peer-reviewed paper by MCF Smith described the UK's adult ADHD services as in crisis, with demand outstripping capacity. In January 2026, The Guardian reported that the NHS was restricting access to ADHD assessment to save money without telling GPs. England's NHS had earlier planned to move about 40,000 pending child consultations for ADHD, autism and other conditions from its main waiting list. NHS England scheduled starting work on new ADHD official statistics for December 2025 to January 2026 under its ADHD data improvement plan, while the House of Commons Library publishes FAQs on prevalence, waiting lists and waiting times.
The broader context here is a shift from diagnosis-led entitlement to needs-led allocation, with need for medication as a key criterion for referral to specialist clinics. In my view, this would decouple support from diagnostic status and raise questions that are operational and legal as much as clinical: how thresholds for acuity and functional impairment are defined, who conducts holistic assessments and with what safeguards, how qualitative evidence is weighted alongside rating scales, and whether support without diagnosis carries parity in education, employment and benefits decisions. Extending the same logic to autism and wider mental health would widen those questions considerably.
