The Government has published the final independent review led by Professor Peter Fonagy and says its forthcoming mental health strategy will shift towards earlier, needs-led support. The review covers mental health conditions, ADHD and autism in England. Its publication is a policy milestone, but several of the Government’s announced steps are commitments to develop, consult on or work towards changes rather than reforms already in force.
Help before a diagnosis
The review argues that people should not have to wait for a diagnosis before they can receive appropriate help. It recommends moving from a diagnosis-dependent model to one in which support is guided by a person’s needs, alongside diagnosis where that is clinically important. It is not an argument to abolish assessment: the report says diagnosis can be necessary for treatment and meaningful to individuals, and that those with significant impairment should be able to access assessment within a reasonable time.
That distinction matters for people facing long waits. Practical help in school, college, work or the community could address a person’s immediate difficulties while assessment continues, but the review does not say that this support is already universally available. The Government says it will set out its wider response in a new mental health strategy later this year and has asked NHS leaders to examine access to advice, assessment and treatment.
The evidence described in the review also cautions against treating referral totals as a direct measure of how many people have a condition. It finds that common mental distress has increased substantially, particularly among young people, while population-level prevalence of ADHD and autism appears broadly stable on the available evidence. The report separately notes sharp growth in recorded diagnoses and assessment demand. It says the evidence does not establish large-scale overdiagnosis, and stresses that underdiagnosis, misdiagnosis and overdiagnosis can all occur. Current population data for ADHD and autism is limited and out of date.
Proposed oversight and prices
On assessment quality, the review recommends that ADHD and autism diagnostic assessments become a regulated activity overseen by the Care Quality Commission (CQC). The Government says it is working with NHS England and the CQC towards this approach, covering NHS-funded, privately funded and self-funded assessments. That is an intended regulatory change, not confirmation that every provider is currently subject to a new CQC assessment regime.
The review also recommends a national pricing framework for NHS-funded ADHD and autism services. NHS England is to consult on proposals for a common set of prices, covering assessment, post-diagnostic support and follow-ups. The Government says it intends new payment arrangements to begin in April 2027, after the consultation and finalisation process. These proposals concern services funded by the NHS; they do not set a universal price for all private assessments.
Other actions are at an earlier stage. The Health Secretary says she will write to the Advertising Standards Authority about advertising for ADHD and autism services. The review recommends banning direct-to-public advertising of NHS-funded assessments, while the Government’s announcement describes a review of advertising practices and a request for accurate information. It has also asked the National Institute for Health and Care Excellence (NICE) to consider the report’s implications for its clinical guidance. Neither step amounts to a new advertising ban or revised clinical guidance today.
What happens next
The review’s wider recommendations call for joined-up support across health, education and other local services, and for outcomes to be judged by people’s wellbeing and participation in daily life, not simply by diagnoses or waiting-list figures. A professional body representing speech and language therapists has welcomed recognition of communication needs and called for investment and workforce growth, underlining that implementation depends on staff as well as policy design.
For families and adults seeking help, the immediate position therefore remains mixed: the review sets out a direction and the Government has made several commitments, but the strategy, pricing consultation and regulatory arrangements still have to be developed. Diagnosis remains available where needed, while the stated aim is to make suitable support less dependent on securing a label first. The practical test will be whether the promised changes translate into timely, consistent services without weakening access to specialist care for people with the most complex needs.
