NHS boards imposing minimum two-year waits for ADHD and autism assessments aren’t responding to falling need. They’re rationing care by making people wait.
Nearly 1 million people in England are now on waiting lists for an ADHD assessment. The average wait has already reached 64 weeks, while about 295,000 people are waiting to be assessed for autism. Behind those figures are people unable to access treatment, educational support, workplace adjustments or disability benefits because the state demands formal proof of their condition while failing to provide the assessments needed to obtain it.
Diagnoses have risen sharply. Among people aged three to 25, the annual rate of autism diagnosis between 2020 and 2022 rose from 185 to 580 per 100,000 males and from 45 to 320 per 100,000 females.
Part of this rise reflects a genuine improvement in knowledge. Autism and ADHD were long understood through narrow stereotypes based overwhelmingly on how they appeared in boys and men. Girls and young women were frequently overlooked, misdiagnosed or expected to conceal their difficulties. As the interim report of Peter Fonagy’s government-commissioned review acknowledged: “Some groups that were historically under-identified are now entering the services in greater numbers.”
Greater public awareness and declining stigma have also enabled more people to recognise their own difficulties and seek help. The pandemic, growing economic insecurity and worsening distress among young people have added to demand. These conditions haven’t somehow created autism or ADHD, but they can make unsupported people’s lives harder and push needs that were previously hidden into the open.
The culture-war right treats the rise in diagnoses as proof that neurodevelopmental conditions have become fashionable. Its talk of “woke overdiagnosis” shifts attention away from the collapse of public provision and towards suspicion of the people seeking help. Patients are recast as scroungers, gullible consumers or attention-seekers competing for a supposedly undeserved advantage.
But a diagnosis isn’t a prize. Under the existing system, it’s an administrative key. Schools, employers, benefits departments and healthcare providers regularly demand clinical recognition before they’ll offer support. Fonagy describes diagnosis as the “practical mechanism through which individuals obtain access to support, adjustments or formal recognition”. What reactionaries sneer at as a “golden ticket” is often simply the document required to make an institution acknowledge a person’s needs.
This arrangement generates demand for diagnosis by design. The state insists that people pass through a medical gate before receiving assistance, then starves the service responsible for operating that gate. It creates a bottleneck and blames those trapped inside it for overcrowding.
Fonagy’s interim report observed that “Unmet needs, misdiagnosis and concerns about over-medicalisation can coexist in the same system,” and that’s true. Any rapidly expanding diagnostic system can misidentify some people or force varied forms of distress into categories that institutions recognise. But this doesn’t explain away the mass of unmet need. Nor does it justify leaving hundreds of thousands of people without assessment for years.
Capitalism has a powerful tendency to treat support as an individual exception rather than a collective provision. Instead of schools, workplaces and public services being organised to accommodate a broad range of human needs, individuals must prove that they deviate sufficiently from an imagined “normal” person. Diagnosis becomes the certificate authorising limited relief from institutions otherwise organised around discipline, productivity and cost-cutting.
The burden is also divided by class. Those with money may be able to seek private assessments, pay for therapy or survive periods without benefits and institutional support. Working-class people are more likely to remain trapped in the NHS queue while struggling through schools, workplaces and welfare assessments that demand evidence they can’t obtain. The same formal right to an assessment therefore produces profoundly unequal real outcomes.
Families are left to carry work that should be socially provided. Parents fight schools, chase referrals, manage crises and compensate for missing services. Adults are expected to keep working or navigating the benefits system while waiting years for answers. The unpaid labour involved falls heavily on women, reproducing the same gendered division of care found throughout capitalist society.
The NHS didn’t simply fail to predict a fashionable new demand. It has been denied the staff and capacity needed to respond to needs that were always more widespread than official diagnosis suggested. Years of financial pressure have left services unable to cope as previously excluded groups finally come forward.
This scarcity reflects political priorities. Britain’s ruling class treats spending that protects property, profits and imperial power as essential, while healthcare is continually subjected to affordability tests. Public services are expected to absorb rising need without the workers or resources required. When they inevitably fail, the resulting suffering is blamed on patients for asking too much.
A two-year minimum wait turns delay into policy. It leaves people suspended between a state that demands a diagnosis and a health service prevented from providing one. The scandal isn’t that too many people now recognise they need help. It’s that capitalist Britain has built an elaborate machinery for certifying human need, only to close the gate when the scale of that need becomes impossible to ignore.
