Fonagy review 2026: what changes for ADHD and autism providers

The Fonagy review (the independent review into mental health conditions, ADHD and autism, published by the Department of Health and Social Care on 9 October 2026) found that independent providers now do more than half of NHS-funded ADHD assessments while commissioners can see very little of that work. It wants every ADHD and autism diagnostic assessment regulated by CQC and held to common standards. So far the government has committed to CQC regulation, with no date. NHS England will consult on national prices and intends new payment arrangements from April 2027.

What this means for you

• If you only assess, you are likely to need CQC registration once new regulations are in place, whether your patients are NHS-funded or self-pay. No date has been set.
• Expect to report activity, waits and outcomes with NHS-funded and private work kept separate. At the same providers, NHS-funded patients waited a mean of 151 days for ADHD assessment and 170 for autism, against 21.5 days for privately funded patients. By our calculation that is roughly seven to eight times as long.
• NHS England will consult on national prices and intends new payment arrangements from April 2027. Prices now vary about fourfold between areas, so expect them to move closer together.

The Fonagy review wants support based on need, with diagnosis carried on alongside#

The final report, chaired by Professor Peter Fonagy, makes ten recommendations. Its central proposal is a move from a "diagnosis-dependent" system to a "needs-led plus diagnosis" one (Recommendation 2). People would get support for what they find hard as soon as the need is clear, and diagnosis would carry on alongside for those who need it. As Professor Fonagy put it, "Diagnosis remains essential and must be protected - what has to change is that it is no longer the only door through which help can be reached."

Below are the findings that matter most for providers, each linked to a deeper article in this series.

ADHD and autism waiting lists in England are 13 to 17 times 2019 levels#

Open ADHD and autism referrals in England, 2019 to 2025People waiting for or in assessment, all ages.December 2025583,000ADHD, 17.2× April 2019250,000Autism, 13.8× April 2019From February 2025 NHS England's ADHD figures include new submissions from independent providers, so they are not directly comparable with earlier months.0200k400k600kFeb 2025: data changeADHD
583,000Autism
250,000202020212022202320242025Values redrawn from the review's chart and rounded. The review's text gives more than 560,000 ADHD and more than 254,000 autism open referrals at the end of 2025. NHS England says its ADHD figures from February 2025 are not directly comparable with earlier months because of new submissions from independent providers. Source: Independent review into mental health conditions, ADHD and autism, DHSC, 2026, Figure 7.4 (NHS England data); NHS England, ADHD Management Information, May 2026. Contains public sector information licensed under the Open Government Licence v3.0.

Open ADHD referrals reached about 583,000, 17 times the 2019 level#

By December 2025 the review's chart shows about 583,000 open ADHD referrals, 17.2 times the April 2019 level. The review's text gives more than 560,000 open ADHD referrals. Monthly ADHD referrals more than tripled between 2019 and 2024.

The ADHD line jumps from about 376,000 in January 2025 to about 463,000 in February. NHS England says its ADHD figures from February 2025 are not directly comparable with earlier months because of new submissions from independent providers. So part of that jump reflects wider coverage.

Over 90% of open autism referrals had waited more than 13 weeks#

For autism, the review's chart shows about 250,000 open referrals by December 2025, 13.8 times the April 2019 level. The review's text gives more than 254,000. More than 90% of people with an open autism referral had waited longer than 13 weeks, and only 3.6% had a first appointment within the expected time. The review says the autism list, about 13 times its 2019 size, reflects better data coverage as well as more recognition and help-seeking.

The rise is real, and more of those diagnosed are women and girls#

The review cannot conclude that overdiagnosis is happening at scale, but says that if present trends continue, the balance of risk is shifting towards misdiagnosis and overdiagnosis. Recorded autism among 6 to 11-year-olds went from 0.24% in 2000 to 4.58% in 2025, against a population estimate of about 1.2% for young people. People coming forward now are no less affected than those identified before. Recorded ADHD has kept rising without levelling off. Our reading is that capacity, price and access rules will limit providers long before demand does.

