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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

Linked Opinion

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

Rapid Response:

The Other New Normal: Autism and the Boiling Frog Principle

Dear Editor

Further to my letter of 21 May [1] I bring to attention my calculation that on the given proportion of boys to girls (3 to 1) in the Northern Irish ASD schools census it means that with 64% of cases being at Stage 5 approximately 4 in 100 boys across the province will have severe autistic disability, a figure which goes up to 6.7 in 100 in Belfast.

It would be absurd to suggest this is "better recogniton". ASD has been rising at an almost exponential rate for 30 years years or more without any official explanation and much denial. Quite apart from the tragic human dimension it is an immmensely costly growing burden on society and has long term implications far worse than COVID-19 - with a gigantic lifetime dependent population to come. I doubt whether the situation is much better in the rest of the United Kingdom only better accounted for in Northern Ireland. If the costs were calculated at £32b annually in 2014 it could easily be double that now and rising [3].

Successive governments just twiddle their thumbs and pretend nothing is happening: they dare neither to look at the causes or the consequences. Nothing to see here folks? Really?

[1] John Stone,'SEND not for whom the bell tolls 2020 (ASD reaches 4.2% in Northern Ireland, 6.9% in Belfast)' 21 May 2020,

[2] Heidi Rodgers and Jessica McCluney, 'The Prevalence of Autism (including Asperger Syndrome) in School Age Children in Northern Ireland 2020', Information Analysis', Directorate 21 May 2020,

[3] John Stone, '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', 23 July 2019,

Competing interests:, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor

30 May 2020
John Stone
UK Editor
London N22