Proposals to reduce the number of people receiving a formal diagnosis for attention deficit hyperactivity disorder (ADHD) have sparked criticism, with some calling the move "rationing" healthcare. The idea comes from an ongoing government review, which is expected to suggest that not everyone with ADHD symptoms should automatically get a formal diagnosis. Instead, individuals would be assessed for the level of support they need, potentially without a formal label. This "needs-based" approach, first reported in the Times, would prioritize those most in need, such as people at risk of self-harm or those struggling to work. Those with less severe symptoms might not be referred for a formal diagnosis but could still receive help through a "holistic" evaluation of their situation. The review was commissioned by the former health secretary, Wes Streeting, in December 2023, as concerns grew over a sharp increase in sickness benefit claims linked to mental health, autism, and ADHD. Led by Prof Peter Fonagy, a clinical psychologist and psychoanalyst from University College London, the interim report highlighted that the current system pushes people to seek a formal diagnosis in order to access support. This has created long waiting times, with 800,000 individuals on NHS waiting lists. In recent years, complaints about ADHD and autism services in England have more than tripled. Many people with ADHD are now not in education, training, or work, and around 100,000 are on health-related benefits due to their condition. The ADHD taskforce estimated the cost of not treating ADHD to be £17 billion annually. Fonagy’s review is expected to recommend that only those who clearly need a formal diagnosis—such as those requiring medication—should be referred to ADHD clinics. Under the proposed system, individuals would be triaged based on the severity of their symptoms and how well they can cope in different environments like school, work, or home. They would then receive targeted support, regardless of whether they have a diagnosis. This could include one-on-one help for children, quiet spaces in schools, classes for parents, and workplace adjustments like flexible hours for employees with ADHD. The final report is likely to suggest a similar approach for autism and mental health support. However, some experts argue that this could lead to the rationing of healthcare and that early support can already be provided in schools and workplaces without a formal diagnosis. Henry Shelford, chief executive of ADHD UK, criticized the review, saying it would force people to self-diagnose via social media. He noted that ADHD can have serious health consequences, with people diagnosed with ADHD living significantly shorter lives than their peers. Shelford emphasized that investing in ADHD services has a high return, citing the NHS’s £574 million spent on a weight-loss drug last year, which helped people return to work. Mel Merritt, from the National Autistic Society, warned that denying people a diagnosis could worsen existing inequalities. A government spokesperson confirmed that the review, led by Prof Fonagy, was initiated in December and that the final report would soon be published, shaping the country’s new approach to mental health, autism, and ADHD support.