The British Association for Community Child Health welcomes the publication of the Fonagy Report and its thoughtful contribution to a complex and often polarised discussion regarding neurodevelopmental assessment and support for children, young people and adults.
For some time now, BACCH members involved in the assessment of autism and ADHD have expressed concern that children and young people often face significant delays in having their needs recognised and addressed, and that the wider system has become heavily focused on obtaining a diagnosis, and that this can unintentionally create barriers to timely support, leaving families waiting for services while difficulties continue to affect education, wellbeing and quality of life.
We particularly welcome the report's commitment to bringing together differing perspectives with compassion, respect and a shared focus on improving outcomes for children, young people and adults. The report acknowledges the complexity of the current landscape and avoids reducing the debate to simplistic narratives. Rather than framing concerns solely in terms of over-diagnosis, it highlights the multiple interacting factors that influence need as well as current patterns of identification, assessment and support. BACCH strongly supports the report's recognition of the importance of understanding the social, economic and environmental influences on children's development and wellbeing.
We also welcome the report's clear recognition that missed diagnosis, delayed diagnosis, inaccurate diagnosis and over-diagnosis can all be harmful. Each represents a failure of systems designed to support children and young people. A child whose needs are not recognised may be denied appropriate support, while a child who receives an inaccurate diagnosis may be directed towards interventions that do not address their underlying difficulties. Both situations can have lasting consequences for wellbeing, education and life opportunities.
The report appropriately recognises that support should not be contingent solely upon a
diagnostic label. Some children and young people require support despite not meeting
diagnostic thresholds, while those sharing the same diagnosis may have markedly
different strengths, challenges and health needs. Services must therefore be responsive
to individual need rather than diagnosis alone.
As demand for assessment has increased, a growing number of providers have entered
the system. While expanding capacity is important and welcomed, public confidence
depends on assurance that assessments are evidence-based, safe, consistent and of
high quality. Publicly funded assessments, regardless of provider, should be
commissioned, regulated and monitored to the same robust standards. Children, young
people, and families deserve to trust that the assessments they receive are accurate,
clinically sound and delivered within strong governance frameworks.
We believe the report presents a genuine opportunity to reshape services around the
needs of children and young people. Achieving this will require stronger accountability
and leadership for child public mental health across both the Department of Health and
Social Care and the Department for Education, together with a sustained focus on
quality, equity and early support. BACCH is committed to contributing constructively to
this work and to ensuring that future systems deliver timely, evidence-based and
person-centred care for all children and young people.
BACCH Response to Fonagy Report
