The waiting list is not a support plan

Picture an employee who tells their manager that noise in the office makes it almost impossible to concentrate. They suspect they may have ADHD and have been referred for an assessment, but the appointment could be months away. For now, they would like to work somewhere quieter for part of the day.

The manager can try it, agree a review point and see whether it helps. Or they can wait until someone with a clinical qualification explains why the employee is struggling.

For some managers, waiting for diagnosis can feel safer. We have built systems in which diagnosis becomes a gateway to support, even when the difficulty is already understood and a practical fix is available.

On 9 October, the government published the final report of the Independent Review into Mental Health Conditions, ADHD and Autism, chaired by Professor Peter Fonagy. It describes rising demand for assessment, long waiting lists and services struggling to respond in time. By the end of 2025, there were more than 560,000 open ADHD assessment referrals in England, more than 17 times the number recorded in 2019. The review also recognises that access to treatment and support can remain slow after diagnosis.

The numbers are striking. The more telling finding is what the review says about the system around them: diagnosis has become a primary gateway to support that could and should be available earlier.

It would be easy to turn this into an argument about whether people need diagnoses at all. That would miss the point.

For many people, a diagnosis matters enormously. It can explain years of confusion or distress, open the door to specialist treatment and medication and help someone understand themselves in a way they could not before. The Fonagy review’s executive summary is clear that timely, high-quality diagnosis and specialist care still matter where they are clinically indicated.

The review also considers the risks of underdiagnosis, misdiagnosis and overdiagnosis. It concludes that the available evidence does not establish overdiagnosis at scale, while warning that assessment quality, data gaps and a diagnosis-dependent system create real risks that need managing. That is more measured than much of the public debate.

A person who cannot concentrate in a noisy room has that problem whether the explanation is eventually ADHD, anxiety, a hearing-related condition or something else. The clinical explanation may decide the treatment. It does not always decide whether a quieter desk, clearer written instructions or more predictable routines would help.

The review proposes a needs-led plus diagnosis model. Diagnosis stays. The aim is that people receive appropriate help before, during and after assessment, rather than being left without support while they wait.

The government has welcomed that direction and says its forthcoming mental health strategy will focus on earlier, needs-led support. The policy detail is still to come, so this is not a new legal rule for employers. It is a strong signal about the direction of public policy and the practical consequences of treating diagnosis as the only route to help.

Employers do not have to wait for the NHS to change before they work differently. Acas guidance on adjustments for neurodiversity says that a worker does not need a diagnosis to be considered disabled under the Equality Act 2010. It also says employers should offer support, including reasonable adjustments, whether or not a worker has a diagnosis.

The legal duty is still fact-specific. The Equality Act 2010 sets out when reasonable steps may be required to avoid substantial disadvantage. Some requests need specialist assessment, professional advice or a hard look at cost, safety and practicality. This does not mean every request must be agreed. It does mean that a diagnostic letter should not become a default reason to do nothing.

For many workplace barriers, a manager can start with a practical conversation. The question is not “What condition do you have?” It is “What is getting in the way of doing your job, and what could make that easier?”

Acas gives similar examples, including quieter spaces, support with written communication, regular check-ins and changes that reduce sensory overload. The objective is not to guess at someone’s diagnosis. It is to reduce a known barrier and learn whether the response works.

There is an equity issue here too. Someone who can afford a private assessment may receive a diagnosis sooner. Someone else may remain dependent on stretched public services. If practical workplace support is conditional on diagnostic paperwork, access to healthcare starts shaping access to opportunity.

The Fonagy review recognises that fragmented and complicated systems disadvantage people who are less able to navigate them or pay for alternatives. Employers cannot fix NHS waiting lists. They can avoid reproducing those waits inside their own organisation.

That starts with treating accessibility as organisational capability: managers who can have useful conversations, systems that keep a clear record and adjustment processes that move at the pace of the person’s working life rather than a clinical queue.

The review challenges how success is measured. Waiting times, assessment quality and treatment access all matter. But it says success should also be judged by whether people can participate more fully in education, work, relationships, family and community life.

That is a useful test for employers. A diagnosis can mean a great deal to an individual without changing the environment that is causing the difficulty. In the same way, an organisation can commission awareness training, write a disability policy and encourage disclosure, all worthwhile, while still not know whether anything has improved for the person facing a barrier.

Did they get the adjustment they asked for? Did it help? Can they do their job more effectively? Do they have to explain the same difficulty again when they change manager or department?

Those answers say more about an inclusion programme than the number of training certificates issued.

At Calling All Minds, our philosophy of Anticipatory Welcome rests on the idea that inclusion should be considered before someone meets a barrier, rather than after they have had to make a case for being accommodated. It also means giving people control over how they communicate their needs.

That is part of the thinking behind AXS Passport. A person’s practical needs can be recorded and shared with the people who need to understand them, without a diagnosis label becoming the centre of every conversation. Managers still have decisions to make. Organisations still have responsibilities. But the conversation can start with the barrier the person is trying to solve.

A structured record also helps prevent repeated disclosure and creates continuity when people change roles, teams or managers. It does not guarantee an outcome or replace sound judgement. It makes it easier to act consistently, explain a decision and review whether support is working.

For related practical guidance, read our Insight on why reasonable-adjustment decisions need accountable systems, our guide to reasonable adjustments at work and our guide to tracking reasonable adjustments.

The review is mainly about reforming mental health and neurodevelopmental support in England. Its recommendations need investment, clinical expertise and time. It also makes a simpler point: people should not be denied practical support while they wait for a diagnosis.

Employers can act on that direction now. They can ask why a particular piece of medical evidence is being requested and whether it is genuinely needed. They can train managers to talk about barriers without trying to diagnose their colleagues. They can make small adjustments sooner and design processes that let people ask for help without unnecessary delay.

A diagnosis may explain the difficulty. It should not always be the price of doing something about it.

• •Independent review into mental health conditions, ADHD and autism: executive summary
• •Independent Review into prevalence and support for mental health conditions, ADHD and autism: final report
• •Department of Health and Social Care: Government pledges earlier support to tackle mental health crises
• •Acas: Adjustments for neurodiversity
• •Equality Act 2010, section 20