Universities can’t keep demanding diagnoses the NHS is slowing down

Ask a university disability adviser what a student needs to get support and the answer usually starts with paperwork – a diagnosis letter, an assessment report, or evidence from a medical professional. Without it, extra time, recorded lectures, and Disabled Students’ Allowance mostly stay out of reach.

The final report of the independent review into mental health conditions, ADHD and autism says that’s the wrong way round. The review, chaired by Peter Fonagy, argues for a shift from a “diagnosis-dependent” system to a “needs-led plus diagnosis” one. Support should be available “before, during and after assessment, and not be withheld while waiting for a diagnosis.”

Students will recognise the problem. The trouble is what happens if only half the system listens.

A narrower front door

The review is clear that waits are far too long. By the end of 2025, more than 560,000 people had an open ADHD referral and more than 254,000 had an open autism referral, and many students have coped the only way they could – by paying privately or using Right to Choose to be seen sooner.

That route is now in the review’s sights. Independent providers carry out more than half of NHS-funded ADHD assessments, and spending on them has risen by around 252 per cent in three years. The review wants all ADHD and autism assessments regulated by the Care Quality Commission, along with a ban on advertising NHS-funded assessments and a clinical review of waiting lists.

It also warns that the risk of misdiagnosis and overdiagnosis is growing, especially where assessments are short or done remotely.

There are good reasons for all of that – nobody benefits from a rushed assessment that misses anxiety or gets the diagnosis wrong. But the likely effect is fewer quick diagnoses, at least for a while.

Still asking for the letter

The review’s answer to slower diagnosis is to make diagnosis matter less, so that support follows need. It identifies education, health and care plans, Access to Work, and the benefits system as places where a diagnosis has become an “administrative key.” Its executive summary doesn’t mention universities.

Universities work in much the same way. DSA asks for evidence of a condition, and most university disability services want something similar before agreeing adjustments – students already describe the process as a merry-go-round of telling their story to different offices.

So picture a student who starts to struggle in first year. Under the review’s plan, the NHS would offer them help while they wait, but their university would still be waiting for a diagnosis that’s now harder to get quickly. By the time it arrives they could be in final year – or they could have left.

The numbers suggest this isn’t a small group. The share of 16 to 24 year olds with a common mental disorder has risen from around one in six to one in four, and among them 57 per cent screened positive for ADHD and 61 per cent for autistic traits. Those students are in lecture theatres now.

No label required

Universities don’t need anyone’s permission to change this. The Equality Act defines disability by the effect an impairment has on someone’s day-to-day life rather than by a diagnosis. The duty to make reasonable adjustments is also anticipatory – universities are meant to plan ahead for what disabled students might need, not wait for each one to prove it. The Office for Students is due to publish a statement of expectations on disability by early 2027.

A lot of what students ask for doesn’t need a clinician anyway. Recorded lectures, flexible deadlines, low-distraction exam rooms, and clear information in advance help many students, diagnosed or not. The review says support should match what someone needs to get through the day, and much of that is good teaching and good neuroinclusive design.

DSA is harder, because it’s public money with eligibility rules set by government. The Department for Education has already asked whether universities should take on some of what DSA pays for, which is exactly why DSA needs to be part of the conversation now.

The review calls for a cross-government mental health strategy this year. If nobody asks the Department for Education how DSA fits a needs-led system, the strategy will fix one front door and leave the other locked.

What SUs can push for

SUs can start by asking what support their university offers students who are on a waiting list, and whether any adjustments can start on the basis of need. It’s worth finding out what evidence disability services accept – and if they only take diagnosis letters, asking why.

The case can be made in terms of retention. The review wants participation in education to be a core measure of success, and universities already care about students staying on their course. DSA should also be raised with MPs and in any response to the coming strategy, because health reform that stops at the NHS door won’t reach students.

The review is right that people are not the problem, and students who have waited months for an assessment just to get extra time in an exam would agree. But if universities keep asking for the letter while the NHS stops rushing to write it, students will be the ones left in the middle.