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Social care: pressure mounts for urgent and radical reform

BMJ 2019; 366 doi: (Published 05 July 2019) Cite this as: BMJ 2019;366:l4564

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Anita Charlesworth: We need a social care system that is as much a source of national pride as the NHS

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Re: Social care: pressure mounts for urgent and radical reform - the cost of Brexit is a blip compared with the cost of the unexplained surge in ASD

According to the Office for Budget Responsibility, the cost of a 'No Deal Brexit ' may be £30 biillion, roughly doubling their estimated cost of a negotiated exit (in itself around £30 billion) [1]. Five years ago according to a paper from JAMA Pediatrics the cost to the British economy of supporting autism was £32 billion every year, at 2014 monetary values [2]. Although I had doubts about the method of calculation, I took the view at the time that this was a ball-park figure (while only an estimate of the cost of support not the overall cost to the economy).

This is the problem. In 2014 the authors projected the number of cases of ASD in the UK at 604,824 and just under 1% of the population [3], which in my view - supported by figures from the Department for Work and Pensions - was far too high [4], while the estimated cost per case was far too low [5]. But the question for the Office of Budget Responsibility is where are we heading with the rate of autism among young people speeding catastrophically past 3%, while we still have no credible explanation of this rise from official sources [6-8].

[1] 'No-deal Brexit could cause £30bn economic hit, watchdog says', BBC News 18 July 2019,

[2] Helen Briggs, 'Autism costs '£32bn per year' in UK', 9 June 2014,

[3] Buescher et al, Costs of Autism Spectrum Disorders in the United Kingdom and the United States', JAMA Pediatr. doi:10.1001/jamapediatrics.2014.210 Published online June 9, 2014,

[4] John Stone, 'Response to David Oliver I (The Indisputable Rise in Autism)', 28 August 2018,

[5] John Stone, 'Re: Autism spectrum disorder: advances in diagnosis and evaluation', 21 May 2018,

[6] John Stone, 'Social care: are the autistic dependent becoming more numerous than the aged?', 6 July 2019,

[7] John Stone, 'Science, Facts and Jonathan Kennedy's Sociology of Medical Dissent', 20 May 2019,

[8] John Stone, 'Re: Whorlton Hall: the downward spiral to hell', 23 June 2019,

Competing interests: No competing interests

23 July 2019
John Stone
UK Editor
London N22