Fonagy review: the 10 recommendations and what each means for providers

The Fonagy review (the independent review into mental health conditions, ADHD and autism, published by DHSC on 9 October 2026) makes ten recommendations. Six affect ADHD and autism assessment providers, and recommendation 5, on regulation and commissioning, affects them most. The government has committed to parts of four so far and will give its full response in a Mental Health Strategy.

What this means for you

• Diagnosis-only assessment is set to come under CQC, with common standards and data reporting proposed alongside it. No date has been set.
• The review wants support while people wait and a guaranteed offer after diagnosis, so the time either side of an assessment becomes part of the service.
• Most of the review's dates are its own asks. The only firm date for providers is NHS England's intended new payment arrangements from April 2027.

This article is the full list. For the review's main findings, see our summary of the Fonagy review for providers.

Six of the ten recommendations affect providers, and the government has committed to parts of four#

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.

The government responded on 9 October through a press release and the minister's speech, not recommendation by recommendation. It committed to support without waiting for a diagnosis (2), working towards CQC regulation of all diagnostic assessment (5), an urgent look at NICE guidance (8) and a Mental Health Strategy (10). For 1, 3, 4 and 6 it pointed to existing programmes. Recommendations 7 and 9 were not mentioned.

The number behind each recommendationOne figure from the review for each of the ten. Blue numbers mark the six that affect assessment providers.1. Preventionp5£300bnestimated yearly cost of mental ill health in England2. Need-led supportp10560,000+open ADHD referrals by the end of 2025, over 17 times 20193. Joined-up carep1257%of 16 to 24-year-olds with a common mental disorder also screened positive for ADHD4. Treatment gapsp12915–25%of people with ADHD receive medication, against 70 to 90% who benefit in trials5. Regulationp18252%rise in NHS spending on independent ADHD services in three years6. Workforcep32721%fall in health visiting staff between 2016 and 20217. Digital and AIp4402027when the review wants AI-supported needs assessment pilots to begin8. Data and NICEp92017year of the latest diagnostic survey of children's mental health9. Informationp25855%of ADHD traits in 100 popular TikTok videos did not match the diagnostic criteria10. Strategyp44912–24months for the immediate actions the review wants in a new strategySource: Independent review into mental health conditions, ADHD and autism, DHSC, 2026 (page references as shown). The 15–25% figure is the ADHD Taskforce's, quoted by the review. Contains public sector information licensed under the Open Government Licence v3.0.

1. Prevention and public mental health: no new duties for assessment services#

• It asks for: action on the causes of distress, such as sleep, safer online spaces, belonging and financial security, through a national public mental health and prevention programme led by DHSC, with parenting support available to all (pp438-439).
• The number behind it: mental ill health costs England around £300 billion a year (p5).
• Where the government stands: it pointed to existing programmes, such as mental health support teams in every school and college by 2029, and left its full answer to the strategy.
• What it means for you: nothing directly. Over time it may change demand, but it adds no duties for assessment services.

2. Support based on need, alongside diagnosis: waiting lists would be reviewed person by person#

• It asks for: "no wrong front door" to support, a shared needs assessment under senior clinical oversight, rapid specialist assessment for people with severe needs, support while waiting for people with mild to moderate needs, and a guaranteed offer after diagnosis. It also wants a clinically led review of current ADHD and autism waiting lists, in which no one is taken off a list without being connected to help (pp439-441).
• The number behind it: open ADHD referrals exceeded 560,000 by the end of 2025, more than 17 times the 2019 figure (p10).
• Where the government stands: it backed support "without having to wait for a clinical diagnosis". It did not mention the waiting-list review or the 2027 digital and AI pilots.
• What it means for you: expect to be asked what people get from you while they wait and after diagnosis, and for lists to be reviewed person by person. Our article on the post-diagnostic offer sets out what the review expects.