The review says the ADHD rise is consistent with better recognition of groups missed before, particularly women and girls, and adults (p131). Between 2017 and 2025, recorded ADHD prevalence rose more than tenfold in females and around threefold in males. Among adults, the review says this catch-up looks largely complete; the fastest growth is now in adolescents and young adults. Expect closer scrutiny of child assessments and diagnosis rates, and check your tools and informant forms work for adult women. Our who is being diagnosed article has the numbers by age and sex.

Independent providers do most NHS-funded ADHD assessment, but commissioners see little of it#

The review says its concerns are "no criticism of independent provision in principle", but that public spending on assessment has grown faster than the checks on it.

NHS spending on independent ADHD services rose about 252% in three years#

The review's provider estimates say independent providers did more than half of NHS-funded ADHD assessments and more than a third of autism assessments in 2025/26. NHS spending on independent-sector ADHD services rose by about 252% in three years, with a projected £164 million overspend in the areas analysed, figures the review takes from a Centre for Health and the Public Interest report.

Prices vary about fourfold between ICBs, and top margins approach one third#

Prices for similar assessments vary about fourfold between integrated care boards (also from the Centre for Health and the Public Interest report), and the highest operating margins are approaching one third. The review warns that current prices may reward combined ADHD and autism assessments whether or not both are clinically needed. Our reading: if your local price is high, or many of your assessments are combined, model what a lower national price does to your margin now, starting from the 2026/27 guide prices.

At the same providers, NHS-funded patients wait about seven to eight times longer#

Within the same providers, NHS-funded patients waited a mean of 151 days for an ADHD assessment and 170 days for autism, against 21.5 days for privately funded patients. The review gives a single private figure, not split by condition, so the ratio of roughly seven to eight times is our calculation. These are provider estimates, with no sample size or period given for the waits.

Recommendation 5 would require separate reporting of NHS-funded and private referrals, waits and outcomes, showing this gap provider by provider. Be ready to explain how you decide who goes first. Our data reporting article covers what to have ready.

Only about 10 of 120 ADHD providers submitted data#

Of about 120 ADHD providers, only around 10 submitted data, partly because Right to Choose providers generally do not have to send routine data to commissioners. The review says it is "not acceptable" that public money spent with independent providers runs without consistent oversight or transparency, and wants a common minimum dataset, consistent prices and agreed standards as conditions of funding and registration. The providers who can already produce that data, split by payer, will be ready first.

In one city, counting waits per referral hid about half the wait#

In one city, the median time to diagnosis was 38.9 months counted per child, but 18.2 months counted per referral, because national figures restart the clock after discharge or re-referral. In the same city's combined autism and ADHD pathway, the figures were 16.0 and 9.3 months. It is one local analysis, but if commissioners link records, they will see the longer number.

The review links misdiagnosis to how assessments are done#

Misdiagnosis is more likely in brief, remote, single-condition assessments#

The review says misdiagnosis is more likely where assessment is brief, not face to face, split across services, made without informants or records, or focused on one condition.

Independent providers reported 66% to 93% of autism assessments ending in diagnosis#

Independent providers who responded reported doing around 90% of autism assessments remotely, with 66% to 93% ending in a diagnosis (averages of 79% to 86%). The review cites the Independent Healthcare Providers Network (IHPN) report for these figures. The review says these figures need careful interpretation, because comparable NHS data on case mix and outcomes are not routinely available.

Proposed standards would cover co-occurring conditions, functioning, remote assessment and training#

The proposed standards would require assessment of co-occurring conditions and day-to-day functioning, guidance on when remote assessment is right, and consistent training standards for assessors. If you work remotely, record for each case why, and which informants and records you used. Our assessment standards article sets out what each record should show.

A diagnosis often leads to another wait#

GP acceptance of shared care has fallen to about 62% and is still falling#

GP acceptance of shared care for medication started by independent providers has fallen to around 62% and is still falling, because of concerns about assessment quality and specialist support. Your assessment quality now affects whether your patients get treatment.

