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Equalities, Human Rights and Civil Justice Committee 24 February 2026 [Draft]

24 Feb 2026 · S6 · Equalities, Human Rights and Civil Justice Committee

Item of business

Neurodivergence

Robby Steel (Scottish Government) Watch on SPTV

Diagnosis in the whole of medicine is a bit more complicated than is often portrayed. For example, your general practitioner might tell you that you have hypertension. The cut-off point for where your blood pressure has to be for that diagnosis and how often it needs to be checked to confirm that that is a true reading is inherently arbitrary. No risk curve in medicine has a sudden step at the cut-off point for hypertension. The risk curves for heart disease, stroke and so on follow a continuum. Similarly, with neurodevelopmental disorders, the side of a line that a person falls on as to whether they fit the diagnosis does not necessarily tell us what their needs will be or what will help.As a psychiatrist, I would say that health boards need to be robust in their use of clinical mechanisms for confirming or refuting a diagnosis but that assessment is much broader than diagnosis. Assessment is assessment of educational needs. What might cause the biggest problem in a person’s life might not be the thing that they fulfil the diagnostic criteria for, if they fit it at all. We need good access to more holistic assessment, which will probably also act as a triage for access to clinical assessment if a person’s profile suggests that they might fulfil the diagnostic criteria.People do not have a right to a diagnosis, but they probably should have a right to an assessment to see whether they fulfil the diagnosis. However, we need to stick with what the diagnoses are. The problem that Scotland is facing is the problem that all countries in the western world are facing: the sudden increase in awareness of these difficulties has led to new demand for assessment across the western world. I do not think that any country has cracked that issue yet. The result is that all countries have huge, pent-up demand from people requesting assessment that they have not quite figured out how to meet. That has ended up with national health service waiting lists in our system. Whether or not we need a new paradigm for looking at it, the way forward might be to allow people to access assessments and to reserve the NHS for those who have a profile that suggests that they need a full clinical assessment.11:30We are looking at that, but this has all western countries on the hop, because systems that are designed for assessing 1 or 2 per cent of the population are the obvious pathways to provide assessments for 20 per cent of the population, and that does not fit, so they are struggling as a result. We have not yet come up with a good solution that is person based and puts diagnosis in its right place but offers assessments all round. I hope that that answers your question.

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Equalities, Human Rights and Civil Justice Committee 24 February 2026 [Draft]

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