3. Joined-up assessment and support: single-condition contracts give way to integrated services#

• It asks for: integrated community support close to home, voluntary sector organisations as core partners, multidisciplinary teams that bring specialist expertise to people ("Expert at Hand"), keyworkers for people with complex needs, joined-up support from birth to 25, and NHS Talking Therapies adapted for ADHD and autism (pp441-443).
• The number behind it: by 2024, among 16 to 24-year-olds with a common mental disorder, 57% also screened positive for ADHD and 61% for autistic traits (pp12-13).
• Where the government stands: it pointed to the £1.8 billion Experts at Hand offer bringing specialists into schools, and left its full answer to the strategy.
• What it means for you: commissioners are steered towards integrated, multidisciplinary services rather than separate contracts for each condition. Recommendation 5 makes clear this does not mean one combined assessment.

4. Treatment gaps and specialist services: starting medication stays specialist work#

• It asks for: better care for people with the most severe and complex needs, wider access to NICE-recommended treatment, fewer avoidable A&E attendances and admissions, specialist capacity focused on diagnostic uncertainty, complexity, risk and starting medication, and consistent medication reviews and safe deprescribing (pp443-444).
• The number behind it: the ADHD Taskforce found only around 15 to 25% of people with ADHD receive medication, against 70 to 90% who benefit in trials. The review notes the gap could also reflect "changes in case mix, prescribing practice or patient preference" (p129).
• Where the government stands: it pointed to more NHS talking therapies and 159 new mental health centres and emergency departments, and left its full answer to the strategy.
• What it means for you: mainly relevant if you titrate. Starting medication is treated as specialist work, and medication reviews are to be made consistent.

5. Commissioning, regulation and CQC: the recommendation that affects providers most#

• It asks for: all ADHD and autism diagnostic assessment to become CQC-regulated, with the same quality standards for NHS, independent, voluntary and digital providers; standards that cover co-occurring conditions, functioning, remote or in-person assessment and assessor training; more than one assessment done separately but in a planned sequence; funded shared care to a national standard; data from every provider, Right to Choose included, as a condition of funding, with NHS-funded and private work reported separately; and a ban on direct-to-public advertising of NHS-funded assessments (pp444-445).
• The number behind it: independent providers now carry out more than half of NHS-funded ADHD assessments, and NHS spending on them rose around 252% in three years (p18).
• Where the government stands: it is "working towards" CQC regulation, with no date (CQC will regulate once new regulations are made). No advertising ban was announced; the Health Secretary will write to the Advertising Standards Authority. ICBs must improve oversight of the assessment services they commission. The data condition was not mentioned. NHS England will consult on national prices and intends new payment arrangements from April 2027.
• What it means for you: our articles on CQC regulation, the proposed assessment standards and Right to Choose data reporting cover each part.

6. Multidisciplinary workforce: a competency framework would set out who does what#

• It asks for: national and local workforce strategies written with the Royal Colleges, neighbourhood multidisciplinary teams, a tiered workforce in which all staff have core competence, and a nationally agreed competency framework for each level of the system (pp445-446).
• The number behind it: health visiting, a statutory service, lost about 21% of its staff between 2016 and 2021 (p327).
• Where the government stands: it pointed to existing measures, such as recruiting mental health workers and training for every teacher, and left its full answer to the strategy.
• What it means for you: our reading is that, alongside the assessor training standards in recommendation 5, a competency framework could set out who may do which parts of an assessment. The review does not say whether it will cover diagnostic assessors.

7. Digital and AI: tools for admin and navigation, with clinical judgement left to professionals#

• It asks for: shared digital infrastructure and data standards, AI to support the needs assessment in recommendation 2, regulated digital therapies, clear updates on the NHS App for people who are waiting, data that follows the person, an "ADHD Passport" in the NHS App holding diagnosis, care plans and medication history, and in-person routes kept open (pp446-447).
• The number behind it: pilots of AI-supported needs assessment should begin in 2027 (p440).
• Where the government stands: not mentioned.
• What it means for you: the review says "AI and structured digital tools can assist navigation, information gathering and administration, but responsibility for clinical judgement, diagnosis, safeguarding and assessment of suicide or self-harm risk must remain with appropriately qualified professionals". It wants digital tools endorsed only where they meet the NICE evidence standards and DTAC (p430).