40% of clinicians report no ongoing support after an autism diagnosis#

In autism, 40% of clinicians surveyed reported no ongoing post-diagnostic support, and only 12.6% described support beyond a single session. The review says "a diagnostic report and signposting alone do not constitute an adequate post-diagnostic offer". Waiting does harm too. In CQC's 2024 Community mental health survey, reported in CQC's State of Care 2024/25 and reproduced in the review (p318), the share of people aged 16 and over who said their mental health got worse rose from around one in four for waits under two weeks to more than seven in ten for waits over six months. The survey did not cover ADHD or autism waiting lists, and only about one in five people replied. See our post-diagnostic offer article.

Of the ten recommendations, the government has backed CQC regulation, not standards or data#

The ten recommendations and where the government standsGovernment position as of 9 October 2026. Tap a recommendation for the detail.12345678910Committed4Left to the strategy4Not mentioned2Only the 6 that affect providersShowing 10 of 10 recommendations1Recommendation 1: Prevention and public mental healthLeft to the strategy2Recommendation 2: Support based on need, alongside diagnosisCommittedAffects providers3Recommendation 3: Joined-up assessment and supportLeft to the strategyAffects providers4Recommendation 4: Treatment gaps and specialist servicesLeft to the strategy5Recommendation 5: Commissioning, regulation and CQCCommittedAffects providers6Recommendation 6: Multidisciplinary workforceLeft to the strategyAffects providers7Recommendation 7: Digital and AINot mentionedAffects providers8Recommendation 8: Data, evaluation and NICECommittedAffects providers9Recommendation 9: Public information campaignNot mentioned10Recommendation 10: Cross-government strategyCommittedGovernment positions are our reading of the DHSC press release and the minister's speech of 9 October 2026. There is no recommendation-by-recommendation response yet. Source: Independent review into mental health conditions, ADHD and autism, DHSC, 2026, chapter 20. Contains public sector information licensed under the Open Government Licence v3.0.

Six of the ten recommendations affect assessment providers, recommendation 5 most directly. There is no full, recommendation-by-recommendation response yet. Our guide to all ten recommendations goes through each one, with the number behind it.

The government will bring in CQC regulation and ICB oversight, and consult on prices#

On the day the report was published, CQC said it had been asked to regulate all ADHD and autism diagnostic assessments. Based on the DHSC press release and the minister's speech, the government:

• is working towards making all ADHD and autism diagnostic assessments a CQC-regulated activity, with no date;
• has not announced an advertising ban; as part of a review of advertising practices, the Health Secretary will write to the Advertising Standards Authority;
• will require ICBs to improve oversight of the ADHD and autism assessment services they commission;
• will have NHS England consult on national prices, with new payment arrangements intended from April 2027;
• will work with NICE to look urgently at its ADHD and autism guidance;
• backs support without having to wait for a diagnosis.

Common standards, data conditions and Right to Choose were not mentioned#

Common standards for every provider, data as a condition of funding, the waiting-list review and Right to Choose were not mentioned, although the minister said all NHS-funded services will provide high-quality assessments and support. The review does not propose ending Right to Choose. The full response is due in a Mental Health Strategy in the coming months.

The CQC start date, standards and national prices are still unknown#

Not known yet:

• When CQC regulation starts and which regulated activity it will use. No consultation has been announced.
• Whether the standards and data conditions will be adopted.
• What the national prices will be.

Five steps to take now, before the regulations and prices are set#

1. Check your CQC position. If you prescribe or titrate, you should already be registered for treatment of disease, disorder or injury. If you only assess, start on governance, safeguarding and evidence of assessment quality. See our CQC regulation article.
2. Report referrals, waits and outcomes for NHS-funded and private work separately, and measure waits per patient as well as per referral.
3. Check each assessment file records co-occurring conditions, day-to-day functioning, why it was remote or in person, and informant evidence.
4. Write down what you offer while people wait and after diagnosis, including a clear GP letter.
5. Work out your cost per assessment, so you can answer the prices consultation with numbers.

Where Cerebric fits#

Cerebric records each referral with its payer, so waits and outcomes can be reported separately for NHS-funded and private work. It sends, chases and scores questionnaires so informant evidence is on file before the assessment, and drafts reports linked to their sources for the clinician to review, edit and sign. Clinics using it cut report writing time by 75%.¹

Footnotes#

1. Measured at UK Right to Choose and private neurodevelopmental providers using Cerebric, 2025–26. ↩