The Fonagy Report

Waiting harms patients

The Review is unequivocal: "waiting lists are too long and delay itself causes harm". By the end of 2025, more than 560,000 people had an open ADHD referral. Among people waiting more than six months for mental health care, more than seven in ten say their health got worse. Behind these numbers are students falling behind, parents struggling to hold family life together, and adults losing work they could have kept.

 We particularly welcome the Review's finding that it "cannot conclude that overdiagnosis is occurring at scale", and that people coming forward today are no less impaired than those diagnosed in the past. In the Review's own words, people seeking help "are not the problem".

Treatment works. Too few patients receive it.

The Review finds that the effect sizes of ADHD medication are "among the largest reported for any psychiatric intervention". Treatment is associated with fewer accidents, less substance misuse, less suicidal behaviour and lower mortality. Yet only 15–25% of people with ADHD receive medication, against the 70–90% who benefit in trials.

The stakes are high. Young people diagnosed with ADHD before 17 are around four times more likely to end up out of education, employment or training. Closing the treatment gap, with medication where it is clinically right and wider support alongside it, is one of the clearest opportunities to change the lives of hundreds of thousands of patients and their families.

The Review is honest that long-term evidence on how treatment affects education, work and quality of life is still limited. Every provider, NHS and independent, should measure what happens after diagnosis. We are committed to collecting and publishing these outcomes, so that what our patients tell us can be evidenced, not just believed.

Care built around patients' needs, not just a diagnosis

Patients have long told us they need more than a prescription. We welcome the Review's call for support before, during and after diagnosis: understanding their diagnosis, building practical skills, coaching, family support, and adjustments at school and at work. Care ADHD is already building this kind of support alongside clinical care.

Every patient deserves care they can trust

• Regulation. We strongly support making all ADHD and autism assessments regulated by the Care Quality Commission (CQC), the independent regulator of health and care in England, with the same national standards for every provider - NHS and independent alike. Responsible independent providers, including Care ADHD, have called for this for some time. We hold more than 20 NHS contracts and have met demanding accreditation standards to earn them.

• Transparency. The Review finds that only around 10 of roughly 120 ADHD providers submit data. For services funded by the public and trusted by patients, that’s unacceptable. Care ADHD already submits to the Mental Health Services Data Set (MHSDS), the NHS's national record of mental health care. Every provider should, as a condition of funding, including outcomes that matter to patients.

• Value. The Review highlights a fourfold variation in prices for equivalent assessments. Every pound saved means more patients can be seen. Last year we estimate our tariffs, lower than most Right to Choose providers and NHS trusts, saved the NHS over £10 million. We do this by investing in technology and efficient operations - never by cutting corners on care.

Right to Choose must be protected and strengthened

Right to Choose lets NHS patients in England choose where they are assessed, including approved independent providers. The Review recognises it has "increased assessment capacity and provided alternative routes into care for many people facing long waits", and where NHS lists have closed, it is "the only practical route to a publicly funded assessment".

We agree with the Review that the question is quality, not access. Every provider should meet national standards, submit data, charge consistent prices and guarantee care continues after diagnosis, including properly funded shared care with GPs. Choice only works for patients when every option on the list is a good one.

Our concern: needs-led care must never become a barrier

The Review is clear that needs-led support must be "additive" and must "never become another hurdle" before diagnosis. That nuance really matters.

National policy often loses its nuance as it is interpreted across England's 36 integrated care boards (ICBs) - the local NHS bodies that plan and fund services. If "needs-led" becomes a reason to raise thresholds, close lists or delay diagnosis, patients will pay the price.

NHS England and the Department of Health and Social Care (DHSC) now need to lead implementation with clear guidance, consistent standards in every ICB, and monitoring of access to diagnosis and treatment, not just waiting times.

Working with the NHS for patients

Care ADHD stands ready to work with NHS England, DHSC and ICBs to share our data, help test needs-led models, and help patients waiting today get safe, timely care.