8. Data, evaluation and NICE: outcomes reported by ethnicity and deprivation#

• It asks for: regular national prevalence surveys of children and adults, better local and national data on need, access and outcomes, a minimum dataset, updated NICE guidance on ADHD, autism and co-occurring conditions, and outcomes reported by ethnicity and deprivation (pp447-448).
• The number behind it: the most recent diagnostic survey of children's mental health is from 2017, and the review says England lacks up-to-date prevalence data (p9).
• Where the government stands: it will work with NICE to "urgently consider" what the report means for its ADHD and autism guidance. Regular surveys and wider data collection were not mentioned.
• What it means for you: expect data returns that cover functioning and outcomes, Right to Choose included, and updated NICE guidance to assess against. Our article on who is being diagnosed has the current figures.

9. Public information campaign: information and support without needing a diagnosis#

• It asks for: a national campaign to build understanding of mental health and neurodevelopmental conditions, and an open-access digital platform offering information and support without a diagnosis, which could build on Every Mind Matters (pp448-449).
• The number behind it: in an analysis of 100 popular ADHD TikTok videos, 55% of the characteristics shown did not match the DSM-5-TR criteria (p258). The minister quoted this figure in her speech.
• Where the government stands: not mentioned.
• What it means for you: indirect. Better information may change what people expect before they are referred.

10. Cross-government strategy: the strategy sets the timetable for everything else#

• It asks for: a Mental Health Strategy this year, with immediate actions over the next 12 to 24 months and a 10-year reform plan, shared outcomes across government, and the investment and workforce needed to tackle long waiting lists (p449).
• The number behind it: 12 to 24 months for the immediate actions (p449).
• Where the government stands: it will set out its response in a new Mental Health Strategy "in the coming months".
• What it means for you: the strategy is where the government's answer on standards, data and advertising is due. Until then, most of recommendation 5 is a proposal.

Only the new payment arrangements have a date; most dates are the review's asks#

What has a date, and who set itHappenedGovernment commitmentThe review's askCommitted, no date9 October 2026Review published; government responds by press release and ministerial speechAllThis yearA cross-government Mental Health Strategy. The government says its full response will come in it “in the coming months”Rec 102027Pilots of AI-supported needs assessment beginRec 2April 2027NHS England intends new payment arrangements, after consulting on national pricesRec 512 to 24 monthsImmediate actions under the strategyRec 1010 yearsA long-term reform planRec 10No dateCQC regulation of all ADHD and autism diagnostic assessment, once new regulations are madeRec 5No dateNICE to “urgently consider” its ADHD and autism guidanceRec 8Status as of 15 October 2026. Sources: Independent review into mental health conditions, ADHD and autism, DHSC, 2026 (pp440, 444–449); DHSC press release and Minister McGovern's speech, 9 October 2026; CQC, 9 October 2026. Contains public sector information licensed under the Open Government Licence v3.0.

CQC regulation is the commitment providers ask about most, and it has no date. New regulations are needed first, and no draft or consultation had been published by 15 October 2026.

Five steps prepare you whichever recommendations are adopted#

1. Check your CQC position. Diagnosis-only services are expected to come into scope; our CQC regulation article covers what registration involves.
2. Report referrals, waits and outcomes for NHS-funded and private work separately, as our data reporting article sets out.
3. Make sure every assessment record shows co-occurring conditions, functioning, informant evidence and why it was remote or in person. Our assessment standards article has a self-audit.
4. Write down what you offer while people wait and after diagnosis, using our post-diagnostic offer article.
5. Work out your cost per assessment, so you can answer NHS England's price 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. ↩