Ukraine faces decisive months ahead as key allies gear up for crunch elections. While early presidential campaigning in the US and a looming general election in Poland will grab the international headlines, a snap election in Slovakia on 30 September may prove every bit as consequential. 

With Robert Fico — Slovakia’s former prime minister and one of the West’s most outspoken critics of the Ukrainian war effort — poised to win the vote, a change of government in Bratislava could have a profound effect on EU policymaking. Fico has promised that if his party makes it into government “we will not send a single bullet to Ukraine,” proudly proclaiming that “I allow myself to have a different opinion to that of the United States” on the war.  

Fico has also claimed on the campaign trail that “war always comes from the West and peace from the East,” and that “what is happening today is unnecessary killing, it is the emptying of warehouses to force countries to buy more American weapons.” Such statements have resulted in him being blacklisted by Kyiv as a spreader of Russian propaganda.  

Yet the former prime minister spearheads a new brand of Left-wing, anti-American populism that has become a powerful force in Central Europe since the war began. Perceptions that “the Americans occupy us” — as one MP in Fico’s Smer party evocatively put it — are shared with a similar groundswell of anti-Western opinion in the neighbouring Czech Republic.  

Yet Smer has been handed a chance to gain power thanks to the chaos which has engulfed Slovakia’s pro-EU, pro-Western forces. Personal grievances coupled with serious policy errors tore apart a four-party coalition formed after elections in 2020, leaving Fico to capitalise on heightened mistrust in establishment politics. Smer is expected to become the nation’s largest party after this month’s election, with an anticipated 20% of the vote.  

Whatever the specific makeup of the new government, if Smer is the largest party it will likely pursue a foreign policy similar to that of Viktor Orbán’s government in Hungary. A halt to until-now generous Slovak arms shipments to Ukraine is Fico’s central electoral pledge, while the arrival on the scene of another Orbán-style government prepared to obstruct EU aid efforts for Ukraine would create a serious headache. That is particularly the case as Brussels struggles to win support for both short and long-term war funding commitments. 

Victory for Fico would also amplify Orbán’s scepticism about the overall Western narrative on Ukraine — a scepticism which the Hungarian Prime Minister recently conveyed to Western conservatives during an interview with Tucker Carlson. Orbán portrayed Ukraine’s attempts to win back the territories taken by Russia as ultimately hopeless and claimed that Donald Trump’s promise to end the war quickly makes him “the man who can save the Western world”. 

Like Trump in America and Orbán in Europe, Fico is hated with a passion by establishment forces. But in Slovakia, the pro-Western establishment itself has become so mistrusted that power may soon pass to a man intent on shattering what’s left of European unity on Ukraine. 

This week, new figures published by the NHS showed that there has been a 31% increase in prescriptions for ADHD medications in Britain over the last year. The largest increase was among middle-aged women, where there was a 40% rise in prescriptions. There will surely be calls of “overdiagnosis” in response, but those calls may be short-sighted.

In the past few years, ADHD diagnoses and prescriptions have skyrocketed. The likely reason for the increase in prescriptions for female patients aged between 55-59 is due to greater knowledge of the symptoms to be aware of. This matches the broader reasons behind the increase in diagnosis across all age groups. Given that a large majority of new diagnoses are made earlier in life, a correction is expected with increased diagnosis in this cohort.

However, the debate over ADHD has become heated. Skeptics blame the spread of content online about the disorder for this rise, and suggest that doctors are overdiagnosing patients. Whether this reflects genuine unmet need finally being named, or a softer diagnostic bar, is exactly what’s contested.

Last year, then-Health Secretary Wes Streeting claimed that a mass rise in overdiagnosis of ADHD was putting pressure on welfare services, particularly the PIP system which allows people to claim benefits for disability. Given the sudden rise since the pandemic, such skepticism is understandable. But this doesn’t explain why only roughly 100,000 people who claimed PIP cited ADHD as their primary reason. This is quite a low figure, considering an estimated 2.5 million people in Britain have ADHD and only 800,000 have a formal diagnosis.

Streeting demanded an independent review into ADHD overdiagnosis, but the interim findings suggested the issue is more complicated than first thought. These findings showed that the prevalence of the disorder has remained largely stable, but diagnosis and referral have increased, suggesting multiple changes are happening at once. It seems plausible that, given the political pressure, future welfare reform will tighten eligibility for neurodivergent claimants, but the interim review’s more cautious findings may complicate that push.

Suzanne O’Sullivan, a neurologist and author of The Age of Diagnosis, has pointed out that in the Eighties ADHD was mainly seen as a childhood condition, which resolves in adulthood. Only in 2008 did the NHS recognize it as a condition found among adults. This, along with the subjective parameters of what the disorder constitutes, has led to overdiagnosis. With ADHD, many of the symptoms are non-specific and often can be roused by general working life with restlessness, hyperactivity and inattention.

However, a paper published this year claimed that, if anything, underdiagnosis of ADHD is still prevalent, which has complicated matters further. In 2023, a BBC Panorama documentary exposed the underworld of private ADHD diagnosis, showing the lax approach private clinicians took to their diagnostic process compared to the NHS.

There is a fine line to tread here. While it is clear that greater awareness around ADHD has led to an increase in diagnosis, Britain needs to be wary of how to approach this going forward. Some people genuinely need support, which diagnosis and medication can help, but only if it leads to a return to a functioning and normal life with thorough diagnostic investigation. The Government has already announced plans to crack down on unregulated practice in the private sector, but this debate is likely to carry on into the next decade.

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Dr Ammad Butt is a freelance writer and doctor working in the UK.

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