The Fonagy Review: what the ADHD and autism reforms mean for you

The one big idea: help based on need, not just a diagnosis

Today, the system is diagnosis-dependent: for most people, nothing much happens until you have a formal diagnosis — and the wait for that can run to years. The review says this has to change.

Its central recommendation is a shift to a 'needs-led plus diagnosis' model. In plain English: support should be able to start earlier, based on how much you're struggling, without having to wait for a diagnosis first. A diagnosis still matters — especially where medication or specialist treatment is involved — but it would no longer be the only door to getting help.

To make that work, the review proposes a 'no wrong front door' approach, so people can get help through schools, GPs, community services, employers or self-referral — with a shared way of working out who needs what, and how urgently.

What's changing for assessments

Two things stand out.

1. All assessments would be regulated. The review recommends that every ADHD and autism assessment — NHS, private, or digital — be regulated by the Care Quality Commission (CQC), under one set of quality standards, with consistent data and oversight. Today, many private, assessment-only services aren't rated by the CQC at all. Bringing them all into one framework is meant to give you confidence that an assessment is good quality, wherever you get it. The CQC has since confirmed it will begin regulating all ADHD and autism assessment providers, including private clinics that currently only carry out assessments — so this change is already moving ahead.
2. Providers would have to share their data. All providers — including those working through Right to Choose — would have to report consistent information on their activity, waits, and outcomes as a condition of being funded. For the first time, NHS-funded and privately funded assessments would be reported separately.

Why this matters to you: today it's genuinely hard to compare providers on quality, because the information simply isn't collected in the same way. These changes are designed to fix that.

What's changing for Right to Choose

Right to Choose — the legal route that lets people in England ask their GP to refer them to an NHS-funded provider of their choice — is not being abolished. But it is being brought into line with the rest of the system.

The review found that Right to Choose had grown very large and sat largely outside the normal rules: independent providers delivered more than half of NHS-funded ADHD assessments and over a third of autism assessments in 2025/26, around 90% of them through Right to Choose — yet only about 10 of roughly 120 ADHD providers were submitting data. The plan is to hold these providers to the same data, pricing, quality and registration standards as directly commissioned NHS services.

The government also plans to stop providers advertising NHS-funded assessments directly to the public, so that access is based on clinical need rather than marketing. (This is about provider advertising of NHS-funded services — it doesn't change your legal right to ask for a referral.)

Read the Right to Choose guide

What's changing for costs and prices

The review found something striking: the price the NHS pays for what looks like the same assessment varies about fourfold between different NHS areas, and spending per child ranged from roughly £569 to £2,410 — differences not explained by how complex the case was. It also found wide variation in provider profit margins, with the highest approaching a third.

To address this, NHS England has said it will consult on a single national price for NHS-funded ADHD and autism services, with new arrangements intended to begin in April 2027. The prices put forward for consultation are around £850 for a face-to-face adult assessment, £700 for a virtual adult assessment, and £950 for a child's assessment, covering the assessment, follow-ups and post-diagnostic support. The review found the NHS was overspending by around £164 million a year because prices were so inconsistent — with some clinics billing the NHS up to £3,000 per patient. (This price change is the government and NHS England's plan — the review itself called for 'consistent pricing' but didn't set a date.)

What this means for you: on the NHS-funded side, prices should become more consistent over time. If you pay privately, fees will still vary a lot — so it remains worth comparing what's included (the written report, follow-ups, and any ongoing prescribing costs), not just the headline price.

Understand private assessment and first-year costs

What's changing after a diagnosis

The review is clear that assessment has raced ahead of what comes next — the treatment, reviews and ongoing prescribing. It recommends:

• More care handled in primary care over the long term, through funded, standardised shared-care arrangements with your GP. (At the moment, GP acceptance of shared care for privately started medication has fallen to around 62% and is still declining — one of the biggest sources of stress and cost for patients.)
• An 'ADHD Passport' — a single record you hold in the NHS App, with your diagnosis, care plan and medication history, so your information follows you.

The numbers behind it

• ADHD open referrals passed 560,000 by the end of 2025 — about 17 times the 2019 figure.
• Within the same providers, privately funded patients waited about 21.5 days, while NHS-funded patients waited about 151 days for ADHD and 170 days for autism.
• Independent providers carried out roughly 220,000 NHS-funded assessments in a single year.

These are the review's own findings, and they show why change is coming: demand has far outrun the system's capacity, and access has become very uneven.

Read The State of ADHD Access in England

When will this happen?

Some of this is firm and near-term; some is a direction of travel.

• Expected soon: a cross-government mental health strategy 'this year', a clinical review of existing waiting lists (with a promise that no one is removed from a list without being connected to support), CQC regulation of all assessments, the advertising change, and mandatory data reporting.
• Phased or still to be consulted on: the national price (NHS England's consultation, intended to start April 2027), early-help pilots using a shared needs-assessment tool (pilots from 2027), and a longer 10-year reform programme.

In other words: the ground is shifting, but much of it will arrive gradually over the next one to ten years. If you need an assessment now, today's routes still apply.

NeuroCompare's view

We think these reforms point in the right direction — towards earlier help, clearer quality standards, and more honest information about cost and waits. That's the same thing we've argued for, and much of what the review documents (the price variation, the uneven waits) matches what we've found in our own analysis of NHS data.

As the system becomes more regulated, our job stays the same: to give you an independent, transparent picture of your options — NHS and private — so you can make an informed choice. We don't take payment for rankings, and we never will.

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